toothwear 3

Question 1

name 4 reasons why knowing the aetiology is vital in toothwear cases

Answer 1

• 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

Question 2

Name 4 modifying factors that may increase the rate of attrition

Answer 2

• 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)

Question 3

Name 3 features of a bruxist patients dentition that may be found

Answer 3

repeated restoration failure
significant wear throughout dentition
root fractures

Question 4

what occlusions may experience more tooth wear

Answer 4

deep overbite - wear on lower incisors
edge to edge occlusion - localised anterior wear

Question 5

what are the two main groups of acidic threats to teeth

Answer 5

extrinsic acids - carbonated drinks, citrus drinks, acidic fruits, pickles etc
intrinsic acids - GORD, bulimia, other medical conditions

Question 6

name 3 modifying factors that may increase the progression of erosion

Answer 6

lifestyle - alcohol, diet
amount and frequency of acid attacks
extrinsic and intrinsic in combination will increase progression rate

Question 7

what are common findings in a dentition of someone who drinks a lot of carbonated drinks

Answer 7

incisal erosion of upper centrals
cupping of lower molars
palatal erosion of upper incisors
sensitivity
interproximal caries

Question 8

name 3 common dental features of an eating disorder

Answer 8

palatal erosion on upper teeth
erosion around restorations
halitosis
polished restorations (particularly amalgam)

Question 9

name 4 abrasive behaviours

Answer 9

toothbrush abrasion - too much force
interdental brush abrasion (localised)
tongue studs - lingual of lower incisors (often paired with recession)
pipe smoker/ pen chewers

Question 10

name 4 things that should be considered when dealing with a toothbrush abrasion case

Answer 10

• 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?

Question 11

what may a BEWE indice be used for

Answer 11

assessing erosive toothwear

Question 12

common preventative advice for toothwear patients

Answer 12

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

Question 13

what interventions may be done to control aetiology of toothwear

Answer 13

splint therapy - bruxists
toothbrushing instruction
signposting to other services (CBT, hypnotherapy)
referral - GP, psychiatrist, social services

Question 14

why may a denture be recommended to toothwear patients

Answer 14

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

Question 15

what is an overdenture

Answer 15

any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants

Question 16

name 4 advantages of overdentures

Answer 16

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

Question 17

name 4 disadvantages of overdentures

Answer 17

• 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

Question 18

what are transitional dentures

Answer 18

provisional dentures made to see if patient can cope with dentures and potentially an increased OVD

Question 19

what may be done when making a denture for bruxists

Answer 19

metal backing on occlusal and palatal surfaces
(technically difficult)

Question 20

what is an overlay denture/ splint

Answer 20

a denture which covers worn down remaining teeth to protect them and build height
often well tolerated but technically demanding to make