Dental erosion and associated dentine hypersensitivity has been increasing for several years. With people living for longer and retaining their teeth for longer it is only going to become more prevalent.
2. We need to be able to recognise early erosive toothwear. Patients usually only notice tooth wear when the dentine becomes exposed i.e. the tooth is chipped or looks more yellow – it is often more difficult to treat at this stage. Early diagnosis is difficult but critical in order to implement preventative measures and preserve tooth tissue.
3. Take your patient’s age into account. In old age, we would expect some physiological tooth wear. Tooth wear in a young patient would be seen as pathological rather than physiological.
4. Use the BEWE (Basic Erosive Wear Examination) to record tooth wear for all your patients. This is likely to become an NHS requirement in the near future. The BEWE uses a 4 point scale to assess wear and the most severely worn surface is scored in each sextant: 0 = no erosive tooth wear, 1 = initial loss of surface texture, 2 = distinct defect, minor loss hard tissue, <50% surface area, 3 = hard tissue loss or more or equal than 50% of the area surface (Bartlett 2008). The cumulative score of all the sextants can then be used to determine the risk level and corresponding management.
5. 85% of patients with tooth wear will present with some degree of sensitivity and severity of toothwear is correlated with the prevalence of dentine hypersensitivity.
6. To get dentine hypersensitivity you need dentine exposure AND tubule exposure. Dentine exposure (lesion localisation) can occur through soft tissue loss (gingival recession) or enamel/dentine tissue loss (abrasion/erosion). Tubule exposure (lesion initiation) can occur through erosion and abrasion.
7. Be aware of the key risk factors and give appropriate preventative advice:
8. Management:
9. Follow up and reassessment must be performed regularly in the future to assess if wear has been halted or is still progressing. Refer complex cases of tooth wear to a specialist.
10. Bonus tip: If you want to perform supragingival scaling on teeth with dentine hypersensitivity, rub prophy polish (ideally the one for sensitivity) onto the surfaces of the teeth and then perform the procedure. This usually means you can avoid administering local anaesthesia.
These notes were derived from a webinar produced by the British Society of Periodontology. Further resources can be found at: www.bsperio.org.uk.
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