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
What material is the post dam in metal based dentures and why?
Acrylic post dam as chrome is not ideal for peripheral seal.
How are small saddle areas simplified in toothwear?
Can use cantilever bridge design with metal ceramic Pontic.
If using adhesive bridge- exam occlusion carefully to ensure no lateral or protrusive forces on Pontic which will result in deboning.
What are the requirements to allow you to conform to the occlusion?
Stable occlusion with sufficient index teeth
What is occlusal rehabilitation?
Unstable occlusion lacking sufficient index teeth - need to increase OVD
Why are 2 Inter occlusal records required when changing the OVD?
One taken with increasing OVD and one taken without.
How much tooth structure above the gingival margin is required for foxed restorations?
50%
What are some problems for crown prep in Toothwear cases?
Lack of occlusal gingival height
Lack of occlusal space
Severely compromised tooth
What are some modifications that can be added to crown prep in toothwear?
Grooves
Parallel preps
Inlay within crown prep
Cores
Surgical crown lengthening
How can material sue be modified in Toothwear patients for indirect restorations?
Metal on biting surfaces
Metal margins (less tooth prep)
What is crown lengthening surgery?
Remove bone around tooth to increase gingival height
Suture flap more apically so more clinical crown when heals
How long does crown lengthening surgery take to heal?
3 months
Why is dental demolition common in toothwear?
Heavily restored teeth
Previous failure
Small teeth
High occlusal loads
What bur is used to cut porcelain?
Coarse diamond bur
What is used to cut through metal?
Gold cutting bur
What is used to remove previous GP?
Eucalyptus oil
