8 - Tooth wear 1

Question 1

What are the main aetiologies of tooth wear?

Answer 1

• attrition
• erosion
• abrasion
• combination
• unknown

Question 2

Why is understanding the aetiology of tooth wear important?

Answer 2

• attempt to reduce further wear
• plan for problems, contingencies and failure
• identify wider medical/wellbeing issues
• prognostic indicator
• informed consent

Question 3

What are the modifying factors of attritive tooth wear?

Answer 3

• lack of posterior support
• occlusion
• restorations
• stress and anxiety

Question 4

What are common presentations of bruxism?

Answer 4

• significant wear throughout dentition
• repeated restoration failure
• root fractures
• early onset in adulthood
• progressive

Question 5

What are common presentations of physiological wear?

Answer 5

• wear in line with the patient’s age
• incisal cupping in older patients
• loss of canine cusp in older patients

Question 6

What are the common features of lack of posterior support?

Answer 6

• progressive wear on remaining anterior teeth
• wear is more extensive due to all masticatory force being placed on anterior teeth

Question 7

How does a deep overbite present with bruxism?

Answer 7

Wear on labial surface of lower incisors

Question 8

How does an edge to edge occlusion present with bruxism?

Answer 8

Localised wear on contacting incisors

Question 9

What material causes significant wear when used in restorations?

Answer 9

Porcelain

Question 10

What are the modifying factors in erosive tooth wear?

Answer 10

• lifestyle
• amount and frequency of erosive agents
• level of control
• psychosocial

Question 11

What are extrinsic sources of erosive agents?

Answer 11

• carbonated drinks
• sports drinks
• alcoholic drinks
• citrus drinks
• acidic sweets
• pickles
• drugs

Question 12

What are intrinsic sources of erosive agents?

Answer 12

• eating disorders
• GORD
• other medical conditions

Question 13

What are common features of tooth wear caused by carbonated drinks?

Answer 13

• incisal erosion on upper centrals
• cupping on lower molars
• palatal erosion on upper incisors
• sensitivity
• interproximal caries
• buccal white spot caries

Question 14

What are common features of tooth wear caused by an eating disorder?

Answer 14

• palatal erosion on upper teeth
• polished restorations
• erosion around restorations
• sensitivity
• caries
• altered taste
• halitosis
• soft tissue changes (eg abrasions under tongue)

Question 15

What are abrasive behaviours?

Answer 15

• over toothbrushing
• oral self harm
• tongue studs
• occupational
• unusual habits

Question 16

What are common causes for a combination of tooth wear types?

Answer 16

Erosion (both), attrition and abrasion
- alcoholism and drug use
- eating disorder
Extrinsic erosion and attrition
- bruxist with poor diet
Erosion (both) and attrition
- bruxist with poor diet and GORD

Question 17

Why is lack of posterior support a common problem?

Answer 17

• denture intolerance
• denture refusal
• supervised neglect (ie not told to get a denture)

Question 18

Define an overdenture.

Answer 18

Removable prosthesis that rests on one or more remaining natural teeth, roots of natural teeth and/or implants

Question 19

What are the advantages of overdentures?

Answer 19

• correction of occlusion and aesthetics
• tooth wear management
• preservation of ridge form
• proprioception
• denture retention
• can incorporate precision attachments
• avoids XLA
• psychological benefits
• transition to edentulism

Question 20

What are the disadvantages of overdentures?

Answer 20

• need good OH
• increased caries/perio problems
• denture fracture
• discomfort or infection risk
• potentially future XLA more traumatic

Question 21

What is involved in the care of overdentures?

Answer 21

• good OH
• fluoride toothpaste application and brushing of roots
• regular exams
• denture hygiene

Question 22

What are transitional dentures?

Answer 22

Can be used to increase OVD in cases where poor posterior support to create space for restorations

Question 23

How can denture teeth be modified for a bruxist?

Answer 23

• CoCr backing of teeth
• CoCr palate with acrylic post dam
• overlay denture to act as splint

Question 24

What is the purpose of “simplifying small saddles”?

Answer 24

The use of bridgework to remove single tooth additions to dentures