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Tooth Wear and BEWE

Tooth Wear and BEWE

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Tooth Wear and BEWE

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  1. Tooth Wear and BEWE Scott Wright

  2. Introduction Explanation Aetiology Screening Management Conclusion

  3. Tooth Wear AKA Tooth Surface Loss Growing problem within the UK – 1979 28% edentulous, 2009 9% (Eng, Wales, NI) Defined as ‘progressive loss of dental hard tissue by chemical & mechanical actions – other than those caused by caries or trauma’ Multifactorial Classified in two ways Paper by Victor Ka Cheong Yim– Tooth Wear: Screening, Diagnosis and Management in General Dental Practice

  4. Tooth Wear Classification 1

  5. Tooth Wear Classification 2

  6. Signs and Symptoms of Tooth Wear

  7. Erosion Dissolution of enamel and dentine by acidic compounds of non-bacterial origin Extrinsic factors – fruit juices, carbonated drinks, beer, wine Intrinsic factors – stomach acid eg. bulimia, alcoholism, gastro-oesophageal reflux disease Change of colour– transparency of incisal edges, yellowing as underlying dentine shines through Dentine hypersensitivity Saliva protects against – buffers acids to return to neural pH where enamel cannot be dissolved Can be physiological or pathological

  8. Attrition Tooth Wear caused by tooth to tooth contact Starts at incisal edges or occlusal surfaces particularly cusps Wear facets develop Most commonly caused by bruxism Can be due to malocclusion Can be physiological or pathological

  9. Abrasion Combination of chemical and mechanical tooth wear Classically cervical lesions of canines and premolars Caused by excessive toothbrushing, denture clasps, whitening toothpastes,holding metal objects in mouth etc Sensitivity, aesthetics Pathological

  10. Abfraction Mechanical loss of tooth structure Theoretical loss of cervical part of tooth due to flexion under excessive and repeated forces over time Forms very smooth surface – often stained but not carious

  11. Basic Erosive Wear Examination AKA BEWE +/- RAG (Red, Amber, Green) Previously indices were used such as Eccles, Smith & Knight, Lussi Screening tool originally for erosion, now applicable to all types of tooth wear Can give an indication of management options

  12. How to Use Scored like a BPE – split mouth into sextants Score most severe in each sextant Add together for indication for management and assessment of pathological or physiological tooth wear relative to age

  13. Detailed Assessments for TW Red And TW Amber

  14. Treatment Far-reaching – paper didn’t really go into this Address underlying causative factors –eg. Acidic components of diet, toothbrushing equipment and technique Restoration – bonding issues, reduced OVD PREVENTION

  15. How treatment of pathological tooth wear fits into treatment planning…..

  16. Prevention of Tooth Wear

  17. Conclusion BEWE-RAG should be used as a screening tool for all patients Early detection, monitoring and treatment are key to halt/slow progression Prevention is key

  18. Please don’t ask questions…