toothwear - aetiology

Question 1

What are the 3 main components of tooth wear?

Answer 1

Attrition
Erosion
Abrasion

Question 2

Why is the aetiology of toothwear important?

Answer 2

So you can attempt to reduce further wear and plan for problems
Aids clinical diagnosis and tx planning

Question 3

What are the modifying factors of attrition

Answer 3

Lack of posterior teeth
Occlusion
Restorations
Erosion and abrasion
Stress and anxiety

Question 4

Give 4 common features seen in bruxists

Answer 4

Significant wear throughout dentition
Repeated restoration failure
Root fractures - especially concerning in virgin teeth
Often onset in early adulthood

Question 5

What is physiological tooth wear?

Answer 5

Wear that you would expect to see given the age of the patient

Question 6

How can the pt’s occlusion cause toothwear?

Answer 6

A deep OB can cause incisal wear
Edge to edge occlusion can lead to localised wear

Question 7

How can restorations cause toothwear?

Answer 7

Natural teeth are opposed by restorations, mainly porcelain
The porcelain is particularly abrasive

Question 8

What gives evidence of parafunction without toothwear?

Answer 8

Multiple cusp fracture
Multiple cracks around restorations
Root fractures in unrestored teeth

Question 9

Give 4 causes of extrinsic erosion

Answer 9

Any from:
- carbonated drinks
- sports drinks
- alcoholic drinks eg - white wine, cider
- citrus drinks
- acidic fruits
- pickles
- drugs

Question 10

Give 4 causes of intrinsic erosion

Answer 10

Eating disorders eg - bulimia nervosa
GORD
Barrett’s oesophagus
Uncontrolled diabetes

Question 11

Name 4 modifying factors of erosion

Answer 11

Lifestyle
Amount and frequency of acid exposure
Level of control
Psychosocial

Question 12

What are the signs of erosion from carbonated drink intake?

Answer 12

Incisal erosion on upper centrals
Cupping on lower molars
Palatal erosion on upper incisors
Sensitivity
Interproximal caries and buccal white spot/brown spot caries

Question 13

Name 4 oral features of eating disorders

Answer 13

Any from:
- palatal erosion on upper teeth
- polished restorations
- erosion around restorations
- sensitivity
- caries
- altered taste - sometimes
- halitosis - sometimes
- soft tissue changes (bulimia) - rarely

Question 14

Give 5 examples of abrasive behaviours

Answer 14

Toothbrush abrasion
Oral self-harm
Tongue studs
Occupational
Unusual habits

Question 15

What should be considered with toothbrush abrasion?

Answer 15

Whether it is localised or generalised
Frequency and duration of brushing
Bristle and toothpaste abrasiveness
Brushing technique instruction
Electric or manual brush
Is wear a combination problem eg - eating disorder
Is wear part of a stress/anxiety problem

Question 16

Name 3 common combinations of toothwear and where they are seen

Answer 16

Erosion (I + E), attrition and abrasion - alcohol and drug abuse, eating disorders
Erosion (E) and attrition - bruxist with poor diet
Erosion (I + E) and attrition - bruxist with poor diet and GORD

Question 17

What common preventative advice is used in regards to toothwear?

Answer 17

Fluoride - high F toothpaste, alcohol free mouthwash
Diet modifications - frequency and quantity, method of delivery, elimination and addition
Remineralisation - tooth mousse
Sugar free gum

Question 18

What interventions are used to control aetiology of toothwear?

Answer 18

Toothbrushing instruction
Splint therapy
Signposting - CBT and hypnotherapy
Referral to - GMP, psychiatrist, social services if vulnerable adult or child

Question 19

What should be expected when treating toothwear?

Answer 19

Failure and cycles of restorations