DENTAL Wear & EROSION
When I qualified, I always remember seeing masses of decay, especially from the radiographs inter proximally. I'd be very concerned if I noted anything occlusally, as it would need some CAOH and "IDPC" in my extensive notes for a clue later on. Then gain access under LA, remove the soft tissue, then fill the holes with amalgam.
It was simpler back then and safer when we progressed to encapsulated amalgam.
And the evidence is that dental amalgam lasts longer in the average mouth than white fillings. Every time you have a filling replaced, there is less tooth left.
It was simpler back then and safer when we progressed to encapsulated amalgam.
And the evidence is that dental amalgam lasts longer in the average mouth than white fillings. Every time you have a filling replaced, there is less tooth left.
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I would say it's only within the last twenty years I have noted erosion, other than with those living with bulimia.
It's becoming far too common. From memory, it was taken about eight years ago on a fourteen-year-old boy. Your heart sinks! |
I tell the parent about their children's BEWE scores and how they compare with their own.
Then I send an email template to the parent with the BEWE score. We discussed diet in the surgery, and in my experience, it's ALWAYS carbonated drinks or orange juice and explained the tooth wouldn't grow back using toothpaste.
The marketing of toothpaste has an interesting history. Claude Hopkins from advertising, improved OH by focusing on removing the "film" and having fresh breath using Pepsodent in the '30s. The brushing habit improved the nation's teeth as Fluoride didn't arrive until the 50s in Crest.
Apadent in the 80's with a nano-hydroxyapatite to repair the tooth
And more recently, a biomimetic hydroxyapatite.
I'm not convinced about some products, such as corsodyl toothpaste, as I can't find an unbiased article. Triclosan has also been in the news and banned in certain countries. The original toothpaste tubes were made of lead, and my favourite floss contains Teflon after watching "Dark Waters " on Netflix. That is a potential issue. 🤔
When it comes to reducing dental problems, we all know the brush does over 95% of the work. This directive on diet for child obesity may be a welcome start, and while it doesn't mention teeth, the Dental Profession could promote it. Similarly, we could encourage diet histories to lose weight. It's in Charles Duhigg's Ted Talk. The App is designed to Nudge and use gamification to improve habits with a traffic light system. And while dentistry only gets two paragraphs in the prevention document, perhaps we can highlight the mutual benefits of dental and health promotion. There is no magic money tree for dentistry. The new norm in preventive dentistry is we will have to do it outside government help despite their own research.
Then I send an email template to the parent with the BEWE score. We discussed diet in the surgery, and in my experience, it's ALWAYS carbonated drinks or orange juice and explained the tooth wouldn't grow back using toothpaste.
The marketing of toothpaste has an interesting history. Claude Hopkins from advertising, improved OH by focusing on removing the "film" and having fresh breath using Pepsodent in the '30s. The brushing habit improved the nation's teeth as Fluoride didn't arrive until the 50s in Crest.
Apadent in the 80's with a nano-hydroxyapatite to repair the tooth
And more recently, a biomimetic hydroxyapatite.
I'm not convinced about some products, such as corsodyl toothpaste, as I can't find an unbiased article. Triclosan has also been in the news and banned in certain countries. The original toothpaste tubes were made of lead, and my favourite floss contains Teflon after watching "Dark Waters " on Netflix. That is a potential issue. 🤔
When it comes to reducing dental problems, we all know the brush does over 95% of the work. This directive on diet for child obesity may be a welcome start, and while it doesn't mention teeth, the Dental Profession could promote it. Similarly, we could encourage diet histories to lose weight. It's in Charles Duhigg's Ted Talk. The App is designed to Nudge and use gamification to improve habits with a traffic light system. And while dentistry only gets two paragraphs in the prevention document, perhaps we can highlight the mutual benefits of dental and health promotion. There is no magic money tree for dentistry. The new norm in preventive dentistry is we will have to do it outside government help despite their own research.
FROM THE BMJ What this study adds
- This systematic review demonstrates a median return on investment of public health interventions of ∼14:1. Thus, for every £1 invested in public health, £14 will subsequently be returned to the wider health and social care economy. Furthermore, this review categorises the return on investment according to the public health speciality and local versus national levels of intervention. It suggests that cuts to public health services are short-sighted and represent a false economy with substantial opportunity costs.
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Unfortunately, you can often compare a teenager's BWS with their parent's teeth and show the enamel loss.
A picture says a thousand words. Look for erosion wear on your BWS. In the future, I think your digital scanner will warn you and your patient. |
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In my opinion, the most significant cause of erosion is carbonated drinks and fresh orange juice. It may not be practical to tell a parent and their teenage children to stop totally. But we know having the drinks at mealtimes, very cold, and with a straw helps. I think this may be better than the expectation that some of the newer kinds of toothpaste will cure the problem. It's unusual to see erosion at these levels as a recent event in adults. Possibly due to the effect of fluoride toothpaste on the surface enamel for many years?
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This is an attempt to merge a few messages in a short period of time using a phrase that we have all come to learn in 2020.
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Concerning wear and occlusion, I worked for the chairman of the UK branch of the
Pankey Institute 35 years ago. I made a lot of tanner appliances. If the occlusion is an interest of yours, then this is a great resource. And now you can do the course from home.
Pankey Institute 35 years ago. I made a lot of tanner appliances. If the occlusion is an interest of yours, then this is a great resource. And now you can do the course from home.
This is a slide taken from a talk by the Clinical Director of the Pankey Institute. At the Sironaworld meeting in 2015 in Las Vegas where I first heard the term Volkscrown.
As the material bonds to the tooth surface, how should you make your prep? Or should you bother at all?
When I started work, I'd occasionally tell the patient the technician made a mistake, and it would be a few weeks, and the crowns would "bed in". We hadn't become aware of the Dahl process that worked well for the erosion case above.
I took a scan, designed it, milled it and fitted it.
Sometimes, they have chipped but not in the occlusal portion, and the dentine is protected. The choice then is a composite repair or observation.
I used the same process for his front tooth. What else can you do? Refer to a non-existent NHS specialist unit?
These teeth were thin. There was no preparation. I am just trying to protect tooth tissue until a better long-term solution is available.
These teeth were thin. There was no preparation. I am just trying to protect tooth tissue until a better long-term solution is available.
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