Tooth Wear Part 2 DTH23 - Dental Presentation PDF

Tooth Wear 2 Miss Felix Oral and Dental Sciences Tooth Wear Lectures and Assessments Lectures:  Tooth Wear 1: Pre-recorded + workbook  Tooth Wear 2: Pre-recorded + quiz  Tooth Wear 3: Live + case studies to apply theory Assessments:  Formative: workbook, quiz and case studies  Sum...

Tooth Wear 2 Miss Felix Oral and Dental Sciences Tooth Wear Lectures and Assessments Lectures:  Tooth Wear 1: Pre-recorded + workbook  Tooth Wear 2: Pre-recorded + quiz  Tooth Wear 3: Live + case studies to apply theory Assessments:  Formative: workbook, quiz and case studies  Summative: E-assessment and or cases Intended Learning Outcomes By the end of the session, students should be able to: Describe clinical signs and symptoms of tooth wear and how to detect them Describe the BEWE screening tool Outline preventive management strategies GDC Learning Outcomes: 1.1.2, 1.1.4, 1.1.8, 1.7.7, 1.10.1, 1.10.2, 1.10.3, 1.10.4, 1.10.6 Clinical detection: Signs and Symptoms Clinical signs, BEWE and patient history Detection Clinical examination (signs) Tooth wear risk assessment Patient factors (symptoms & history) Clinical Detection Prepare Examine BEWE Mirror + clinical signs systematic Dry surface: Occlusal screening tool 3 in 1 OR Palatal/lingual sextants Cotton wool Buccal like BPE for rolls hard tissues Tips to detect clinical signs… Use your knowledge of normal tooth morphology Will not always be obvious in the early stages - look for subtle changes in the tooth morphology Most adults will show some signs of tooth wear as a result of normal physiological processes Assess the rate of wear compared to the age of a patient  Basic Erosive Wear Examination (BEWE) Index Score ( per Description sextant) 0 No erosive wear 1 Initial loss of surface texture (brightness loss, opaque surface or ‘frosted glass’ appearance) 2 Distinct defect, hard tissue loss, less than 50% of the surface area. Dentine may be involved. 3 Hard tissue loss more than 50% of the surface area. Dentine could be involved. Each sextant score is then added together achieve a cumulative BEWE score (maximum 18) per patient. This cumulative score then informs risk and clinical management strategies. Despite the name, the BEWE is used to record Tooth wear regardless of the aetiology (Araguiz et al 2020)  BEWE 0 Occlusal surface of a premolar and molar showing no signs of erosive tooth wear, staining evident (Aranguiz et al 2020)  BEWE 1 (Aranguiz et al 2020) A discrete area of wear on the UR1 on the buccal surface and the incisal edge – take a look at the shape  BEWE 1 d) BEWE score 1 showing early signs of erosive tooth wear with discrete, small erosive lesions on occlusal surface. (Aranguiz et al 2020) Less than 50% loss with signs of erosive tooth wear on the buccal (facial) surface but also some loss of the incisal edge exposing the dentine. There is a loss of the clinical crown height less than 50%. BEWE 2 (Aranguiz et al 2020)  BEWE 2 BEWE 2 on the premolar. The wear is just less than 50%. (Aranguiz et al 2020) Cuspal changes Healthy cusp – pointy with steep inclines – think mountain top Mt Vesuvius, volcano in Napoli Stob Dearg, Glencoe, Scotland  More than 50% of the palatal surface affected – can see the exposed dentine especially at the gingival margins (where you would expect to see cingulums) and at the incisal edges. A ‘halo effect’ is visible. May be sensitive as a result of dentine hypersensitivity depending whether it the tooth wear is active or not BEWE 3 What else can you identify in this image? (Aranguiz et al 2020)  BEWE 3 f) BEWE 3 showing erosive tooth wear covering more than 50% of the tooth surface. (Aranguiz et al 2020)  BEWE 0 A molar with hypoplasia but no sign of erosive tooth wear. (Aranguiz et al 2020) BEWE in clinical notes An example: BEWE: 0 1 0 1 0 1 Cumulative BEWE score = 3 This score is used to inform the level of intervention. Patient Factors to consider in risk assessment Age – how is the rate wear for the patients’ age? Verbal history to identify aetiological factors Past and current frequent exposure to internal and external acids Occupation Medical history Past and current fluoride exposure Stress Habits Dietary factors Patient symptoms or concerns Sensitivity due to exposed dentine and loss of smear layer Noticed changes ie chipping anterior teeth Reports of grinding Saliva is a significant modifying factor – why? Interventions Preventive and Restorative Interventions Risk Preventive Restorative Review Assessmen Care and Care or and t Advice Referral monitor Bartlett et al 2019  Management guidance Use as opportunity to raise awareness Adapted from Bartlett et al 2019 Preventative: Home Care Advice Oral health education and advice: Tailored advice to patients needs Non-abrasive tooth brushing technique – avoid scrubbing Medium or soft bristle toothbrush, avoid hard bristles Use a low abrasive toothpaste Avoid brushing immediately after acidic foods or drinks Avoid brushing immediately after vomiting or reflux episodes Use fluoride toothpaste, spit and no rinse Preventative: Diet advice Dietary analysis and advice: Tailored advice – try to identify potential contributing factors Avoid, eliminate or reduce frequent intake of acidic foods and drinks Limit acidic drinks to meal times and 1/day Encourage buffering/neutralising with water Do not advise to avoid eating fruits – these are essential for our general health Preventative: Fluoride advice Maximise Fluoride Exposure Possible prescription of 2800/5000ppm fluoride toothpaste for moderate to severe tooth wear Spit, no rinse Mouthrinse 0.05% fluoride at diff time to brushing Preventative: Fluoride Toothpaste Fluoride varnish application 22600ppm requires a prescription! Preventative: Monitoring Take impressions for study models to monitor change over time Take clinical photographs Preventative: Occlusal Splint Involves impressions and preparation of a splint Stress management Referral may be required for both ONLY WHEN EROSION IS UNDER CONTROL Restorative options Restorations may be necessary once the tooth wear is stable – it is often difficult to bond materials Options include bonding materials, veneers, crowns, complex build ups Specialist referral may be required depending on complexity Clinical image showing a) severe tooth wear and b) restorative intervention Source: springernature.com Referrals May be beyond our scope, there is a limit to our care: severe tooth wear  GDP/specialist Bruxism  GDP ?splint + stress management Complex restorative care  GDP/specialist Query eating disorder  GP Query GORD  GP Summary Detection Risk assessment Patient history Clinical signs BEWE Interventions Preventive Monitoring Restorative References Aránguiz V, Lara JS, Marró ML, et al. 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