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BDS4 Restorative > 4 - Wear > Flashcards

4 - Wear Flashcards

1
Q

What is defined as tooth surface loss?

A
  • caries
  • trauma
  • developmental problems
  • tooth wear
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2
Q

What is physiological tooth wear?

A
  • normal process that increases with age
  • estimated normal tooth wear is 20-38um a year
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3
Q

What is pathological tooth wear?

A
  • remaining tooth structure and pulpal health is compromised
  • tooth wear that is in excess of what wold be expected for the age of the patient
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4
Q

What are the different types of tooth wear?

A
  • attrition
  • abrasion
  • erosion
  • abfraction
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5
Q

Define attrition.

A

Physiological wearing away of tooth structure as a result of a tooth to tooth contact

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6
Q

Describe how attrition presents.

A
  • lesions are on the occlusal and incisal surfaces
  • early appearance as a polished facet on cusp or slight flattening of incisal edge
  • progression leads to reduction in cusp height and flattening of occlsual incisal planes
  • anterior crown height is reduced
  • restorations wear at the same rate as tooth tissue
  • wide lateral excursion
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7
Q

What causes attrition?

A

Parafunction and bruxism

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8
Q

Define abrasion.

A

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

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9
Q

Describe how abrasion presents.

A
  • site and pattern of tooth loss is related to abrasive element
  • most common area is labial/buccal and cervical
  • v shaped or rounded lesions
  • sharp margin at enamel where dentine is worn away preferentially
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10
Q

What causes abrasion?

A
  • tooth brushing
  • habits including holding items between the teeth (pins, pipe, fishing line, thread)
  • cracking nuts with the teeth
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11
Q

What impact does vaping have on abrasion?

A
  • holding the vape between the teeth can cause abrasion
  • the vape liquid is acidic so speeds up the process
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12
Q

Define erosion.

A

Loss of tooth surface by a chemical process that does not involved bacterial action.

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13
Q

What is the most common type of tooth wear?

A

Erosion

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14
Q

Describe how erosion presents.

A
  • early stages the outer enamel surface detail is lost
  • bilateral concave lesions that are shiny (unlikely chalky carious lesions)
  • as progresses, dentine is exposed and is preferentially eroded leading to cupping of occlusal surfaces and incisal edges of anteriors, base of lesion does not contact opposing arch
  • restorations do not dissolve
  • no staining
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15
Q

What causes erosion?

A
  • acidic drinks (also - alcohol)
  • eating disorders
  • medications (low pH or xerostomia)
  • GORD
  • rumination
  • pregnancy
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16
Q

Define abfraction.

A

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

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17
Q

Describe the forces behind abfraction.

A
  • biomechanical loading forces which result in flexure and failure of enamel at a location away from the loading
  • disruption in the crystalline structure of the enamel by cyclic failure
  • cracks can cause tooth structure to chip away
18
Q

Describe how abfraction presents.

A
  • v shaped lesions at cervical margin where the tooth is under tension
  • sharp margin at ADJ
19
Q

Describe the patient demographic would experiences abfraction.

A
  • only seen in patient who have a clean mouth
  • abfraction occurs in combination with abrasion
  • abrasion begins lesion which is made worse but the cyclic forces
20
Q

What is involved in the assessment of tooth wear?

A
  • accurate diagnosis is essential
  • recognise risk factors eg diet
  • grade the severity
  • monitor progress of disease
  • provide preventative measures
21
Q

Do patients with tooth wear typically report pain?

A

Uncommon unless rapidly progressing or pulpally involved

22
Q

What functional difficulties are reported by patients with tooth wear?

A
  • typically that teeth are sharp (biting lips/cheeks)
  • masticatory efficiency
23
Q

How does PDH impact tooth wear treatment planning?

A
  • wear treatment requires multiple visits so compliance is important
  • OHI and education vital
24
Q

What should you assess in the EO exam?

A
  • TMJ for restriction of movement, clicking, crepitus
  • hypertrophy of musculature
  • opening for restriction/deviation
  • overclosure
  • lip line
  • smile line
25
Q

What should assess about the patient’s occlusion?

A
  • freeway space
  • OVD and RVD
  • any dento-alveolar compensation?
  • overbite and overjet
  • stable tooth contacts in occlusion
  • excursive movements
26
Q

What is dento-alveolar compensation?

A

Teeth continue to erupt to maintain occlusion with opposing arch (more common in upper)

27
Q

What should you assess in the IO exam?

A
  • xerostomia (more susceptible to erosion)
  • buccal keratosis or lingual scalloping (parafunction)
  • OH
  • perio assessment and charting
28
Q

What should you assess when looking at the tooth wear?

A
  • location
  • localised vs generalised
  • severity
29
Q

What is the most common distribution of tooth wear?

A

Localised anterior

30
Q

What causes localised posterior toothwear?

A

Associated with rumination

31
Q

What are the different wear indices?

A
  • BEWE
  • Smith and Knight
32
Q

What are the scores of the BEWE index?

A

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

33
Q

What does BEWE stand for?

A

Basic erosive wear examination

34
Q

How does the BEWE function?

A

Cumulative score of all sextants decides treatment and risk level

35
Q

What is the score for no risk level with the BEWE index?

A

Less than or equal to 2

36
Q

What is the score for a low risk level with the BEWE index?

A

3 - 8

37
Q

What is the score for a medium risk level with the BEWE index?

A

9 - 13

38
Q

What is the score for a high risk level with the BEWE index?

A

14+

39
Q

What special tests can be utilised when planning wear treatment?

A
  • sensibility testing
  • radiographs
  • articulated study models
  • photos
  • diagnostic wax up
  • dietary analysis
40
Q

What should you assess on radiographs?

A
  • associated apical pathology
  • if 1/3 crown lost, assess proximity to pulp

BDS4 Restorative (18 decks)

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