Wear

Question 1

What are the causes of tooth wear?

Answer 1

• Attrition
• Abrasion
• Erosion
• Abfraction

Question 2

What is ‘attrition’?

Answer 2

Physiological wear of tooth due to tooth-tooth contact

–> Main causes = BRUXISM

Question 3

What is ‘abrasion’?

Answer 3

Physiological wear of tooth due to foreign object/ substance repeatedly contacting tooth

–> Process independent of occlusion

Question 4

What is ‘erosion’?

Answer 4

Loss of tooth surface due to chemical process

–> Does not involve bacteria

Question 5

What is ‘abfraction’?

Answer 5

Loss of hard tissue from abnormal occlusal
forces leading to
stresses at the cervical fulcrum areas of the
tooth

Question 6

What wear indices may be useful in a clinical examination for wear?

Answer 6

• Tooth Wear Index (Smith & Knight)

- Basic Erosive Wear Examination (BEWE)

Question 7

What may be an immediate treatment for tooth wear?

Answer 7

PAIN

• Desensitise = F agents, DBA, GIC
• Pulp extirpation (if wear exposed pulp)
• Smooth sharp edges
• Extr (unrestorable/ non-functional)
• TMJ pain = control acute symtpoms

Question 8

What is the initial treatment for wear?

Answer 8

PREVENTATIVE REGIME

• Monitor (assess progressive or arrested) = models, photos, BEWE/ smith & knight
• Remove abrasive component
• Change toothpaste
• Habits?

ABRASION
- Cervical restorations (toothbrush abrasion); RMGI, flowable comp

ATTRITION

• Hypno
• CBT
• Splints

EROSION

• F regimes
• Desensitising agents (toothpastes etc) = not really preventative
• Dietary management

Question 9

What is the active management for MAXILLARY ANT tooth wear?

Answer 9

Rapid tooth wear (i.e. not alveolar compensation- OVD not decreased)
- Restorations

Loss of OVD

• Increased OVD (reorganised approach)
• ICP -> RCP
• Surgical crown lengthening
• RCT & post crowns
• Ortho

Question 10

What is the Dahl technique?

Answer 10

• Technique to gain space in LOCALISED MAXILLARY ANT tooth wear
• 3-6months
• Palatal coverage –> discrepancy in posterior occlusion –> posterior alveolar compensation –> increases OVD

Question 11

What are the contra-indications for the Dahl technique?

Answer 11

• Active perio disease
• TMD
• Post ortho
• Bisphosphonates
• Dental implants
• Existing conventional bridges

Question 12

What would you suspect for causes of localised posterior tooth wear?

Answer 12

• Erosive in ruminating, bulimic and alcoholic pts

Question 13

What techniques can be used to build up teeth with composite?

Answer 13

• Wax up and putty matrix made –> mould for build up

- Clear vacuum formed matrix (made from wax up and poured cast) –> mould for build up

Question 14

What would you tell your patient before building up their teeth with composite?

Answer 14

• Tooth coloured fillings, prevents more wear
• No LA as no/min drilling
• Improvement in appearance possible
• Bite will be strange few days as only front teeth will touch
  
  • -> back teeth will come back together ~3-6 months
  • -> over a week, will get accustomed but may need to cut food into bite sized pieces
• Lisping possible
• May bite tongue/ lip
• Crowns/ bridges at back will need to be replaced
• Good longevity, but possible to fall off, but can be replaced with no damage to tooth
• Will require maintenance

Question 15

How is GENERALISED tooth wear managed?

Answer 15

EXCESSIVE, LOSS OF OVD but space

• Splint to adjust new height
• Straight to increasing OVD with direct build ups
  
  • -> half max, half mand

EXCESSIVE, LOSS OF OVD, min space
- Reorganised approach with splint to adjust to new height –> restor post and ant teeth

EXCESSIVE, W/O LOSS OF OVD, no space

• Splints +/- dentures
• Crown lengthening
• RCT
• Ortho
• Over dentures