Tooth Wear 2 - Oral and Dental Sciences

Tooth Wear 2 - Miss Felix

• Course: Oral and Dental Sciences
• Lecturer: Miss Felix
• Institution: Eastman Dental Hospital, LSBU

Tooth Wear Lectures and Assessments

• Lectures:
  • Tooth Wear 1: Pre-recorded lectures with workbooks
  • Tooth Wear 2: Pre-recorded lectures with quizzes
  • Tooth Wear 3: Live lectures with case studies for application of theory
• Assessments:
  • Formative: Workbooks, quizzes, and case studies
  • Summative: E-assessments and/or case studies

Intended Learning Outcomes

• Students will be able to describe clinical signs and symptoms of tooth wear, and how to detect them.
• Students will be able to describe the BEWE screening tool.
• Students should be able to outline preventive management strategies.
• GDC learning outcomes relevant to the topic include 1.1.2, 1.1.4, 1.1.8, 1.7.7, 1.10.1, 1.10.2, 1.10.3, 1.10.4, and 1.10.6

Clinical Detection: Signs and Symptoms

• Key factors for clinical detection include clinical signs, the BEWE tool, and patient history.

Detection

• Tooth wear risk assessment is conducted by combining clinical examination (signs) with patient factors (symptoms and history).

Clinical Detection

• Preparation: Mirror, dry surface (3 in 1 or cotton wool rolls)
• Examination: Occlusal, palatal/lingual, buccal clinical signs
• BEWE: Systematic screening tool, including sextants, similar to BPE assessment for hard tissue.

Tips to Detect Clinical Signs

• Morphology: Use knowledge of normal tooth morphology to detect subtle changes
• Early Stages: Early tooth wear may not be obvious; look for subtle changes
• Physiological Processes: Most adults exhibit tooth wear due to normal physiological processes
• Age Comparison: Assess the rate of wear in comparison to patient age

Basic Erosive Wear Examination (BEWE) Index

• Scoring:
  • 0: No erosive wear
  • 1: Initial loss of surface texture (e.g., "frosted glass" appearance)
  • 2: Distinct defect, hard tissue loss <50% of the surface area.
  • 3: Hard tissue loss >50% of the surface area.
• Cumulative Score: Scores per sextant are added for a total score; this score informs risk assessment for clinical management.
• Purpose: Used to record tooth wear regardless of etiology.

Patient Factors in Risk Assessment

• Age: Rate of wear specific to the patient's age
• History: Etiological factors of past and current frequent exposures to internal/external acids, occupation, and medical history
• Habits: Dietary factors, patient symptoms/concerns, sensitivity due to exposed dentine, chipping of anterior teeth, and grinding habits
• Saliva: Saliva plays a significant role in modifying tooth wear

Interventions

• Preventive: Risk assessment, preventive care and advice, and monitoring
• Restorative: Restorative care or referral. This is considered only when tooth wear is under control.

Restorative Options

• Bonding difficult: Depending on complexity, specialist referral is possible
• Options: Bonding materials, veneers, crowns, complex build-ups
• Stability: Restorative options are considered when tooth wear is stable.

Referrals

• Limits of Care: Sever tooth wear, Bruxism, complex restorative care, eating disorders, and gastroesophageal reflux disease (GORD) may require referrals outside of immediate scope
• Specialists: Recommendations for referring to GDP/specialist.

Summary

• Detection: Risk assessment, patient history, and clinical signs (such as BEWE).
• Interventions: Preventive, monitoring, and restorative care.