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Clinical skills- Clinical application > Toothwear > Flashcards

Toothwear Flashcards

1
Q

Clinical consequences:

A

Change in appearance
Pain and/or sensitivity
Lack of occlusal stability 
Functional difficulties

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2
Q

Initial management:

A

Identify the presence and severity of tooth wear
Aetiology
Monitoring
Prevention

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3
Q

Possible Aetiology:

A 
Patient history  
Food  
Drink 
Medication  
Medical history 
Habits 
Often multifactorial
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4
Q

what may help determine aetiology

A

Diet sheet may be helpful 3-4 days detailed history to include a weekend if possible

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5
Q

How does caries and erosion differ?

A

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

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6
Q

How to grade Severity:

How to Grade distribution:

A

(mild, moderate, severe) 

localised, generalised

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7
Q

Tooth wear is a normal physiological process Occurs throughout life however it ….
May lead to problems with …..

A

pathological when the rate of loss or degree of destruction is excessive
function, aesthetics or sensitivity

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8
Q

Clinical appearance of erosion:
Anterior teeth:
(intrinisc and extrinsic)
Posterior teeth:

A

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

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9
Q

Extrinsic erosion is?

A

‘Acid going in’

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10
Q

Intrinsic erosion is?

A

‘Acid coming up’

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11
Q

Key factor in extrinsic erosion?

A 
Diet-
Amount  
Frequency 
Method of consumption
Timing of consumption
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12
Q

Acidic drinks and food :

A

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

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13
Q

Intrinsic erosion causes:

A

Gastro oesophageal reflux (GOR)
Vomiting
Ruminent eating

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14
Q

what is Gastro oesophageal reflux (GOR) and symptoms?

A

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’

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15
Q

What causes Vomiting (voluntary/involuntary)

A 
Psychosomatic 
Metabolic /endocrine 
 GI disorders 
 Drug induced
 Alcoholism
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16
Q

How Ruminent eating cause erosion?

A

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

17
Q

Define attrition:

A

The loss of tooth substance or a restoration caused by tooth-to-tooth contac

18
Q

Clinical apperance of attrition:

A

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

19
Q

Define bruxism and clinical apperance:

A

 Common parafunctional activity on response to stress  Associated tongue scalloping and / or cheek ridging in active cases  Masseteric hypertrophy in severe cases

20
Q

Define Abraison

A

The abnormal wearing away of tooth substance or a restoration by a mechanical process other than tooth contact

21
Q

causes of abrasion:

A

•Tooth brushing •Abrasive dentifrices •Abrasive food particles •Piercings •Habits •Nail biting •Tobacco chewing •Pen chewing •Pipe smoking •Wire stripping •Iatrogenic •Unglazed porcelaine

22
Q

Clinical apperance of abrasion

A

General  Mainly cervical  Sharply defined margins  Smooth, hard surface  More rounded and shallow if associated with erosion

23
Q

Define abfraction:

A

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.

24
Q

clinical apperance of abfraction

A

Deep V-shaped notch  May be a single tooth affected  Toothbrush unable to contact base of defect  Defects may be subgingival

25
Q

Treatment- Monitoring
How can you monitor toothwear

Recall?

A 
• Study models 
• Silicone index 
• Clinical photographs
•Description(indices)
 • Measurement 
– Crown height 
– Gingival margin

Initially review 4-6 monthly then annually

26
Q

Treatment- Monitoring

Clues to determin toothwear rate of progression

A

Clues:
Sensitivity
Staining
Monitoring

27
Q

Treatment- operative technique

managment

A
  1. Identify the cause if possible and assess the long term prognosis for the patient’s dentition
  2. Institute preventive measures and try to control the TSL
  3. Monitor the TSL
  4. Operative treatment if required
  5. Review
28
Q

Treatment- operative technique

when to interven?

A
  • Early rather than late
  • Protect pulp
  • Aesthetics
  • Functional problems
  • Loss of structural integrity
  • Prevention of further complex treatment
  • Patients wishes/cooperation
29
Q

Prevention of abrasion

A 
Patient education/habits  
OHI  
Bristle stiffness  
Brushing force  
Frequency 
Paste abrasivity  
Abrasive restorations
30
Q

Prevention of attrition

A

Patient awareness/education
Splints
Composite

31
Q

Soft splint

A

 Vacuum formed on model of one arch  Usually lower in bruxism cases  Can be used as an upper fluoride/sodium bicarbonate tray  Full coverage  Quick and easy  Try patient with one of these first – if bites through quickly then consider hard splint

32
Q

Hard splint

A
  • Stabilisation splint/Michigan splint/Tanner appliance
  • More time consuming and difficult
    -Provides ideal occlusion / guidance
    -Relaxes muscles and repositions mandible
    Class I/II – upper Class III – lower
33
Q

Prevention of erosion

A

Diet advice
Avoid brushing immediately after acidic foods
Control of GORD/eating disorders ( may need to liaise with the GMP)
Water and sodium bicarbonate M/W

34
Q

Desensitising treatment

A 
Fluoride mouthrinses and varnish 
Fluoride paste -GelKam 
 Low abrasivity toothpaste 
 Sugar free chewing gum 
Dentine bonding agents 
‘Anti-erosion ‘ toothpastes 
 Tooth mousse
35
Q

Summary

A

Tooth wear is a physiological process 
Toothwear is common 
Pathological tooth wear is often multifactorial 
A clear and detailed history is required to aid identification of the primary aetiology 
In some cases it may not be possible to elicit a cause  Intervene early 
Prevention of further wear is important

36
Q

Clinical consequences

A

Aesthetics
Function
Pupal problems
Occlusion

Clinical skills- Clinical application (18 decks)

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