Toothwear

Question 1

Types of toothwear?

Answer 1

Abrasion
Erosion
Attrition
Abfraction

Question 2

What are normal toothwear figures?

Answer 2

0.2-0.5mm over 10 years

Question 3

Effects of toothwear on pt?

Answer 3

Poor aesthetics
Dentine hypersensitivity
Pulpitis symptoms in severe tooth wear
Change in bite
Reduced facial height in severe cases
Difficulty bonding

Question 4

What SIs for tootwear pt?

Answer 4

Plaque and bleeding
OHI
Diet Diary
BEWE
Tooth wear index - smith and knight
Photos
Study casts

Question 5

How do we tx plan toothwear cases?

Answer 5

Pt expectations - what are they?

IDENTIFY AETIOLOGY

MANAGE AETIOLOGY

CONSIDER TOOTH TISSUE, PERIO SUPPORT, PULPAL AND PA STATUS (IS THERE ENOUGH TOOTH TISSUE, WHERE ARE MARGINS)

Question 6

What are the different types of guidance?

Answer 6

Canine

Group function

Question 7

What is canine guidance?

Answer 7

This is a guidance system that protects the teeth - as pt carry out lateral excursion and moves to LHS (working side) there is no tooth contact on working side or non working side except from on the canines - protects all other teeth during lateral excursion

canines good for this as they have large roots

Question 8

What is group function?

Answer 8

This is where when pt carries out lateral excursion there are contacts on working side but no contacts on non working side

Question 9

What do we use canine guidance for?

Answer 9

To protect anterior teeth from fracturing and chipping

Question 10

What is ICP?

Answer 10

This is when pt is in maximum intercuspation and is the pts comfortable bite regardless of position of the condyles, it occurs when pt has sufficient index teeth and can be hand occluded an Dif so we conform to this occlusion

Question 11

RCP?

Answer 11

most reproducible position - pt condyle in most anterior superior position and can be preroduced to restore pt teeth, used when not enough index teeth and we cant occlude teeth - reorganised approach

Question 12

What comes under tx plan for toothwear pt?

Answer 12

Immediate - pain (dentine hypersensitivity)

Initial - identify aetiology, management
OHI and Diet - delivering better health toolkit
Splint
GP referral
Pt expectations
Passive management

Re-evaluation - has aetiological factor been controled

Re-con:
- active tx
can fill in cupping defects, seal restorations
or can consider Dahl