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BDS4 > Wear > Flashcards

Wear Flashcards

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1
Q

Causes of non-carious tooth surface loss

A

Trauma
Developmental problems
Tooth wear

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2
Q

Types of tooth wear

A

Physiological- normal- 20-38um per annum
Pathological:
remaining tooth structure/pulpal health compromised
rate of tooth wear> than expected for age
masticatory/aesthetic deficiency

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3
Q

Causes of toothwear

A

attrition
abrasion
erosion
abfraction

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4
Q

What is attrition

A

physiological wearing away of tooth structure as a result of tooth to tooth contact
found on occlusal and incisal contacting surfaces

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5
Q

Early appearance of attrition

A

polished facet on cusp/slight flattening of incisal edge/cusps

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6
Q

Progression of appearance of attrition lesions

A

reduction in cusp height
flattening of occlusal inclined planes
shortening of clinical crown of incisor and canine teeth

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7
Q

Cause of attrition

A

parafunctional habit (bruxism)

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8
Q

What is abrasion

A

physical wearing away of tooth structure through an abnormal mechanical process independent of occlusion
includes foreign objects/substance repeatedly contacting tooth
commonly found on labial/buccal, cervical on canine and premolar teeth

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9
Q

characteristics of teeth with abrasion

A

V shaped or rounded lesions
sharp margin at enamel edge where dentine is worn away
can manifest as notching of incisal edges

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10
Q

Cause of abrasion

A

Tooth brushing
habits/lifestyle: holding pins, nails, electrical wire stripping, fishing line, thread, pipe smoking, cracking sunflower seeds

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11
Q

What is erosion

A

Wearing away of tooth structure by chemical process that does not involve bacterial action

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12
Q

Cause of erosion

A

chronic exposure of dental hard tissues to acidic substances which can be intrinsic or extrinsic

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13
Q

characteristics of erosion

A

Typically bilateral, concave lesions without chalky appearance of bacterial acid decalcification
Increased translucency of incisal edges
Base of lesion not in contact with opposing tooth
Amalgam and comp. restorations stand proud of tooth

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14
Q

Early appearance of erosion

A

enamel surface detail affected, surface becomes flat and smooth

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15
Q

Progressed appearance of erosion

A

Dentine becomes exposed
Preferential wear of dentine leads to cupping of occlusal surfaces of molars + incisal edges of anteriors

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16
Q

What is abfraction

A

loss of hard tissue from eccentric occlusal forces leading to compressive + tensile stresses at cervical fulcrum of tooth

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17
Q

Characteristics of abfraction

A

Pathological loss of tooth substance at cervical margin
V shaped tooth loss where tooth is under tension
Sharp rim at ACJ
Restorations in area, wear at same rate as tooth structure

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18
Q

Cause of abfraction

A

Biomechanical loading forces
Forces result in flexure and failure of enamel and dentine at area away from loading
Disruption of ordered crystalline structure of enamel and dentine by cyclic fatigue
Cracks in tooth substance-chips out

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19
Q

MH linked to toothwear

A

Medications with low pH/which cause dry mouth
Eating disorders
Alcoholism
Heartburn/GORD
Hiatus hernia
Rumination
Pregnancy

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20
Q

SH linked to toothwear

A

lifestyle stresses- grinding
bruxism
occupation
alcohol/diet/habit/sport

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21
Q

What to record on wear examination

A
  1. Location:
    anterior/posterior
    localised/generalised
  2. Severity:
    enamel only
    into dentine
    severe
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22
Q

Examples of wear indices

A

Smith and Knight Index
BEWE(basic erosive wear exam)

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23
Q

What is the Smith and Knight Index

A

0- no loss of enamel surface detail
1- loss of enamel surface detail
2- B/L/O complete loss of enamel, exposing dentine for <1/3rd of surface incisal enamel loss
minimal dentine exposure
3- B/L/O complete loss of enamel, exposing dentine for>1/3rd of surface incisal enamel loss
substantial dentine exposure
4- B/L/O complete enamel loss, pulpal exposure/secondary dentine exposure

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24
Q

BEWE scores

A

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 surface

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25
BEWE risk level for cumulative score of all sextants
None- less than or equal to 2 Low- between 3&8 Medium- between 9&13 High-14 and over
26
Special tests for tooth wear
Radiographs sensibility tests articulated study models intra oral photographs salivary analysis diagnostic wax up dietary analysis
27
How to diagnose toothwear
1. Determine primary causative factor 2. Identify patterns: localised, generalised 3. Assess if dento-alveolar compensation has occurred
28
Immediate stage of preventative plan
Deal with pain
29
When do you create a prevention plan?
Once you have a dentally fit patient, diagnosis and have identified primary causative factor
30
Key element in prevention
Removal of cause
31
Abrasion prevention
Remove foreign object/substance causing abrasive wear Change toothpaste/brushing habits Change habits
32
Tx of toothbrush abrasion
Simple RMGIC=best survival rate, GIC or comp, can also be considered No tooth prep pt wears through restoration rather than damaging tooth
33
Attrition prevention/tx
Difficult to prevent as related to parafunctional habit-stress CBT Hypnosis Splint
34
Splint advantages
Cause no damage to opposing teeth Habit breaker Soft splint=can be used as a diagnostic device(wear for 2 weeks) Hard splint=more robust and can be used long term
35
Advantages of Michigan splint (type of hard splint)
Provides ideal occlusion with centric stops Has canine rise which provide disclusion in eccentric mandibular movements Provides canine guidance
36
Erosion prevention
Fluoride e.g. Duraphat Desensitising agents Dietary management esp. if extrinsic acid Habit changes: use straw, vegan diet, rumination, overly healthy eating, sports drinks Medical conditions control: gastric acid, GORD, reflux, hiatus hernia, xerostomia, anorexia and bullimia
37
Abfraction prevention
consider occlusal equilibrium Fill cavity with low modulus restorative materials=RMGIC or flowable comp
38
What is passive management of tooth wear
First part of tx Prevention and monitoring For about 6 months
39
Requirements to progress to active management
Wear leading to further complications/more complex tx being needed Aesthetics have gone beyond pt acceptability
40
Goal of active management
Preservation of remaining tooth structure Pragmatic improvements in aesthetics Functioning occlusion Stability
41
5 factors in deciding tx of maxillary anterior tooth wear
1. pattern of wear 2. inter occlusal space 3. space required for planned restorations 4. quality/quantity of remaining tooth tissue/enamel 5. Aesthetic demands of pt
42
Patterns of maxillary incisor wear
1. Wear limited to palatal surface 2. Wear involving palatal and incisal edges with reduced clinical crown height 3. Wear limited to labial surface
43
Tx for different patterns of maxillary incisor wear
composite
44
In what cases is there adequate inter incisal space in maxillary anterior teeth
If wear is rapid and no time for alveolar compensation AOB Increased OJ
45
How to create space for restorations
1. Increase OVD: multiple posterior extra-coronal restorations 2. Occlusal reorganisation from ICP to RCP 3. Surgical crown lengthening 4. Elective RCT + post crowns 5. Conventional ortho
46
What is the DAHL technique?
-Method of gaining space in localised tooth wear -Cover palatal surfaces on incisors and canines with composite allowing occlusion on raised cingulum -Results in posterior disclusion and 2-3mm increase in OVD -Anteriors intrude and posteriors erupt, results in space between upper and lower anteriors allowing restorations with no need for occlusal reduction -If no movement in 6 months, won't work
47
Why do you use composite in DAHL technique and not CoCr
Better aesthetics Better compliance as not removable Easier to adjust Immediate or definitive tx
48
Contraindications of DAHL
Active perio Post ortho Bisphosphonates If dental implants If existing conventional bridges
49
Anterior wear tx contraindications
short roots reduced periodontal support due to perio disease lack of remaining enamel reduces success rate significantly- enamel ring of confidence positively influences success rate
50
Why is lower anterior wear more difficult to treat
less enamel-smaller bonding area
51
Tx of localised posterior tooth wear
If localised and asymptomatic, prevention and monitoring are appropriate Occlusal erosive wear can be filled directly with comp with no change in occlusion Loss of canine guidance common cause
52
How to correct loss of canine guidance for posterior wear
Add comp to palatal of upper canines to increase canine rise and disclude posteriors during lateral and protrusive excursions- can use comp free hand or with diagnostic wax up
53
Why is pathological wear more common in upper than lowers
Tongue and saliva protects lowers
54
Methods of composite build up
putty matrix wax up alginate impressions pickle juice habit
55
3 categories for generalised and localised tooth wear
1. Excessive wear with loss of OVD 2. Excessive wear without loss of OVD but with limited space 3. Excessive wear without loss of OVD but with no space available
56
Adhesive approaches to generalised tooth wear
Adhesives used to assess patient tolerance of new occlusal scheme as medium term restoration If conventional preps are required at later date, these adhesive addition may form the bulk of removed material-preserving tooth structure
57
Tx of excessive wear with loss of OVD
-splint can be used to assess pt tolerance of new face height or use adhesive approach -ideally half the OVD increase should be maxillary and half mandibular -often mixture of adhesive and conventional restorations required
58
Tx of excessive wear without loss of OVD but with limited space
Can involve reorganisation of occlusion Splint should be considered as increase in occlusal facial height required Restoration of anterior and posterior teeth carried out at new occlusal facial height-if possible should involve minimum adhesive restoration
59
Treatment of excessive wear without loss of OVD but with no space available
Requires specialist opinion prior to Tx Attempt to increase OVD by use of splints +/- dentures if lack of posterior support or if enough teeth use adhesive restorations Crown lengthening surgery Elective RCT Ortho Overdentures
60
Crown lengthening disadvantages
May result in black triangles between teeth where ID papilla is further down Can lead to unfavourable crown:root ratio=increased tooth mobility if tooth loaded subsequently Post op sensitivity Any subsequent conventional crown prep will be further down root, problematic if tooth has significant coronal-cervical taper and has greater chance of pulpal damage
61
Overdenture features
preserves tooth structure and bone for support of denture when teeth are so worn down that Rx is impossible can be bulky difficult keeping teeth and gingivae healthy beneath denture

BDS4 (50 decks)

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