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Tooth wear Flashcards

(48 cards)

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1
Q

What is tooth wear referred to as?

A

non-carious tooth tissue loss (NCTTL)

or non-carious tooth surface loss (NCTSL)

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2
Q

When does tooth wear become pathological?

A

when rate of loss or degree of destruction is excessive

there are problems with function, aesthetics or sensitivity

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3
Q

What are the 3 types of tooth wear?

A

erosion

abrasion

attrition

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4
Q

How is toothwear defined by?

A
  • Aetiology
  • Severity (mild, moderate, severe)
  • Distribution (localised, generalised)
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5
Q

What type of tooth wear is increasing in the younger population?

A

erosion

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6
Q

What effect does early treatment have on tooth wear compared to later?

A

early treatment makes it simple and effective

complex to manage in later stages

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7
Q

What is attrition?

A

The loss of tooth substance or a restoration caused by tooth-to-tooth contact

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8
Q

What is the clinical presentation of attrition?

A

Enamel and dentine wearing at the same rate

Localised facets, flattened cusps/incisal edges

Worn surfaces ‘mate’ in closed eccentric movements (these surfaces meet together perfectly)

Shiny amalgam in areas of contact

Slow process so secondary dentine forms and usually not sensitive

Possible masseteric hypertrophy

Possible fractured cusps and/or restorations

Increased risk of tooth mobility

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9
Q

What is bruxism?

A

common parafunctional activity on response to stress

associated with tongue scalloping and/or cheek ridging in active cases

Can lead to masseteric hypertrophy in severe cases

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10
Q

What is abrasion?

A

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

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11
Q

What could be causing abrasion?

A

Tooth brushing

Abrasive dentifrices

Piercings

Habits

  • Nail biting
  • Tobacco chewing
  • Pen chewing
  • Pipe smoking
  • Wire stripping

Iatrogenic

  • Unglazed porcelain
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12
Q

What is the clinical presentation of abrasion?

A

Mainly cervical

Sharply defined margins

Smooth, hard surface

More rounded and shallow if associated with erosion

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13
Q

What is abfraction?

A

Theory supposes occlusal forces cause compressive and tensile stresses, which are concentrated at the cervical region of the tooth and cause microfracture of cervical enamel rods

This is not seen commonly

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14
Q

How does abfraction appear?

A

Deep V-shaped notch

May be a single tooth affected

Toothbrush unable to contact base of defect

Defects may be subgingival

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15
Q

What is erosion?

A

the irreversible, progressive loss of dental hard tissue by an acidic chemical process not involving bacteria

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16
Q

How are the acids in erosion classified?

A

Intrinsic – ‘acid coming up’

Extrinsic – ‘acid going in’

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17
Q

What does intrinsic acid cause?

A

regurgitation erosion

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18
Q

In what condition is there intrinsic acid?

A

Gastro oesophageal reflux (GOR)

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19
Q

Vomiting causes intrinsic acid to come up, when may this occur?

A
  • Eating disorders
  • Pregnancy
  • Metabolic/endocrine
  • GI disorders
  • Drug induced (eg chemotherapy)
  • alcoholism
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20
Q

What foods and drinks contribute the most extrinsic acid?

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A

Soft drinks – fruit juice, carbonated and still

Alcohol drinks

Fresh fruit, fruit pulp and dried fruit

Pickles, vinegar, acetic acid added to crisps

Yoghurts and sauces

Fruit and herbal teas

Energy/sports supplements

21
Q

Which type of juice has the highest erosion potential?

Study These Flashcards
A

grapefruit

apple

orange

22
Q

Which type of drinks has medium erosion potential?

Study These Flashcards
A

cola

carbonated orange

white wine

23
Q

Which type of drinks has the lowest erosion potential?

Study These Flashcards
A

beer (bitter)

lager

sparkling water

24
Q

What are the symptoms of GOR?

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A
  • Heartburn
  • Retrosternal discomfort
  • Epigastric pain
  • Chronic cough
  • Sore throat
  • Hoarseness
  • Sour taste at back of throat

However, in many cases may be ‘silent’ reflux

25
What is the general clinical presentation of erosion?
worn surface not in contact in closed eccentric movements, not like in attrition
26
What is the clinical presentation of erosion on anterior teeth?
Loss of surface anatomy, smooth enamel surface Increased incisal translucency Chipping of incisal edges Palatal hollows Areas where enamel is absent Exposure of pulp in severe cases Intrinsic often affects palatal surface, extrinsic affects the labial
27
What is the clinical presentation of erosion on posterior teeth?
Loss of surface anatomy Cuspal cupping (appears as indented circles on occlusal surface) ‘proud restorations’ (tooth has worn but restoration hasn’t) Darkening of colour (due to secondary dentine being laid down) Pulpal exposure is rare in permanent teeth
28
How does erosion differ from caries?
In caries, plaque acid leads to demineralisation but the organic matrix is not affected In erosion, extrinsic/intrinsic acid leads to demineralisation and loss of organic matrix
29
What happens in anorexia nervosa?
Aversion to food Restricting and purging types Female to male ratio 10:1 More than 15% below ideal body weight
30
What happens in bulimia nervosa?
Over-eating followed by inappropriate compensatory behaviour eg purging Female to male ratio 10:1 Within 10% of ideal body weight or grossly overweight
31
What oral hygiene products may contribute to erosion?
- Mouthwashes - Saliva substitutes
32
What medications may contribute to erosion?
- Vitamin C - Asthma inhalers - Those affecting saliva quality/quantity
33
What are the 2 predisposing factors of erosion?
saliva dry mouth (xerostomia)
34
What factors affect saliva?
- Flow rate - pH - Buffering capacity - Presence of salivary mucins - Clearance rates from different oral sites
35
What is dry mouth caused by?
- Drugs (eg tricyclic antidepressants, antihistamines, diuretics) - Dehydration - Anxiety - Sjogrens syndrome - Radiotherapy of head and neck
36
What are the 4 stages of initial management?
- Identify presence and severity of toothwear - Identify aetiology - Monitoring - Prevention
37
What are the clinical consequences of NCTTL?
Change in appearance Pain and/or sensitivity Loss of OVD (occlusal vertical dimension) and/or lack of occlusal stability Functional difficulties
38
What difficulties come with the severely worn dentition?
Lack of tooth tissue Pulpal problems Aesthetic compromise Lack of space for restoration Occlusal changes Soft tissue changes Habitual / aetiological factors (ongoing may cause damage to restorations and further wear of teeth)
39
How does sensitivity relate to tooth wear?
If tooth is sensitive, that means toothwear is progressing quickly as there is a lack of secondary dentine laid down
40
How does staining relate to tooth wear?
If there’s staining, the progression is slow as there has been time for the stain to accumulate
41
How can we monitor NCTSL?
Study models Silicone index Clinical photographs Description (indices) Measurement (crown height, gingival margin) initially 4-6 monthly, then annually
42
What preventative advice can be given for erosion?
Give diet advice Avoid brushing immediately after acidic foods (at least half an hour after) Control of GORD/eating disorders (may need to liaise with the GMP) Water and sodium bicarbonate m/w
43
Name some desensitisation and protection products
- Fluoride mouthrinses and varnishes - Fluoride paste – GelKam - Low abrasivity toothpaste - Sugar free chewing gum - Dentine bonding agents (seals exposed tubules) - ‘anti-erosion’ toothpastes - Tooth mousse
44
What preventative advice can be given for attrition?
Ensure patient awareness and education Composite to protect teeth (make sure occlusion is not affected) Splints (can be hard or soft)
45
How are splints made?
A vacuum is formed on model of one arch - Usually lower arch in bruxism cases These prevent wear and protect new restorations Can be used as an upper fluoride/sodium bicarbonate tray which can help with sensitivity Must be full coverage of all tooth surfaces (if patient is wearing at night and the splint wasn’t full coverage then they may get over-eruption of some teeth which may be uncomfortable) This method is quick and easy
46
What preventative advice can be given for abrasion?
Find out about patient habits and reinforce education Deliver OHI, focussing on... - Bristle stiffness - Brushing force - Frequency - Paste abrasivity Abrasive restorations must be avoided or replaced
47
What happens during intervention?
1. Prevention! 2. Monitoring 3. Therapeutic agents 4. Appliances (eg bite guards, splints) 5. Restorations
48
Why must we intervene?
- To protect the pulp - Aesthetics - Functional problems eg chewing - Loss of structural integrity - Prevention of further complex treatment Only when patient wishes and cooperates

Clinical skills 2 (25 decks)

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