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BDS4 RESTORATIVE DENTISTRY > TOOTHWEAR > Flashcards

TOOTHWEAR Flashcards

1
Q

What is tooth surface loss?

A

EVERYTHING = caries, trauma, developmental problems, tooth wear

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2
Q

What are the types of tooth wear?

A

PHYSIOLOGICAL = normal process and increases with age, associated with normal function

PATHOLOGICAL = occurs if the remaining tooth structure or pulpal health is compromised or the rate of tooth wear is in excess for what is expected

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3
Q

What are some causes of tooth wear?

A
  • attrition
  • abrasion
  • erosion
  • abfraction
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4
Q

What is attrition?

A

The physiological wearing away of tooth structure as a result of tooth to tooth contact

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5
Q

Where are attritive lesions found?

A

The occlusal and incisal contacting surfaces (early appearance is of a polished facet on a cusp or flattening of incisal edge)

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6
Q

What is attrition typically related/caused by?

A

Parafunctional habit

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7
Q

How does attrition present?

A
  • polished facet of cusps
  • flattened incisal edge
  • reduction in cusp heights
  • shortened clinical crown
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8
Q

What is abrasion?

A

The physical wear of tooth substance through an abnormal mechanical process independent of occlusion
- involves foreign object or substance repeatedly contacting the tooth

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9
Q

Where is the commonest area to find abrasion?

A

Labial/buccal, cervical on canine and premolar teeth (aggressive toothbrushing)

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10
Q

How can abrasion manifest on incisors?

A

Notching of incisal edges

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11
Q

What is erosion?

A

The loss of tooth surface by a chemical process that does not involve bacterial action.

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12
Q

What is the most common type of pathological tooth wear?

A

Erosion

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13
Q

What causes erosion?

A

Chronic exposure of dental hard tissues to acidic substances which can be extrinsic or intrinsic

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14
Q

How does erosion present in the mouth?

A

EARLY STAGES = enamel surface is affected with loss of surface detail, surfaces become flat and smooth

LATER = dentine becomes exposed

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15
Q

How do erosion lesions clinically present?

A

Typically bilateral
- concave lesions without chalky appearance of bacterial acid décalcification

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16
Q

What can transparent incisal edges suggest?

A

Erosion

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17
Q

What is abfraction?

A

The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of tooth

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18
Q

You suspect a patient with heavily restored anterior teeth is suffering from erosion, what would be a sign?

A

Teeth are affected BUT restorations are not

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19
Q

How does abfraction present?

A

Loss of tooth substance at the cervical margin
(cracks in tooth substance which causes tooth substance to chip out)

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20
Q

What causes abfraction?

A

Caused by biomechanical loading forces
- results in flexure and failure of the enamel and dentine at a location away from the loading

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21
Q

What clinical signs would suggest a patient is suffering from abfraction?

A

V shaped tooth loss where the tooth is under tension
- classically sharp rim at the ACJ

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22
Q

In order to prevent or reduce tooth loss due to wear you must…:

A
  • recognise the problem
  • grade its severity
  • diagnose the likely cause or causes
  • monitor the progression of disease
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23
Q

What are some medical history causes fo tooth wear?

A
  • medications with low pH
  • medications which dry the mouth
  • eating disorders
  • alcoholism
  • heart burn
  • GORD
  • hiatus hernia rumination
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24
Q

When examining a patient with toothwear, what must you asses when looking at occlusion?

A
  • FWS checked
  • resting face height and OVD
  • any dento-alveolar compensation?
  • record overbite & overjet
  • are there stable contacts in centric relation
  • check tooth contacts in excursive movements
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25
Q

What might toothwear patients come to you complaining of?

A
  • aesthetic impairment
  • functional difficulties
26
Q

How might the musculature of a toothwear patient present during your extra oral exam?

A

hypertrophy !

27
Q

How might the TMJ of a toothwear patient present during your extra oral exam?

A
  • restricted movement
  • clicking
  • crepitus
28
Q

Give an example of a tooth wear index that you may refer to on clinic?

A

BEWE (basic erosive wear examination)

29
Q

Where is the most common area for toothwear?

A

Localised anterior teeth

30
Q

What special tests might you do on a patient with toothwear?

A
  • sensibility testing
  • radiographs
  • articulated study models
  • intra-oral photographs
  • salivary analysis
  • diagnostic wax up
  • dietary analysis
31
Q

What is the first stage of treatment planning for a patient with tooth wear?

A

DEAL WITH PAIN
- sensitivity
- pulp extripation
- smooth sharp edges
- extraction
- TMJ pain

32
Q

How can you deal with sensitivity caused by tooth wear?

A

Desensitising agents
- fluorides
- bonding agents GIC coverage of exposed dentine

33
Q

What is dento-alveolar compensation?

A

As teeth wear your bone remodels to ensure biting surfaces of teeth remain in contact

34
Q

What is involved in the initial treatment of toothwear patients?

A

Stabilise the existing dentition (wear is important but treat the whole mouth and whole patient)
- deal with caries
- deal with perio

35
Q

What is the key element in prevention?

A

Removal of the cause

36
Q

How might abrasion be prevented?

A
  • remove foreign object/substance involved in causing the wear
  • change toothpaste
  • alter tooth brushing habits
  • change habits (nail biting, wire stripping, piercing biting, pen chewing)
37
Q

How can cervical toothbrush abrasion be prevented (treated)?

A

Simple RMGIC, GIC or composite restorations can be placed with no tooth prep
- patient then wears through the restoration rather than damaging teeth
- simple & effective measure

38
Q

What dental material would be the first choice of filling for abrasion cavities?

A

RMGIC (best survival rate)

39
Q

Why is composite compromised when consideration of use in abrasion cavity treatment?

A

Higher modulus may compromise its retention

40
Q

How can attrition be prevented?

A
  • lower patients stress levels (CBT, hypnosis)
  • splints
41
Q

Why are splints used in the prevention of attrition?

A

Splint softer than teeth
- soft splint can be used as a diagnostic device as it will wear rapidly and show wear facets

42
Q

Give an example of a type of splint used in attrition prevention?

A

Michigan splint
- hard splint
- provides ideal occlusion
- has canine rise which provide disclusion in eccentric mandibular movements

43
Q

How can erosion be prevented?

A
  • desensitising agents (this is rly more symptomatic relief)
  • dietary management
  • using straws when drinking acidic drinks
  • avoid sports drinks/gels
  • control gastric acid
  • control xerostomia
  • control anorexia and bulimia
44
Q

What GI conditions may speed up tooth erosion?

A
  • GORD
  • reflux
  • hiatus hernia
45
Q

Which tooth wear patients are splints not suitable for?

A

Erosion patients (especially relating to acid reflux)

46
Q

In cases of maxillary anterior tooth wear, what factors affect decision on treatment and restorations of these teeth?

A
  • the pattern of anterior maxillary tooth wear
  • inter-occlusal space
  • space required for the restorations being planned
  • quality and quantity of remaining tooth tissue (especially enamel)
  • aesthetic demands of patient
47
Q

What are the different categories of maxillary incisor wear?

A
  • tooth wear limited to the palatal surfaces only
  • tooth wear involving the palatal and incisal edges with reduced clinical crown height
  • tooth wear limited to labial surfaces
48
Q

What is the Dahl Technique in reference to toothwear cases?

A
  • method of gaining space in cases of localised tooth wear
  • add composite to anterior teeth, which causes posteirors to over erupt
  • anteriors then have space to be restored with no need for occlusal reduction
49
Q

Who is the Dahl Technique not suitable for?

A
  • active periodontal disease
  • TMJ problems
  • post orthodontics
  • bisphosphonates
  • if dental implants present
  • if existing conventional bridges
50
Q

What might be a contraindication of repairing anterior toothwear?

A
  • short roots
  • reduced periodontal support due to perio disease
51
Q

Is upper or lower anterior tooth wear harder to fix? Why?

A

LOWER
- less enamel, smaller bonding area

52
Q

What increases the likelihood of longevity of toothwear repair?

A

Sufficient remaining enamel

53
Q

In which patient cases might you see localised posterior erosive toothwear?

A

Bullimic and alcoholic patients

54
Q

What is a way to help localised posterior toothwear?

A

Adding composite resin to palatal of upper canines to increase the canine rise & disclude the posteriors during later & protrusive excusions

55
Q

Loss of what typically leads to posterior toothwear?

A

Loss of canine guidance

56
Q

What is a common method of anterior composite buildup?

A
  • alginate impressions
  • wax up
  • putty matrix
57
Q

When you decide to build up anterior teeth with composite to help toothwear, what information do you give to patients?

A
  • front teeth will receive tooth coloured fillings to cover worn surface
  • no local anaesthetic needed
  • bite will feel strange for a few days but this will sort itself out (back teeth will touch again in 3-6 months)
  • over a week or so you will be used to new bite
  • may experience lisping for a few days
58
Q

When you perform anterior composite build ups, and the patient has posterior crowns/bridges, what will need to occur?

A

Replacement of posterior crowns/bridges

59
Q

What is generalised tooth wear divided into?

A
  1. excessive wear with loss of OVD
  2. excessive wear without loss of OVD but with available space
  3. excessive wear without loss of OVD and with no space available
60
Q

What are some negatives to crown lengthening surgery?

A
  • may results in black triangles
  • can lead to unfavourable crown to root ratio
  • post op sensitivity
61
Q

When examining a patient with toothwear, what must you asses when looking at them extra-orally?

A
  • is there any overclosure?
  • lip line
  • smile line

BDS4 RESTORATIVE DENTISTRY (9 decks)

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