Posted by: The Probe 2nd August 2018
Dr Ben Atkins is the Owner and Clinical Director of the Revive Dental Care group in Greater Manchester. He has a specialist interest in restorative dentistry and is passionate about educating patients. Ben was one of the clinicians that trialled the CALCIVIS® imaging system during the beta testing stage.
A case of intrinsic dental erosion
The signs and symptoms of dental erosion can be diverse. Often recognised by slight loss of tooth surface characteristics, there may be very little or no pain. Nevertheless, continual demineralisation can cause sensitivity and if extensive loss of tissue and pulp exposure occurs, it can result in severe pain. In order to manage dental erosion effectively, dental practitioners must first diagnose the condition accurately, identify the causal factors, increase the patient’s awareness and take measures to prevent it from causing irreversible damage to the teeth.
Here, Dr Ben Atkins, Clinical Director at Revive Dental Care, describes intrinsic dental erosion and presents one of his cases:
“Intrinsic dental erosion can be hard to identify and treat, and can often be an indication of a wider problem. When enamel is worn away, the teeth absorb stains far more readily and appear darkened. Sensitivity can also increase and as a result, patients may find some foods uncomfortable to eat. The reduced size of teeth can result in a shortening of face height, which can prematurely age the appearance.
“I recently saw a man in his twenties who always attends regular check ups and was not aware of any dental problems. He had not experienced any pain and his previous dentist had not mentioned it; yet he was suffering from intrinsic dental erosion. Upon examination a 2/3 mm loss on each of his front teeth and damage to his back teeth was identified. This had weakened and eroded his front teeth, resulting in shortening as well as the exposure of the darker, yellower dentine beneath the enamel. The erosion was also identifiable from the hollows in his teeth and the general wearing away of the tooth surface as well as the biting edges. (Figs 1 to 3)
Fig 1. Anterior view, showing shortening of the teeth and exposure of dentine
Fig 2. Damage to the biting edges
Fig 3. Hollows in the posterior teeth
“Both to confirm our findings and to effectively illustrate the extent of the problem to the patient we used the CALCIVIS imaging system. This is a highly innovative, biotech dental device, which is revolutionising
dentistry. It uses a luminescent photoprotein, which produces a low level light in the presence of free calcium ions when released from actively demineralising tooth surfaces. (Figs. 4 and 5) An integrated intraoral sensor then detects this light and displays a live, glowing map of active demineralisation at the chair side.
Fig 4. Lower right 6
Fig 5. Lower left 6.
“The CALCIVIS imaging system enabled the patient to visualise his oral health status and he was astounded at the diagnosis. He believed that he had been looking after his teeth well; he said that having healthy teeth was important to him and he wanted to set a good example to his young family. In this case, I identified the erosion as having been caused by an excess of gastric acid, and recommended that the young man went to visit his doctor. I contacted secondary care on the patient’s behalf, as it was vital to find out what was causing the erosion and to ensure that it was stopped before measures were taken to restore the teeth.
“At this point, the patient was given preventive oral health instructions and was advised to use a special toothpaste to help repair the surface of the teeth. He was advised to minimise toothbrush abrasion by waiting an hour after meals before brushing his teeth to allow time for the teeth to remineralise and stabilise naturally. The patient also received dietary information; we advised him to reduce direct contact with acids and to chew a sugar-free gum after meals to increase saliva flow.
“This experience made the patient more aware of the importance of looking after his teeth correctly and he has changed some of his dental hygiene habits accordingly. He said: ‘I feel very lucky that the problem has been picked up in time and although my teeth have already suffered some damage, the damage that has been done can be repaired and steps have been put in place to ensure that it doesn’t happen again.’
“We saw the patient after a few months and scanned the teeth again using the CALCIVIS imaging system. This is where the technology is particularly valuable because it enables us to precisely visualise demineralisation at its very earliest stages – something that has never been possible before. Previously, I had no real way of monitoring active erosion unless the enamel was visibly reduced and exposure continued. With the CALCIVIS images I could confirm that the medication and preventive strategies had been successful, which meant that we could confidently begin restoring the damaged teeth, without the risk of entering a continuous circle of restoration, further erosion, restoration and so on. Going forward, we will regularly monitor the patient’s teeth using the CALCIVIS imaging system to ensure that problems do not reoccur.
“The key to effective prevention is early detection. We now have the technology to help us to indentify dental erosion at the initial stages and educate patients with engaging images to help them to fully understand their oral health and the reasons for the preventive strategies we suggest. With a few simple changes, complex and invasive dental treatments can be avoided and we can encourage and motivate patients to look after their teeth correctly.”
For more information visit www.CALCIVIS.com
or call 0131 658 5152
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