Applying aetiology to txt plans

Question 1

What are main aetiology of tooth wear?

Answer 1

• Attrition
• Erosion
• Abrasion
• Combo of these
• Idiopathic unknown

Question 2

What is pathophysiology of tooth wear?

Answer 2

• Age is physiological and older people are going to have some wear
• Pathophysiology is the wear that is more than what is expected of them at their age

Question 3

Why is aetiology of tooth wear important ?

Answer 3

• Attempt to reduce further wear
• Plan for problems, contingencies and failure
• Allows you to be realistic with yourself and pt
• Identifies wider medical and well being issues and allows signposting to correct facilities
• Acts as prognostic indictor (bruxist)
• Enhances consent process
• Aids clinical diagnosis and txt planning

Question 4

Attrition tooth wear is a spectrum rangin from physiological wear to bruxist. What are some modifying factors that can enhance the wear?

Answer 4

• Lack of posterior teeth
• Occlusion (certain teeth take heavy load )
• Restorations (e.g. lots on one side can cause more wear on opposite side natural teeth)
• Erosion and abrasion in combo or isngular
• Stress and anxiety

Question 5

What are some common features of a Bruxist?

Answer 5

• Significant wear throughout dentition
• Repeated restoration failure
• Root fractures
• Often onset in early adulthood
• Rapidly Progressive

Question 6

What are some common features of physiological tooth wear?

Answer 6

• Canine tips flat
• Tooth wear on anterior portion of teeth
• with elderly like 50+
• natural process

Question 7

Why is lack of posterior support considered a modifying factor to attrition?

Answer 7

• No posterior support leads wear to be more extensive
• It is often more rapidly progressive as well
• Common in a shortened dental arch with lack of post support (gives reduced occlusal pairs)
• Physiological wear becomes pathological

Question 8

Why is occlusion considered a modifying factor of attrition?

Answer 8

• Wear can be caused by nature of occlusion and is often compounded by parafunction
• Deep overbite shows mainly lower incisor wear but also a little bit on the palatal upper incisors
• Edge to edge occlusion gives localised wear anterior teeth (usually gives lack of posterior support)

Question 9

Why are restorations considered to be a modifying factor of attrition?

Answer 9

• Porcelain particular if unglazed or unpolished is quite abrasive to opposing arch of natural teeth giving wear

Question 10

At early stages of a tooth wear pt where there is no evidence of obvious wear we may see evidence of what? Give some examples of this

Answer 10

• Parafunction
• Multiple cusp fracture
• Multiple cracks around restoration
• Root fractures in unrestored teeth

Question 11

What can contribute to the rate of progression of erosion?

Answer 11

• Extrinsic and Intrinsic acid factors
• Modifying factors like
  
  • Lifestyle like drinking or stress
  • Psychosocial
  • Amount and frequency of drink etc sipping, with straw etc
  • Level of control

Question 12

What extrinsic factors can affect rate of progresion of erosive tooth wear?

Answer 12

• Carbonated drinks
• Sports drinks
• Alcoholic acidic drinks like cider
• Citrus drinks
• Acidic fruits
• Acidic sweets
• Pickles
• Drugs (metaamphetamines)

Question 13

What intrinsic factors can alter the rate of progression of erosive tooth wear?

Answer 13

• Eating disorders like bulimia nervosa
• GORD
• Medical conditions like uncontrolled diabetes and barest oesophagus

Question 14

What are the common erosive features of carbonated drink intake?

Answer 14

• Incisal erosion on upper centrals (holding can or bottle directly onto teeth)
• Cupping on lower molars
• Palatal erosion on upper incisors
• Gives tooth sensitivity due to rapid erosion
• Interproximal caries and buccal white spot/brown caries

Question 15

What are some common erosive features of pts with eating disorders?

Answer 15

• Palatal erosion on upper teeth
• Polished restorations
• Erosion around restorations
• Sensitivity
• Caries
• Altered taste sometimes
• Halitosis sometimes
• Soft tissue change rarely

Question 16

What abrasive behaviours can alter the rate of progression of abrasive toothwear? What is different about this tooth wear to the others?

Answer 16

• toothbrush abrasion
• Oral self harm
• Tongue studs lingual of lowers
• Occupational
• Unusal habits
• Different as can easily modify the rate of progression by eliminating these factors

Question 17

Your pt has toothbrush abrasion. What issues do you need to consider when examining a pt?

Answer 17

• Is it localised or generalised
• Frequency and duration
• Bristle and toothpaste abrasiveness
• Electric v manual
• Brushing technique instruction
• Part of a combo wear problem i.e. eating disorder
• Part of stress or anxiety related problems

Question 18

Tooth wear is said to have what in terms or rate and progression?

Answer 18

• A synergistic rate of wear progression (work together)

Question 19

What are the common combinations of toothwear aetiology seen?

Answer 19

• Erosion (intrin and extrin) , attrition and abrasion
  - Alcoholism and drug abuse
  
  • Eating disorder

Erosion (extrinsic) and attrition
- Bruxist with poor diet

Erosion (Intrin and extrin) and attrition
- Bruxist with poor diet and GORD

Question 20

Sometimes a comprehensive history and exam does not provide an aetiology. What can you do?

Answer 20

• Often shows unusual wear patten
• pt may know aetiological but wont tell you
• If planning txt plan warily and communicate a guarded prognosis - may fail

Question 21

History taking in tooth wear cases can be challenging. As an individual how should you address this section?

Answer 21

• Be comprehensive
• be compassionate
• Unconditional positive regard
• Show patience

Question 22

If you know the aetiology you can now plan for the pt. What may be included in a plan?

Answer 22

• Individualised preventative plan
• reinforcement of OHI
• Signposting / referral to other health and social care professionals
• Review before definitive plan

Question 23

What are common preventative advice as a broad scope?

Answer 23

Fluroide
- High dose toothpaste
- Alcohol free mouthwash

Dietary modification
- Frequency and quantity of particular foods or drinks
- Method of delivery i.e. straw
- Elimination and addition

Remineralisation
- Tooth mousse

Sugar free gum

Question 24

What are some interventions to control aetiology of tooth wear?

Answer 24

Toothbrushing instruction
Splint therapy
Signposting:
- CBT
- Hypnotherapy
Referral:
- GMP
- Psychiatrist
- Social services

Question 25

Failure to control aetiology may result in what?

Answer 25

• Failure to correct or prevent further tooth wear

Question 26

This is an example of tooth wear case. What history would you take. On examination what can you see?
What special test would you want?
What are your diagnoses?

Answer 26

History
- C/O
- HPC
- PMH, gastro issues, any eating disorders
- PDH, toothbushing habits , toothpaste, grind, habits , diet
- SH (job, stress, anxiety

Exam
- Tongue piercing
- Deep overbite non traumatic
- Class I incisors
- Class 1 canines
- Translucent centrals
- Cupping defects on centrals (looking like erosion)
- Caries 12 mesially
- Mild attrition upper incisors and lower incisors including 33 into dentine
- Attrition on palatal canines
- Severe erosion premolar and molars lower with total loss of occlusal enamel
- Defects of restorations upper with erosion surrounding it

Special test
- Bitewings to assess caries, bone levels and extent of wear
- PA

Diagnoses
- Extrinsic acid with combo of attrition and maybe intrinsic depending on medical conditon

Preventative plan
- Modify diet with advisory what to change
- OHI
- Fluoride toothpaste ? or mouthwash
- If eating disorder consider signposting pt
- Is pt going to address problems , review
- Prognosis of molar poor if aetiology not underwarps

Question 27

In tooth wear pts what as a dentist do you need to be mindul of?

Answer 27

• Expect failues and cycles of restoration in tooth wear pts