Chapter 3

Formulating a Management Strategy

Aim

To outline a systematic approach to history taking, examining, investigating, assimilating and arriving at a diagnosis so that a management strategy, tailored to the individual patient, may be formulated.

Outcome

After reading this chapter the practitioner should have an understanding of:

• what to look out for in both a patient’s history and medical history

• what to look out for when conducting both an intraoral and extraoral examination

• the importance of the patients’ expectations

• the application of some useful special investigations (Dietary survey tools, Radiographic examination, Study models and intraoral radiographs, salivary tests)

• behaviour that increases the risk of dental erosion developing

• the importance of a holistic and individual approach to the management of patients with dental erosion

Making the Diagnosis

The development of dental erosion is insidious. Often it is a member of the dental team who will be the first to discover that the patient has this condition. It is generally not until the integrity of the enamel is breached that a patient will report any symptoms, such as sensitivity of the affected teeth to hot or cold. It is therefore important that the early signs are recognised and acted upon, in consultation with the patient, if the condition is to be prevented from progressing further.

Making a definitive diagnosis to develop a management strategy, tailored to the individual patients needs, involves four principal components:

• History taking

• Acquisition of the medical history

• An extra- and intraoral examination

• Determining the patients’ expectations.

Each may act as a trigger for a special investigation to acquire further information to assist in the development of the management strategy.

History Taking

It is important to elicite from the patient when and for how long they have been aware of the problem. Typically, the patient will report chipping of the incisal edges, fracture of teeth and alterations in the appearance of anterior teeth, such as greying of the incisal edge following an alteration in translucency as a result of loss of palatal tooth substance. Where dentine has become exposed, pain or sensitivity of the teeth may be reported. This could be upon exposure to hot and cold drinks or even on toothbrushing following the intake of an acidic food.

Acquisition of the Medical History

A comprehensive medical history should always be obtained and recorded. With specific reference to dental erosion, it is important to establish any potential source of intrinsic acid. This could be as a result of an undiagnosed level of gastro-oesophageal reflux, reported by the patient as heartburn or indigestion, arising from either an underlying medical condition (Table 3-1) or as a side-effect of medication (Table 3-2).

* Reproduced from Scheutzel P. Etiology of dental erosion – intrinsic factors. European Journal of Oral Sciences 1995;104:178–190, by kind permission of the Editor, Journal of Oral Sciences.

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