tooth wear 2 Flashcards
What are the subcategories of generalised tooth wear?
Wear with loss of OVD
Wear without loss of OVD but with space available
Wear without loss of OVD but with limited space available
What is dento-alveolar compensation?
Bone resorbs so that teeth still touch when tooth wear occurs
It’s a protective mechanism but makes treating tooth wear more difficult
How can tooth wear be treated in the immediate stages of treatment?
Treat sensitivity
Pulp extripation if wear is compromising pulpal health
Smooth sharp edges to prevent trauma
Extract if tooth unrestorable/non-functional
Treat TMJ pain
How can tooth wear be treated in the initial stages of treatment?
Stabilise the existing dentition
Treat caries
Treat periodontal condition
Find the causative wear factor and create a preventative regime
What stage of treatment is tooth wear treated in and why is this the case?
Reconstructive
Treatment without prevention first, will fail
Name 4 preventative treatments for abrasion
Any from:
- Remove the factor causing the abrasive wear eg - smoking pipe
- Change toothpaste
- Alter tooth brushing habits
- Change habits eg - nail biting
- Simple restorations placed cervically with no tooth preparation
Name 4 preventative treatments for attrition
CBT
Hypnosis
Hard or soft splints
Michigan splint - hard splint providing an ideal occlusion
Name 4 preventative treatments for erosion
Any from:
- Diagnosis a big part of the problem
- Desensitising agents for symptomatic relief
- Stop swirling drinks around mouth
- Drink using a straw
- Stop rumination
- Reduce sports a drinks and gels
- Control gastric acid
- Treatment of eating disorders
Name 2 ways abfraction may be prevented (if it exists)
Occlusal equilibrium - reshaping of teeth to correct occlusion
Fill cavities with RMGIC/composite just as in abrasion
How can space be increased when treating maxillary anterior tooth wear?
Increase OVD using multiple posterior extra-coronal restorations
Occlusal reorganisation from ICP to RCP
Surgical crown lengthening
Elective RCT and post crowns
Orthodontics
What is the Dahl technique?
A method of gaining space in cases of localised tooth wear
Composite placed to cover palatal surfaces of maxillary anterior teeth, allowing occlusion on a raised cingulum
This results in posterior disclusion and in increase in OVD of 2-3mm
Over 3-6 months, the anteriors intrude and the posteriors erupt resulting in space between upper and lower incisors, so space for restorations and no need for occlusal reduction
How successful is the Dahl technique?
Works faster in younger patients
If no movement in 6 months its not going to work
Success rate of 90%
Name 4 categories of patients that the Dahl technique is not suitable for
Any from:
- with active periodontal disease - not enough bone support
- with TMJ problems - this exacerbates them
- post orthodontics - don’t want to move the teeth again
- on bisphosphonates - poor bone turnover
- with dental implants - these are ankylosed
- with existing conventional bridges
