Non-Carious Tooth Surface Loss Overview

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Questions and Answers

What is the primary goal when the presence of GORD is identified in a patient?

  • Immediately referring the patient to a specialist
  • Prescribing medication to reduce stomach acid
  • Performing a BEWE examination
  • Eliminating any contributing factors to the condition (correct)

Which of the following actions would NOT be included in the management strategy for a patient with a summed BEWE score between 3 and 8?

  • Dietary assessment and recommendations
  • Using a scalpel to score the affected tooth surface (correct)
  • Reviewing the patient at two-year intervals
  • Routine dental maintenance

What is the significance of a BEWE score of 0?

  • It necessitates a dietary assessment and oral hygiene recommendations
  • It indicates the presence of significant tooth wear
  • It suggests a need for immediate referral to a specialist
  • It implies no signs of erosive tooth wear (correct)

What is the clinical management recommendation for a patient with a summed BEWE score of 2?

<p>Dietary assessment and advice, with regular follow-up (A)</p> Signup and view all the answers

What does the term 'aetiological agent' refer to in the context of tooth erosion?

<p>The underlying causes that lead to tooth erosion (B)</p> Signup and view all the answers

What is defined as the wear that occurs from tooth-to-tooth contact?

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

Which factor is increasingly significant for the long-term health of the dentition?

<p>Non-carious tooth surface loss (B)</p> Signup and view all the answers

What describes wear occurring due to the friction of exogenous material?

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

What is a common consequence of non-carious tooth surface loss?

<p>Increased risk of decay (A)</p> Signup and view all the answers

Which option is not a type of non-carious tooth wear?

<p>Cavitation (A)</p> Signup and view all the answers

What external factor can contribute to abrasion on teeth?

<p>Brushing with hard bristles (D)</p> Signup and view all the answers

Which of the following is least likely to cause tooth surface loss?

<p>Passive salivary flow (C)</p> Signup and view all the answers

In terms of tooth wear, what is the main distinction between attrition and abrasion?

<p>Attrition occurs due to tooth contact and abrasion involves external materials (B)</p> Signup and view all the answers

What is the main difference between intrinsic and extrinsic erosion?

<p>Intrinsic erosion originates from inside the body, while extrinsic comes from outside sources. (A)</p> Signup and view all the answers

Which of the following factors is NOT mentioned as influencing the severity of erosive damage?

<p>The temperature of the acidic food (A)</p> Signup and view all the answers

How do liquids of low pH affect dental tissues?

<p>They affect the palatal surfaces of the maxillary anterior and premolar teeth. (C)</p> Signup and view all the answers

What is a common property of solid acidic foods mentioned in the content?

<p>They are usually masticated. (D)</p> Signup and view all the answers

Which sour food product is noted for having a very low pH level?

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

What is the role of the tongue during the swallowing process regarding acidic liquids?

<p>It helps distribute the liquid against the palate. (C)</p> Signup and view all the answers

What effect does gastric acid have as compared to dietary acids?

<p>Gastric acid contributes to intrinsic erosion. (A)</p> Signup and view all the answers

Which of the following is an example of a factor that may NOT influence erosive patterns in oral health?

<p>Environmental conditions like humidity (D)</p> Signup and view all the answers

What is abfraction mainly associated with?

<p>Flexing of teeth under load (C)</p> Signup and view all the answers

Which factor is considered a co-factor contributing to cervical lesions?

<p>Toothbrush abrasion (D)</p> Signup and view all the answers

What might indicate that enamel surfaces are 'mildly active'?

<p>Pristine oral conditions (C)</p> Signup and view all the answers

What is the purpose of the 'scratch test' used for determining enamel activity?

<p>To evaluate enamel hardness over short-time (C)</p> Signup and view all the answers

What pH level is generally associated with moderate acids affecting tooth surfaces?

<p>pH = 5 (A)</p> Signup and view all the answers

Which condition is more likely to cause erosion of the mandibular teeth rather than the maxillary teeth?

<p>Burping action causing liquid to flood (D)</p> Signup and view all the answers

What type of tooth damage is characterized by subsurface demineralization?

<p>Carious white spot lesion (D)</p> Signup and view all the answers

How quickly do erosive acids act on tooth surfaces compared to moderate acids?

<p>Much faster and primarily on the surface (D)</p> Signup and view all the answers

What is the primary philosophy that must be applied in managing tooth wear?

<p>Minimal intervention dentistry (D)</p> Signup and view all the answers

Which mechanism is NOT typically associated with non-carious tooth surface loss?

<p>Cavity formation (D)</p> Signup and view all the answers

What co-factors may exacerbate the effects of tooth wear?

<p>Hyposalivation and hypomineralisation (B)</p> Signup and view all the answers

How should tooth wear mechanisms be assessed by the clinician?

<p>By determining the active mechanism of wear (D)</p> Signup and view all the answers

Flashcards

Non-carious tooth surface loss

Loss of tooth structure not caused by decay, affecting long-term dental health.

Tooth wear

The gradual loss of tooth structure from mechanisms like attrition, abrasion, and erosion.

Attrition

Wear of teeth caused by tooth-to-tooth contact without food being involved.

Abrasion

Tooth wear resulting from friction with external materials or forces on the tooth surfaces.

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Risk assessment

Process of evaluating factors contributing to tooth surface loss.

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Long-term dental health

Overall condition of teeth and gums maintained over time.

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Exogenous materials

Foreign substances that can cause wear on teeth surfaces.

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Dental function

The ability of teeth to perform their roles in chewing and speaking efficiently.

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GORD

Gastro-Oesophageal Reflux Disease is a condition that can lead to erosive tooth wear.

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BEWE Score 0

Indicates no erosive wear on any tooth surfaces, excluding third molars.

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BEWE Score 1

Represents initial loss of surface texture on teeth, indicating early erosive activity.

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BEWE Score 2

Indicates distinct defects with hard tissue loss on the tooth surface, worsening erosive wear.

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Management for Erosion Risk Level <2

Routine maintenance and observation; review every 3 years with no erosive wear.

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Abfraction

Flexing of teeth under load leading to cervical lesions.

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Cervical lesions

Wedge-shaped lesions at the gum line, often due to abfraction.

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Aetiological co-factors

Contributing factors that lead to dental issues.

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Scratch test

A method to determine enamel activity over a short time.

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Activity determination

Evaluating the health or deterioration of enamel surfaces.

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Serial colour photographs

Used to record changes in enamel translucency over time.

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Tooth morphology changes

Subtle alterations in dental shape over time.

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Dietary acid sources

Identifying acids in diet that may affect dental health.

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Minimum Intervention Dentistry

An approach that focuses on preserving tooth structure in treatment.

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Erosion

Loss of tooth material due to chemical action, often from acids.

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Hyposalivation

Reduced saliva production, which can exacerbate tooth wear.

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Hypomineralisation

Deficient mineral content in teeth, making them more susceptible to wear.

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Tooth Erosion

Wear of tooth enamel due to acidic substances.

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Demineralization

Loss of minerals from the tooth enamel leading to decay.

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White Spot Lesion

Early sign of demineralization characterized by white patches on teeth.

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pH Level

A measure of how acidic or basic a substance is.

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Subsurface Damage

Damage to the inner layers of enamel without affecting the outer layer.

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Mandibular Teeth

Lower teeth, often more affected by certain acids.

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Erosive Demineralization

Fast erosion of tooth surface due to strong acids.

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Plaque Acids

Acids produced by plaque that can harm tooth enamel.

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Intrinsic erosion

Erosion caused by gastric acid originating from within the body.

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Extrinsic erosion

Erosion caused by external acids from diet or environment.

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pH/buffering titration

A measure of acidity in solutions that affects erosion.

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Frequency of acid exposure

How often teeth are exposed to acidic substances, affecting erosion severity.

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Palatal surfaces

The tongue-side surfaces of the upper teeth, affected by acids.

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Erosive patterns

Distinct ways in which acids can erode teeth, guiding diagnosis.

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Critical pH

The pH level below which dental enamel begins to dissolve.

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Solid acidic food

Foods that can cause erosion when masticated due to their acidity.

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Study Notes

Non-Carious Tooth Surface Loss (Tooth Wear)

  • Tooth wear is a significant factor affecting long-term dental health, impacting both young and older adults.
  • This necessitates better preventive and restorative approaches by dental professionals.
  • The main mechanisms of tooth surface loss are erosion, attrition, and abrasion.

Mechanisms of Tooth Surface Loss

  • Erosion: Chemical dissolution of tooth substance without plaque.
  • Factors impacting erosion include:
    • Acids (intrinsic, exogenous): Gastric acid, dietary, environmental, and occupational acids.
    • Frequency of exposure.
    • pH/buffering.
  • Common erosive patterns:
    • Vomiting (palatal surfaces most affected).
    • Gastroesophageal reflux disease (GORD).
    • Rumination.
    • Eructation (burping).
    • Dietary intake (acids).
    • Drinking acidic beverages (labial surfaces).
    • Acidic sour candies.
  • Attrition: Tooth-to-tooth contact without food.
  • Factors impacting attrition:
    • Stress (chronic stress, "highly strung" individuals).
    • Distress.
    • Sleep disturbances.
    • Occlusal interferences (generally, not a direct significant factor).
  • This grinding action can lead to pathological damage (enamel flaking, cusp fractures) and tooth damage, particularly on anterior teeth.
  • Abrasion: Wear due to exogenous material friction.
  • Abrasive sources: food, toothbrushes, dentifrices, foreign objects.
  • Abrasion can be from hard foods, occupations, etc.
  • Food abrasion is less of a problem now due to food processing.

Identifying Erosion

  • Micro-anatomical enamel features are lost leading to a "glazed" or "silky" appearance.
  • The teeth lose contours with curved enamel areas flattening.
  • Scooped dentine.
  • The presence of wedge-shaped non-carious cervical lesions suggests erosion.

Identifying Attrition

  • Presence of facets (flattened areas).
  • Enamel flaking/cusp fractures.
  • Craniomandibular disorders.

Identifying Abrasion

  • Asymmetric wear ("notch").
  • Scooped dentine (incisal/occlusal surfaces).
  • Lack of sensitivity.
  • Impacted by associated erosion.

Minimum Intervention for Tooth Surface Loss Treatment

  • Identify the mechanism(s).
  • Assess if the mechanism(s) are active.
  • Determine why the patient has this problem (lifestyle, medications, etc.).
  • Develop a preventive/monitoring program tailored to the patient.
  • Perform minimum intervention where needed, preserving tooth structure.
  • Ensure patient assumes responsibility for preventive treatment success.

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