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bds4 > tooth wear > Flashcards

tooth wear Flashcards

1
Q

why is aetiology important

A

can reduce further wear
allows planning for problems and failures
dictates prognosis
allows sign posting
enhances consent

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2
Q

what factors contribute to attrition

A

lack of posterior teeth
occlusion (edge to edge or deep OB)
ceramic crowns
combination with erosion
stress

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3
Q

what are the common intra occlusal features of bruxists

A

significant wear throughout dentition
repeated restoration failures
root fractures (worrying in virgin teeth)
often onset in early adulthood
rapid progression

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4
Q

what is physiological tooth wear

A

wear that is expected given the age of the patient

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5
Q

what are the modifying features of erosion

A

extrinsic acids (sports drinks, fizzy drinks, inhalers, swimming, alcohol, fruit)
intrinsic acids (poorly controlled diabetes, bulimia, GORD, Barrett’s oesophagus)
high frequency of acids

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6
Q

what are common intra oral features of high carbonated drink intake

A

incisal erosion on upper centrals
cupping on lower molars
palatal erosion on upper incisors
sensitivity
interproximal caries

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7
Q

what are the common intra oral features of eating disorders

A

palatal erosion on upper teeth
polished restorations
erosion around restorations
sensitivity
caries
may have altered taste or halitosis

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8
Q

what behaviours can contribute to abrasion

A

toothbrushing habits (OCD, cheap electric toothbrush with no pressure stop, canines and premolars most affected, poor brushing technique)
tongue studs (lingual wear)
occupational

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9
Q

what individualised interventions could you perform to reduce tooth wear

A

high fluoride use, alcohol free mouthwash
toothbrushing instruction
personalised diet advice (reduce frequency of acids, elimination and addition)
remineralisation (tooth mousse)
splint therapy
signposting (CBT, hypnotherapy)
referral to GMP or psychiatrist
manage patient expectations

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10
Q

how can you monitor tooth wear

A

3D scan
silicone index
photos
casts
tooth wear index
basic erosive wear exam
anterior clinical erosive classification

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11
Q

describe the use of the tooth wear index by smith and knight

A

4 surfaces of the teeth are scored based on the level of enamel/dentine/contour lost
comprehensive index usually used for research as it is time consuming in practice and can easily over or under estimate multifactorial wear

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12
Q

describe the use of the basic erosive wear exam

A

record the most severely affected surface of each sextant and add the 6 scores together
guides management
simple, reliable, easy, quick

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13
Q

describe the use of the anterior clinical erosive (ACE) classification

A

patient is grouped into one of six classes based on 5 parameters relevant to treatment and prognosis
specific to anterior maxillary teeth only
most severely affected tooth decides classification
developed to be easier than BEWE

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14
Q

why should you avoid complete dentures in tooth wear patients

A

bruxism doesnt stop so can lead to fractured dentures, ridge resorption due to heavy occlusal load, pain and ulceration under complete dentures

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15
Q

what are the advantages of overdentures

A

corrects occlusion
aesthetics
psychological benefit of still having teeth
transition to edentulism
avoids extraction in patients at risk of MRONJ
preserves the alveolar ridge

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16
Q

what is the definition of an overdenture

A

a removable prosthesis that rests on natural teeth, natural roots or implants

17
Q

what are the disadvantages of overdentures

A

need good oral hygiene
can make extractions harder as carious roots are now at a sub alveolar level
can fracture in bruxism patients

18
Q

what is the function of transitional dentures

A

increase OVD in cases where poor posterior support to create space for restorations
after transitional dentures have been worn for a few months and the patient tolerates the dentures and the new OVD definitive dentures can be made to the new OVD

19
Q

what are the advantages of metal based dentures in tooth wear cases

A

CoCr backing to denture teeth is stronger than acrylic

20
Q

why would you use bridgework to simplify small saddles in tooth wear cases

A

the pontic of the bridge is metal ceramic which is stronger than the acrylic denture tooth that could break off
need to ensure it is not involved in protrusive or excursive movements otherwise it could fail

21
Q

why is occlusal rehabilitation commonly needed in tooth wear cases

A

often the occlusion is unstable and there is a lack of sufficient index teeth
it is usually more challenging to record the occlusion

22
Q

what planning is needed for rehabilitation in toothwear cases

A

impressions and facebow
mounted casts on a semi adjustable articulator (with or without surveying)
high quality interocclusal record at new and old OVD
diagnostic wax ups
sents
transitional/ temporary dentures
clinical photographs

23
Q

how can you increase retention for indirect restorations in tooth wear cases

A

grooves parallel to the path of insertion
ferrule
parallel preps
metal on biting surfaces as it is stronger in thin sections
surgical crown lengthening
cores

24
Q

why is tooth preparation for indirect restorations in tooth wear cases difficult

A

lack of occluso-gingival height leaves very little retention and resistance form for crown prep
lack of occlusal space, esp on the palatal of the upper incisors
severely compromised tooth

25
Q

what factors should be considered during dental demolition

A

operator safety (eye protection, surgical gloves to protect from sharp metal edges)
patient safety (airway, eye protection)
assess ease of demolition
repeat endo
posts
extractions
can you achieve health and aesthetic objectives
valid consent - risks and benefits (health and aesthetics)
be clear about longevity and cycles of replacement

26
Q

what basic technique should you under take for dental demolition

A

porcelain - coarse diamond
metal - gold cutting bur
chisel whole way up buccal surface
high volume suction
non precious metal is harder to cut through than precious metal
keep bridges as intact as possible to use as temporary
take a pre op impression to make temporary

27
Q

what is a failing dentition

A

a dentition where deteriorating teeth, restorations or oral health means a loss of adequate basic oral functions such as mastication and aesthetics is inevitable if untreated

28
Q

what are the keys to success when managing failure

A

comprehensive history and exam
thorough planning
seek advice if needed
prevention
avoid over ambitious treatment
effective communication
keep plans simple
have an effective maintenance strategy and regularly reassess

29
Q

what is effective communication when managing failure

A

effective listening
honesty and transparency
take into account the patient’s wishes
address difficult issues
seek advice
document discussions
be assertive and compassionate
patience
avoid patient led treatment
have a holistic approach to treatment

30
Q

how would you break bad news to patients

A

SPIKES

Set up interview (mental and physical prep)
Perception (assess what the patient knows about the medical situation)
Invitation (ask how much they want to know)
Knowledge (give the medical facts)
Emotion (respond to patient’s emotions)
Strategy and summary (negotiate a concrete follow up step)

bds4 (13 decks)

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