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BDS4 > Wear > Flashcards

Wear Flashcards

1
Q

Causes of non-carious tooth surface loss

A

Trauma
Developmental problems
Tooth wear

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2
Q

Types of tooth wear

A

Physiological- normal- 20-38um per annum
Pathological:
remaining tooth structure/pulpal health compromised
rate of tooth wear> than expected for age
masticatory/aesthetic deficiency

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3
Q

Causes of toothwear

A

attrition
abrasion
erosion
abfraction

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4
Q

What is attrition

A

physiological wearing away of tooth structure as a result of tooth to tooth contact
found on occlusal and incisal contacting surfaces

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5
Q

Early appearance of attrition

A

polished facet on cusp/slight flattening of incisal edge/cusps

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6
Q

Progression of appearance of attrition lesions

A

reduction in cusp height
flattening of occlusal inclined planes
shortening of clinical crown of incisor and canine teeth

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7
Q

Cause of attrition

A

parafunctional habit (bruxism)

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8
Q

What is abrasion

A

physical wearing away of tooth structure through an abnormal mechanical process independent of occlusion
includes foreign objects/substance repeatedly contacting tooth
commonly found on labial/buccal, cervical on canine and premolar teeth

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9
Q

characteristics of teeth with abrasion

A

V shaped or rounded lesions
sharp margin at enamel edge where dentine is worn away
can manifest as notching of incisal edges

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10
Q

Cause of abrasion

A

Tooth brushing
habits/lifestyle: holding pins, nails, electrical wire stripping, fishing line, thread, pipe smoking, cracking sunflower seeds

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11
Q

What is erosion

A

Wearing away of tooth structure by chemical process that does not involve bacterial action

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12
Q

Cause of erosion

A

chronic exposure of dental hard tissues to acidic substances which can be intrinsic or extrinsic

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13
Q

characteristics of erosion

A

Typically bilateral, concave lesions without chalky appearance of bacterial acid decalcification
Increased translucency of incisal edges
Base of lesion not in contact with opposing tooth
Amalgam and comp. restorations stand proud of tooth

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14
Q

Early appearance of erosion

A

enamel surface detail affected, surface becomes flat and smooth

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15
Q

Progressed appearance of erosion

A

Dentine becomes exposed
Preferential wear of dentine leads to cupping of occlusal surfaces of molars + incisal edges of anteriors

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16
Q

What is abfraction

A

loss of hard tissue from eccentric occlusal forces leading to compressive + tensile stresses at cervical fulcrum of tooth

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17
Q

Characteristics of abfraction

A

Pathological loss of tooth substance at cervical margin
V shaped tooth loss where tooth is under tension
Sharp rim at ACJ
Restorations in area, wear at same rate as tooth structure

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18
Q

Cause of abfraction

A

Biomechanical loading forces
Forces result in flexure and failure of enamel and dentine at area away from loading
Disruption of ordered crystalline structure of enamel and dentine by cyclic fatigue
Cracks in tooth substance-chips out

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19
Q

MH linked to toothwear

A

Medications with low pH/which cause dry mouth
Eating disorders
Alcoholism
Heartburn/GORD
Hiatus hernia
Rumination
Pregnancy

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20
Q

SH linked to toothwear

A

lifestyle stresses- grinding
bruxism
occupation
alcohol/diet/habit/sport

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21
Q

What to record on wear examination

A
  1. Location:
    anterior/posterior
    localised/generalised
  2. Severity:
    enamel only
    into dentine
    severe
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22
Q

Examples of wear indices

A

Smith and Knight Index
BEWE(basic erosive wear exam)

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23
Q

What is the Smith and Knight Index

A

0- no loss of enamel surface detail
1- loss of enamel surface detail
2- B/L/O complete loss of enamel, exposing dentine for <1/3rd of surface incisal enamel loss
minimal dentine exposure
3- B/L/O complete loss of enamel, exposing dentine for>1/3rd of surface incisal enamel loss
substantial dentine exposure
4- B/L/O complete enamel loss, pulpal exposure/secondary dentine exposure

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24
Q

BEWE scores

A

0- no erosive wear
1- initial loss of surface texture
2- distinct defect; hard tissue loss <50% of surface
3- hard tissue loss>50% of surface

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25
Q

BEWE risk level for cumulative score of all sextants

A

None- less than or equal to 2
Low- between 3&8
Medium- between 9&13
High-14 and over

26
Q

Special tests for tooth wear

A

Radiographs
sensibility tests
articulated study models
intra oral photographs
salivary analysis
diagnostic wax up
dietary analysis

27
Q

How to diagnose toothwear

A
  1. Determine primary causative factor
  2. Identify patterns: localised, generalised
  3. Assess if dento-alveolar compensation has occurred
28
Q

Immediate stage of preventative plan

A

Deal with pain

29
Q

When do you create a prevention plan?

A

Once you have a dentally fit patient, diagnosis and have identified primary causative factor

30
Q

Key element in prevention

A

Removal of cause

31
Q

Abrasion prevention

A

Remove foreign object/substance causing abrasive wear
Change toothpaste/brushing habits
Change habits

32
Q

Tx of toothbrush abrasion

A

Simple RMGIC=best survival rate, GIC or comp, can also be considered
No tooth prep
pt wears through restoration rather than damaging tooth

33
Q

Attrition prevention/tx

A

Difficult to prevent as related to parafunctional habit-stress
CBT
Hypnosis
Splint

34
Q

Splint advantages

A

Cause no damage to opposing teeth
Habit breaker
Soft splint=can be used as a diagnostic device(wear for 2 weeks)
Hard splint=more robust and can be used long term

35
Q

Advantages of Michigan splint (type of hard splint)

A

Provides ideal occlusion with centric stops
Has canine rise which provide disclusion in eccentric mandibular movements
Provides canine guidance

36
Q

Erosion prevention

A

Fluoride e.g. Duraphat
Desensitising agents
Dietary management esp. if extrinsic acid
Habit changes: use straw, vegan diet, rumination, overly healthy eating, sports drinks
Medical conditions control: gastric acid, GORD, reflux, hiatus hernia, xerostomia, anorexia and bullimia

37
Q

Abfraction prevention

A

consider occlusal equilibrium
Fill cavity with low modulus restorative materials=RMGIC or flowable comp

38
Q

What is passive management of tooth wear

A

First part of tx
Prevention and monitoring
For about 6 months

39
Q

Requirements to progress to active management

A

Wear leading to further complications/more complex tx being needed
Aesthetics have gone beyond pt acceptability

40
Q

Goal of active management

A

Preservation of remaining tooth structure
Pragmatic improvements in aesthetics
Functioning occlusion
Stability

41
Q

5 factors in deciding tx of maxillary anterior tooth wear

A
  1. pattern of wear
  2. inter occlusal space
  3. space required for planned restorations
  4. quality/quantity of remaining tooth tissue/enamel
  5. Aesthetic demands of pt
42
Q

Patterns of maxillary incisor wear

A
  1. Wear limited to palatal surface
  2. Wear involving palatal and incisal edges with reduced clinical crown height
  3. Wear limited to labial surface
43
Q

Tx for different patterns of maxillary incisor wear

A

composite

44
Q

In what cases is there adequate inter incisal space in maxillary anterior teeth

A

If wear is rapid and no time for alveolar compensation
AOB
Increased OJ

45
Q

How to create space for restorations

A
  1. Increase OVD: multiple posterior extra-coronal restorations
  2. Occlusal reorganisation from ICP to RCP
  3. Surgical crown lengthening
  4. Elective RCT + post crowns
  5. Conventional ortho
46
Q

What is the DAHL technique?

A

-Method of gaining space in localised tooth wear
-Cover palatal surfaces on incisors and canines with composite allowing occlusion on raised cingulum
-Results in posterior disclusion and 2-3mm increase in OVD
-Anteriors intrude and posteriors erupt, results in space between upper and lower anteriors allowing restorations with no need for occlusal reduction
-If no movement in 6 months, won’t work

47
Q

Why do you use composite in DAHL technique and not CoCr

A

Better aesthetics
Better compliance as not removable
Easier to adjust
Immediate or definitive tx

48
Q

Contraindications of DAHL

A

Active perio
Post ortho
Bisphosphonates
If dental implants
If existing conventional bridges

49
Q

Anterior wear tx contraindications

A

short roots
reduced periodontal support due to perio disease
lack of remaining enamel reduces success rate significantly- enamel ring of confidence positively influences success rate

50
Q

Why is lower anterior wear more difficult to treat

A

less enamel-smaller bonding area

51
Q

Tx of localised posterior tooth wear

A

If localised and asymptomatic, prevention and monitoring are appropriate
Occlusal erosive wear can be filled directly with comp with no change in occlusion
Loss of canine guidance common cause

52
Q

How to correct loss of canine guidance for posterior wear

A

Add comp to palatal of upper canines to increase canine rise and disclude posteriors during lateral and protrusive excursions- can use comp free hand or with diagnostic wax up

53
Q

Why is pathological wear more common in upper than lowers

A

Tongue and saliva protects lowers

54
Q

Methods of composite build up

A

putty matrix
wax up
alginate impressions
pickle juice habit

55
Q

3 categories for generalised and localised tooth wear

A
  1. Excessive wear with loss of OVD
  2. Excessive wear without loss of OVD but with limited space
  3. Excessive wear without loss of OVD but with no space available
56
Q

Adhesive approaches to generalised tooth wear

A

Adhesives used to assess patient tolerance of new occlusal scheme as medium term restoration
If conventional preps are required at later date, these adhesive addition may form the bulk of removed material-preserving tooth structure

57
Q

Tx of excessive wear with loss of OVD

A

-splint can be used to assess pt tolerance of new face height or use adhesive approach
-ideally half the OVD increase should be maxillary and half mandibular
-often mixture of adhesive and conventional restorations required

58
Q

Tx of excessive wear without loss of OVD but with limited space

A

Can involve reorganisation of occlusion
Splint should be considered as increase in occlusal facial height required
Restoration of anterior and posterior teeth carried out at new occlusal facial height-if possible should involve minimum adhesive restoration

59
Q

Treatment of excessive wear without loss of OVD but with no space available

A

Requires specialist opinion prior to Tx
Attempt to increase OVD by use of splints +/- dentures if lack of posterior support or if enough teeth use adhesive restorations
Crown lengthening surgery
Elective RCT
Ortho
Overdentures

60
Q

Crown lengthening disadvantages

A

May result in black triangles between teeth where ID papilla is further down
Can lead to unfavourable crown:root ratio=increased tooth mobility if tooth loaded subsequently
Post op sensitivity
Any subsequent conventional crown prep will be further down root, problematic if tooth has significant coronal-cervical taper and has greater chance of pulpal damage

61
Q

Overdenture features

A

preserves tooth structure and bone for support of denture when teeth are so worn down that Rx is impossible
can be bulky
difficult keeping teeth and gingivae healthy beneath denture

BDS4 (50 decks)

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