Upload
alaa-adas
View
214
Download
0
Embed Size (px)
Citation preview
8/13/2019 Tooth Wear 11
1/19
1
A surface loss of dental hard tissues other than by caries or trauma
and its a natural consequence of ageing so everyone gets old he or she
will suffer from tooth wear and it may happen in children or adults
The Doctor was talking about tooth loss of several pictures but
unfortunately theresno soft copy I tried my best forgive me if
theres a picture that is not clear ..
there are different things that can cause damage to theteeth ..
dental caries, tooth caries involves the action of bacteria tooth wear , it doesnt involve the action of bacteria traumatic injuries because of accidents causes fractured of
the tooth and causes tooth loss
sometime during development the teeth can be damaged
8/13/2019 Tooth Wear 11
2/19
2
the difference between dental caries and the rest
both causes damage to the teeth and lossof dental tissue
dental caries involves the action ofbacteria, if bacteria acts on sweets the end
result will be acids
tooth wear doesnt involve the action ofbacteria
if tooth wear is associated with acid thentooth wear will be worse, but not with the
action of bacteria which makes the tooth
wear worse
o Components of tooth wear Erosion Abrasion Attrition
8/13/2019 Tooth Wear 11
3/19
3
Erosion
It means something eroding the surfaces of your teeth andcausing damage ,minerals loss or tooth substance loss
So its the loss of dental hard tissue as a result of a chemicalprocess not involving bacteria
The cause is acid ,but itsnot coming from bacteria you are takingthe acid directly in your mouth from citrus fruit for example
The sources of acids ..It can be
Extrinsic acids like dietary Intrinsic acids like the acids associated with the
stomach
1. Dietary including :
- foods such as citrus fruits ,pickles and other items containing
vinegar ( )-carbonated and acid containing drinks such
- acidic medications is occasionally implicated
- occupational and recreational acids.
those who works as painter are subjected sometimes to erosion.
8/13/2019 Tooth Wear 11
4/19
4
2. stomach acids associated with : ..
o anorexia nervosa (this is a psychological effect, whenpeople eat too much and they are worry about their
weight ,they try to vomit himself, by inducing vomiting,
All of the acids in the stomach comes out to erode and
flush the palatal surfaces of the front teeth causing
tooth loss
o hiatus herniao peptic ulcers ( keeping the acid in your mouth, so the
acidity in your mouth directed to the palatal surface
of your teeth so demineralization of the palatal teeth
occur)
o pregnancy with prolonged morning sickness ( the pregnantwoman will vomit in the morning, when the stomach is empty
usually she vomits acidic fluids and this is can cause damage
to the palatal surface of the teeth)
o digestive disturbances which cause recurrent vomiting ( anystomach, GIT problems that may cause vomiting, then you
are subjected to dental erosion
The clinical appearance-clean, non-tarnished appearance of amalgams
- loss of surface characteristics of enamel in young children
- preservation of enamel "cuff inthe gingival crevice is common
- hypersensitivity in teeth
- pulp exposure especially in deciduous teeth
8/13/2019 Tooth Wear 11
5/19
5
- broad concavities within smooth surface enamel
- cupping of occlusal surface,, (incisal grooving) with dentinexposure
- increased incisal transluency
- wear on non-occluding surfaces
- "raised" amalgam restorations or crowd amalgam restorations
Examples
1**this is 14-year old female exhibits total LOSS OF SURFACE
CHARACTERISTICS and polished appearance of enamel on her
maxillary incisors, the enamel layer was also very thin.
8/13/2019 Tooth Wear 11
6/19
6
2** Gastroesaphageal reflux disease(GERD) was discovered in this 19
years old boy who exhibited early, GENERALIZED EROSION (arrow
A)..Note the preservation of the enamel (cuff) at the gingival
crevice (arrow B),, because of acids ..
3**. when you see a cuff on enamel itsnot due to crown preparation
then you should think of erosion...the blue arrow indicates a cuff of
enamel
8/13/2019 Tooth Wear 11
7/19
7
4**. The fissure sealant in this 14-year old boy stands "raised" from
surronding eroded occlusal enamel ,the acids eroded the tooth
substance without eroding the fissure sealant because its made of
resin ,notice that there is no any anatomical landmarks on the occlusal
surface ,they have been eroded
the acids will leave the resin or amalgam without erodingalso the surface of the amalgam will be shiny because ofcontinuously washed with acids (non tarnished)
5**. here we have erosion due to soft drinks ,erosion of the left side
mandibular molars of female who habitually enjoyed holding a cola
beverage in this area here which is the left side for several minutes
before swallowing..
as we know that the ph of the cola is above 3 which is very acidic
8/13/2019 Tooth Wear 11
8/19
8
6.** here a two years of continual consumption of canned citrus drinks
in a hot country led to this erosion of the cervical areas of posterior
teeth.
7**. restoration of eroded teeth in this patient will require crown
,here you got something very damaged you start talking aboutdifferent solution you will put composite it will stick to the surface no
problem, but if you dont stop the causative agent the lesion will
continue
8/13/2019 Tooth Wear 11
9/19
9
8**. extreme example of tooth erosion in patient who sufferedrepeated gastric regurgitation.., here the palatal surfaces are eroded
with thin enamel labialy
9.**Here the tooth tissue has been eroded and the amalgam setting
thereundisturbed, the surface of the amalgam its shiny because its
continuously being washed with acid so its non-tarnished ,raised
Whats a proud amalgam restoration? , the amalgam seen inthe case of erosion
The amalgam and fissure sealants will be setting proudly inthe eroding surfaces ..
8/13/2019 Tooth Wear 11
10/19
10
Attrition
The lower jaw is occluding with the upper jaw for chewing forexample so teeth are rubbing against each other during this
dynamic contact throughout life this will cause tooth loss
mechanical loss of tooth surface or restoration caused by toothto tooth contact during mastication or parafunction (bruxism) .
so againEROSION : due to acidsATTRITION : due to tooth to tooth contact
CLINICAL FEATURES OF ATTRITION:
- shiny facets on amalgam contacts
- enamel and dentin wear at the same rate
- possible fracture of cusps or restorations
and you may have a condition called ABFRACTION
8/13/2019 Tooth Wear 11
11/19
11
Examples
1. this 42- years old female has a bruxism and no other known riskfactors for erosion ,demonstrating moderate to severe attrition
2. this is attrition in eccentric occlusion
8/13/2019 Tooth Wear 11
12/19
12
3. this is Cusp facets,, cusp tips have been eliminated and the result is
a crack areas show yellowish color which is dentin ,,The buccal of the
lower cusps tend to suffer more because they are functional
Sever attrition may cause problem to the lower teeth,andteeth may become non vital
Abrasion
pipe smokers for example this will cause abrasive lesion in theteeth
so itsthe wearing a way of tooth substance by mechanicalmeans of other than by opposing teeth, such as over-vigorous
tooth brushing or holding pipe..
- usually located at cervical areas of teeth
- lesions are more wide than deep
- premolars and cuspids are commonly affected
8/13/2019 Tooth Wear 11
13/19
13
Just to remind you ;P ,,
EROSION : acids to tooth contact
ATTRITION : tooth to tooth contact
ABRASION : foreign bodies to tooth contact (mechanical)
Examples
1. this abrasion due to pipe smoking , holding the pipe will cause rubbing
to the teeth
2. this abrasion due to nail biting
8/13/2019 Tooth Wear 11
14/19
14
3. this abrasion due to vigorous tooth brushing (hard
toothbrush ) here lower and upper incisors are the teeth
that suffer most
ABFRACTION:
Is the loss of tooth surface at the cervical areas of teeth
caused by tensile and compressive forces during tooth
flexure
Clinical features of ABFRACTION :
Affects buccal/labial cervical areas of teeth deep, narrow V-shaped notch commonly affects single teeth with excursive
interferences or eccentricocclusal loads
8/13/2019 Tooth Wear 11
15/19
15
this patients canines and bicuspids have characteristics that can
be attributed to both abrasion and abfraction.It started with abfraction then because of tooth brushing
it will increase so its a combination
By the way this is not class five , its not caries!
Note , class five can be buccaly or labialy (facially ) and
lingually ..
o You can ask the patient ,, how long has it beenAlso was it small and got larger
So by this you can rule out caries
o If you want to rule out abfraction you can askWhats thejob ?
Do they get angry ?
8/13/2019 Tooth Wear 11
16/19
16
some examples ..
A painter , paints contain acids so we expect erosion in the
anterior teeth in the labial surfaces
A finical leader we expect attrition because of stress
A carpenter we expect abrasion because of holding foreign
objects in the mouth
Diagnosis and monitoring of tooth wear:-view teeth clean and dry
- take study models at six months interval to determine the
rate of progress ( this is ver imp.) its still the same or its
deteriorating
- take sympathetic history to elicit the cause
Taking history for Erosion:- past and present diet
- digestive disorders
- past and present slimming habits
- alcohol intake
- is the patient under any medications?
- occupation
8/13/2019 Tooth Wear 11
17/19
17
Taking history for Attrition and Abrasion- clenching and grinding habits
- periods of stress or anxiety
- square face which because of over developed muscles
Seen usually in leaders ..
- pipe smoking ,opening hairgrips...etc
Preventing tooth wearo diminishing the frequency and severity of the acid
challenge
o enhance the defense mechanisms of the body (increase salivary flow
and pellicle formation)
o enhance acid resistance , remineralization of the toothsurface
o decrease abrasive forceso provide mechanical protection.byBRA.. its the bight raising appliance that protect the
teeth like (night guard)
o monitor stability (casts and recall visits)
8/13/2019 Tooth Wear 11
18/19
18
When are restorations necessary? this is a very imp.
question
A. patientsdecision :
-patient appearance
- tooth becomes sensitive
B. Dentists decision:
- decrease in occlusal vertical dimension
- pulp exposure- in advance cases crowns are required
8/13/2019 Tooth Wear 11
19/19
19