Toothwear Flashcards
- What are the different types of tooth wear?
- Attrition – physiological wearing away of tooth structure as a result of tooth to tooth contact e.g. bruxism
- Abrasion – physical wear of tooth substance through an abnormal mechanical process independent of occlusion e.g. toothbrushing
- Erosion – loss of tooth surface by chemical process that does not involve bacterial action e.g. acidic drinks, GORD
- Abfraction – loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth.
- What are the BEWE scores?
- 0 = no erosive wear
- 1= initial loss of surface texture
- 2 = distinct defect hard tissue loss <50% of surface
- 3 = hard tissue loss >50% of the surface area
- Add up scores for all sextant and then risk assess - None = <2, Low = 3-8, Medium 9-13, High = >14
- Name 3 routes or ways in which teeth can be desensitised?
- Duraphat fluoride varnish
- Prime and bond to protect surfaces
- Sensodyne/Colgate relief toothpaste
- What is the DAHL technique?
- It is a technique used to gain inter-occlusal space in cases of localised tooth wear without tooth reduction over a period of 3-6 months allowing for dento-alveolar compensation.
- An appliance such as a composite platform is placed anteriorly to increase the OVD by 2-3mm and over time the posterior teeth erupt into occlusion and the anteriors are intruded.
- This creates space to allow restorations of the anterior teeth without further tooth reduction.
- List 4 contraindicated groups for using Dahl on
- Patients with active periodontal disease
- Patients with TMJ problems
- Post orthodontic treatment
- Patients taking bisphosphonates
- If dental implants exist
- Name 4 constituents of composite and give an example for each constituent
- Glass – silica or quartz
- Low weight dimethacrylate – TEGDMA
- Light activator – camphorquinone
- Silane coupling agent – bifunctional molecule binding resin and filler
- On a cervical abrasion cavity why would you use RMGI instead of composite resin?
- Due to poor moisture control at the cervical region, meaning composite would fail. RMGIC has less polymerisation shrinkage and is best suited for cervical abrasion lesions where moisture cannot be controlled.
- What are the clinical signs of erosion?
- Enamel surface affected with loss of surface detail
- Surface becomes flat and smooth and later dentine can become exposed leading to cupping of the occlusal surfaces of the moles and Incisal edges of anteriors
- Typically bilateral, concave lesions without chalky appearance
- Increased translucency of Incisal edges without tooth staining
- Amalgam and composite restorations will stand proud on the tooth
- What are the causative factors? erosion
- Loss of tooth surface by a chemical process that does not involve bacterial action.
- Caused by chronic exposure of dental hard tissues to acidic substances which can be extrinsic or intrinsic
- Intrinsic – GORD, bulimia, hiatus hernia, xerostomia
- Extrinsic – acidic drinks, acidic fruits
How is erosion managed
- Find out causative agent and treat underlying problem
- Treat with fluoride toothpaste, mouthwash, fluoride varnish for tooth protection
- Use desensitising agents if the teeth are sensitive
- Dietary management – habit changes, dietary changes,
- Name 4 types of tooth wear and describe their appearance
Attrition – wear as a result of tooth to tooth contact (bruxism)
- Lesions on occlusal and Incisal contacting surfaces
- Early polished facet on cusp or slight flattening of Incisal edge
- Reduction in cusp height and flattening of occlusal Inclined planes
- Restorations show same wear as tooth structure
Abrasion – physical wear through abnormal mechanical process independent of occlusion (brushing)
- Tooth structure loss is related to abrasive element
- Usually labial/buccal, cervical on canines and premolars with V shaped or rounded lesions
- Notching of Incisal edges
Erosion – chemical process causes loss of tooth surface (acidity)
- Enamel surface affected as the enamel becomes flat and smooth
- Dentine can layer be exposed leading to cupping of the occlusal surface of molars and Incisal edges of anteriors
- Typically bilateral, concave lesions without chalky appearance
- Increased translucency of Incisal edges
- Restorations will stand proud on the tooth
Abfraction – caused by eccentric occlusal forces leading to compressive and tensile stress at cervical fulcrum areas
- Wear at cervical margin with cracks in tooth surface which causes tooth substance to chip out along with C shaped tooth loss
- Classically sharp at rim of the ACJ
How may tooth wear be monitored?
- BEWE index or Smith and Knight
- Clinical photographs
- Study models
- What percentage of adults have tooth wear?
- 77% have some form of tooth wear anteriorly involving dentine
