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BDS4 Restorative > Wear Part 2- Lecture 1 Part 1 > Flashcards

Wear Part 2- Lecture 1 Part 1 Flashcards

1
Q

What are the causes of tooth wear?

A

Attrition
Erosion
Abrasion
Combination
Time- physiological wear
Unknown

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2
Q

What is the point in determining the aetiology of wear?

A
  • 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
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3
Q

What factors can modify the progression rate of attrition?

A
  • 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
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4
Q

What are the common dental features seen in bruxism patients?

A
  • Significant wear throughout dentition
  • Repeated restoration failure
  • Root fractures
  • Often onset in early adulthood- Progressive
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5
Q

In older patients, what can we do to fix physiological tooth wear into dentine?

A

Cover area with composite

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6
Q

What advice should be given to a patient suffering tooth wear due to lack of posterior support?

A

Consider wearing a RPD

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7
Q

What factors can increase rate of tooth wear progression in patients who already have difficult occlusions?

A

Bruxism

Parafunction

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8
Q

What would the wear pattern in a patient with deep OB look like?

A

lower incisors worn, some wear seen on palatal surface of uppers

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9
Q

What would the wear pattern in patient with edge to edge occlusion look like?

A

Localised destructive wear due to posterior open bites

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10
Q

What are the warning signs of attritive/parafucntion without evidence of actual wear?

A

Multiple cusp fracture

Multiple cracks around restorations

Root fractures in unrestored teeth

Lip, tongue and cheek chewing

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11
Q

What are the extrinsic causes of erosive wear in teeth?

A

Carbonated drinks
Sports drinks
Alcoholic acidic drinks
Citrus drinks Acidic fruits
Acidic sweets
Pickles
Drugs- methamphetamine

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12
Q

What are the intrinsic cause of erosive tooth wear?

A

Eating Disorders- AN
GORD
Medical conditions- Barrett’s

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13
Q

Which factors can contribute to rate of progression of erosive wear?

A

 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

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14
Q

What are the dental features of patients who consume a high intake carbonated beverages?

A

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

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15
Q

What are the common dental features of patients who have eating disorders causing erosive wear?

A
  • 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
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16
Q

What forms of wear are commonly associated with erosive wear in patients with eating disorders?

A

Abrasion

Attrition

17
Q

Which factors can cause abrasive wear?

A

Toothbrush abrasion

Oral-self harm

Tongue studs- lingual surface of lower incisors

Habits- pipe smoking

Occupational- sewing, bakers

18
Q

What advice can be given to patients with abrasive lesions?

A

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

19
Q

What are examples of patients who may have erosion (I/E), attrition and abrasion in combination?

A

Alcoholics

Drug abuser

Eating disorders

20
Q

How does alcoholism contribute to combination wear?

A

 Extrinsic erosion- from drinks
 Intrinsic- being sick
 Attrition- bruxism due to stress
 Abrasion- in attempt to clean mouth after being sick or drinking heavily

21
Q

What should you do when aetiology of wear in unknown or patient won’t tell you?

A

Plan warily as you have no idea what caused the wear
-> give guarded prognosis- as this factor could be reproduced on next restoration

22
Q

What is an example of a patient who may suffer extrinsic erosive and attritional wear in combination?

A

Bruxist with poor diet

23
Q

What is an example of a patient who may suffer extrinsic/intrinsic erosive wear and attritional wear in combination?

A

Bruxist with poor diet and GORD

24
Q

What can help you elicit the aetiological cause of wear in patients who are resistant?

A

Comprehensive

Compassionate

Unconditional positive regard- don’t blame patient

Show patience- gain trust first

25
Q

What information about the patient may you uncover when investigating their tooth wear?

A

Eating disorders

Undiagnosed diabetes

Mental health issues

GI issues

Abuse, harm, addiction

Vulnerable adults or children

-> be sensitive

26
Q

What aspects of examination can help you decide on the likely aetiology and rate of progression of tooth wear?

A

 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

27
Q

Which common preventive advice/tx can be given to most patients with tooth wear? (give positive alternatives)

A

High dose toothpaste

Alcohol free mouthwash

Dietary modification
-> Lower frequency
-> Method of delivery- use straws
-> Elimination & addition

Remineralisation
-> Tooth Mousse
-> Sugar free gum

28
Q

What occurs as a result of carrying out oral rehabilitation in patients who have uncontrolled or only partially controlled aetiology?

A

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)

29
Q

What are the interventions that can be used to control aetiology of tooth wear?

A

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

30
Q

Which teeth are most likely to be worn and why?

A

Incisors and FPMs
-> been in mouth the longest

BDS4 Restorative (12 decks)

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