Toothwear Part 1 Flashcards
Aetiology of toothwear
- attrition: tooth to tooth
- erosion: acid attack
- abrasion: toothbrush abrasion
- combination
** older pt is likely to have more wear than a younger pt
Why aetiology is important?
- allow us to reduce further wear
- plan for problems, contingencies and failure
- allow you to be realistic with yourself and patients
- identifies wider medical & wellbeing issues
- allows signposting to medical services
- prognostic indicator, ie: bruxism
- enhances consent process
- aids clinical diagnosis & Tx planning
Attrition
- one spectrum is physiological wear, one is when pt is a bruxist
Modifying factors for attrition
- lack of posterior teeth
- occlusion
- restorations; ie: porcelain
- erosion and abrasion
- stress and anxiety
Common features of bruxist
- significant wear throughout dentition
- repeated restoration failure, ie: crown splitting
- root fractures
- often onset in early adulthood
- progressive
Physiological Toothwear
wear is expected given the pt age
Lack of posterior support
- wear is more extensive as no posterior support
- more rapidly progressive as no posterior support
- advise pt to wear dentures to protect anterior dentition
Occlusion
- caused by nature of occlusion often linked by parafunction
- deep overbite, affecting lower incisors
- edge to edge occlusion- localised wear
Restorations
- wear is normally worse than expected
- natural teeth opposed by restorations
- porcelain main cause normally
Evidence of parafunction without obvious wear
Extrinsic factors of Erosion
- carbonated drinks
- sport drinks
- alcoholic acidic drinks
- citrus drinks
- acidic fruits
- acidic sweets
- pickles
- drugs
Intrinsic factors of erosion
- eating disorders
- GORD
- other medical conditions
Modifying factors of erosion
- lifestyle
- multiple factors
- amount and frequency
- level of control
- psychosocial
Common features of carbonated drink intake
- incisal erosion on upper centrals
- cupping on lower molars
- palatal erosion on upper incisors
- sensitivity
- interproximal caries and buccal white spot/ brown spot caries
Common features of eating disorders
- palatal erosion on upper teeth
- polished restorations
- erosion around restorations
- sensitivity
- caries
- altered taste
- halitosis
- soft tissue changes (bulimia)
Abrasion behaviours
- toothbrush abrasion
- oral self harm
- tongue studs
- occupational
- unusual habits
Issues to consider for toothbrush abrasion
- localised/ generalized
- frequency and duration
- bristle and toothpaste abrasiveness
- brushing technique instruction
- electric vs manual
- part of a combination wear problem, ie: eating disorder
- part of a stress/ anxiety related problem
Less common abrasion
- oral self harm
- tongue studs
- occupational
- various habits
Combination aetiology
- erosion; attrition; abrasion
- alcoholism and drug abuse
- eating disorder
- erosion & attrition
- bruxist with poor diet
- erosion & attrition
- bruxist with poor diet and GORD
Unknown aetiology
- often unusual wear pattern
- pt may know aetiology but not telling the truth
- communicate a guarded prognosis
Common preventative advice
- high dose fluoride toothpaste
- alcohol free MW
Dietary modification
- frequency & quantity
- method of delivery
- elimination & addition
Remineralisation
- tooth mousse
- sugar free gum
Interventions to control aetiology
- toothbrushing instructions
- splint therapy
- signposting to CBT and hypnotherapy
- referral to GMP, psychiatrist and social services
