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