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Full Mouth Rehabilitation
Management of tooth wear

Tooth Wear

Tooth wear refers to the gradual loss of tooth structure due to biting forces wearing the teeth away or acids dissolving away tooth structure. This process can affect the enamel, dentine, and, in severe cases extend into the pulp (nerve space) of the tooth. Tooth wear can be caused by a range of factors, and understanding these can help in diagnosing and treating the condition effectively. There are four main types of wear;

  1. Attrition: This is the wearing away of the tooth structure caused by the friction between teeth. It typically occurs due to tooth-to-tooth contact, such as grinding or clenching (bruxism). It can also result from activities like chewing hard foods or using teeth to open packages.

  2. Abrasion: This type of wear is caused by external mechanical factors, such as the use of a hard toothbrush or abrasive toothpaste. It can also be due to habits like chewing on pens or nails. Abrasion usually affects the cervical (gumline) areas of the teeth.

  3. Erosion: This involves the chemical dissolution of the tooth enamel by acids, which can come from dietary sources (like citrus fruits, carbonated beverages, and wine) or gastric acids (from conditions like gastroesophageal reflux disease (GERD) or bulimia). Erosion typically affects the smooth surfaces of the teeth and can lead to a loss of enamel.

  4. Abfraction: This is the loss of tooth structure at the cervical area due to biomechanical forces, such as tooth flexure during chewing or clenching. It is often associated with stress concentration at the gumline and can lead to wedge-shaped defects.

Symptoms of Tooth Wear:

  • Sensitivity to hot, cold, or sweet stimuli.

  • Visible changes in the teeth, such as flattening, cupping, or shortening of the tooth crowns.

  • Increased wear on dental restorations, such as fillings and crowns.

  • Changes in the appearance of the bite or misalignment of teeth.

Management:​

Managing tooth wear involves addressing both the causes and the effects, aiming to preserve dental health and functionality while enhancing the patient's comfort and appearance. It can be complex to manage tooth wear because there are often multiple teeth that need treatment. A common issue we see at the clinic wis where teeth are treated in isolation and then the fillings that are placed regularly fail/ fall off. When treating these cases, it is important to look at all the teeth together rather than focussing on a single tooth. It is often necessary to place fillings or crowns on multiple teeth at the same time to give a stable bite and protect the teeth that have been built up. This treatment of multiple teeth is known as 'Full Mouth Rehabilitation.

This tooth wear case was treated by Dr Chris O'Connor at our Great Park Clinic (@Newcastle_Dentsit)

Tooth wear full mouth rehab
Tooth wear full mouth rehabilitation

Full Mouth Rehabilitation

Full mouth rehabilitation, also known as full mouth reconstruction or restoration, is a comprehensive dental treatment plan designed to address and restore the health, function, and aesthetics of the entire mouth. This involves a combination of dental procedures aimed at protecting  all the teeth in a patient's mouth.

Here are some key aspects of full mouth rehabilitation:

  1. Assessment and Diagnosis:

    • Oral Health Evaluation: Comprehensive examination of teeth, gums, jaw, and overall oral health.

    • Imaging and Diagnostics: X-rays, three dimensional digital imaging, and other imaging techniques to assess the condition of teeth, jawbone, and surrounding tissues.

    • Occlusal Analysis: Evaluation of the bite (occlusion) to identify issues with how the teeth come together and how different biting positions impact upon the stability of any planned fillings.

  2. Treatment Planning:

    • Individual Planning: Development of a personalised treatment plan based on the patient's specific needs and goals.

    • Multidisciplinary Approach: Often cases are complex and different dentists within the practice will be involved in different phases of treatment.

  3. Various different dental procedures may be required as part of an overall treatment plan:

    • Restorative Procedures: Crowns, bridges, inlays, onlays, and fillings to repair damaged teeth.

    • Prosthetic Solutions: Dentures, implants, and implant-supported restorations to replace missing teeth.

    • Orthodontics: Braces or aligners to change the position of teeth.

    • Periodontal Treatments: Scaling, root planing, and gum surgery to address periodontal (gum) disease.

    • Endodontic Therapy: Root canal treatments for teeth with infected or damaged pulp.

    • Cosmetic Procedures: Veneers, bonding, and teeth whitening to improve the appearance of the teeth.

  4. Rehabilitation Goals:

    • Functionality: Restoring the ability to chew, speak, and function normally.

    • Aesthetics: Enhancing the appearance of the teeth and smile.

    • Oral Health: Improving the overall health of the mouth and preventing future dental problems.

  5. Post-Treatment Care:

    • Maintenance: Regular dental check-ups and cleanings to maintain oral health.

    • Stabalisation: A splint may be needed to stabalise biting forces especially at night time. There may also be periodic adjustments to dental appliances and restorations as needed.

 

Full mouth rehabilitation is typically recommended for patients with extensive dental issues such as severe tooth decay, significant tooth wear, multiple missing teeth, advanced periodontal disease, or trauma. It can be a transformative process, significantly improving both the functionality and appearance of a patient's mouth.

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