Toothwear Revision PDF

Toothwear  Tooth wear (TW) = Cumulative loss of The key is the mineralised tooth tissue due to physical frequency of or chemical-physical processes exposur...

Toothwear  Tooth wear (TW) = Cumulative loss of The key is the mineralised tooth tissue due to physical frequency of or chemical-physical processes exposure Accelerated tooth wear = Severe tooth wear = Erosive tooth wear = rate of wear is significant for a tooth wear that chemical — physical patients age significantly impacts a patient’s life Aetiology of tooth wear Erosion The chemical loss of mineralised tooth tissues caused by exposure to acids not derived from oral bacteria. Extrinsic acids Acid drinks regardless of when they’re consumed >2 fruit intake in between meals or in high quantities Drinking habits prior to swallowing Reduced quality or >3 daily acid intakes quantity of saliva can increase erosive Intrinsic acids potential of intrinsic and Stomach acid - hydrochloric acid pH 1–2 extrinsic acids Gastro-oesophageal reflux disease (GORD) Eating disorders Frequent vomiting Pregnancy - severe morning sickness Attrition The physical loss of mineralised tooth tissues causes by tooth-to-tooth contact. Bruxism Teeth grinding causing tooth-to-tooth contact Jaw clenching can also cause attrition Malocclusion Misaligned teeth increases the amount of stress and tooth-to-tooth contact. Abrasion The physical loss of mineralised tooth tissue caused by physical factors other than teeth. Oral hygiene routine Lifestyle/habits Over-zealous tooth brushing Nail biting Abrasive toothpastes Pen biting Hard bristled tooth brush Piercings Poorly fitted retainers Occupational/environmental Diet Miners and construction workers Hard diet working in abrasive environments Chewing bones Dress makers Musicians Abfraction Tooth structure loss in the cervical region caused by complexity of flexure forces occlusally and cervically during functioning. Record separately Distinct wedge shape clinically evident in cervical region. NOT an accepted aetiology for tooth wear Multifactorial aetiology Erosion + Attrition + Abrasion = Tooth wear Modern lifestyles and Living longer diets (more acids) and keeping teeth for longer Affects all ages and dentitions Why is tooth wear an issue? Not systematically recorded High impact on Difficult to detect patient (function early stages and aesthetics)  = Clinical examination Patient factors Tooth wear risk (Signs) + (Symptoms & history) assessment Clinical examination Prepare; Examine clinical signs; BEWE; Mirror Systematic approach Systematic screen tool Dry surface Occlusal Sextants used 3 in 1 Palatal/lingual Like BPE but for hard Cotton wool rolls Buccal tissues Basic Erosive Wear Examination (BEWE) Index Assess rate of wear Score (per Description compared to age of sextant) patient 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. May not always be Dentine could be involved obvious, look for subtle changes in tooth morphology Used to record tooth wear regardless of aetiology. Each sextant score is added together to achieve cumulative BEWE score. This score informs of risk and clinical management strategies.  BEWE 0 No clinical signs of erosive tooth wear Can see fissure details Pointy cusps Solid inter-proximal contacts BEWE 0 Hypoplasia present No signs of tooth wear BEWE 1 Discrete, small erosive lesions Subtle halo effect Slight flattening of occlusal surface Early signs of cupping on buccal cusps BEWE 2 < 50% tooth loss Possible dentine exposure Loss of clinical crown height < 50% BEWE 3 > 50% tooth loss Exposed dentine Visible halo effect May be sensitive Patient factors to consider Age Patients concerns or symptoms - how is the rate of tooth wear for the patients age - sensitivity due to exposed dentine - noticing changes (chipped anterior teeth) Verbal history — identify aetiological factors - reports grinding - exposure to internal and external acids - occupation Saliva - medical history - dry mouth - past and current fluoride exposure - stress - habits - dietary factors Restorative Preventative Review and Risk assessment care or monitor care & advice referral Interventions Using BEWE cumulative sextant scores 14 Identify aetiological factors Consider additional fluoridation As per 9 — 13 measures Consider restorative intervention Avoid placement of restorations Consider specialist referral Monitor with study casts, photos, Discuss with patient digital scans Repeat BEWE every 6-12 months. Preventative advice Restorative options Home care; Restorations; Tailored advice to patients needs Only when tooth wear is stable Non-abrasive toothbrushing technique Often difficult to bond Avoid hard bristle toothbrush Composite, veneers, crowns Use low abrasive toothpaste Specialist referral may be required Avoid brushing immediately after acidic foods or drinks Avoid brushing immediately after vomiting or reflux Referrals; Use fluoride toothpaste, spit don’t rinse technique If beyond our scope Severe tooth wear - GDP/specialist Diet advice; Bruxism - GDP (splint/stress Tailored advice for patient management) Identify contributing factors Complex restorative - GDP/specialist Avoid, elminate or reduce frequent intake of acidic foods/ Query wasting disorder - GP drinks Query GORD - GP Limit acid drinks to meal times Encourage buffering/neutralising with water Encourage fruit intake at meal times due to acidity Educate patients different ways of eating fruits Fluoride advice; Maximise fluoride exposure Possible prescription of 2800/5000ppm fluoride toothpaste Encourage spit, don’t rinse technique Increased fluoride intake with mouthwash at different time to brushing Fluoride varnish application with prescription (22600ppm) Monitoring; Take impressions for study models Take clinical photographs at intervals to monitor rate Take digital scans to create digital study model Occlusal splint; Only consider when erosion is under control Involves impression/scan Stress management