Toothwear Pt 2 Flashcards
What are the main aetiological factors in toothwear patients?
Attrition
Erosion
Abrasion
Abfraction
Combination of these
Sometimes unknown
All need time for effect to be noticeable.
What is physiological toothwear?
Tooth wear which is normal for the age of the patient.
Why is the aetiology of tooth wear important when treatment planning?
So you can attempt to reduce further wear
To plan for problems and failures which may occur
To be realistic with treatment aims
Can identify medical and wellbeing issues
Enhances consent process
What are some factors which increase the progression of attrition?
Lack of posterior teeth
Occlusion- deep OB, edge to edge
Restorations- eg in porcelain (much harder than tooth tissue
Erosion and abrasion
Stress and anxiety
What are some clinical features of bruxism?
Significant wear throughout dentition
Repeated restoration failure
Root fracture
Onset in early adulthood
Progression is rapid
What are common findings of physiological tooth wear?
Wear into dentine on lower incisors
Flattened canine cusps
What clinical findings could suggest parafunction without obvious wear?
Multiple cusp fractures
Multiple cracks around restorations
Root fractures in unrestored teeth
What are extrinsic factors for erosion?
Carbonated drinks, acidic drinks, acidic sweets, pickles, drugs
What are intrinsic factors for erosion?
Eating disorders
GORD
Other medical conditions - uncontrolled diabetes, Barrett’s oesophagus
What are modifying factors for erosion?
Lifestyle
Multiple factors (extrinsic and intrinsic)
Amount and frequency (eg of acidic drinks)
Level of control
Psychosocial
What is a common clinical feature of erosion from carbonated drinks?
Incisal and palatal erosion on upper centrals
Cupping on lower molars
Sensitivity
Inter próximas caries and bucal white/ brown spots
What are common dental findings of an eating disorder?
Palatal erosion on upper teeth
Polished restorations (especially amalgam) and erosion around restorations
Sensitivity
Caries (high calorie intake followed by vomiting)
Can get abrasive lesion under tongue from sharp incisors
What are the common causes of abrasion?
Toothbrush abrasion
Oral self harm
Tongue stud
Occupational
Unusual habits
What is common preventative advice for further erosion?
Fluoride - high dose toothpaste, alcohol free mouthwash
Diet modification - frequency, quantity, delivery
Remineralisation - tooth mousse
Sugar free gum
What are some examples of interventions to control the aetiology of tooth wear?
Tooth brushing instruction
Splint therapy
Signposting - CBT, hypnotherapy
Referral - GMP, psychiatrist, social services
Why might a patient present with lack of posterior support?
Denture intolerance, denture refusal, supervised neglect
Why should complete dentures be avoided in bruxism?
The bruxism will wear through the denture- resulting in fracture ridge resorption, pain and ulceration.
Overdentures are better as they offer some tooth support.
What a re the removable pros options in toothwear patients?
Overdentures
Transitional dentures
Metal based dentures
Simplifying small saddle areas
What is an Overdenture?
Any removable prosthesis which rests on one or more remaining natural teeth, the roots of natural teeth or implants.
What are advantages of overdentures?
Correction of occlusion and aesthetics
Support (tooth and mucosal)
Toothwear management
Preservation of ridge form
Proprioception
Denture retention - better undercuts around the roots, can add precision attachments
Avoids extractions
Eases transition to edentulism
What are disadvantages of overdentures?
Need for good OH
Increased caries/ perio - difficult in care homes
Denture fracture is more common
Discomfort/ infection
Potentially more complex extractions in future
What is the denture care advise for overdentures?
Good OH
Fluoride toothpaste over roots
Regular exams and radiographs
Denture hygiene advice
What are transitional dentures?
Acrylic overdentures given to the patient at increased OVD.
Wear for a couple of months to get patient used to new OVD/ wearing dentures.
What are metal based dentures in toothwear?
These dentures have CoCr backing - metal is brought up on to occlusal surfaces of worn teeth and in the palate with acrylic post dam
