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BDS4- restorative dentistry > Tooth wear > Flashcards

Tooth wear Flashcards

1
Q

What can causde tooth surface loss

A

Everything:
Caries, Trauma, Developmental Problems,
Tooth Wear

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2
Q

What are the types of tooth loss

A

PHYSIOLOGICAL tooth wear is the normal wear associated with normal function

PATHOLOGICAL tooth wear occurs if the remaining tooth structure or pulpal health is compromised or the rate of tooth wear is in excess of what would be expected for that age

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3
Q

Causes of tooth wear

A

Attrition
Abrasion
Erosion
Abfraction

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4
Q

What is attrition and where is it found normally

A

The physiological wearing away of tooth structure as a result of tooth to tooth contact

found on the occlusal and incisal contacting surfaces

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5
Q

What is the apperance of attrition

A

Early appearance is of a polished facet on a cusp or slight flattening of an incisal edge

Progression leads to reduction in cusp height and flattening of occlusal inclined planes

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6
Q

What is attritioon normally related to

A

Almost always related to a parafunctional habit (bruxism)

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7
Q

What is abrasion

A

The physical wear of tooth substance through an abnormal mechanical process independent of occlusion. It involves a foreign object or substance repeatedly contacting the tooth

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8
Q

Where is abrasion found

A

The site and pattern of tooth loss is related to the abrasive element

Commonest area is labial/buccal, cervical on canine and premolar teeth

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9
Q

What does abrasion look like

A

V shaped or rounded lesions

Sharp margin at enamel edge where dentine is worn away preferentially

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10
Q

What is the most common form of abrasion

A

Toothbrushing

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11
Q

What is erosion

A

The loss of tooth surface by a chemical process that does not involve bacterial action

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12
Q

What is the most common cause of pathological tooth wear

A

Erosion

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13
Q

What is erosion caused by

A

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

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14
Q

What are the stages of erosion and what do they look like

A

Early stages enamel surface is affected, there is loss of surface detail, surfaces become flat and smooth

Later dentine becomes exposed
Preferential wear of dentine leads to ‘cupping’ of the occlusal surfaces of the molars and incisal edges of the anteriors

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15
Q

What can be signs of erosion

A

Increased translucency of incisal edges (can appear dark)

Base of lesion not in contact with opposing tooth

Amalgam and composite restorations stand proud of the tooth

There is no tooth staining present

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16
Q

What is abfraction

A

The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth

Pathological loss of tooth substance at the cervical margin

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17
Q

What is abfraction caused by and what does it result in

A

biomechanical loading forces

Forces result in flexure and failure of the enamel and dentine at a location away from the loading

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18
Q

Is wear multifactorial

A

Almost all wear is

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19
Q

What increases with age

A

wear

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20
Q

What is most common type of wear in old people

A

physiological

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21
Q

What is succcessful management based on

A

An accuraste diagnoses

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22
Q

How do you prevent or reduce tooth loss

A

Recognise the problem is present

Grade its’ severity

Diagnose the likely cause or causes

Monitor the progression of the disease
-Is it active or historic
-Are preventative measures working or is active restorative treatment required

23
Q

In medical history what could hell found out cause of wear

A

Medication with low pH
Medications which cause xerostomia
Eating disorder
Alcoholism
Heartburn
GORD
Hiatus Hernia
Rumination
Pregnancy

24
Q

What are you looking for in the examination of a patient

A

E/O
Examine TMJ for problems
Examine muscles for hypertrophy
Examine mouth opening restriction and any deviation

Occlusion

Soft tissues

BPE

25
Q

What wear indices are there

A

Smith and knight

BEWE

26
Q

What is the smith and knight wear index

A

0- no enamel loss
1- loss of enamel surface characteristic
2- surface loss of enamel exposing dentine for less than 1/3 of surface , incisal loss of enamel, minimal dentine exposure

3- surface loss more than 1/3, incisal loss, substantial dentine exposure

4- pulled exposure or secondary dentine, incisal pulp/2nd dentine exposure

27
Q

BEWE wear index

A

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

28
Q

What special tests can you do for wear
L

A

Sensibility
Radiograph
Articulated study model

29
Q

What patterns of tooth wear is there

A

Localised

Generalised

30
Q

What falls under generalised pattern of tooth wear

A

Wear with loss of OVD

Wear without loss of OVD but with Spabe available

Wear without loss of OVD but with limited space

31
Q

What is the immediate treatment to tooth wear

A

Deal with pain:

Sensitivity- desensitisation agents
Pulp extripation- if pulp compromised
Smooth sharp edges
Extract- pain and unrestorable
TMJ pain- important in attrition, acute symptoms need to be controlled

32
Q

What is initial treatment for tooth wear

A

Stabilise existing dentition
Deal with caries
Deal with Perio

Once you have a diagnosis and have identified the primary causative factor
-Institute a preventative regime

33
Q

What is the preventative treatment

A

Monitor and identify if wear progressing or historic

34
Q

What is the prevention treatment for ABRASION

A

Remove the ‘foreign object or substance’ involved in causing the abrasive wear

Change toothpaste

Alter tooth brushing habits

Change habits
-Nail biting

35
Q

How to fix cervical toothbrush abrasion

A

Simple RMGIC, GIC or composite restorations

Patient then wears through restoration and not the tooth

36
Q

What is the prevention treatment for ATTRITION

A

More difficult as related to parafunctional habit- cognitive behavioural therapy

Could use splints

37
Q

How do splints work in treatment for attrition

A

All work by being softer than teeth

Wear away in preference to tooth

Cause no damage to the opposing teeth

Soft splint can be used as a diagnostic device as wears fast and shows wear facets

38
Q

What is a Michigan splint

A

Popular type of hard splint

Provides an ‘ideal occlusion’ with even centric stops

Has canine rise which provide disclusion in eccentric mandibular movements

39
Q

What is the prevention treatment for EROSION

A

Habit changes (drink cans with straws, swilling drinks in mouth, diet advice)

Medical (control gastric acid, xerostomia, anorexia and bulimia)

40
Q

What is the prevention treatment for abfraction

A

Assess occlusion and fill cavities with low modulus restorative materials (RMGIC, Flowable comp)

41
Q

What is the first part of any dental wear treatment

A

Prevention and monitoring

42
Q

For the active management of Maxillary Anterior Tooth Wear what 5 factors affects described on Tx

A

•The pattern of anterior maxillary tooth wear
•Inter-occlusal space
•Space required for the restorations being planned
•Quality and quantity of remaining tooth tissue, particularly enamel
•The aesthetic demands of the patient

43
Q

Maxillary incisor wear can be categorised as what

A

Tooth wear palate only

Tooth wear involving palatial and incisal edges with reduced clinical crown height

Tooth wear limited to labial surfaces

44
Q

If there is tooth wear with no increase in freeway space what happens

A

Compensation for the loss of tooth substance by dento alveolar bone growth

45
Q

What is the Dahl technique

A

Method of gaining space in cases of localised tooth wear

-Originally a removable CoCr anterior bite plane
-Covering palatal surfaces and allowing occlusion on raised cingulum
-Resulted in posterior disclusion and increase in OVD of 2-3mm
-Occlusal contacts only on incisor/canine teeth

46
Q

What happen in the Dahl technique

A

Over a period of 3-6 months you gain space between incisor teeth

-Interiors intrude
-Posteriors erupt
-Results in space between upper and lower anteriors allowing restoration with no need for occlusal reduction

47
Q

When is Dahl technically not suitable

A

If no movement in 6mnths

Active Perio

TMJ problems

Post Ortho

Biphosphonates

Implants

Bridges

48
Q

In anterior toothnwewr what do you look for if you think you can restore

A

Remaining enamel ‘ring of confidence’

49
Q

What to do in lower anterior wear

A

Generally in conjunction with maxillary wear

More difficult to fix

Less enamel, smaller bonding area.

If possible improve aesthetics but do not increase OVD with lowers

If you have to build them up do this first before the uppers

Same techniques as upper

50
Q

What approach should be used for treating generalised tooth wear and why

A

Adhesive approach

Used to assess a patient tolerance to a new occlusion as a medium term restoration

51
Q

How to treat generalised tooth wear with excessive tooth wear & loss of OVD

A

Easiest to treat but least common

Splint or adhesive approach to see tolerance of new face height

Mixture of adhesive and conventional restorations and maybe dentures for post. Support

52
Q

How to treat generalised tooth wear without loss of OVD but with limited space available

A

Complicated

May reorganise occlusion

Splint to increase occlusal height

Restoration of anterior and posterior teeth is then carried out at new occlusion

53
Q

What’s the most severe type of generalised tooth wear

A

Generalised tooth wear without loss of OVD and no space available

BDS4- restorative dentistry (8 decks)

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