Toothwear - Applying Aetiology To Treatment Plans

Question 1

What are common features of a bruxist?

Answer 1

Attrition

Significant wear throughout dentition that is progressive

Root fractures possible

Restoration failure

Started in early adulthood

Evidence of parafunction without obvious wear - multiple cracks or fractures around restored teeth or root fractures in unrestored teeth

Question 2

How can occlusion affect the toothwear?n

Answer 2

If lower incisors are worn, a deep overbite can occur

If there is generalised toothwear, often there is an edge to edge contact

Question 3

What are the extrinsic factors that increase rate of progression of erosive toothwear?

Answer 3

Methamphetamine

Carbonated / sugary drinks

Acidic sweets and fruits

Question 4

What are the main intrinsic causes of toothwear?

Answer 4

Eating disorders such as bulimia nervosa

GORD

Other medical conditions

Question 5

What features may present in someone who drinks a lot of fizzy drinks?

Answer 5

Incisal erosion and palatal erosion on upper centrals

Cupping on lower molars

Sensitivity

Interproximal caries

Question 6

Common features of an eating disorder erosion?

Answer 6

Palatal erosion of upper teeth

‘Polished’ restorations and erosion around them

Sensitivity

Skinny pt

Caries

Altered taste / halitosis - sometimes

Question 7

What are some causes of abrasion of teeth?

Answer 7

Brushing too hard

Oral self harm

Tongue studs / tongue modifications - lingual abrasion and gingival recession risk

Unusual habits - chewing items or using a pipe on same side

Occupational - grit in the air can affect toothwear e.g. working in a mine or something idk

Question 8

What should i consider when someone appears with abrasion?

Answer 8

Localised or generalised

Are they using electrical or manual brush

What brushing technique are they using

Frequency and duration of brushing?

Is it part of a combination problem with other factors influencing the wear?

Question 9

What are some common preventative advice we can give to those with toothwear?

Answer 9

Fluoride
- high fluoride toothpaste

Diet
- modify frequency of sugar
- method of delivery e.g. use a straw for any carbonated drinks and only at mealtimes and infrequently

Brushing technique
- reduce force of brushing
- change brushing technique

Referral to
- GMP
- social services
- CBT signposting

Question 10

What is the most important factor in treating toothwear?

Answer 10

Controlling the aetiology

• rehab without control of aetiology will result in high failure rates
• must ensure patient understands this and is on board with control of aetiology
• pt must know that work needs done on their teeth but if the cause of the wear does not improve, then there can often be repeat cycles of restoration