Tooth Surface Loss - Monitoring and Management

What is abrasion?

physical wear by objects other than another tooth

eg tools like lewis

what is erosion

loss of enamel and dentine from chemical attack and not by bacteria eg vomiting

what happens to amalgam in erosion

enamel is more acid resistant than enamel and dentine so if erosion happens the tooth surface will be lost and amalgam is the same so it becomes higher than tooth - submargination

what is attrition

physical wear of one tooth surface against another tooth surface causing tissue loss on the contacting surfaces

what are the extrinsic risk factors of erosion

diet

enviornmental

meds

lifestyle

what are the environmental extrinsic risk factors

exposure to in inorganic agents

eg swimmers, wine tastersm fertiliser factory workers eg

why are acid containing drinks bad

2 main acids - citric and phosphoric

directly attack the tooth lattice and remove calcium

citrate annion has higher affinity for lattice than phosphate so can cause direct acid attack at ph 2

32% ca in saliva is complexed by citrate which reduces saliva saturation and buffer effect and encourages dissolution

what are the medication extrinsic risk factors

method of drug administration - frequency duration and inhalation/liquid

pH of meds

eg aspirin, iron tonics, HCL supplement, vit C, acidic salivary flow stimulants

what are the lifestyle extrinsic risk factors

behavioural eg excessive consumption if acidic foods

night time baby bottle feeding with acidic beverages

healthier lifestyles and dieting - vegetarians prone

strenous sporting activities - prone to acid reflux and reduced saliva

OH and tooth whitening

what are intrinsic factors

vomiting

regurgitation and reflux

rumination - regurgitation then chewing and swallowing it

what is the difference between vomiting and reflux/regurgitation

vomiting - forceful expulsion of stomach contents

reflux/regurgitation - lack of diaghramatic muscular contraction and small quantity ejected

what biological factors modifying the erosion process

saliva

tooth composition and structure - variation of tooth substance

dental anatomy and occlusion - prominent teeth get hit by acid and abrfaction can make it worse

soft tissue anatomy and physiological function - influences acid contact areas

what does saliva do

dilution and clearance of acid out the mouth

neutralising and buffering

maintenance of supersaturated state next to the tooth surface of ca and phosphate

acquired pellicle formation

why do teeth not grow

statherin protein stops ca and phosphate in saliva to precipitate on tooth surface

how do we prevent and treat tooth wear

diagnosis - IO and full history, photos, salivary tests, study models

inform and instruct on causes

oh advice

what do u need in a diet history

day of the week and weekend at least usually a whole week

and when and what they ate

What is the BEWE?

basic errosive wear exam

highest score per sextant recorded and totalled

how do we treat tooth wear

arrest errosive process

make space for restorations

repair palatal loss with veneers

maintain/increase OVD

what is dahl appliance

creates space orthodontically and decreases no. of crowns required

removable co/cr splint with thick coverage of palatal anteriors and buccal retention