Restorative & Materials · patient case question
All of the following are appropriate management options for this patient EXCEPT:
Patient case: Generalized tooth wear from combined erosion and attrition
Patient: Male, 44 years old
Chief Complaint: “My teeth are getting shorter and they are sensitive to cold.”
Background: Long history of gastro-oesophageal reflux, poorly controlled. Reports night-time grinding; his partner hears it. No caries history.
Vital Signs: BP 128/80 mmHg · HR 74 bpm
Findings: Generalized loss of tooth structure: cupped, shiny concavities on the occlusal surfaces of the posterior teeth with restorations standing proud, together with flat matched wear facets on the anterior teeth. All teeth respond normally to cold testing with no lingering pain. No percussion tenderness and no periapical changes on radiographs.
Show answer and explanation
Correct answer: A. Elective root canal treatment of the worn teeth
- A. CORRECT as the exception. ROOT CANAL TREATMENT is not a management option for tooth WEAR. These pulps are VITAL and responding normally, with no lingering pain, no percussion tenderness and no periapical change. Wear that progresses slowly allows TERTIARY (reparative) dentin to be laid down, so the pulp recedes ahead of the wear front and exposure is uncommon. Devitalising sound teeth to restore them removes the proprioceptive feedback, weakens them, and treats a problem that does not exist. Endodontics enters the plan only if a pulp is genuinely exposed or symptomatic.
- B. Full-coverage crowns are the conventional definitive option for severely worn teeth needing both protection and restoration of vertical dimension.
- C. Direct composite is increasingly the first choice in wear cases — it is ADDITIVE, so no further tooth structure is sacrificed, it is repairable, and it allows the vertical dimension to be tested reversibly before anything definitive is committed to.
- D. Controlling the aetiology comes first in every wear case: medical management of the reflux plus dietary advice for the erosive component, and a hard splint for the attritional component. Restoring without controlling the cause guarantees the restorations wear out too.
Note: Read the wear pattern for the cause. EROSION gives smooth, shiny, CUPPED lesions with restorations standing proud of the surrounding tooth, because the acid dissolves tooth but not the restorative material. ATTRITION gives flat, MATCHED facets on opposing surfaces. This patient has both, which is common and means both causes need addressing. Sequence: diagnose and control the cause → monitor and stabilise → restore additively → definitive full coverage only where genuinely needed.
Practice Restorative & Materials questions Restorative & Materials study notes