toothwear 3 Flashcards
name 4 reasons why knowing the aetiology is vital in toothwear cases
- attempt to reduce further wear
- identify wider medical and wellbeing issues e.g eating disorder
- allows planning for problems, contingencies and failure
- prognostic indicator e.g bruxists will have poor prognosis of composites
Name 4 modifying factors that may increase the rate of attrition
- lack of posterior teeth (will see more wear on remaining teeth)
- occlusion (malocclusion will increase forces to certain teeth)
- restorations (ceramic and porcelain more abrasive to opposing teeth )
- erosion and abrasion (may exacerbate problem)
- stress and anxiety (can increase progression of wear)
Name 3 features of a bruxist patients dentition that may be found
repeated restoration failure
significant wear throughout dentition
root fractures
what occlusions may experience more tooth wear
deep overbite - wear on lower incisors
edge to edge occlusion - localised anterior wear
what are the two main groups of acidic threats to teeth
extrinsic acids - carbonated drinks, citrus drinks, acidic fruits, pickles etc
intrinsic acids - GORD, bulimia, other medical conditions
name 3 modifying factors that may increase the progression of erosion
lifestyle - alcohol, diet
amount and frequency of acid attacks
extrinsic and intrinsic in combination will increase progression rate
what are common findings in a dentition of someone who drinks a lot of carbonated drinks
incisal erosion of upper centrals
cupping of lower molars
palatal erosion of upper incisors
sensitivity
interproximal caries
name 3 common dental features of an eating disorder
palatal erosion on upper teeth
erosion around restorations
halitosis
polished restorations (particularly amalgam)
name 4 abrasive behaviours
toothbrush abrasion - too much force
interdental brush abrasion (localised)
tongue studs - lingual of lower incisors (often paired with recession)
pipe smoker/ pen chewers
name 4 things that should be considered when dealing with a toothbrush abrasion case
- is it localised or generalised
- frequency and duration of patients brushing
- bristle and toothpaste abrasiveness
- brushing technique
- manual vs electric (electric have pressure indicator)
- part of combination wear problem?
what may a BEWE indice be used for
assessing erosive toothwear
common preventative advice for toothwear patients
fluroride - high dose toothpaste, alcohol free mouthwash, FV
dietary modification - frequency and quantity modification, method of delivery modification
sugar free gum - may be good for bruxists
alter brushing habits - frequency, pressure, toothbrush/paste abrasiveness
what interventions may be done to control aetiology of toothwear
splint therapy - bruxists
toothbrushing instruction
signposting to other services (CBT, hypnotherapy)
referral - GP, psychiatrist, social services
why may a denture be recommended to toothwear patients
if they have no posterior support
results in increased severity of wear, increased progression of wear and ultimately occlusal collapse
complete dentures should be avoided in toothwear patients - bruxism doesn’t stop
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
name 4 advantages of overdentures
correction of occlusion and aesthetics
preservation of ridge form (particularly for future implants)
retains some proprioception (keeping root keeps PDL)
avoids extractions in MRONJ and radiotherapy patients
gains support from teeth AND mucosa
eases transition to edentulism
increase OVD in toothwear patients
name 4 disadvantages of overdentures
- require good oral hygiene
- increased risk of caries and perio problems due to denture sitting over roots/ teeth
- care homes OH often not maintained
- discomfort/ infection around roots
- potentially more traumatic extractions in the future e.g subcrestal caries
what are transitional dentures
provisional dentures made to see if patient can cope with dentures and potentially an increased OVD
what may be done when making a denture for bruxists
metal backing on occlusal and palatal surfaces
(technically difficult)
what is an overlay denture/ splint
a denture which covers worn down remaining teeth to protect them and build height
often well tolerated but technically demanding to make
