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BDS4 RESTORATIVE DENTISTRY > TOOTHWEAR PART 2 > Flashcards

TOOTHWEAR PART 2 Flashcards

1
Q

What is the aetiology of toothwear?

A
  • attrition
  • erosion
  • abrasion
  • combination of above
  • unknown
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2
Q

Why is knowing the aetiology of a patients toothwear important?

A
  • attempt to reduced further wear
  • plan for problems, contingencies & failure
  • allow you to be realistic with yourself & pt
  • identifies wider medical & wellbeing issues
  • prognostic indicator
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3
Q

What can attrition be split into?

A
  • physiological wear
  • bruxism
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4
Q

What are modifying factors of attrition?

A
  • lack of posterior teeth
  • occlusion
  • restorations
  • erosion & abrasion
  • stress & anxiety
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5
Q

what are common clinical features seen in bruxism patients?

A
  • significant wear throughout dentition
  • repeated restoration failure
  • root fractures
  • often onset in early adulthood
  • progressive
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6
Q

How can you decide if toothwear is physiological or pathological?

A

Is the toothwear what you would expect of a patient at that age??
- if NOT… suspect pathology (eg bruxism)

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7
Q

A patient has lack of posterior support in their mouth, what common toothwear features are seen?

A
  • extensive anterior wear
  • progresses rapidly
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8
Q

What restorations/material can make toothwear WORSE?

A

Porcelain restorations!
- you will see significantly worse wear than you would expect if dentition was opposed by natural teeth

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9
Q

What are signs that a patient may have a parafunctional habit, even if there is no obvious toothwear present?

A
  • multiple cusp fracture
  • multiple cracks around restorations
  • root fractures in unrestored teeth
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10
Q

What modifying factors affect the rate of erosion in patients’ mouths?

A
  • lifestyle
  • amount & frequency of acid intake
  • level of control
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11
Q

Give examples of extrinsic factors that can increase rate of progression of erosion?

A
  • carbonated drinks
  • acidic drinks (eg sports drinks)
  • acidic foods (eg pickles)
  • drugs
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12
Q

Give examples of intrinsic factors that can increase rate of progression of erosion?

A
  • eating disorders
  • GORD
  • other medical conditions
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13
Q

What are common erosion features seen in patients with a high carbonated drink intake?

A
  • incisal erosion of upper centrals
  • cupping on lower molars
  • palatal erosion of upper incisors
  • sensitivity
  • interproximal caries & buccal white spots/brown caries
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14
Q

What are common erosion features seen in patients with an eating disorder?

A
  • palatal erosion of upper anteriors
  • polished restorations
  • erosion around restorations
  • sensitivity
  • caries
  • halitosis
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15
Q

What are examples of factors that can cause abrasion?

A
  • toothbrush abrasion
  • oral self harm
  • tongue studs
  • unusual habits
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16
Q

If a patient presents with toothwear abrasion what should you do?

A
  • brushing technique instruction
  • find out if its as a result of stress/anxiety?
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17
Q

What are common combinations of NCTSL that you may see in pts with alcoholism & drugs abuse?

A

Erosion + Attrition + Abrasion

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18
Q

What are common combinations of NCTSL that you may see in pts with an eating disorder?

A

Erosion + Attrition + Abrasion

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19
Q

What combination of NCTSL may you see in pts with a bruxism habit & poor diet?

A

erosion (extrinsic) & attrition

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20
Q

Why can uncovering toothwear aetiology when history taking be challenging?

A

You may uncover:
- eating disorders
- undiagnosed diabetes
- mental health issues
- GI issues
- abuse/harm/addiction
- vulnerable adult/child

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21
Q

What preventative advice can you give to patients with toothwear?

A
  1. Fluoride: high dose tp & alcohol free mouthwas
  2. Dietary modification
  3. Remineralisation: tooth mousse
  4. Sugar free gum?
22
Q

Where can we signpost patients with severe toothwear related to habits/stress/suspected medical disorders?

A
  • CBT
  • hypnotherapy
  • GMP
  • psychiatrist
  • social services
23
Q

Why might patients have a lack of posterior support?

A
  • denture intolerance
  • denture refusal
  • supervised neglect
24
Q

Why should you try to avoid complete dentures in bruxist toothwear patients?

A

Bruxism does not stop!
- fractured dentures
- ridge resorption
- pain & ulceration under denture

25
Q

what is an overdenture?

A

Any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants

26
Q

What are some advantages of using overdentures?

A
  • correction of occlusion & aesthetics
  • support
  • toothwear management
  • preservation of ridge form
  • increased proprioception
  • denture retention
  • avoids extractions
  • psychological benefits
  • eases transition to edentulism
27
Q

What are some disadvantages of overdentures?

A
  • NEED good oral hygiene
  • increased caries/perio risk
  • denture fracture
  • discomfort/infection
28
Q

How should overdenture patients be cared for?

A
  • ensure good OH
  • fluoride toothpaste application to remaining teeth/roots
  • regular exams/radiographs
  • ensure good denture hygiene
29
Q

What is the function of transitional dentures in toothwear pts?

A

Transitional dentures can increased OVD in cases where poor posterior support to create space for restorations

30
Q

What change is there between conforming to a pts occlusions vs rehabilitating a pts occlusion?

A

Conforming = OVD stays the same

Rehabilitation = OVD is changed

31
Q

What planning/clinical steps are required in tooth wear rehabilitation patients?

A
  • impressions & facebow
  • mounted articulated casts on semi-adjustable articulator
  • high quality interocclusal record
  • diagnostic wax-ups
  • stents for build-ups
  • clinical photographs
32
Q

Why is tooth preparation in tooth wear cases difficult?

A
  • lack of occluso-gingival height
  • lack of occlusal space
  • severly compromised tooth
33
Q

Why do we need to modify preparations in tooth wear patients when aiming to restore?

A

creating retention & resistance in small teeth

34
Q

What are some examples of modified preparations performed in restorative work of tooth wear pts?

A
  • grooves
  • inlays
  • ferrule
  • parallel preps
  • cores
  • electrosurgery
  • surgical crown lengthening
35
Q

What material do we tend to use in tooth wear pt biting surfaces?

A

metals!
- to prevent fracture

36
Q

How can electrosurgery be used in toothwear patients restorative treatment?

A

Electrosurgery used to remove gingiva and lengthen appearance of tooth crown (creates ferrule of sorts) to allow restorative work

37
Q

If you are using a metal crown, what margin preparation should you have?

A

metal margin = chamfer

38
Q

If you are using a porcelain crown, what margin preparation should you have?

A

porcelain margin = shoulder

39
Q

Why should porcelain preps be curved and smooth in toothwear pt?

A

To prevent crack propagation of porcelain, especially in pt with increased occlusal load/parafunction

40
Q

How long does it roughly take for gingiva to stabilise after crown lengthening surgery?

A

About 3 months

41
Q

What problems are sometimes associated with silver points used for root filling?

A

They can become corroded
- very difficult to remove once this happens

42
Q

What bur should be used for cutting porcelain when removing restorations?

A

Coarse diamond bur

43
Q

What bur should be used for cutting metal when removing restorations?

A

Gold cutting bur (these cause loads of vibration)

44
Q

Describe the steps of removing an indirect restoration such as a crown/bridge:

A
  • cut whole way up buccal surface with bur
  • use chisel to split things apart
  • ensure high volume suction
45
Q

What problem may arise when removing an indirect restoration with instruments such as enamel chisel or sliding hammers?

A

High risk of core fracture

46
Q

Before removal of an indirect restoration that to plan to replace long term, what clinical procedure should you carry out?

A

Take a pre-op impression so you can make a temporary restoration for in between appts.

47
Q

What can be used to soften gutta-percha during re-RCT?

A

Eucalyptus/Turpentine oil

48
Q

What must we determine before removing a post from a pt tooth?

A
  • is there a fracture risk?
  • how easy will the removal be
  • have plan in place in case of fracture
  • is there other pathology within tooth?
49
Q

Effective communication is important in managing patients with failing dentitions. Give examples of aspects of effective communication:

A
  • effective listening
  • honesty & transparency
  • seeking advice
  • listen to pt wishes
  • documenting discussions
  • time & patience
50
Q

Outline the SPIKES protocol for giving bad news:

A

Set up the interview: mental & physical preparation

Perception: asses what the pt knows about the medical situation

Invitation: ask how much they want to know

Knowledge: give the facts

Emotion: response to pt emotions

Strategy and summary

51
Q
A

BDS4 RESTORATIVE DENTISTRY (9 decks)

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