Tooth Wear

Question 1

what is tooth loss also known as

Answer 1

non carious tooth tissue loss( NCTTL)

Question 2

what does NCTTL stand for

Answer 2

no carious tooth tissue loss

Question 3

is tooth loss normal

Answer 3

occurs in life normally

Question 4

when is tooth loss pathological

Answer 4

when rate of loss or degree of destruction is excessive

Question 5

what can tooth loss lead to

Answer 5

aesthetics
sensitivity
function

Question 6

what is toothwear due to

Answer 6

a non carious process

Question 7

which processes are included in toothwear

Answer 7

attrition
abrasion
erosion

Question 8

what is toothwear described by

Answer 8

aetiology
distribution localised or generalised
severity

Question 9

which population is erosion increased in

Answer 9

youths

Question 10

which material used for crowns could cause tooth surface loss

Answer 10

porcelain

Question 11

what percentage of 5 year olds have TSL

Answer 11

33%

Question 12

which surfaces do 5 year olds have TSL ON

Answer 12

buccal surfaces of primary incisors

Question 13

what is the pathological loss of tooth tissue

Answer 13

erosion
attrition
abrasion

Question 14

what is erosion

Answer 14

irreversible progressive loss of dental hard tissue caused by an acidic chemical process not caused by bacteria

Question 15

what is attrition

Answer 15

the loss of tooth surface or a restoration caused by tooth-tooth contact
remember by the two tt in attrition

Question 16

what is the definition of abrasion

Answer 16

the abnormal wearing away of a tooth surface substance or a restoration by a mechanical process other than tooth contact

Question 17

what do teeth clinically look like when suffering from erosion

Answer 17

shiny
cupping in the teeth- eg post teeth or palatally
proud restorations

Question 18

how is erosion classified

Answer 18

by source of acid extrinsic or intrinsic

Question 19

what is intrinsic acid

Answer 19

acid coming up
bulimia
stomach acid-GORD( gastro oesophageal reflux disease)

Question 20

what is extrinsic acid

Answer 20

acid going in
ef citrus fruit
juices
white wine worse than red

Question 21

what do we need to ask in regard to bulimia

Answer 21

past or present history of being bulimic

Question 22

what are the four things needed for erosion

Answer 22

tooth surface
time
extrinsic
host

Question 23

what might delay erosion

Answer 23

fluoride

Question 24

why might GORD occur

Answer 24

sphincter incompetence
increased gastric pressure
increased gastric volume

Question 25

why might vomiting occur

Answer 25

``` psychosomatic metabolic/endocrine drug induced alcoholism GI disorders ```

Question 26

what is ruminant eating

Answer 26

chew and then bring it up and chew it more

Question 27

what are the symptoms of GORD

Answer 27

``` HEARTBURN retostenral discomfort epigastric pain dysphagia chronic cough sore throat hoarseness sour taste at the back of the throat ```

Question 28

describe anorexia nervosa

Answer 28

aversion to food | restricting and purging types

Question 29

what is bulimia

Answer 29

overeating followed by purging

Question 30

what affects dietary erosion

Answer 30

amount frequency method of consumption timing of consumption

Question 31

what are predisposing factors

Answer 31

``` saliva flow ph buffering presence of salivary mucins clearance rates from from different oral sites ```

Question 32

what is the clinical presentation of erosion

Answer 32

``` anterior teeth- loss of surface anatomy smooth enamel surface chipping of incisor edges palatal hollows areas where enamel is absent exposure of pulp if intrinsic- palatal surface if extrinsic- labial ```

Question 33

what does erosion look like on posterior teeth

Answer 33

``` loss of surface anatomy cusp cupping proud restorations darkening of colour pupal exposure ```

Question 34

how does caries and erosion differ

Answer 34

loss of the organic matrix in erosion

Question 35

what is the clinical presentation of attrition

Answer 35

enamel and dentine wearing away at the same rate localised facets, flattened cups and incisal edges worn surfaces shiny amalgam in areas of contact possibly massetric hypertrophy possibly fractured cusps or restorations increased risk of tooth motility slow process as secondary dentine is laid down

Question 36

what is bruxism

Answer 36

common parafunctional activity in response to stress associated tongue scalloping and cheek ridging masseteric hypertrophy

Question 37

what is abfraction

Answer 37

supposes that occlusal forces cause compressive and tensile strength which are concentrated on the cervical regions of the tooth and cause micro-fracture of cervical enamel rods

Question 38

what is the clinical look of abfraction

Answer 38

deep v shaped notch may be single tooth affected toothbrush unable to contact base of defects defects may be sub gingival

Question 39

clinical consequences of NCTTL

Answer 39

change in appearance apin or sensitivity loss of OVD functional difficulties

Question 40

what is OVD

Answer 40

occlusal vertical dimension

Question 41

what is the initial management of tooth wear

Answer 41

identify presence and severity identify aetiology monitoring prevention

Question 42

what is the issues with the severely worn dentition difficulties

Answer 42

``` lack of tooth tissue plural problems aesthetic compromise soft tissue changes occlusal changes lack of space for restoration habitual/ aetiological factors ```

Question 43

what might aetiological factors cause

Answer 43

damage to restoration | further wear of teeth

Question 44

how do we see if the toothwear is progressing

Answer 44

sensitivity and staining | monitoring

Question 45

what can we use for monitoring

Answer 45

``` study models silicone index clinical photographs description measurement: crown indicies ginigval margin ```

Question 46

what is the management of NCTTL

Answer 46

identify cause and assess long term prognosis institute preventative measures to reduce TSL monitor operative treatment Review

Question 47

prevention of alcohol

Answer 47

don't get them to brush after they've eaten diet advice control of GORD- liase with the GP water and sodium bicarb mouthwash

Question 48

what can we use to desensitise and strengthen the teeth

Answer 48

``` fluoride mouthwash and varnish fluoride paste-Gelkam low abrasive toothpaste sugar free gum dentine bonding agent tooth mousse anti erosion toothpaste ```

Question 49

what can splints be used for

Answer 49

``` bruxism hard or soft splints prevention of wear creating of space assessing tolerance of raising OVD mandibular dysfunctions protection of new restorations ```

Question 50

where is a soft splint used

Answer 50

on lower teeth

Question 51

how do we prevent abrasion

Answer 51

``` low abrasive toothpaste brushing technique patient habits brushing force bristle stiffness frequency abrasive restorations ```