6 - Wear 3 Flashcards
What are contraindications for treating anterior tooth wear?
- short roots (crown-root ratio can cause orthodontic tooth movement)
- reduced periodontal support
In what order should anterior teeth be built up in?
- mandibular teeth should be restored before maxillary teeth
- mandibular teeth are more likely to fail than uppers due to lack of enamel to bond to
- mandibular teeth should not be used to increase the OVD
How do you manage localised posterior tooth wear?
- if asymptomatic, prevention and monitoring are appropriate
- direct composite restorations can be placed with no change to the occlusion
How can posterior wear be prevented?
Composite added to palatal surfaces of upper canines to correct canine guidance and disclude posteriors
What is the “daughter test”?
A question to ask yourself during treatment - whether you would complete this treatment on a family member
How should you explain why a patient needs composite build ups for managing tooth wear?
- tooth coloured fillings will go on your front teeth to cover the exposed and worn tooth surface
- this will prevent them from wearing more and this is the main reason for your treatment
- there is no local anaesthetic required as there will be no/minimal prep required
- we are adding to your teeth not removing anything
- this should also improve how your teeth look
What post-op information shovel you give the patient after composite build ups for managing tooth wear?
- your bite will feel strange for a few days and only your front teeth will touch together but this will go back to normal in 3-6 months
- you may lisp for a few days as the shape of your teeth has changed
- teeth may be tender for a few days
- may bite tongue and lips initially
- any crowns, bridges and partial dentures may need replaced
What information should you give your patients about the longevity of anterior composite build ups?
- should be good (uppers) but they may de-bond and need replaced
- this will cause no damage to your own teeth
- restorations like this require maintenance (not free)
What three categories can generalised tooth wear be divided into?
- excessive wear with loss of OVD
- excessive wear without loss of OVD but available space
- excessive wear without loss of OVD but no available space
How should generalised tooth wear be managed?
- initially adhesive restorations should be placed to help patient adapt to new occlusal scheme
- conventional preparations should be placed at a later date (adhesive restorations may form core of prep)
What can be used to help patients accommodate a new occlusal scheme?
Splint
How can excessive tooth wear without loss of OVD with no available space be managed?
- refer to specialist
- attempt to increase OVD with splint or dentures
- crown lengthening surgery
- elective endodontics +/-
- orthodontics
- over dentures
Describe the risk management used in tooth wear cases.
- advice (recorded in notes along with compliance)
- surface treatments such as topical fluoride
- ensure to document conversations around management and patient consent to treatment/observation
What impacts the rate of tooth wear?
- frequency
- acid type
