Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion.

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Dental Radiological Practice in Trinidad and Tobago: A Pilot Project

OBJECTIVE: The aim of this study was to identify the current standards of radiologic practice in Trinidad and Tobago in relation to international ionizing radiation regulations with respect to dentistry. MATERIALS AND METHODS: A 32-point questionnaire that was previously tested was administered to 55 dentists who practice in different regions of Trinidad. The survey aimed to gather information on demographic factors, types of radiographic equipment, techniques and processing and radiation protection measures. RESULTS: The majority of dentists (61.8%) were not aware of the technical details of their equipment. Thirty- three dentists did not know the kVp of their machines and 17 dentists were not aware of the intraoral film speed that they utilize. Of the respondents, 85.5% used rounded collimators. The most common technique for periapical radiography was the paralleling technique (64%). Many respondents own panoramic X-ray units, but the majority of them (90.9%) did not take panoramic radiographs on all patients regardless of the dentists working environment. This was proven to be statistically significant (P<0.05). All dentists reportedly used some form of radiation protection, but only 8 respondents properly disposed of their radiographic waste by incineration. Lead aprons were utilized by 65.5% of respondents. CONCLUSION: The results of this study indicate that current radiological practices utilized by dentists in Trinidad and Tobago need improvement in some areas and there is a dire need for the development of national ionizing radiation guidelines specific to dentistry if best practice is to be maintained.