Erosive Tooth Wear

 

K.W., 30 years old, African American, Female. Light calculus case value/ Type II Perio.

Patient has no chief complaints and came for a routine checkup. Patient reports using Oral B Vitality powered toothbrush and Sensodyne dentifrice containing desensitizing and fluoride agent. She also uses glidePik twice daily and Listerine antiseptic oral rinse twice daily. She reports she is thorough with her oral care and occasionally brushes up to four times a day.

Patient presents with Class I occlusion bilaterally, open bite, and 1mm overjet. Patient presents with generalized mild recession found on buccals of both arches, mostly on the incisor and premolar areas. Furcation of class I found on #2, #3, #15, #18, #30. Clinical evidence of erosion found on facials of anteriors of both arches- smooth surface presents with loss of enamel luster. Patient reports she loves biting into lemons and consumes about two daily as a snack. Gingiva presents with minimal inflammation with localized minimal redness on linguals of mandibular anteriors. Stippling and resiliency are present.

Patient is a free-lance writer who works from home and often snacks on lemons. She reports she’s had an acidic diet from childhood. She is also an aggressive brusher and reports sensitivity on areas presenting with recession.

For intervention, I provided nutritional counseling and explained the oral manifestations of those who have a high diet in acidic foods. Patient reports that it will be difficult for her to quit acidic foods so I suggested she can start by squeezing lemon into her water and drinking through a straw. I explained that the frequency of acidic food ingestion plays a large factor in erosion and recommended that the patient avoids frequent and long-term exposures. I also demonstrated the appropriate placement for powered toothbrushes because she reports she is an aggressive and horizontal brusher. I advised her to brush twice daily rather than up to four times. I applied 5% NaF varnish to alleviate the sensitivity caused by her recession.

Treatment plan: 

V1- Perform assessments. Debridement of all four quadrants with ultrasonic and hand instruments. Engine polish with fine paste and apply 5% NaF varnish with micro brush. Provide patient post-op instructions of no eating abrasive/hot foods and no brushing/flossing for 4-6 hours. Recall 6 months.