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    Advanced Tooth Wear/ Non Bacterial Loss of Tooth Substance

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    Gareth Bale
    Advanced tooth wear can involve attrition, abrasion, erosion, or abfraction. It is caused by mechanical or chemical processes without bacteria. Common causes include grinding teeth, consuming acidic foods/drinks, occupations involving grit/debris, and acid reflux. Clinical signs depend on the specific cause but may include facial wear facets, cervical lesions, root exposure, or cupped incisal edges. Diagnosis involves assessing the nature, cause, and progression of wear. Management focuses on controlling causes, reducing sensitivity, and providing restorations if needed to increase vertical dimension or replace lost tooth structure.

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    Advanced Tooth Wear/ Non Bacterial Loss of Tooth Substance

    Uploaded by

    Gareth Bale
    19 views38 pages
    Advanced tooth wear can involve attrition, abrasion, erosion, or abfraction. It is caused by mechanical or chemical processes without bacteria. Common causes include grinding teeth, consuming acidic foods/drinks, occupations involving grit/debris, and acid reflux. Clinical signs depend on the specific cause but may include facial wear facets, cervical lesions, root exposure, or cupped incisal edges. Diagnosis involves assessing the nature, cause, and progression of wear. Management focuses on controlling causes, reducing sensitivity, and providing restorations if needed to increase vertical dimension or replace lost tooth structure.

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    Advanced tooth wear can involve attrition, abrasion, erosion, or abfraction. It is caused by mechanical or chemical processes without bacteria. Common causes include grinding teeth, consuming acidic foods/drinks, occupations involving grit/debris, and acid reflux. Clinical signs depend on the specific cause but may include facial wear facets, cervical lesions, root exposure, or cupped incisal edges. Diagnosis involves assessing the nature, cause, and progression of wear. Management focuses on controlling causes, reducing sensitivity, and providing restorations if needed to increase vertical dimension or replace lost tooth structure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views38 pages

    Advanced Tooth Wear/ Non Bacterial Loss of Tooth Substance

    Uploaded by

    Gareth Bale
    Advanced tooth wear can involve attrition, abrasion, erosion, or abfraction. It is caused by mechanical or chemical processes without bacteria. Common causes include grinding teeth, consuming acidic foods/drinks, occupations involving grit/debris, and acid reflux. Clinical signs depend on the specific cause but may include facial wear facets, cervical lesions, root exposure, or cupped incisal edges. Diagnosis involves assessing the nature, cause, and progression of wear. Management focuses on controlling causes, reducing sensitivity, and providing restorations if needed to increase vertical dimension or replace lost tooth structure.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 38

    ADVANCED TOOTH WEAR/

    NON BACTERIAL LOSS OF TOOTH


    SUBSTANCE
    ADVANCED TOOTH WEAR/
    NON BACTERIAL LOSS OF TOOTH SUBSTANCE/
    TOOTH SURFACE LOSS

    • Chiefly involves
    ATTRITION
    ABRASION
    EROSION
    and also abfraction
    Inter related with one aspect predominating
    PREVALENCE
    • One third of pre-school children (wear)
    • One half of teen agers (erosion)
    • 7 % of adults exhibit (wear)
    • Evidence showing tooth wear due to erosion is
    increasing in child and young adult population.
    DIFFERENCE BETWEEN
    TOOTH WEAR AND DENTAL CARIES
    • ATTRITION
    Marked in Egyptians( 3000 BC) due to sand content n
    their diet.
    Mechanical wear tooth caused by movement of one
    tooth against other as a result of functional
    (which surfaces of teeth would be involved?)
    or
    • Para functional movements of mandible caused by
    Bruxism
    stress
    marked malalignment or malocclusion
    loss of posterior teeth
    dust/grit mixed with saliva (occupational / diet)-
    combination of attrition and abrasion
    CLINICAL
    APPEARANCE

    • Sharp well-defined
    interdigitating tooth
    wear lesions on the
    incisal edges of
    anterior teeth that
    meet in occlusion.
    CLINICAL APPEARANCE

    in posterior wear facets


    where complete loss of surface enamel dentine is exposed and
    stained heavily
    SEVERE CASE
    Teeth worn down to gingivae level
    • ABRASION
    Loss resulting from direct frictional forces b/w
    teeth and external objects. Caused by
    • Abrasive tooth pastes, powders
    • Improper brushing tech. or use of hard tooth
    brushes
    • Habits as holding pipe, pins, biting thread,
    chewing tobacco and hard objects as pen
    pencils
    CLINICAL
    APPEARANCE

    Dish or saucer shaped


    lesions on facial
    surfaces.
    Usually involving
    cervical margins
    areas most commonly
    affected labial and
    buccal surfaces of
    canines and premolars
    Worn, shiny
    polished
    yellow brown
    areas at the
    cervical
    margins
    exposed root
    surfaces when
    gingival recession
    has exposed
    cementum and
    subsequently
    dentine
    CLINICAL
    APPEARANCE
    May be seen as
    worn notch at incisal
    surfaces
    related to
    para functions,
    habits, occupation
    mainly affecting
    incisal edges of
    anterior teeth
    Habits as
    pipe smoking
    pencil chewing
    nail biting
    Intra oral ornaments
    across teeth
    Occupation related
    seamstresses- pins
    carpenters- nails
    electricians- wires
    beauticians- hair pins
    • EROSION
    Irreversible loss of dental hard tissues by a
    chemical process (acid attack) that does not
    involve bacteria.

    Described as early as 1892 among Sicilian


    lemon pickers
    MULTIFACTORIAL
    ETIOLOGY SUSCEPTIBLE
    TOOTH
    Acid resistance

    HOST
    Saliva
    TIME Anatomy
    EROSION Reflux
    Medical

    EXRINSIC
    Diet
    Lifestyle
    Medication
    Environment
    EXTRINSIC SOURCES
     DIETARY EROSION
    Crescent or dished defects commonly on labial
    surfaces of usually upper anterior teeth.
    Caused by excess of food & drink with low pH
    • Citrus fruits
    • Pickles, foods /drinks containing vinegar
    • Carbonated FIZZY drinks, sparkling water,
    energy drinks
    • ALCOHOL
    • Medication-
    CLINICAL
    PRESENTATION

    wide shallow lesion


    affecting the labial
    surfaces of anterior
    teeth

    or

    cupped or scooped
    lesion on incisal
    edges or cusp tips
    • ACIDS INVOLVED
    chiefly citric acid, found in most fruit juices and
    soft drinks.
    carbonic , acetic acid, hydrochloric, phosphoric
    acids found in many fizzy drinks and colas.
    • EROSIVE EFFECT
    due to low chemical pH or high titratable acidity
    or by chelation
    TOTAL TITRATABLE
    ACIDITY
    measure of amount of
    alkali that needs to be
    added to an acid to
    neutralize it
    inside mouth- how long
    it takes for the saliva to
    buffer it
    EXTRINSIC SOURCES – HABITS & LIFESTYLES

    Change in attitudes
    • 3 meals / day to grazing and snacking
    • Glass bottles to plastic bottles and cans
    • Drinking to swishing and frothing of drinks
    • Bed time milk to fruit-based drinks
    • Water to energy drinks (dry mouth combined with
    dehydration from vigorous exercise)
    • Habitual sucking of fruits
    • Use of drugs - ecstasy
    EXTRINSIC SOURCES –
    ENVIRONMENTAL/ INDUSTRIAL/
    OCCUPATIONAL EROSION
    • Industrial processes using acids
    fertilizers, dynamite, battery, chemicals and paint
    factories, crystal glass manufacturers
    • Occupational requirement
    competitive swimmers
    wine tasters
    athletes
     INDUSTRIAL EROSION
    Pitting defects on labial surfaces of upper anterior teeth
    INTRINSIC SOURCES

    Commonly affecting palatal surfaces of anterior and


    occ. & buccal surfaces of lower post. teeth.

    Caused by
     REFLUX (GORD)
     VOMIT ( SPONTANEOUS OR SELF INDUCED)
    Obesity
    INCREASED pregnancy
    GASTRIC
    PRESSURE ascites
    Posture including
    exercise

    Heavy spicy, fatty


    PRINCIPAL INCRREASED late night meals
    GASTRIC
    CAUSES OF VOLUME Obstruction
    GORD and/or spasm
    Hiatus hernia
    Drugs;
    SPHINCTER
    diazepam
    INCOMPETENCE Neuromuscular
    ; cerebral palsy
    Oesophagitis;
    alcohol
    METABOLIC Uraemia
    ENDOCRINE Diabetes
    HORMONAL Pregnancy-morning sickness

    Peptic ulcer, gastritis


    GASTROINTESTINAL Obstruction
    DISORDERS Nervous system disorders
    Cerebral palsy
    PRINCIPAL
    CAUSES OF Primary – cytotoxic
    VOMITING Secondary- gastric irritation by
    DRUG INDUCED Alcohol, aspirin, NSAIDS
    Long term drug induced xerostomia

    Eating disorders-
    bulimia/ anorexia
    nervosa
    PSYCHOSOMATIC
    Bizarre habits-
    rumination
    IDIOPATHIC EROSION ALSO CALLED
    ABFRACTION ( STRESS COROSION)

    Cervical wedge shaped defect caused by heavy


    force in eccentric occlusion resulting in flexural
    (elastic bending ) of tooth

    ETIOLOGY
    Occlusal forces cause the tooth to flex, causing
    enamel flecks to break off inducing abrasive
    lesions
    CLINICAL PICTURE
    wedge shaped lesions with
    sharp angles found at the
    cervical margins
    Common in patients
    PA • with poor
    alignment
    Can be associated
    with
    • Anterior open bite
    • Occlusal
    restorations that
    change cuspal
    movement
    • Abnormal tongue
    movement
    DIAGNOSIS

    • HISTORY
    • CLINICAL PICTURE
    ASSESS
    ~ NATURE OF PROBLEM
    ~ WEAR IS ONGOING OR NOT
    then
    ~ FIND THE CAUSE OF PROBLEM
    MANAGEMENT

    • CONTROL OF AETIOLOGICAL FACTORS


    • SENSITIVITY, PAIN AND CARIES CONTROL
    • PERIOD TO DETERMINE IF WEAR IS PROGRESSIVE
    • POSTERIOR SUPPORT ( dentures)
    • INCREASE IN OVD ( over dentures, bite planes, dahls
    appliance)
    • DEFINITIVE REHABILITATION ( definitive dentures,
    crowns)
    • ATW
    • TSL
    • NCTSL
    • NCTTL
    • NBTSL
    • GERD
    • GORD

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