Tooth Wear Part 2 DTH23 - Tagged 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 prevenAve 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 detecAon: Signs and Symptoms Clinical signs, BEWE and paIent history DetecAon Clinical examinaAon (signs) Tooth wear risk assessment PaAent factors (symptoms & Pt complaints history) How they noticed any changes? Clinical DetecAon BEWE Basic erosive wear examination Systematic approach (Hard tissues) Prepare Examine BEWE Mirror + clinical signs systematic Dry surface: Occlusal incisal screening tool 3 in 1 OR Palatal/lingual sextants Cotton wool Buccal Cervical 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 e? Assess the rate of wear compared to the age of a paAent normal  add score together Basic Erosive Wear ExaminaAon (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 cumulaAve BEWE score (maximum 18) per paIent. This cumulaIve score then informs risk and clinical management strategies. Despite the name, the BEWE is used to record Tooth wear regardless of the aeAology (Araguiz et al 2020) Molar and premolar Pointy cusps Solid inter-proximal contacts BEWE 0 Occlusal surface of a premolar and molar showing no signs of erosive tooth wear, staining evident (Aranguiz et al 2020)  Wear on UR1 buccal and incisal edge Tooth morphology has early signs of tooth wear 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  Discrete small erosive lesion on occlusal surface Cupping on buccal cusps Flattened surface 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) Buccal erosive wear Incisal wear Loss of crown height Some denting exposed 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)  Loss of tooth surface on cusps BEWE 2 BEWE 2 on the premolar. The wear is just less than 50%. (Aranguiz et al 2020) Cuspal changes Flattened top/cusp 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)  Not related to tooth wear. BEWE 0 A molar with hypoplasia but no sign of erosive tooth wear. (Aranguiz et al 2020) Mil Molar incisal hypolasia BEWE in clinical notes An example: BEWE: 0 1 0 1 0 1 CumulaIve BEWE score = 3 This score is used to inform the level of intervenIon. PaAent Factors to consider in risk assessment Age – how is the rate wear for the patients’ age? Wear consistent with age? Or not..? Verbal history to identify aetiological factors Past and current frequent exposure to internal and external acids Acidic foods/drinks, acid reflux? Occupation Seamstress pins in between teeth? Medical history Past and current fluoride exposure Stress Quantify 1-10 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? IntervenAons Preventive and Restorative IntervenAons what we can... do Risk Preventive Restorative Review Assessmen Care and Care or and t Advice Referral monitor  ↓ Z Erosive tooth wear Bartlett et al 2019  Management guidance Use as opportunity to raise awareness Adapted from Bartlett et al 2019 PreventaAve: 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  diet Sheet PreventaAve: 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 between meals Do not advise to avoid eating fruits – these are essential for our general health natural form smoothie X  toothpaste PreventaAve: Fluoride advice NAF 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 at different time to brushing PreventaAve: Fluoride Toothpaste Fluoride varnish application 22600ppm requires a prescription! we can apply !  ? PreventaAve: Monitoring progressing Take impressions for study models to monitor change over Ime Take clinical photographs ↳ at intervals PreventaAve: Occlusal Splint Involves impressions and preparaIon of a splint Stress management Referral may be required for both ONLY WHEN EROSION IS UNDER CONTROL RestoraAve opAons Suitable not always RestoraAons may be necessary once the tooth wear is stable – it is o^en di_cult to bond materials OpIons 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 restoraIve care  GDP/specialist Query eaIng 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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