What are the causes of tooth wear?
- Attrition
- Abrasion
- Erosion
- Abfraction
What is ‘attrition’?
Physiological wear of tooth due to tooth-tooth contact
–> Main causes = BRUXISM
What is ‘abrasion’?
Physiological wear of tooth due to foreign object/ substance repeatedly contacting tooth
–> Process independent of occlusion
What is ‘erosion’?
Loss of tooth surface due to chemical process
–> Does not involve bacteria
What is ‘abfraction’?
Loss of hard tissue from abnormal occlusal
forces leading to
stresses at the cervical fulcrum areas of the
tooth
What wear indices may be useful in a clinical examination for wear?
- Tooth Wear Index (Smith & Knight)
- Basic Erosive Wear Examination (BEWE)
What may be an immediate treatment for tooth wear?
PAIN
- Desensitise = F agents, DBA, GIC
- Pulp extirpation (if wear exposed pulp)
- Smooth sharp edges
- Extr (unrestorable/ non-functional)
- TMJ pain = control acute symtpoms
What is the initial treatment for wear?
PREVENTATIVE REGIME
- Monitor (assess progressive or arrested) = models, photos, BEWE/ smith & knight
- Remove abrasive component
- Change toothpaste
- Habits?
ABRASION
- Cervical restorations (toothbrush abrasion); RMGI, flowable comp
ATTRITION
- Hypno
- CBT
- Splints
EROSION
- F regimes
- Desensitising agents (toothpastes etc) = not really preventative
- Dietary management
What is the active management for MAXILLARY ANT tooth wear?
Rapid tooth wear (i.e. not alveolar compensation- OVD not decreased)
- Restorations
Loss of OVD
- Increased OVD (reorganised approach)
- ICP -> RCP
- Surgical crown lengthening
- RCT & post crowns
- Ortho
What is the Dahl technique?
- Technique to gain space in LOCALISED MAXILLARY ANT tooth wear
- 3-6months
- Palatal coverage –> discrepancy in posterior occlusion –> posterior alveolar compensation –> increases OVD
What are the contra-indications for the Dahl technique?
- Active perio disease
- TMD
- Post ortho
- Bisphosphonates
- Dental implants
- Existing conventional bridges
What would you suspect for causes of localised posterior tooth wear?
- Erosive in ruminating, bulimic and alcoholic pts
What techniques can be used to build up teeth with composite?
- Wax up and putty matrix made –> mould for build up
- Clear vacuum formed matrix (made from wax up and poured cast) –> mould for build up
What would you tell your patient before building up their teeth with composite?
- Tooth coloured fillings, prevents more wear
- No LA as no/min drilling
- Improvement in appearance possible
- Bite will be strange few days as only front teeth will touch
- -> back teeth will come back together ~3-6 months
- -> over a week, will get accustomed but may need to cut food into bite sized pieces
- Lisping possible
- May bite tongue/ lip
- Crowns/ bridges at back will need to be replaced
- Good longevity, but possible to fall off, but can be replaced with no damage to tooth
- Will require maintenance
How is GENERALISED tooth wear managed?
EXCESSIVE, LOSS OF OVD but space
- Splint to adjust new height
- Straight to increasing OVD with direct build ups
- -> half max, half mand
EXCESSIVE, LOSS OF OVD, min space
- Reorganised approach with splint to adjust to new height –> restor post and ant teeth
EXCESSIVE, W/O LOSS OF OVD, no space
- Splints +/- dentures
- Crown lengthening
- RCT
- Ortho
- Over dentures
