Applying aetiology to txt plans Flashcards
(28 cards)
What are main aetiology of tooth wear?
- Attrition
- Erosion
- Abrasion
- Combo of these
- Idiopathic unknown
What is pathophysiology of tooth wear?
- 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
Why is aetiology of tooth wear important ?
- 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
Attrition tooth wear is a spectrum rangin from physiological wear to bruxist. What are some modifying factors that can enhance the wear?
- 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
What are some common features of a Bruxist?
- Significant wear throughout dentition
- Repeated restoration failure
- Root fractures
- Often onset in early adulthood
- Rapidly Progressive
What are some common features of physiological tooth wear?
- Canine tips flat
- Tooth wear on anterior portion of teeth
- with elderly like 50+
- natural process
Why is lack of posterior support considered a modifying factor to attrition?
- 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
Why is occlusion considered a modifying factor of attrition?
- 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)
Why are restorations considered to be a modifying factor of attrition?
- Porcelain particular if unglazed or unpolished is quite abrasive to opposing arch of natural teeth giving wear
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
- Parafunction
- Multiple cusp fracture
- Multiple cracks around restoration
- Root fractures in unrestored teeth
What can contribute to the rate of progression of erosion?
- 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
What extrinsic factors can affect rate of progresion of erosive tooth wear?
- Carbonated drinks
- Sports drinks
- Alcoholic acidic drinks like cider
- Citrus drinks
- Acidic fruits
- Acidic sweets
- Pickles
- Drugs (metaamphetamines)
What intrinsic factors can alter the rate of progression of erosive tooth wear?
- Eating disorders like bulimia nervosa
- GORD
- Medical conditions like uncontrolled diabetes and barest oesophagus
What are the common erosive features of carbonated drink intake?
- 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
What are some common erosive features of pts with eating disorders?
- Palatal erosion on upper teeth
- Polished restorations
- Erosion around restorations
- Sensitivity
- Caries
- Altered taste sometimes
- Halitosis sometimes
- Soft tissue change rarely
What abrasive behaviours can alter the rate of progression of abrasive toothwear? What is different about this tooth wear to the others?
- 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
Your pt has toothbrush abrasion. What issues do you need to consider when examining a pt?
- 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
Tooth wear is said to have what in terms or rate and progression?
- A synergistic rate of wear progression (work together)
What are the common combinations of toothwear aetiology seen?
- 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
Sometimes a comprehensive history and exam does not provide an aetiology. What can you do?
- 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
History taking in tooth wear cases can be challenging. As an individual how should you address this section?
- Be comprehensive
- be compassionate
- Unconditional positive regard
- Show patience
If you know the aetiology you can now plan for the pt. What may be included in a plan?
- Individualised preventative plan
- reinforcement of OHI
- Signposting / referral to other health and social care professionals
- Review before definitive plan
What are common preventative advice as a broad scope?
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
What are some interventions to control aetiology of tooth wear?
Toothbrushing instruction
Splint therapy
Signposting:
- CBT
- Hypnotherapy
Referral:
- GMP
- Psychiatrist
- Social services
