Occlusion. Factors of occlusion. The clinical significance of restoring individual occlusion, tools...

Occlusion. Factors of occlusion. The clinical significance of restoring individual occlusion, tools and steps to achieve it.

Dental Erosion: Etiology

Destruction of the dental tissues (enamel, dentin, cementum) can occur as a result of physical loss, chemical dissolution,

and/or multifactorial etiology.3,6

Tooth Wear

Destruction of the dental tissues (enamel, dentin, cementum) can occur as a result of:3,6

• Physical Loss

– Abrasion—mechanical

– Attrition—tooth-to-tooth contact

– Abfraction—lesions

• Chemical dissolution

• Multifactorial etiology


Tooth Wear


• Physical Loss


– Erosion

-- Extrinsic acids

-- Intrinsic acids



Tooth Wear


• Physical Loss



– Erosion

– Abrasion

– Attrition

– Abfraction


Tooth Wear

The pathological wearing away of hard dental tissue through abnormal mechanical processes involving foreign objects or substances repeatedly introduced in the mouth and contacting the teeth.6

• Oral hygiene habits Excessive brushing/flossing Abrasives in dentifrices/toothpastes

• Personal habits Putting foreign objects in the mouth

• Demastication Wear from chewing food

Abrasion


The pathological wearing away of hard dental tissue as a result of tooth-to-tooth contact, with no foreign substance intervening.6

• Enamel wearing enamel Occlusal wear Malocclusion (buccal, lingual, and interproximal surfaces)

Attrition


Wedge-shaped defects at the cementoenamel junction of a tooth caused by eccentrically applied occlusal forces leading to tooth flexure that results in microfracture of enamel and dentin.6

• Loss of tooth in the cervical area Tooth flexure

– Chewing

– Grinding (bruxism)

Abfraction


The physical results of a pathologic, chronic, localized loss of hard dental tissue that is chemically etched away from the tooth surface by acid and/or chelation without bacterial involvement.7

• Extrinsic acids—ingested Food, beverages, medicine

• Intrinsic acids—internal Originate in the stomach

Erosion


Tooth wear is multifactorial

• One process typically impacts the other

– Erosion and abrasion

Multifactorial


Tooth erosion was described as a condition distinct from caries as early as the 18th century.8

Dental Erosion: Epidemiology

In 1995, the European Journal of Oral Science stated that “dental erosion is an area of research and clinical practice that will undoubtedly experience expansion in the next decade.”9

Change in Perception



Global Prevalence

Global data on the prevalence of dental erosion is building. “Erosive tooth wear is a common condition in the developed

countries.”10

United States

CanadaIceland

Ireland

Sweden

Germany

Turkey

Saudi ArabiaIndia

Brazil

Japan

Malaysia

Switzerland

The NetherlandsUK

China

• European studies suggest prevalence of:11-13

– Up to 50% if all preschool children– Between 24% to 60% of school-aged children– As high as 82% in 18 to 88 years of age10

• Emerging prevalence studies providing data on gender, socio-economic status, ethnic, and culture difference in addition to the age factor will prove to be invaluable

Global Prevalence


“Diagnosis is the intellectual course that integrates information obtained by clinical examination of the teeth, use of diagnostic aids, conversation with the patient, and biological knowledge. A proper diagnosis cannot be performed without inspection of the teeth and

their immediate surroundings.”14

Dental Erosion: Diagnosis

Dental Erosion—Diagnosis

Check list to unveil etiological factors for

erosion15


Interaction of the different factors for the development of

erosive tooth wear16,18

From: Lussi A. Dental Erosion: From Diagnosis to Therapy. Karger; 2006.


Clinical Appearance

There is no device available for the specific detection of dental erosion in routine practice. Therefore, the clinical appearance is the most important feature for

dental professionals to diagnosis dental erosion.16

Dental Erosion—Diagnosis

Tooth Wear—Clinical Appearance17

• Chemical factors—erosive potential of intrinsic and extrinsic acids

• Biological factors—involve properties and characteristics of the oral cavity

• Behavioral factors—personal and oral habits

Erosion is multifactorial


• pH and buffering capacity of the product

• Type of acid (pKa values) Intrinsic (gastric origin) Extrinsic (environmental, dietary, medicinal)

• Adhesion of the products to the dental surface

• Chelating properties of the products

• Calcium concentration

• Phosphate concentration

• Fluoride concentration

Chemical Factors18


• Saliva: flow rate, composition, buffering, capacity, and stimulation capacity

• Acquired pellicle: diffusion-limiting properties, composition, maturation, and thickness

• Type of dental substrate (permanent and primary enamel, dentin) and composition (eg, fluoride content as FHAp or CaF2-like particles)

• Dental anatomy and occlusion

• Anatomy of oral soft tissues in relationship to the teeth

• Physiologic soft tissue movements

Biological Factors19


• Unusual eating and drinking habits

• Healthy lifestyle: diets high in acidic fruits and vegetables

• Unhealthy lifestyle: frequent consumption of “alcopops” and designer drugs

• Alcoholic disease

• Excessive consumption of acidic foods and drinks

• Nighttime baby bottle feeding with acidic beverages, including milk

• Oral hygiene practices: frequent toothbrushing, abrasive oral care products

Behavioral Factors20


Loss of tooth surface is a multifactorial process and education

is the first step in the line of defense.4

Prevention


Dynamics of Dental Erosion21

Before During After

Time (Frequency)

Interactions between Behavioral and Biological Factors

Dental Erosion: Diagnosis/Management

21. Lussi A, Kohler N, Zero D, et al.

Dental Erosion:Management/Etiological Factors

Dietary factors15

• Avoid radical changes in dietary habits

• Reduce acid exposure by reducing frequency and contact time of acid

• Avoid acidic foods and drinks late at night

• Avoid high-acidity liquids via baby bottle for infants

• Avoid low pH values in food and beverages

Awareness/Association/Education

Dental ErosionManagement/Etiological Factors

Dietary factors: generally, a pH value of 5.5 or lower is capable of softening the surface of enamel

in only a few minutes.3


3. Strassler HE, Drisko CL, Alexander DC.


Behavioral/habits15

• Do not hold or swish acidic drinks in your mouth

• Avoid sipping acidic drinks—use a straw

• Avoid toothbrushing immediately after an erosive challenge (vomiting, acidic diet)

• Avoid toothbrushing immediately before an erosive challenge, as the acquired pellicle provides protection against erosion

• Use a soft toothbrush



Behavioral/Habits15

• Use a low-abrasion fluoride-containing toothpaste; high-abrasive toothpaste may destroy pellicle

• Avoid toothpastes or mouthwashes with too-low pH

• After acid intake, stimulate saliva flow with chewing gum or lozenges

• Use chewing gum to reduce postprandial reflux

• Refer patients or advise them to seek appropriate medical attention when intrinsic causes are involved


Gastroesophageal Origin22

• Heartburn and other symptoms of reflux

• Regurgitation

• Dysphagia

• Asthma

• Rumination

• Eating disorders (anorexic or bulimia)



Medicinal factors associated with dental erosion23

• Some medicines can potentially induce GERD theophyline progesterone anti-asthmatics calcium channel blockers

• Aspirin (especially in chewable format)

• Medicines that decrease salivary flow antihistamines anticholinergics antidepressants antipsychotics



Prosthodontic Treatment of Tooth Wear

Dental Erosion/Toothwear

Prevention is better than a cure… Education is the key!

Occlusion. Factors of occlusion. The clinical significance of restoring individual occlusion, tools...

Documents

Transcript of Occlusion. Factors of occlusion. The clinical significance of restoring individual occlusion, tools...