Wear Part 2- Lecture 1 Part 1 Flashcards
What are the causes of tooth wear?
Attrition
Erosion
Abrasion
Combination
Time- physiological wear
Unknown
What is the point in determining the aetiology of wear?
- Attempt to reduce further wear
- Plan for problems, contingencies & failure
- Allow you to be realistic with yourself & patient
- Identifies wider medical & wellbeing issues & allows signposting
-> eating disorders - Prognostic indicator
- Enhances consent process- individualised
- Aids clinical diagnosis & treatment planning
What factors can modify the progression rate of attrition?
- Lack of posterior teeth (SDA)- increases rate of tooth wear due to contact only being between anteriors
- Occlusion- deep OB or edge to edge would increase attrition progression rate
- Restorations- porcelain is abrasive to teeth if they contact opposing teeth
- Stress and anxiety- can vary through life
-> Episodes of clenching and grinding
What are the common dental features seen in bruxism patients?
- Significant wear throughout dentition
- Repeated restoration failure
- Root fractures
- Often onset in early adulthood- Progressive
In older patients, what can we do to fix physiological tooth wear into dentine?
Cover area with composite
What advice should be given to a patient suffering tooth wear due to lack of posterior support?
Consider wearing a RPD
What factors can increase rate of tooth wear progression in patients who already have difficult occlusions?
Bruxism
Parafunction
What would the wear pattern in a patient with deep OB look like?
lower incisors worn, some wear seen on palatal surface of uppers
What would the wear pattern in patient with edge to edge occlusion look like?
Localised destructive wear due to posterior open bites
What are the warning signs of attritive/parafucntion without evidence of actual wear?
Multiple cusp fracture
Multiple cracks around restorations
Root fractures in unrestored teeth
Lip, tongue and cheek chewing
What are the extrinsic causes of erosive wear in teeth?
Carbonated drinks
Sports drinks
Alcoholic acidic drinks
Citrus drinks Acidic fruits
Acidic sweets
Pickles
Drugs- methamphetamine
What are the intrinsic cause of erosive tooth wear?
Eating Disorders- AN
GORD
Medical conditions- Barrett’s
Which factors can contribute to rate of progression of erosive wear?
Lifestyle- what they drink, how they drink it, anxiety/stress relief
Frequency is more important than amount- sipping means acid attack is prolonged
Level of control/psychosocial- both may be occurring at same time
What are the dental features of patients who consume a high intake carbonated beverages?
Incisal erosion on upper centrals
Cupping into dentine on lower molars
Palatal erosion on upper incisors
Sensitivity
Interproximal caries and buccal white spot/brown spot caries
What are the common dental features of patients who have eating disorders causing erosive wear?
- Palatal erosion on upper teeth
- Polished restorations- Amalgam
- Erosion around restorations
- Sensitivity- ascertain whether this is getting worse
- Caries
- Altered taste – sometimes
- Halitosis – sometimes
- Soft tissue changes (bulimia) - abrasive lesions in centre of tongue
What forms of wear are commonly associated with erosive wear in patients with eating disorders?
Abrasion
Attrition
Which factors can cause abrasive wear?
Toothbrush abrasion
Oral-self harm
Tongue studs- lingual surface of lower incisors
Habits- pipe smoking
Occupational- sewing, bakers
What advice can be given to patients with abrasive lesions?
Bristle and toothpaste abrasiveness
Brushing technique instruction
-> consider change to electric brush with pressure sensor
If eating disorder- encourage them not to brush teeth immediately after vomiting
Stress- behavioural management in patients who are obsessive about brushing OR over-brush
What are examples of patients who may have erosion (I/E), attrition and abrasion in combination?
Alcoholics
Drug abuser
Eating disorders
How does alcoholism contribute to combination wear?
Extrinsic erosion- from drinks
Intrinsic- being sick
Attrition- bruxism due to stress
Abrasion- in attempt to clean mouth after being sick or drinking heavily
What should you do when aetiology of wear in unknown or patient won’t tell you?
Plan warily as you have no idea what caused the wear
-> give guarded prognosis- as this factor could be reproduced on next restoration
What is an example of a patient who may suffer extrinsic erosive and attritional wear in combination?
Bruxist with poor diet
What is an example of a patient who may suffer extrinsic/intrinsic erosive wear and attritional wear in combination?
Bruxist with poor diet and GORD
What can help you elicit the aetiological cause of wear in patients who are resistant?
Comprehensive
Compassionate
Unconditional positive regard- don’t blame patient
Show patience- gain trust first
What information about the patient may you uncover when investigating their tooth wear?
Eating disorders
Undiagnosed diabetes
Mental health issues
GI issues
Abuse, harm, addiction
Vulnerable adults or children
-> be sensitive
What aspects of examination can help you decide on the likely aetiology and rate of progression of tooth wear?
Be comprehensive- Look at each tooth that has wear
Indices- BEWE may be useful
Classify wear- generalised/localised, mild/moderate/severe, progressive/non, pathological/physiological
Relate finding to aetiology- is wear pattern what you would expect from history
-> also consider that caries and periodontal disease could be occurring simultaneously
Which common preventive advice/tx can be given to most patients with tooth wear? (give positive alternatives)
High dose toothpaste
Alcohol free mouthwash
Dietary modification
-> Lower frequency
-> Method of delivery- use straws
-> Elimination & addition
Remineralisation
-> Tooth Mousse
-> Sugar free gum
What occurs as a result of carrying out oral rehabilitation in patients who have uncontrolled or only partially controlled aetiology?
Failure to control aetiology may result in failure of dentition
Sometimes you may only be able to improve
If uncontrolled or partly controlled- treatment/restorations are more likely to fail (inform patient of this)
What are the interventions that can be used to control aetiology of tooth wear?
Toothbrushing instruction
Splint therapy- if wear caused by attrition due to parafunction
Signposting:
CBT
Hypnotherapy
Addiction services
Referral:
GMP/specialists- eating disorders, GI issues
Psychiatrist
Social services- vulnerable patients
Which teeth are most likely to be worn and why?
Incisors and FPMs
-> been in mouth the longest
