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Toothwear Flashcards

1
Q

What is the aetiology of non-carious tooth surface loss?

A

Trauma
Developmental Problems
Tooth wear

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2
Q

When does tooth wear count as pathological?

A

If the remaining tooth structure or pulpal health is compromised or the rate of tooth wear is in excess of what would be expected for that age
It can also be considered pathological if the patient experiences a masticatory or aesthetic deficit

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3
Q

What are the 4 types 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
Attritive lesions are found on the occlusal and incisal contacting surfaces
Almost always related to a parafunctional habit (bruxism)

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5
Q

What is Abrasion?

A

The physical wear of tooth substance through an abnormal mechanical process independent of occlusion. It involves a foreign object or substance repeatedly contacting the area
Commonest area is labial/buccal, cervical on canine and premolar teeth

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6
Q

What is the commonest cause of abrasion?

A

Tooth brushing

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7
Q

What is Erosion?

A

The loss of tooth surface by a chemical process that does not involve bacterial action
Caused by chronic exposure of dental hard tissue to acidic substances which can be extrinsic or intrinsic

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8
Q

What are the characteristic feature of erosion?

A

Cupping of the occlusal surfaces of the molars and incisal edges of the anteriors
Typically bilateral
More common on the upper anteriors- lower incisors influx of saliva from the sublingual gland
Increased translucency of incisal edges (appear dark)

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9
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 the tooth
Caused by biomechanical loading forces
Forces result in flexure and failure of the enamel and dentine at a location away from the loading

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10
Q

What are the 2 theories of abfraction tooth wear?

A

Abfraction is the basic cause of all non-carious cervical lesions
Multifactorial aetiology. A combination of occlusal stress, abrasion and erosion

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11
Q

What is the aetiology of cervical wear?

A

Multifactorial
Lesions mainly in premolar and molars on the buccal surface almost never lingually
Good OH and this wear pattern go together
Likely to be combination of erosion, abrasion and abfraction

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12
Q

What features of medical history can contribute to tooth wear?

A

Medications with low pH
Medications which dry the mouth
Eating disorders
Alcoholism
Heartburn
GORD
Pregnancy

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13
Q

What features of social history would you investigate in tooth wear?

A

Lifestyle stresses e.g. Bruxism
Occupational details
Alcohol consumption
Dietary analysis
Habits
Sports

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14
Q

What features of past dental history would you investigate in tooth wear?

A

Previous patient attendance, regular or not
A non-regular poorly motivated patient is not a good candidate for complex treatment
Previous experience of treatment
Oral hygiene habit
-poor oral hygiene
-toothbrushing in abrasive wear- frequency, intensity, duration, type of toothpaste

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15
Q

What about the occlusion should you investigate when examining a tooth wear patient?

A

FWS should be assessed
Record the OVD and resting face height
Record overbite and overjet
Are there stable contacts in centric occlusion

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16
Q

What about the wear should you examine?

A

Location
-anterior/posterior
-generalised/localised
Severity
-enamel only
-into dentine
-severe

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17
Q

What is a BEWE?

A

Basic Erosive Wear Examination

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18
Q

What are the scores and criteria of a BEWE?

A

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

Works like a BPE

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19
Q

What is the immediate treatment of a patient with tooth wear?

A

Deal with pain
Sensitivity
-desensitising agents, fluorides, GIC coverage of exposed dentine
Pulp extirpation
-if wear has compromised pulpal health
Smooth sharp edges
-prevent trauma to cheeks and tongue
Extraction
TMJ pain
-important in attrition, acute symptoms need to be controlled

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20
Q

What is the initial treatment of a patient with tooth wear?

A

Stabilise the existing dentition
Deal with caries and perio
Institute preventative regime

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21
Q

What are the risk levels in a BEWE?

A

None - less than or equal to 2
Low - between 3 and 8
Medium - between 9-13
High - 14 and over

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22
Q

Name 2 index’s used for tooth wear.

A

Smith and Knight
BEWE

23
Q

How can you prevent Abrasion?

A

Remove the ‘foreign object or substance’ involved in causing the abrasive wear
Change toothpaste
Alter tooth brushing habits
Change habits

24
Q

How can you prevent Attrition?

A

Splints
-wear away instead of the tooth
-work as they are softer than teeth
-cause no damage to opposing teeth
-habit breaker
-can be soft splints or hard splints

25
How can you prevent Erosion?
Fluoride (toothpaste, mouthwash, fluoride varnish) Desensitising agents -not prevention, more symptomatic relief
26
How can you prevent erosion through dietary habits?
Habit changing -swilling drinks around the mouth -drinking from cans- use a straw -rumination -sports drinks/gels
27
How can you prevent erosion through medical changes?
Control gastric acid -GORD -Reflux -Hiatus hernia Xerostomia Anorexia and bulimia
28
How can you prevent abfraction?
If it exists Assess occlusion on teeth with abfraction lesions Fill cavities with low modulus restorative materials
29
For maxillary anterior tooth wear, what is the decision on treatment and restoration dependent on?
The pattern of anterior maxillary tooth wear Inter-occlusal space Space require for the restorations being planned Quality and quantity of remaining tooth tissue, particularly enamel The aesthetic demands of the patient
30
What is the pattern of maxillary incisor wear categories?
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
31
How does the bone adjust to tooth wear?
Dento-alveolar compensation Increased bone growth This maintains masticatory efficiency and this is a good thing but leaves no space for restorations to be placed
32
What is the DAHL technique?
Method of gaining space in cases of localised toothwear Most commonly used for localised anterior tooth wear
33
What is involved in the DAHL technique?
Increasing the OVD by 2-3mm to have room for restorations on teeth affected by tooth wear so that there is no need Usually an RPD that is used for posterior disclusion and creating space between upper and lower anteriors
34
When is the DAHL technique not suitable?
Active periodontal disease TMJ problems Post orthodontics Bisphosphonate therapy If dental implants are present If existing conventional bridges
35
What methods are there of composite build ups?
Alginate impressions Wax up Putty matrix
36
What are the 3 categories of localised tooth wear?
Excessive wear with loss of OVD Excessive wear without loss of OVD but with available space Excessive wear without loss of OVD but with no space available
37
List 3 modifying factors of tooth wear.
Lack of posterior teeth- wear on remaining teeth is higher so increases progression Occlusion (e.g. deep overbite, certain teeth take more load and modified progression) Stress & anxiety Restorations Parafunctional habits- e.g. bruxism
38
List 5 extrinsic contributors to erosion.
Carbonated drinks Sports drinks Alcoholic acidic drinks Citrus drinks Acidic fruits Pickles Drug abuse
39
List 3 intrinsic contributors to erosion.
Eating disorders (bulimia) GORD Uncontrolled diabetes
40
What are some common features of erosion due to carbonated drink intake?
Incisal erosion on upper centrals (can or bottle directly goes onto these teeth) Cupping on lower molars Palatal erosion on upper incisors Sensitivity Interproximal caries and buccal white spot/brown spot caries
41
What are some common features of erosion due to an eating disorder?
Palatal erosion on upper teeth Polished restorations Erosion around restorations Sensitivity Caries Altered taste halitosis Soft tissue changes
42
What common preventative advice can you give to someone with erosion tooth wear?
Fluoride use- high dose toothpaste Alcohol free fluoride mouthwash Dietary modification -frequency & quantity -method of delivery (glass, straw, bottle, can) -elimination & addition
43
What is a ferrule? Why is this important?
Amount of sound tooth structure that is left supragingivally (retained coronal dentine) Decreases the risk of tooth fracture and the overall prognosis of the tooth
44
What should you try to avoid in bruxist patients?
Complete dentures Bruxism does not stop- fracture dentures easily, ridge resorption, pain & ulceration under complete denture
45
What is an overdenture?
Any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants
46
What are the advantages of overdentures?
Correction of occlusion and aesthetics Support Tooth wear management Preservation of ridge form Proprioception Denture retention Can be used with precision attachments MRONJ & radiotherapy patients- avoid extraction Eases transition to edentulism
47
What are the disadvantages of overdentures?
Need good oral hygiene Increased caries/periodontal problems Denture fracture Discomfort/infection around the roots Medical History
48
What is conforming to a patients occlusion?
Prosthesis/ restoration does not alter the occlusion Works best in a stable occlusion with sufficient index teeth Patient's OVD remains the same
49
What is changing (rehabilitation) of a patients occlusion?
When occlusion is unstable and there is a lack of index teeth you would change a patients OVD to adjust this accordingly
50
What is dental demolition in tooth wear?
Demolition of restorations Very common Heavily restored teeth Previous failure= less tooth substance High occlusal loads
51
How do you remove a fractured post?
Masseran kit or ultrasonic to go around the side of the post
52
What is a failing dentition?
A dentition where deterioriating teeth, restorations or oral health or a combination of issues means that a loss of basic oral functions such as mastication and acceptable aesthetics is inevitable if untreated
53
What is the Protocol for giving bad news? (SPIKES)
Set up the interview: Mental and Physical preparation Perception: assess what the patient knows about the medical situation Invitation: ask how much they want to know Knowledge: give the medical facts Emotion: respond to patients emotions Strategy and summary: negotiate a concrete follow-up step

Restorative (8 decks)

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