tooth wear 1

Question 1

What is the range of loss for physiological tooth loss?

Answer 1

20-35 micromillimetres per year

Question 2

Define pathological tooth wear

Answer 2

If the remaining tooth structure or pulpal health is compromised
If the rate of tooth loss is excessive for the age
If the patient experiences a masticatory or aesthetic deficit

Question 3

What is attrition and where is it found?

Answer 3

The physiological wearing away of tooth structure as a result of tooth to tooth contact
Almost always related to a parafunctional habit
Found on occlusal and incisal contacting surfaces

Question 4

What is abrasion?

Answer 4

The physical wear of tooth substance through an abnormal mechanical process independent of occlusion
Involves a foreign object or substance repeatedly contacting the tooth
Usually V shaped or rounded lesions

Question 5

Where is abrasion commonly found?

Answer 5

Labial/buccal, cervical on canines and premolars

Question 6

What are the causes of abrasion?

Answer 6

Aggressive tooth brushing technique
Electric wire stripping
Pipe smoking
Smoking e-cigarettes

Question 7

What is erosion?

Answer 7

The loss of tooth surface by a chemical process that does not involve bacterial action, most common cause of pathological toothwear

Question 8

What causes erosion?

Answer 8

Chronic exposure of dental hard tissues to acidic substances

Question 9

What is the difference between early and late erosion?

Answer 9

Early - enamel surface affected, loss of surface detail
Later - dentine becomes exposed, leads to cupping of occlusal surfaces or molars and incisal edges of anterior teeth

Question 10

What types of toothwear does not affect restorations?

Answer 10

Erosion

Question 11

What is abfraction?

Answer 11

The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
V shaped tooth loss where the tooth is under tension

Question 12

What are the two theories of abfraction?

Answer 12

1. Abfraction is the basic cause of all non-carious cervical lesions (not likely)
2. Multi factorial aetiology - a combination of occlusal stress, abrasion and erosion

Question 13

How does the prevalence of tooth wear differ between males and females?

Answer 13

Male - 60%
Females - 70%

Question 14

Name 4 medical history components related to toothwear

Answer 14

Any from:
- meds with low pH
- meds which cause dry mouth
- eating disorders
- alcoholism
- heartburn
- GORD
- hiatus hernia
- rumination
- pregnancy (morning sickness)

Question 15

Which components of dental history relate to toothwear?

Answer 15

Poor OH habits
Tooth brushing in abrasive wear - frequency, intensity, duration and type of toothpaste

Question 16

Name 4 components of social history that relate to toothwear?

Answer 16

Any from:
- stresses (bruxism)
- occupation
- alcohol consumption
- dietary analysis
- habits
- sports

Question 17

Name 4 components of an extra-oral exam that are important when looking at toothwear

Answer 17

Any from:
- TMJ exam for restriction of movement, clicking or crepitus (shown in attritive wear)
- muscular hypertrophy
- limited mouth opening and deviation during opening
- lip line
- smile line

Question 18

Which components of an intra-oral exam are important when looking at toothwear?

Answer 18

Overclosure
Soft tissues - dry, buccal keratosis or lingual scalloping
Oral hygiene
BPE
Charting

Question 19

How should the occlusion be assessed when examining toothwear?

Answer 19

Assess freeway space
Record OVD and resting face height
Is there any dento-alveolar compensation
Record OB and OJ
Are there stable contacts in ICP
What are teeth contacts like in excursive movements

Question 20

How should tooth wear be examined?

Answer 20

By location - anterior/posterior, localised/generalised
By severity - enamel only, into dentine, severe

Question 21

Describe BEWE (basic erosive wear examination)

Answer 21

Used as a diagnostic tool
Score each sextant of the mouth between 0 and 3, add up the scores for a total score

Question 22

What does each score mean in BEWE (basic erosive wear examination)

Answer 22

0 - no erosive wear
1 - initial loss of surface texture
2 - distinct defect, hard tissue loss <50% of surface
3 - hard tissue loss >50% of the surface area

Question 23

Name 4 special tests that can be used for toothwear

Answer 23

Any from:
- sensibility testing
- radiographs
- articulated study models
- intra-oral photography
- diagnostic wax-up
- dietary analysis