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BDS4 > Toothwear part 1 > Flashcards

Toothwear part 1 Flashcards

1
Q

3 causes of NCTSL?

A
  • Trauma
  • Developmental problems
  • Toothwear
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2
Q

What are the 2 types of tooth wear?

A
  • Physiological increases with age (normal rate)
  • Pathological - fast rate
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3
Q

What are the 4 causes of tooth wear?

A
  • Attrition
  • Abrasion
  • Erosion
  • Abfraction
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4
Q

Define attrition?

A

The physiological wearing away of tooth structure as a result of tooth to tooth contact

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5
Q

Where is attrition found?

A

Occlusal and incisal contacting surfaces

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6
Q

5 intraoral signs of attrition?

A
  • Flattening of incisal edges
  • Facets on a cusp
  • Reduction of cuspal height
  • flattening of occlusal inclined planes
  • Wear of restorations at the same level of toothwear
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7
Q

To what is attrition mostly related?

A

Parafunctional habits (bruxism)

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8
Q

What is abrasion?

A

The physical wear of tooth substance through an abnormal mechanical process independent of the occlusion such as abrasive toothbrushing

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9
Q

What is most common site of abrasion?

A
  • Labial/buccal , cervical on canine and premolar teeth
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10
Q

What is the most common cause of abrasion?

A

tooth brushing , also related to habits and lifestyle

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11
Q

What 4 intraoral signs of abrasion?

A
  • V shaped or rounded lesions
  • Sharp margin at enamel edge where dentine is worn away preferentially
  • notching of the incisal edges
  • Gingival recession
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12
Q

What is erosion?

A

The loss of tooth surface by a chemical process that does not involve bacterial action due to exposure of dental hard tissue to acidic substance

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13
Q

What is the most common cause of pathological toothwear?

A

Erosion

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14
Q

6 intraoral signs of erosion?

A
  • Loss of surface detail and flattening of surfaces (early)
  • Bilateral concave lesions that are not chalky
  • Cupping of occlusal and incisal surfaces due to dentine wear
  • Increased translucency of incisal edges
  • Direct restorations stand proud of the tooth
  • No tooth staining
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15
Q

What is abfraction?

A

The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth

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16
Q

Explain how abfraction occurs?

A
  • Biomechanical loading forces result in flexure of enamel and dentine at areas away from the loading
  • leads to disruption enamel and dentine crystallite structure by cyclic fatigue
  • Resulting in cracks in tooth substance which causes it to chip out
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17
Q

What are the 2 theories related to abfraction?

A
  1. it is the basic cause of all non carious cervical lesions
  2. A combination of occlusal stress, abrasion and erosion
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18
Q

3 intraoral signs of abfraction?

A
  • V shaped tooth loss where the tooth is under tension
  • Sharp rim at the amelocemental junction
  • Mainly in buccal of premolar and molar area
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19
Q

How many of adults have some wear on their anterior teeth involving dentine?

A

77%

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20
Q

Who is affected the most from tooth wear , males or females?

A

Males

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21
Q

What information should you gather from a toothwear patient regardung their toothbrushung?

A
  • Frequency
  • Intensity
  • Duration
  • Type of toothpaste
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22
Q

What is important to gather from toothwear patient social history?

A
  • Stress - bruxism
  • Occupation
  • Alcohol
  • Diet analysis
  • Habits
  • Sports
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23
Q

What occlusal records should you gather from a toothwear patient during examination? 6

A
  • Freeway space
  • Dento-alveolar compensation
  • Overbite
  • Overjet
  • OVD
  • Resting face height
  • Contacts in centric relation
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24
Q

What 3 things you should note about soft tissues when examining a toothwear patient?

A
  • Xerostomia
  • Buccal keratosis
  • Lingual scalloping
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25
Q

What are 2 indices that can be used for toothwear?

A
  • Smith and Knight
  • BEWE
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26
Q

What 6 special tests would you carry out for a toothwear patient?

A
  • Radiographs
  • Articulated study models
  • Intra-oral radiographs
  • Diagnostic wax ups
  • Dietary analysis
  • Sensibility testing
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27
Q

What are three types of generalised toothwear?

A
  • Wear with loss of OVD
  • Wear without loss of OVD but with space available
  • Wear without loss OVD but with limited space
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28
Q

What 2 things should you take into consideration when diagnosing toothwear?

A
  • Pattern of tooth wear
  • Dento-alveolar compensation
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29
Q

What 3 basline recordings would you do for a toothwear patient for monitoring?

A
  • Study models
  • Clinical photos
  • Wear indices : Smith and Knight and BEWE
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30
Q

How can you prevent abrasion? 3

A
  • Change toothpaste if abrasive
  • Alter tooth brushing habits
  • advice on changing habits such as nail biting , wire stripping, piercing biting etc..
  • Simple cervical RMGIC, GIC or composite restoration
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31
Q

What material have the best survival rate for filling abrasion cavities?

A

RMGIC

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32
Q

Why would a composite restoration not be as good as an RMGIC restoration for an abrasion cavity?

A

Its higher modulus may compromise its retention

33
Q

2 methods for prevention of attrition?

A
  • Manage parafunctional habit by CBT or hypnosis
  • Splints
34
Q

what is the difference between a hard splint and a soft splint?

A
  • Hard splint more robust and can used long term
  • Soft splint can be used as a diagnostic device as will show signs of wear
35
Q

Why is Michigan splint a good choice for preventing attrition? 3

A
  • It is a hard splint
  • provides Ideal occlusion with even centric stops
  • Has a canine rise which provide disclusion in eccentric mandibular movements (canine guidance)
36
Q

What are the two sources of acids that may cause erosion?

A

Intrinsic and extrinsic

37
Q

4 methods to prevent erosion?

A
  • Fluoride use (toothpaste, varnish, mouthwash)
  • Dietary management
  • Habit changes : rumination, swilling drinks etc..
  • Control gastric acid
38
Q

Give 3 advice you would give to a patient who drinks carbonated drinks to prevent erosion?

A
  • Avoid swilling drinks around mouth
  • Use a straw instead of drinking from cans
  • Try to avoid drinking as can cause erosion or at least keep it to meal times only
39
Q

4 medical causes of erosion?

A
  • GORD
  • Reflux
  • Hiatus hernia
  • Anorexia and bulimia
40
Q

What would you do if erosion is caused by a medical problem?

A
  • consult patient general medical practitioner
  • May require to refer to specialist after that
  • you must gain consent
41
Q

Who would you refer a GORD patient to prevent erosion?

A

Gastroenterologist

42
Q

Who you would refer an anorexic/bulimic patient to prevent erosion?

A
  • Psychiatrist or Psychologist
43
Q

How would you prevent further abfraction

A
  • Assess occlusion on teeth with abfraction cavities and consider occlusal equilibration
  • Fill cavities with RMGIC, Flowable composite
44
Q

How long would most patients be in the passive management phase for managing their tooth wear?

A

6 months

45
Q

When do you progress to active management of toothwear? 3

A
  • Wear leading to further complications
  • unacceptable aesthetics
  • complicated future treatment without intervention
46
Q

What are 4 goals of active management of toothwear?

A
  • Preservation of remaining tooth structure
  • Improve aesthetics
  • occlusal function
  • Stability
47
Q

What 5 factors contributes to the decision on managing maxillary anterior toothwear?

A
  • The pattern of tooth-wear
  • Inter-occlusal space
  • Space required for restorations
  • Quality and quantity of remaining tooth tissue (enamel)
  • The aesthetic demand of the patient
48
Q

What are 3 categories of anterior maxillary tooth wear pattern?

A
  • limited to the palatal surface
  • involving palatal and incisal edges with reduced crown height
  • limited to labial surfaces
49
Q

In what cases there is available space for restoration of maxillary anterior toothwear? and easiest to treat?

A
  • Increased overjet
  • anterior open bite
50
Q

Why is there no increase in freeway space in most cases although tooth wear has occured ? and what is the disadvantage of this in managing toothwear?

A
  • Dentoalveolar compensation, because it leaves no space for restorations to be placed
51
Q

Give 4 different ways to create space for upper anterior toothwear cases ? other than the DAHL technique

A
  • Increase OVD through posterio indirect restorations (unorganised approach)
  • Occlusal reorganisation from ICP to RCP
  • Elective RCT and post crowns
  • Orthodontics
52
Q

What is involved in surgical crown lengthening?

A
  • exposes more crown to aid retention of restorations
  • Reposition the gingivae apically
53
Q

What are 2 disadvantages of crown lengthening?

A
  • Sensitivity
  • Still need occlusal reduction
54
Q

What is the DAHL technique

A
  • Method of gaining space in cases of localised anterior toothwear
  • Using a removable CoCr anterior bite plane (carried out with composite now)
    *Covering palatal surfaces and allowing occlusion on raised cingulum
  • Resulting in posterior disclusion and increase of 2-3mm in OVD
  • Posteriors erupt into occlusion and anteriors intrude over a period of 3-6 months
  • This results in space between incisor teeth to place restorations
55
Q

4 reasons why composite is a better choice than Cocr for DAHL technique?

A
  • Easier to adjust
  • Better aesthetics
  • Better compliance
56
Q

Success rate of DAHL technique?

A

90% and above

57
Q

6 contraindications of DAHL technique?

A
  • Active periodontal disease
  • TMJ problems
  • Post orthodontics
  • Bisphosphonates patients
  • Conventional bridgework
  • If dental implants exist
58
Q

What 2 things reduce the success rate of managing anterior wear?

A
  • Short roots
  • Periodontal disease leading to poor periodontal support
59
Q

What is the ring of confidence?

A
  • when there is remaining enamel in managing anterior wear which has a positive effect on retention
60
Q

give to reasons why is managing lower anterior tooth wear more difficult than upper?

A
  • Less enamel
  • Small bonding area
61
Q

Which teeth will you build up first , the uppers or the lowers?

A

Lowers
PS . do not increase OVD with lowers

62
Q

2 restorative management of occlusal posterior wear?

A
  • Fill posterior lesions with composite
  • Restore canine guidance by adding composite to the palatal of the upper canines to provide posterior disclusion in lateral movements
63
Q

2 methods of composite build ups?

A
  • Alginate impressions -> wax up -> putty matrix
  • Alginate impression > diagnostic wax > poured in stone> vacuum formed clear plastic matrix > cut to size and use as mould
64
Q

Why do maxillary anterior restorations last better than mandibular ?

A
  • Increased bonding area
65
Q

Why is maxillary anterior tooth wear more common than lower?

A

Tongue and saliva protects the lowers

66
Q

What 3 information would you give to a patient recieving composite build ups for anterior teeth to gain consent before treatment?

A
  • Your front teeth will receive tooth coloured fillings to cover worn teeth this will prevent them from wearing more
  • This Procedure will be carried out with LA as there will be no to minimal drilling to your teeth
  • your bite will feel strange for a few days and you may have difficulty chewing this will get better over the next week
  • Your front teeth may feel a little tender to bite on for few days
  • you may have lisping due to this for few days
  • if you have crowns or bridges or partial dentures they will have to be replaced
67
Q

Additional information you would give to the patient?

A
  • Initially you will have to cut your food into small pieces to help swallowing and digestion
  • Your back teeth will come back together in 3-6 months as only your front teeth will be touching
  • The restorations will require regular maintenance
68
Q

What is the least common catagory of generalised toothwear and the easiest to treat?

A

Excessive tooth wear with loss of OVD

69
Q

Treatment of generalised toothwear with loss of OVD?

A
  • increase face height with permanent direct or indirect restorations
  • Half mandible / half maxillary for OVD increase
70
Q

What you may provide the patient with for posterior support after increasing the ovd for generalised tooth wear?

A

Dentures

71
Q

How can you assess the patient tolerance to the new OVD before going ahead with restorations

A

Provide a splint

72
Q

What approach would you take to manage excessive generalised tooth-wear without loss of OVD but with limited space available?

A

Reorganised approach
with minimal preparation adhesive restorations

73
Q

What is the most severe type of toothwear and the most difficult to treat?

A

Excessive tooth wear without loss of OVD with no space available

74
Q

Treatment options for excessive toothwear without loss ovd with no space available?

A
  • Attempt to increase OVD by splints ± dentures
  • Crown lengthening surgery
  • Elective endodontics
  • Orthodontics
  • Overdentures
75
Q

3 Disadvantages of crown lengthening?

A
  • Unfavourable crown to root ratio (more chance of mobility)
  • Post op sensitivity
  • Black triangles between the teeth due to ID papilla is further down
76
Q

Give 1 advantage of over-dentures for treatment of tooth wear?

A

Preserve tooth substance and bone

77
Q

Give 2 disadvantages of over-dentures for treatment of tooth wear?

A
  • can be bulky for patient
  • difficulty cleaning underneath
78
Q

RCS guidance for toothwear treatment

A
79
Q

Risk management in toothwear

A

BDS4 (63 decks)

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