Toothwear Flashcards
Clinical consequences:
Change in appearance
Pain and/or sensitivity
Lack of occlusal stability
Functional difficulties
Initial management:
Identify the presence and severity of tooth wear
Aetiology
Monitoring
Prevention
Possible Aetiology:
Patient history Food Drink Medication Medical history Habits Often multifactorial
what may help determine aetiology
Diet sheet may be helpful 3-4 days detailed history to include a weekend if possible
How does caries and erosion differ?
In CARIES - Plaque acid leads to demineralisation but the organic matrix is not affected.
In EROSION - Extrinsic/intrinsic acid leads to demineralisation and loss of the organic matrix
How to grade Severity:
How to Grade distribution:
(mild, moderate, severe)
localised, generalised
Tooth wear is a normal physiological process Occurs throughout life however it ….
May lead to problems with …..
pathological when the rate of loss or degree of destruction is excessive
function, aesthetics or sensitivity
Clinical appearance of erosion:
Anterior teeth:
(intrinisc and extrinsic)
Posterior teeth:
Anterior teeth - Loss of surface anatomy, smooth enamel surface, Increased incisal translucency, Chipping of incisal edges, Palatal hollows, Areas where the enamel is absent, Exposure of the pulp
Intrinsic often affects the palatal surfaces, extrinsic the labial.
Posterior teeth, Loss of surface anatomy, Cuspal cupping ‘Proud restorations’, Darkening of colour, Pulpal exposure rare in permanent teeth, GeneralWorn surfaces not in contact in closed eccentric movements
Extrinsic erosion is?
‘Acid going in’
Intrinsic erosion is?
‘Acid coming up’
Key factor in extrinsic erosion?
Diet- Amount Frequency Method of consumption Timing of consumption
Acidic drinks and food :
Soft drinks – fruit juice, carbonated and still
Alcoholic drinks , Fresh fruit, fruit pulp and dried fruit Pickles, vinegar, acetic acid added to crisps
Yoghurts and sauces Fruit and herbal teas Energy/sports supplements
Intrinsic erosion causes:
Gastro oesophageal reflux (GOR)
Vomiting
Ruminent eating
what is Gastro oesophageal reflux (GOR) and symptoms?
Sphincter incompetence Increased gastric pressure Increased gastric volume
Heartburn Retrosternal discomfort Epigastric pain Dysphagia
Chronic cough Sore throat Hoarseness
Sour taste at back of throat However in many cases may be ‘silent reflux’
What causes Vomiting (voluntary/involuntary)
Psychosomatic Metabolic /endocrine GI disorders Drug induced Alcoholism
How Ruminent eating cause erosion?
Anorexia nervosa:
‘Aversion to food’
‘Restricting’ and ‘binge/purging’ types
Bulimia nervosa:
Over-eating followed by inappropriate compensatory behaviour e.g.purging Incidence of 8.6 – 14 p
Define attrition:
The loss of tooth substance or a restoration caused by tooth-to-tooth contac
Clinical apperance of attrition:
Enamel and dentine wearing at the same rate Localised facets, flattened cusps/incisal edges Worn surfaces ‘mate’ in closed eccentric movements Shiny amalgam in areas of contact Slow process so secondary dentine forms and usually not sensitive Possible masseteric hypertrophy Possible fractured cusps and/or restorations Increased risk of tooth mobility
Define bruxism and clinical apperance:
Common parafunctional activity on response to stress Associated tongue scalloping and / or cheek ridging in active cases Masseteric hypertrophy in severe cases
Define Abraison
The abnormal wearing away of tooth substance or a restoration by a mechanical process other than tooth contact
causes of abrasion:
•Tooth brushing •Abrasive dentifrices •Abrasive food particles •Piercings •Habits •Nail biting •Tobacco chewing •Pen chewing •Pipe smoking •Wire stripping •Iatrogenic •Unglazed porcelaine
Clinical apperance of abrasion
General Mainly cervical Sharply defined margins Smooth, hard surface More rounded and shallow if associated with erosion
Define abfraction:
Theory of abfraction (Grippo 1991) supposes that occlusal forces cause compressive and tensile stresses, which are concentrated at the cervical region of the tooth (Heymann et al, 1993) and cause microfracture of cervical enamel rods.
clinical apperance of abfraction
Deep V-shaped notch May be a single tooth affected Toothbrush unable to contact base of defect Defects may be subgingival
