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Erosion
Abrasion
Attrition
Abfraction
Study models
Indices
Photographs
Can all be helpful
Restorative treatment
Difficult to control
Very different to dental caries in
appearance and causation
Erosion
Clinical Presentation
Erosion
Erosion
Causes of erosion
Extrinsic factors
Intrinsic factors
Idiopathic factors
Chemicl pH
Acids involved
Titratable acidity
Acidic foods
Pickles, sauces, vinegars, yoghurts,
roasted vegetables
Rumination
The term rumination is derived from
the Latin word ruminare, which
means to chew the cud. Rumination
is characterized by the voluntary or
involuntary regurgitation and
rechewing of partially digested food
that is either reswallowed or
expelled. This regurgitation appears
effortless, may be preceded by a
belching sensation, and typically
Anorexia
Bulimia
Hiatus Hernia
Pregnancy/Hormones
Motion sickness
Obesity
Eating too much
Drinking too much
Alcoholism
Anorexia
Bulimia
Saturday Night?
Idiopathic causes of
erosion
Unknown cause
Patient will not admit to or be aware
of intrinsic or extrinsic causes
Vigorous tooth brushing can
contribute to an over polished
appearance - shiny
Abrasion
Definition: The abnormal wearing
away of tooth tissue by a mechanical
process
The location and pattern of abrasion
is directly dependent upon its course
It usually occurs on the exposed root
surfaces when gingival recession has
exposed the cementum
It may be seen on the incisal or
inteproximal surfaces of the teeth
Causes of Abrasion
Incorrect
Clinical appearance of
Abrasion
Abrasion
Abrasion
Causes of Abrasion
Attrition
Definition: The physiological wearing away
of the tooth surface as a result of tooth to
tooth contact as in mastication
Occlusal and incisal surfaces of the teeth
most commonly affected
May also affect the proximal surfaces of
the teeth due to slight movement of the
teeth in their sockets during mastication
Age related process
Varies from person to person
Attrition
Causes:
Bruxism
Abrasive (gritty) diet
Constant chewing tobacco/ betel
nut
Marked malalignment or
malocclusion
Loss of posterior teeth
Occupational, dust/grit mixed with
saliva
Clinical appearance of
Attrition
Attrition
Attrition
Attrition
Attrition
Abfraction
Definition: The pathological loss of enamel
and dentine due to occlusal stresses
Recently interest has grown in the
development of cervical abrasive lesions
The term abfraction has been used to
describe these cervical lesions
Abfraction
Causes of Abfraction
Abfraction
Common in patients with poor tooth
alignment
Can be associated with:
Anterior open bite
Occlusal restorations that change the
cuspal movements
Abnormal tongue movement
3.
4.
5.
6.
Treatment Plan
Indices BEWE
0 No Erosive Wear
1 Initial loss of Surface texture
2 Distinct defect, hard tissue <50% of
the surface area
3 Hard tissue loss >50% of the
surface area
* (2,3) dentine involved
Sensitivity
Dentine Hypersensitivity Dentine is the highly
sensitive part of the tooth
Patients suffering from dentine hypersensitivity
often think that they have developed a cavity or
lost a filling
On examination there is often no obvious reason for
their pain, gingival recession is sometimes evident
The amount of recession does not seem to correlate
with the amount of pain they are experiencing
c/o short sharp episodes of pain caused by
temperature, touch by metal, sweet foods/drinks
Patients can be very distressed by the pain of
dentine hypersensitivity and often avoid the
causative stimuli as much as possible
Sensitivity
Dentine
Dentine
Dentinal tubules
Dentine Hypersensitivity
Theories
3 theories as to how we feel the pain
of dentine hypersensitivity
1.
2.
3.
Dentine Innervation
Theory
Nerve fibres from the Nerve Plexus of
Raschkow (next to the dentine /pulp
boundary, along side the Odontoblast
activity) penetrate the dentinal
tubules and cause impulses
Not the most likely theory: whilst the
nerve fibres do penetrate the
tubules, there are not enough of
them and they do not penetrate
deeply enough into the tubules to
Odontoblast Receptor
Theory
Proposes that Odontoblasts receive
and pass on impulses and that when
they are touched cause the sensation
of pain
Not the most likely theory: as there are
no synapses between the
Odontoblasts and the Nerve Plexus of
Raschkow
(Synapses junctions between
neurones where chemicals transmit
Hydrodynamic Theory
Most likely theory: Answers more questions
Lymph like fluid inside the dentinal tubules is
stimulated by temperature, touch and sweet
sensations, causing it to flow backwards and forwards
within the tubules, this gives the sensation of pain
Hot/cold causes expansion/contraction causing the
fluid to flow
Salt/sweet causes osmotic pressure, flows towards
the concentrate
Tactile/Electrical (Touch) ?! contraction of the fluid?
Research continues, what they do know is how to treat
it
Dentine Hypersensitivity
Treatments
Most commonly treated by:
Mechanical Barriers
Stimulation of Peritubular or Reactive
Dentine
Increasing potassium concentrations
Mechanical Barriers
Stimulation of Peritubular or
Reactive Dentine
The dentine lays down a protective
layer
High concentration fluoride
Duraphat Varnish, Gel Kam
(Fluorigard gel)
Siloxane Esters Tresiolan, Sensitrol
etc
Both will wear off so need to be
reapplied
Fluoride
Nerve Impulses
Sodium Potassium
Exchange
Toothpaste Claims
Sensodyne
Traditionally Nerve depolarising
toothpastes
Active ingredients :
- Potassium Nitrate + Sodium Fluoride
- Potassium Chloride + Sodium fluoride
Potassium keeps the sodium outside the
cell wall
By adding the fluoride to the newer types
of Sensodyne you get the tubule occlusion
phenomenon caused by dentine irritation
and laying down of a secondary layer
Sensodyne Pronamel
but:
Strontium Chloride Sensodyne Original,
occludes tubules! However as it reacts
with fluoride became less popular
Other Brands
Enamel Care toothpaste - Amorphous Calcium
Phosphate ACP (soluble salts of Calcium and
Phosphate): highly soluble and there is limited
data in the treatment of Dentine Hypersensitivity
Recaldent (Toothmoose) CCP-ACP Casein
Phosphates, derived from milk proteins mixed with
the calcium and phosphate salts: no apparent
published clinical data on its effects of reducing
Dentine Hypersensitivity
Blanx, Biorepair- Hydroxyapatite + Sodium Monofluorophosphate: tubular occlusion but limited
published data
Monitoring
Prevention
Thank you