Toothwear 2 Flashcards
What is erosion and what are the two types?
Erosion is the chemical dissolution of dental hard tissues by acids of non-bacterial origin.
- Extrinsic erosion caused by diet
- Intrinsic erosion caused by gastric contents in mouth
What diet information should a patient be asked?
- quantity of acid intake (having one more acid than someone else has a big effect)
- how long they have the acid for
- when they are having it (with meals or not)
If an acidic food contains phosphate and calcium ions, why does it not affect the tooth?
The H+ will not cause the dissolution of hydroxyapatite.
How long does it take for the saliva to clear the acid content?
2-15 minutes
What unusual ways of drinking can cause tooth wear?
- swishing or rinsing acidic drinks
- holding drinks in mouth
- sipping drinks slowly
- straw directed at the teeth instead of to the back of the mouth
Intrinsic erosion:
Give voluntary and involuntary examples
voluntary: vomiting eating disorders
involuntary: reflux, rumination (food comes back up), chronic alcoholism, vomiting due to pregnancy, heavy abdominal exercise
Give the recap anatomy of the oesophageal tract
- muscular tube with sphincter at each end
- upper sphincter is composed of striated muscle
- lower sphincter is not a true sphincter and is composed of muscular folds
- change in squamous to columnar cells which is a common site for malignant transformations
Explain what occurs during gastro-oesphageal reflux with pressure
Oesophageal pressure < intragastric pressure
What are the symptoms of reflu?
- heartburn
- regurgitation
- difficulty swallowing
- tooth wear
- chest pain
- chronic cough
- sore throat
- globus (lump feeling in throat)
What are the guidelines for those with eating disorders?
- Have regular dental and medical reviews
- Avoid brushing teeth immediately after vomiting
- Rinse gently with non-acid fluoride toothpaste
- Avoid highly acidic food and drinks
Can the erosive tooth wear lesion be remineralised?
No
What do we need to be aware of regarding abrasion in the mouth?
- toothbrush - type, design, brushing technique
- tooth - erosion lesions
- toothpaste - amount, fluoride conc, abrasive conc
- patients variation - force, frequency, duration, technique
Explain the abrasivity of toothwear
The more abrasive the toothpaste, the greater the wear.
Below 70: low abrasivity
Above 150: harmful
RDS - relative dentine abrasivity (Dentine is more likely to be damaged abrasively so important to know this number if you have exposed dentine)
What are some research found on brushing before or after an acid?
- Toothbrushing after acid exposure can removal all demineralised enamel
- Toothbrush abrasion after acid exposure significantly lower after 60 minute exposure to oral environment
- Increased frequency of toothbrushing associated with increased tooth wear progression
How does saliva help toothwear?
- Dilutes the acid
- Assists with oral clearance
- Buffers the acid with minerals
- Salivary pellicle acts as a physical barrier against erosion
What is attrition and how can it be seen?
Loss of tooth structure during tooth to tooth contact.
Obvious to diagnose as everything is flat
What is the wear in kg of a dry and a lubricated tooth?
How is enamel different to dentine regarding loading?
dry = <10kg wet = >14kg
Saliva increases the wear on a tooth.
Dentine wears greater than enamel at smaller loads, at greater loads they are the same.
What preventative advice should be given for attrition?
- Avoid frequent intake of acidic food or drinks
- Keep acidic drinks to mealtimes and limit the number of fruit drinks
- Do not brush immediately after vomiting
- Advise patients to seek medical assistance for gastro-oesophageal reflux disease (GORD) and eating disorders
- Ensure regular medication is acid free and be aware of medications that reduce saliva flow and thus impact on clearance
- Use toothpaste containing at least 1450ppm fluoride twice daily
- Fluoride toothpaste protects enamel
- Choose a toothpaste that is less abrasive in nature – the lower the RDA value the less abrasive it is
- Do not brush immediately after eating or drinking acidic food or drinks
How can you tell the difference between active and inactive erosive tooth wear?
Active = unstained as insufficient time to take up dietary stains, toothbrushing removes stain
Inactive = stained as sufficient time for teeth to take up dietary stains
