Attrition: Clinical Management

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Questions and Answers

What is the potential adverse consequence of repeated re-restoration of worn teeth?

  • Increased risk of tooth decay
  • Loss of pulpal vitality
  • Reduced bond effectiveness
  • All of the above (correct)

Which technique is described as being more conservative than traditional gold crowns?

  • Dahl technique
  • Full arch rehabilitation
  • Adhesive gold onlays (correct)
  • Conventional crowns

What is a major advantage of the Dahl technique?

  • It can be used to treat both attrition and abrasion.
  • It is more effective than other techniques for preventing tooth wear.
  • It is less invasive than traditional gold crowns.
  • Composite restorations can be repaired simply and quickly. (correct)

What is the primary focus of the article?

<p>The Dahl technique for treating tooth wear (A)</p> Signup and view all the answers

What is the main reason why the Dahl technique is preferred over traditional gold crowns?

<p>It is more conservative. (B)</p> Signup and view all the answers

What is the survival probability of adhesive gold onlays at five years, according to the text?

<p>89% (B)</p> Signup and view all the answers

What is the purpose of increasing the Vertical Dimension of Occlusion (OVD) in the Dahl technique?

<p>To improve function. (A)</p> Signup and view all the answers

What is the main reason why the Dahl technique is a good option for restoring worn teeth?

<p>It is less invasive and allows for simple repairs if needed. (A)</p> Signup and view all the answers

What is a potential indicator of a patient who bruxes laterally?

<p>Matching wear facets on the upper and lower canines. (C)</p> Signup and view all the answers

What is a likely reason for the acceleration of tooth wear in patients with exposed dentin?

<p>Dentin is more susceptible to wear than enamel. (A)</p> Signup and view all the answers

What is a key clinical sign that suggests a patient might be experiencing tooth wear?

<p>Tooth mobility. (B)</p> Signup and view all the answers

Which of the following is NOT a common sign of tooth wear?

<p>Tooth sensitivity. (A)</p> Signup and view all the answers

What is the main cause of erosion in teeth, as mentioned in the text?

<p>Acidic food consumption. (D)</p> Signup and view all the answers

What is a potential consequence of the wear on teeth due to bruxism?

<p>Pulp necrosis. (B)</p> Signup and view all the answers

If a patient has a canine guided occlusion, where would wear facets likely be observed?

<p>Upper and lower canines only. (A)</p> Signup and view all the answers

Which of the following is a clinical sign that may indicate tooth wear caused by bruxism?

<p>Matching wear facets. (C)</p> Signup and view all the answers

What specific technique does the provided content discuss as a minimal preparation approach to manage attritional wear?

<p>Double Dahl technique (A)</p> Signup and view all the answers

According to the content, what is one of the main benefits of the Double Dahl technique?

<p>It requires minimal preparation, preserving tooth structure and pulpal vitality. (D)</p> Signup and view all the answers

What is the primary reason for using an occlusal splint in conjunction with the Double Dahl technique?

<p>To redistribute biting forces and reduce tooth wear. (B)</p> Signup and view all the answers

What is the primary purpose of the adhesive gold onlays mentioned in the figure caption?

<p>To manage generalized attritional wear on molar teeth (B)</p> Signup and view all the answers

What type of wear is described as "attritional wear" by the content?

<p>Tooth wear caused by grinding or clenching (D)</p> Signup and view all the answers

Which of the following is NOT mentioned as a potential cause or contributor to erosive tooth wear?

<p>Grinding or clenching of teeth (B)</p> Signup and view all the answers

What is a likely reason conventional techniques are kept in reserve for use "when they are absolutely necessary"?

<p>They may result in greater tooth loss or structural damage. (C)</p> Signup and view all the answers

Which of the following statements is TRUE based on the provided content?

<p>Attritional wear and erosive wear are distinct types of tooth wear. (C)</p> Signup and view all the answers

What is the main focus of the paper referenced in the article by Berry and Poole (1976)?

<p>The possible mechanisms of tooth wear, specifically attrition (D)</p> Signup and view all the answers

Which of the following is a technique specifically designed to treat anterior tooth wear, as mentioned in the provided content?

<p>All of the above (D)</p> Signup and view all the answers

Based on the content provided, what type of dental restoration is most commonly mentioned in the context of anterior tooth wear management?

<p>Resin-based composite restorations (B)</p> Signup and view all the answers

Which of the following publications reported a study that evaluated the long-term effectiveness of a specific restorative technique for anterior tooth wear?

<p>Br Dent J 2011; 211: E9 (C)</p> Signup and view all the answers

Which of the following studies investigated the survival of restorations in managing localized anterior tooth wear, but did not focus specifically on composite restorations?

<p>J Pros Dent 2000; 83: 294–300 (D)</p> Signup and view all the answers

What is the primary focus of the content provided?

<p>Exploring the various treatment techniques for managing anterior tooth wear (D)</p> Signup and view all the answers

Which of the following publications provided a comprehensive overview of generalized tooth wear, including discussion of various aspects of the condition?

<p>Dent Update 2002; 29: 318–324 (A)</p> Signup and view all the answers

What is the main focus of the paper referenced by Chadwick (2006)?

<p>Providing a comprehensive overview of dental erosion and its implications (C)</p> Signup and view all the answers

What is the main concern regarding the transferability of the findings to a cohort of patients with bruxism?

<p>The study only included patients with erosive tooth wear. (A)</p> Signup and view all the answers

What is the estimated longevity of conventional crowns in patients with a history of bruxism?

<p>Less than ten years. (C)</p> Signup and view all the answers

Which of the following factors are considered in the management of patients with attrition caused by bruxism?

<p>All of the above. (D)</p> Signup and view all the answers

What type of patients are considered the most challenging to manage in terms of tooth wear?

<p>Patients with attrition caused by bruxism. (B)</p> Signup and view all the answers

What is the estimated prevalence of bruxism in the population?

<p>Around 10%. (B)</p> Signup and view all the answers

What type of study was conducted on a small group of six patients, where the reconstructions survived well for 5.5 years?

<p>A prospective case series. (B)</p> Signup and view all the answers

Which of the following medications has been linked to bruxism?

<p>Antidepressants. (C)</p> Signup and view all the answers

Which theory regarding the aetiology of attrition is supported by the available research?

<p>Central nervous system aetiology (B)</p> Signup and view all the answers

What is the main argument put forward against the theory that occlusal interferences contribute to bruxism?

<p>Research has found no link between occlusal interferences and bruxism. (B)</p> Signup and view all the answers

Which of the following is NOT considered a potential contributing factor to attrition?

<p>Linear alba (C)</p> Signup and view all the answers

What is the primary reason for the lack of pharmacological treatment options for attrition?

<p>The underlying cause of attrition is not fully understood. (C)</p> Signup and view all the answers

Which of the following is NOT a common modifying factor that can accelerate tooth tissue loss in attrition?

<p>Occlusal interferences (D)</p> Signup and view all the answers

What is the most prevalent theory regarding the aetiology of bruxism?

<p>Central nervous system aetiology (D)</p> Signup and view all the answers

Which of the following statements about attrition management is TRUE?

<p>There is no currently effective pharmacological treatment for attrition. (D)</p> Signup and view all the answers

What is the key takeaway regarding the aetiology of attrition, based on the information presented?

<p>The cause of attrition is complex and not fully understood, with recent research emphasizing the role of the central nervous system. (B)</p> Signup and view all the answers

Flashcards

Dahl Technique

A dental procedure to address tooth wear by increasing occlusal vertical dimension.

Tooth Attrition

Wear of teeth due to grinding or chewing, leading to loss of structure over time.

Adhesive Gold Onlays

Conservative dental restorations that bond gold material to teeth.

Bruxism

A condition involving grinding and clenching of teeth, often during sleep.

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Pulpal Vitality

The health of the dental pulp, which contains nerves and blood vessels.

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Panavia Cement

A type of dental cement known for its strong bonding capabilities.

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Full Mouth Rehabilitation

Comprehensive treatment to restore function and aesthetics in the entire mouth.

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Composite Restorations

Dental fillings made from a mixture of resin and glass used to restore tooth decay.

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Double Dahl technique

A minimally invasive approach to preserving tooth structure and vitality.

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Occlusal splint

A device worn to protect teeth and improve occlusion, often needed in bruxism treatments.

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Tooth structure preservation

The practice of maintaining tooth integrity during dental procedures.

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Erosive potential

The ability of substances, like acidic drinks, to erode tooth enamel.

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Attritional wear

Tooth wear caused by grinding or friction against other teeth.

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Gold onlays

Restorative dental materials used to cover tooth surfaces damaged by wear.

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Direct and indirect composite

Dental materials used to restore teeth, can be applied directly or created outside the mouth first.

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Prevalence of Bruxism

The commonness or frequency of bruxism, reported to be around 10%.

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Longevity of Crowns

Conventional crowns may last less than ten years in patients with bruxism.

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Buspirone

Medication used to treat severe sleep bruxism induced by paroxetine.

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Erosive Tooth Wear

Tooth damage caused by grinding, leading to erosion.

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Attrition

The gradual reduction of teeth due to grinding, particularly in bruxism patients.

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Research on Bruxism

Studies show mixed results on treatment and management of bruxism-related tooth wear.

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Patient Cohort

A specific group of patients studied for bruxism effects and treatments.

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Dental Erosion

The loss of tooth structure due to chemical processes without bacteria.

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Dahl Principle

A dental treatment method to address localized anterior tooth wear.

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Indirect Restorations

Restorations made outside the mouth, then bonded to the tooth.

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Clinical Evaluation

Assessment of treatment effectiveness and patient satisfaction.

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Survival Analysis

A statistical method to determine the longevity of dental restorations.

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Tooth Structure Removal

The process of chiseling away part of the tooth for restoration purposes.

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Masticatory muscle hypertrophy

Enlargement of the jaw muscles, especially masseter and temporalis, often due to grinding.

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Functional theory of attrition

Suggests that wear occurs as a normal function of chewing.

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Central nervous system aetiology

Bruxism primarily caused by signals from the brain rather than physical factors.

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Occlusal interferences

Misalignments in bite that may contribute to bruxism.

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Parafunction

Mouth activities like grinding that aren’t related to normal chewing.

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Modifying factors in attrition

Lifestyle or external factors that can increase tooth wear.

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Erosion

Loss of tooth structure caused by acid, leading to sensitivity and pain.

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Abrasion

Wear caused by external factors like brushing too hard or food.

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Wear facets

Flat surfaces on teeth due to grinding or other types of wear.

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Tooth mobility

Movement of teeth caused by loss of supporting structures.

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Pulp necrosis

Death of dental pulp due to reduced blood supply from excessive pressure.

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Headaches

Pain in the head often related to jaw tension from bruxism.

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Study Notes

Attrition: Clinical Management

  • Attrition is tooth wear from tooth-to-tooth contact, commonly seen occlusally but also interproximally.
  • Often seen in older individuals, potentially related to bruxism (teeth grinding).
  • Age-related phenomenon, with 15% showing moderate wear and 3% severe wear in one study, mostly in patients over 50.
  • Attrition can coexist with erosion (e.g., from acidic foods) or abrasion (e.g., from hard foods).
  • Dentin loss is 2-5 times faster than enamel loss once exposed.

Symptoms of Attrition

  • Tooth grinding (day/night)
  • Jaw pain, fatigue, limited opening
  • Teeth feeling loose
  • Sore teeth/gums
  • Headaches (temporal region)
  • Clenching/grinding while awake

Clinical Signs of Attrition

  • Marked wear facets (especially in protrusion/lateral movements)
  • Tooth fractures (natural teeth or restorations)
  • Tooth mobility
  • Pulp necrosis
  • Traumatic ulcers
  • Linear alba (a whitish line on the gums)

Aetiology of Attrition

  • Functional Theory: Prolonged tooth contact during chewing patterns (e.g., grinding vs. chopping movements).
  • Central Nervous System Theory: Bruxism as a neurologically driven condition affected by stress/anxiety or sleep disorders (nocturnal bruxism).

Modifying Factors in Attrition

  • Ecstasy: Associated with bruxism, xerostomia, and increased tooth wear (dentin loss)
  • Habitual Chewing on Hard Substances: Accelerates wear, particularly in bone chewing.
  • SSRIs (Selective Serotonin Reuptake Inhibitors): Potential link to bruxism, especially when first prescribed – consult the patient's physician.

Clinical Management of Attrition

  • Restorative Treatment: Often used for aesthetic issues or to restore lost tooth structure.
  • Splints (Hybrid/Hard Splints): Crucial for long-term management, often a life-long necessity to reduce damaging parafunctional habits.
  • Initial Diagnostic Phase: Ensure patient compliance with splint use.
  • Dahl Technique: An approach to restore worn teeth by increasing the occlusal vertical dimension (OVD) to address space issues for restorations.
  • Restorations (Composite Resin/Gold Onlays): Options for managing generalized or localised wear, balancing aesthetics and longevity.
  • Occlusal Adjustment/Rehabilitation: Used to minimize stress and/or damage to teeth caused by improper bite.

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A Guide to the Clinical Management of Attrition PDF

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