Investigating the Causes of Wear Facets on Teeth
Here’s the scenario: you’re doing a full clinical exam on a new patient and you see multiple wear facets on the teeth. What do you do next? While it can be tempting to prescribe a nightguard and be done with it, Dr. Paresh Shah, a general dentist from Winnipeg MB, argues that it is important to first get a sense of differential diagnosis and to understand the why. What exactly is going on here? Is the problem caused by attrition? Abfraction? Erosion?
In this conversation with Dr. John O’Keefe, Director of Knowledge Networks CDA, Dr. Shah shares valuable insights into the comprehensive examination and diagnosis of multiple wear facets. He lays out the key lines of questioning, and emphasizes the importance of retaining an inquisitive mindset in order to get a good understanding of the underlying issue.
“I can put an appliance in there but it’s not solving the problem. We need to have a discussion with the patient and try to come up with something that’s more preventative.”
- It is important to establish the underlying problem and why it is happening. Different types of wear will require different types of treatment.
- Is the problem active or inactive? Is it something that happened in the past and is no longer a problem or is it ongoing? Sometimes patients don’t realize the severity of the wear and they don’t understand that it might be changing.
- If the problem is localized to a single tooth, ask if there are any ongoing symptoms (e.g. sensitivity).
- Look at the periodontal chart to see of ligaments have changed. This may indicate that the problem is occlusal.
- Consider looking at an x-ray.
- If the root cause is attrition, look at tooth positions. Has the opposing tooth changed? Has there been compensatory over eruption?
- Investigations may take place over a period of time. Consider taking scans 6-12 months apart and compare them to assess whether there is ongoing change in tooth position, gingival height etc.
We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.
Until next time!
CDA Oasis Team