Wear Flashcards
(47 cards)
Name 4 different causes (types)of wear
- Pathological and physiological
Physiological - normal function and associated with age
Pathological - excessive wear or pulp health is compromised. - Abrasion
- Erosion
- Attrition
- Abfraction
What is erosion
Signs of erosive wear
Loss of tooth substance due to a chemical process not involving bacterial action. Chronic exposure of hard tissues to chemical agent
-Signs - loss of enamel surface detail, smoothing and flattening of surface.
Bilateral concave lesions.
-Later - dentine exposed and patient experiences sensitivity. Restorations stand proud of teeth.
What is attrition.
What are the early and late signs.
It is the wear of tooth substance through repeated tooth to tooth contact.
Parafunction.
- Early = flattening of cusp, polished facet of incisal edge
Progresses to loss of cusp height and flattening of occlusal inclined planes - shortening of clinical crowns.
E/O - TMD - painful muscles,
I/O - bilateral linea alba, scalloped tongue, wear facets.
What is abrasion.
What are the signs
examples of causes
The physical wear of tooth substance through repeated abnormal mechanical process involving a foreign object
- v shaped/rounded lesions
- sharp enamel edges
- excessive toothbrushing, use of vape pen, bad habit.
What is abfraction
Loss of tooth substance through excessive occlusal forces leading to compressive/tensile forces at cervical fulcrum of tooth.
V shaped lesion at ACJ
Important aspect of the patient history
Complaint = Pain/sensitivity/aesthetic/functional issues/
PMH - GORD, alcoholism, hiatus hernia, pregnant, eating disorder.
-Drugs - cause xerostomia or low pH
PDH - reg attender, OH regime, treatment experience,
SH - lifestylr, occupation, diet, habits, alcohol, smoke,
Patient examination - E/O & I/O
E/O -TMJ - function, movement, opening, click, crepitus, pain, locking
-Muscles - hypetrophy - masseter
I/O - Lip and smile line
-Occlusion - FWS, dentoalveolar compensation, centric relation with stable contacts.
Perio, OHI, caries risk, charting
Describe the Smith and Knight ‘Tooth wear index’ scores
LIke 6ppc
Grade 0 - No loss of enamel characteristics
Grade 1 - loss of surface emanel characteristics
Grade 2 - buccal, lingual and occlusal loss of enamel and exposed dentine for < one third of surface
Grade 3 -buccal, lingual and occlusal loss of enamel and exposed dentine for > one third of surface. Incisal loss of enamel. Substantial dentine exposure
Grade 4 - buccal, lingual and occlusal loss of enamel with pulpal exposure and exposure of secondary dentine.
Describe the BEWE (Like BPE)
Score: 0 - no erosive wear 1 - initial loss of surface texture 2 - distinct defect, hard tissue loss <50% surface 3 -Hard tissue loss >50% of surface
Cumulative sextant score No treatment - =2 Low - 3-8 Medium -9-23 High - >14
Special tests to carry out in wear cases
Sensibility tests Radiographs Articulated study models Photographs Diagnostic wax up Salivary evaluation Dietary analysis
Describe possible patterns of wear
- Localised
- Generalised
- wear with reduction in OVD
- wear without reduction of OVD but enough space
- wear without reduction of OVD but with limited space.
Immediate treatment of wear patient
- PAIN = desensitising agents, fluoride, GIC, (exposed dentine)
- Pulp extirpation = compromised pulp
- smooth sharp edges
- XLA= unrestorable/non functional tooth
- TMJ =attrition
Initial treatment of wear patient
Stabilisation of dentition
- caries
- perio
- oromucosal issues
- PREVENTATIVE regime
what baseline measurements/records are required
- Photographs
- Study models
- wear indices
Abrasion treatment
- conservative
- restorative
Eliminate cause (foreign object) - bad habit
- bite nails etc
- less abrasive toothpaste and better technique
- restorative
GIC/RMGIC/composite, no tooth prep
Attrition treatment
- CBT
- Hypnosis
- splint therapy - soft/hard
How can splints help with attrition
- bite splint instead of teeth and wear that away
- habit breaker
- soft splint - diagnostic device to see wear worst worn areas are
- hard splint - more robust and so longer lasting
example of a hard splint
-benefit of using it
Michigan splint
- longer lasting
- ideal postured occlusion with centric stops
- canine rise=disclusion in eccentric mandibular movements
Treatment of erosion
Identify source
- diet
- habit
- medical = GORD/eating disorder
- preventative = fluoride -toothpaste/varnish/MW
- desensitising agents = sensodyne/colgate tp
dietary habits to change in patient with erosion
- reduce sugar/acid consumption
- use a straw
- habit change (swirl drink around mouth)
- sports drinks
- MH - GORD = GMP involved - rennies/gaviscon use
- eating disorder - psychologist/psychiatrist help
Active management
-goals
Cover exposed dentine - cupped defects
- preservation of remaining tooth structure
- improve aesthetics
- restore functionality
- stable occlusion
localised anterior tooth wear
contraind to
short roots/reduced periodontal support
what does the ring of confidence mean
halo of enamel that has a positive effect on retention
lower anterior tooth wear - issue
treat
smaller bonding area,
improve aesthetics but DO NOT INCREASE OVD
