Tooth wear part 2

Question 1

What is the possible aetiologys of tooth wear

Answer 1

Attrition

Erosion

Abrasion

Combination of these

Unknown

Question 2

What is the importance of finding the aetiology of tooth wear

Answer 2

Attempt to reduce further wear

Plan for problems, contingencies and failure

Allows you to be realistic with Pt and yoursef

Could help identify any wider medical and well being issues and allows signposting

Prognostic indicator

Enhances consent processs

Aids in clinical daignosis and Tx plan

Question 3

Within the spectrum of Attrition what are the 2 causes either end of the spectrum

Answer 3

Physiological wear (age)

Bruxist

Question 4

What are the modifying factors that affect attrition

Answer 4

Lack of posterior teeth/support

Occlusion

Restorations

Erosion & Abrasion

Stress & Anxiety

Question 5

What are the common features of a Bruxist

Answer 5

Significant wear throughout dentition

Repeated restoration failure

Root fractures

Often onset in early adulthood

Progressive wear that can be rapid

Question 6

What is a lot of tooth wear caused by and often compounded with

Answer 6

Nature of occlusion often compunded by parafunction

Question 7

In a deep overbite where would wear be found

Answer 7

Lower incisors

Question 8

In edge to edge occlusion where is wear often found

Answer 8

Localised wear

Question 9

What common resoration material has increased likelyhood of tooth wear to opposite teeth

Answer 9

Unpolished or unglazed porcelain

Question 10

What are potential signs of parafunction WITHOUT any obvious tooth wear

Answer 10

Multiple cusp fracture

Multiple cracks around restorations

Root fractures in unrestored teeth

Question 11

What are extrinsic causes of Erosion

Answer 11

Carbonated drinks

sports drinks

Alcoholic acidic drinks

Citrus drinks

Acidic drinks and sweets

Pickles

Drugs

Question 12

What are intrinsic cause sof erosion

Answer 12

Eating disorders

GORD

Uncontrolled diabetes

Other medical causes

Question 13

What are the modifying factors to erosion

Answer 13

Lifestyle

Amount & frequency

Level of control

Psychosocial, stress e.t.c

Question 14

What are common features of excessive carbonated drink intake

Answer 14

Incisal erosion of upper centrals

Cupping on lower molars

palatal erosion on upper incisors

Palatal erosion on upper incisors

Sensitivity

IP caries and buccal white/brown spot caries

Question 15

What are common dental features of a eating disorder

Answer 15

Palatal erosion on upper teeth

Polishes resorations

Erosion around restorations

Sensitivity

Caries

Altered taste

Halitosis

Soft tissue changes in bulimia

Question 16

What behaviours can lead to abrasion

Answer 16

Toothbrush abrasion

Oral self harm

Tongue studs

Occupational types

Unusual habits

Question 17

If a Pt presents with toothbrush abrasion what issues is there to consider

Answer 17

Is it localised or generalised

Frequency and duration of brushing

Bristle and toothpaste abrasiveness

Brushing technique

Electric or manual

Part of a combination wear problem e.g. with a eating disorder

Part of a stress/anxiety problem

Question 18

What are common combinations of tooth wear and what can the reasons be

Answer 18

Erosion (Intrinsic & Extrinsic); Attrition; Abrasion

-Alcoholism & Drug abuse
-Eating disorder

Erosion (Extrinsic) & Attrition

-Bruxist with poor diet

Erosion (Intrinsic & Extrinsic) & Attrition

-Bruxist with poor diet & GORD

Question 19

How would you find the aetiology of tooth wear

Answer 19

Comprehensive examination

Use of indices

Try relate findings to aetiology

Question 20

What is common preventitive advice for tooth wear

Answer 20

Fluoride:
-High dose toothpaste
-Alcohol free mouthwash

Dietary modification:
-Frequency & quantity
-Method of delivery
-Elimination & addition

Remineralization:
-Tooth Mousse
-Sugar free gum

Question 21

What interventions is there to control aetiology

Answer 21

Toothbrush instruction

Splint therapy

Signposting
-CBT
-Hypnotherapy

Referral

Question 22

Why would a Pt have a lack of posterior support

Answer 22

Denture intolerance

Denture refusal

Supervised neglect

Question 23

What is a key principle with dentures and tooth wear Pt’s and why

Answer 23

Try and avoid complete dentures

Bruxism doesnt stop so will just lead to fractured dentures, ridge resorption, pain and ulceration under denture

Question 24

What removeable prosthodontics is involved in Pt with tooth wear

Answer 24

Overdentures

Transitional dentures

Metal based dentures

Simplifying Small saddles

Question 25

What does rehabilitation involve in removeable pros and tooth wear

Answer 25

Increase in the vertical dimension of occlusion

Question 26

What is an overdenture

Answer 26

Any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants

Question 27

What other terms may a overdenture be called

Answer 27

Overlay denture or Overlay prosthesis

Question 28

What are the dvantages of overdentures

Answer 28

Correction of occlusion and easthetics

Support

Toth wear management

Presservation of ridge form

proprioception

Denture retention

Can be used with precision attachments

MRONJ & radiotherapy patients – avoids extractions

Psychological benefits

Useful in elderly patients

Eases transition to edentulism

Question 29

What are the disadvantages of overdentures

Answer 29

Need for good oral health as they are made of tooth so if they dont they will fail

Increased caries/perio problems

Care homes

Denture fracture

Discomfort/infection

Medical hisotry

Potentially more traumatic extractions

Question 30

What care is needed for overdentures

Answer 30

Good OH

Fluoride toothpaste application to roots

Regular examinations and radiographs

Denture hygiene

Question 31

What are transitional dentures used for

Answer 31

If a pt has complete occlusal collapse and cant tolerate posterior support so these are made to see if First can they deal with the dentures and then dentures with an increased OVD to create space for restorations

Question 32

How do transitional dentures work

Answer 32

Let pt wear them for a few months and see if they cope with dentures and increased OVD

If they you can move onto a more definitive Tx plan

Question 33

When is the OVd increased with transitional dentures

Answer 33

Increased from n o denture to transitional BUT NO CHANGE between transitional and definitive

Question 34

If metal based dentures are being used in a tooth wear case what must you do before making it

Answer 34

Need to have a wax trial of teeth before making Co/Cr

Question 35

What is Co/Cr in a complete denture not good at

Answer 35

Getting a peripheral seal

Question 36

How do you fix Co/Cr not giving a good peripheral seal in a complete denture

Answer 36

Make an acryclic post dam

An attempt to make a complete denture both retentive & indestructible

Question 37

How could you simplify small saddles on a denture

Answer 37

Bridgework

Question 38

What is a key principle about occlusion in dentistry

Answer 38

Where possible try to conform to exsisting occlusion

Question 39

When would you conform to exsisting occlusion

Answer 39

Works bests in stable occlusion with sufficent index teeth, ensuring the prosthesis/restoration doesnt alter occlusion

Question 40

When would you change/rehabilitate the occlusion

Answer 40

This often happens in tooth wear

Often occlusion is unstable and lack of sufficient index teeth

Usually more challenging to record occlusion

Decision on how much to increase OVD

Question 41

What do you do in tooth wear rehabilitation

Answer 41

Impressions & facebow

Mounted articulated casts on semi-adjustable articulator +/– surveying

High quality Interocclusal record – with & without increasing the OVD

Diagnostic wax up(s)

Stents – mock-up – temporaries (if indirect); for build-ups; aids consent use something like protemp to show pt

Temporary (transitional) dentures

Clinical photographs
(Radiographs)