Assessment of Prosthetic Rehabilitation of Partially Edentulous Patients with Collapsed Vertical ...

187 Pages·2009·1.77 MB·English

University of Khartoum
College of Graduate Studies
Board of Medical Health Sciences
Faculty of Dentistry

Assessment of Prosthetic Rehabilitation of Partially Edentulous
Patients with Collapsed Vertical Overlap using Electromyography,
Cephalometric, and Clinical Examination
Sana’a Yemen 2004-2008

By:
Mohammed A. Dubais
B.D.S king Saud University 1986
M. Sc. Al- exandria University 1999

A thesis submitted in fulfillment for the Requirement of the Ph.D. Degree in
Dentistry (Prosthodontics)

Supervisor:
Associate Professor M. W. Gilada
B.D.S, M.Sc. London
Associate Professor of Oral Rehabilitation
U of K
Co supervisor
Associate professor H.Abdul-Razak Zeadan
Ph. D. Maxill. Surgery Paris
Associate Professor of Oral and Maxill. Surgery
UST – Yemen

2008
I
To my family, my wife and children for their support
and patience during the difficult times with all love and
respect.

I
First of all, thank to ALLAH for helping me during my work and
providing me the willingness and the strength to accomplish this
work.
My great thanks to Professor Dr. Tariq Abo-lahom, the head of
Administration Council of the University of Science and
Technology and the Executive Director of the UST Hospital,
Sana’a YR for his support and encouragement
It is a great pleasure to express my deepest gratitude and respect
to my supervisor A/professor Dr. M. W. Glada, head department
of oral rehabilitation, Faculty of Dentistry, University of Khartoum
for his guidance and substantial scientific knowledge and
experience and for his encouraging attitude. I highly appreciate all
those efforts he exerted to encourage me and to give me the
strength to keep on working on this project.
I would like to thank Professor Ahmed M. Suleiman, the dean
Faculty of Dentistry, University of Khartoum for his encouragement
and valuable recommendations
I would like to thank A/Professor Nadia A. Yahya the vice dean
Faculty of Dentistry, University of Khartoum and Dr. Al-Neil Ahmed
for their kindness and support.

II
EMG Electromyography
VDO Vertical dimension of occlusion
TMJ Temporomandibular joint
RT Right temporalis muscle
RM Right masseter muscle
LT Left temporalis muscle
LM Left masseter muscle
FHP Frankfort horizontal plane
OP Occlusal plane
SNA Silla- Nasion-Point A angle
SNP Silla-Nasion-Pogonion angle
PNA Porion-Nasion angle
ANSP Anterior Nasal Spine Pogonion line
A-B Point A-Point B line
GLC Golden link caliper
AL Alar-rim
Tri trichion ( forehead)
CH-CH Commissure to commissure
LC-LC Lateral canthus to lateral canthus
VDR Vertical dimension of rest
Sn-Gn Subnasal – Gnathion
E-E Eye-Ear distance
N-Gn Nasion to Gnathion
Zy-Zy Zygion to Zygion
GPT Glossary of Prosthodontic Terms
CO Centric occlusion
CR Centric relation
MI Maximum intercuspation
CRO Centric relation occlusion
CRMI Centric relation maximum intercuspation
III
ICP Intercuspal position
RCP Retruded cuspal position
TMD Temporomandibular disorders
ST Sella tutsica
N Nsion
GERD Gastroesophegeal Reflex Disease

IV
Abstract
Statement of the problems:
There have been no previous studies on the effect of increasing vertical
dimension of occlusion ( VDO ) on masticatory muscles, TMJs, and occlusal
plane orientation in partially edentulous patients with collapsed face height.
Objectives:
This study was carried out to evaluate the effect of increasing VDO and
prosthetic rehabilitation on two group of 20 partially edentulous subjects with
severe occlusal wear on masticatory muscles and TMJs, and on horizontal and
vertical maxillomandibular relationships.
Materials and methods:
20 subjects were selected for this study with a mean age of 61 years old
ranging between 47-75. All selected patients were partially edentulous with
good general health, free of myofacial pain dysfunction syndrome and they
were class 1 maxillomandibular relationships.
Selected patients were divided into two groups:
1. Group 1 were subjected to sudden increase in their VDO to clinical rest
position using transitional partial dentures.
2. Group 2 were subjected to incremental increase in their VDO using
transitional partial denture.
For both groups, the final prosthesis were constructed and inserted 12
weeks after using transitional prosthesis.

V
Methods of evaluation:
1. EMG evaluation of masticatory muscles
a. Before increasing VDO in postural position and maximal clenching
b. After increasing VDO in postural position and maximal clenching
2. Radiographic evaluation of horizontal and vertical dimensions of the
maxillomandibular relationships.
3. Clinical and subjective assessment after prosthetic rehabilitation.
Results: Increasing VDO and prosthetic rehabilitation of subjects of both
groups displayed the following results:
2. EMG muscles activity
a. The FMG voltages in postural position before and after increasing VDO
and prosthetic rehabilitation revealed high range of variations among
subjects of both groups and among subjects of each group. EMG voltages
for right and left temporalis and masseter muscles in all subjects of both
groups displayed significant reduction,
b. In maximal clenching the variations were also seen, and mean values of
the muscle activity showed slight increase ( 5-8%) after increasing VDO
and prosthetic rehabilitation .
1. Radiographic evaluation of the maxillomandibular relationships through
cephalometric analysis of the radiographs before and after increasing VDO
a. In horizontal dimension, no marked changes in the values of the angles
related to horizontal dimension.
b. In vertical direction, there was statistical significant increase in the values
of the angles and lines related to vertical dimension .
Clinical and subjective evaluation of the subjects revealed no distinct
symptoms or discomfort and subjects chewing ability and appearance
were rated as good
VI
ﺺﻠﺨﺘﺴﻤﻟا

ﻡﺍﺩﺨﺘﺴﺈﺒ ﻪﺠﻭﻠﻟ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﺭﻴﺜﺄﺘ ﻥﻋ ﺔﻘﺒﺎﺴ ﺕﺎﺴﺍﺭﺩ ﺩﺠﻭﺘ ﻻ ﻪﻨﺃ ﻡﻭﻠﻌﻤﻟﺍ ﻥﻤ
ﻯﺩﻟ ﻕﺎﺒﻁﻹﺍ ﻯﻭﺘﺴﻤ ﺩﻴﺩﺤﺘ ﻰﻠﻋ ﺍﺫﻜﻭ ﻙﻔﻟﺍ ﻲﻠﺼﻔﻤﻭ ﻎﻀﻤﻟﺍ ﺕﻼﻀﻋ ﻰﻠﻋ ﺔﻔﻠﺘﺨﻤ ﻕﺭﻁ
ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻲﻓ ﺭﻴﺒﻜ ﺽﺎﻔﺨﻨﺇ ﻥﻤ ﻥﻭﻨﺎﻌﻴ ﻥﻴﺫﻟﺍ ﺎﹰﻴﺌﺯﺠ ﺀﺍﺩﺭﺩﻟﺍ ﻙﻭﻜﻔﻟﺍ ﻯﻭﺫ ﺹﺎﺨﺸﻷﺍ
.ﻪﺠﻭﻠﻟ
:ﺔﺳارﺪﻠﻟ مﺎﻌﻟا فﺪﻬﻟا
ﻯﻭﻤﻔﻟﺍ لﻴﻫﺄﺘﻟﺍ ﺓﺩﺎﻋﺇﻭ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭﻟ ﻥﻴﺘﻘﻴﺭﻁ ﻡﻴﻴﻘﺘ ﻰﻟﺇ ﺔﺴﺍﺭﺩﻟﺍ ﻑﺩﻬﺘ
20
ﺍﹰﺭﻴﺒﻜ ﺎﹰﻀﺎﻔﺨﻨﺇ ﻥﻭﻨﺎﻌﻴ ﻥﻴﺫﻟﺍﻭ ﺎﹰﻴﺌﺯﺠ ﺀﺍﺩﺭﺩﻟﺍ ﻙﻭﻜﻔﻟﺍ ﻯﻭﺫ ﻥﻤ ﺍﹰﺩﺭﻓ ﻥﻤ ﺔﻨﻭﻜﻤ ﻥﻴﺘﻋﻭﻤﺠﻤﻟ
ﻙﻔﻟﺍ ﻲﻠﺼﻔﻤﻭ ﻎﻀﻤﻟﺍ ﺕﻼﻀﻋ ﻰﻠﻋ ﺔﻘﻴﺭﻁ لﻜ ﺭﻴﺜﺄﺘ ﺔﺴﺍﺭﺩ ﺍﺫﻜﻭ ﻪﺠﻭﻠﻟ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻲﻓ
.ﻰﻘﻓﻷﺍﻭ ﻲﺴﺍﺭﻟﺍ ﻥﻴﻫﺎﺠﺘﻻﺍ ﻲﻓ ﻥﻴﻜﻔﻟﺍ ﻥﻴﺒ ﺔﻗﻼﻌﻟﺍ ﻲﻓ ﺭﺜﺅﺘ ﺩﻗ ﻰﺘﻟﺍ ﺕﺍﺭﻴﻐﺘﻟﺍﻭ
:ﺚﺤﺒﻟا ﻲﻓ ﺔﻣﺪﺨﺘﺴﻤﻟا قﺮﻄﻟاو تاودﻷا
لﻜ ﻥﻴﺘﻋﻭﻤﺠﻤ ﻰﻟﺇ ﺍﻭﻤﺴﻗ ﺎﹰﻀﻴﺭﻤ ﻥﻭﺭﺸﻋ ﺭﺎﻴﺘﺨﺇ ﻡﺘ ﺔﺴﺍﺭﺩﻟﺍ ﻩﺫﻫ ﺫﻴﻔﻨﺘ لﺠﺃ ﻥﻤ
75 47 61 10
(ﻪﻨﺴ - ) ﻥﻴﺒﺎﻤ ﻡﻫﺭﺎﻤﻋﺍ ﺡﺍﻭﺭﺘﺘﻭ ﻪﻨﺴ ﺭﻤﻌﻟﺍ ﻁﺴﻭﺘﻤ ﺕﻨﺎﻜ ﻰﻀﺭﻤ ﺔﻋﻭﻤﺠﻤ
ﺔﻴﻜﻔﻟﺍ ﺕﺎﺒﺍﺭﻁﻀﻹﺍ ﺔﻤﺯﻼﺘﻤ ﻥﻤ ﻥﻭﻨﺎﻌﻴ ﻻﻭ ﺓﺩﻴﺠ ﺔﺤﺼﺒ ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﺃ ﻊﻴﻤﺠ ﻥﺎﻜﻭ
.لﻭﻻﺍ ﺔﻴﻜﻔﻟﺍ ﺕﺎﻗﻼﻌﻟﺍ ﻑﻨﺼ ﻥﻤ ﻡﻬﻌﻴﻤﺠﻭ ﺔﻴﻏﺩﺼﻟﺍ
:ﻰﻟوﻷا ﺔﻋﻮﻤﺠﻤﻟا .1
ﺓﺩﺤﺍﻭ ﺔﻠﺤﺭﻤ ﻰﻠﻋ ﻰﻟﻭﻷﺍ ﺔﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﻷ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﻡﺘ

.ﻰﻨﺩﻌﻤ لﻜﻴﻫ ﺕﺍﺫ ﺔﻴﻠﺤﺭﻤ ﺕﺎﺒﻴﻜﺭﺘ ﻡﺍﺩﺨﺘﺴﺈﺒ ﺔﺤﺍﺭﻟﺍ ﻯﻭﺘﺴﻤ ﻰﻟﺇ
:ﺔﻴﻧﺎﺜﻟا ﺔﻋﻮﻤﺠﻤﻟا .2
ﻰﻟﺇ ﻰﻨﺩﻌﻤ لﻜﻴﻫ ﺕﺍﺫ ﺔﻴﻠﺤﺭﻤ ﺕﺎﺒﻴﻜﺭﺘ ﻡﺍﺩﺨﺘﺴﺈﺒ ﻥﻴﺘﻠﺤﺭﻤ ﻰﻠﻋ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﻡﺘ
.ﺔﺤﺍﺭﻟﺍ ﻯﻭﺘﺴﻤ
ﻡﺘﻭ ﺩﻴﺩﺠﻟﺍ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﺀﻭﻀ ﻲﻠﻋ ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﻷ ﺔﻴﺌﺎﻬﻨﻟﺍ ﺕﺎﺒﻴﻜﺭﺘﻟﺍ ﻊﻴﻨﺼﺘ ﻡﺘ
.ﺔﻴﻠﺤﺭﻤﻟﺍ ﺔﺒﻴﻜﺭﺘﻟﺍ ﻡﺍﺩﺨﺘﺴﺇ ﺀﺩﺒ ﻥﻤ ﺭﺸﻋ ﻲﻨﺎﺜﻟﺍ ﻉﻭﺒﺴﻻﺍ ﻲﻓ ﻡﻔﻟﺍ ﻲﻓ ﺎﻬﺒﻴﻜﺭﺘ
:ﻢﻴﻴﻘﺘﻟا قﺮﻃ
:ﺔﻴﻟﺎﺘﻟﺍ ﺕﺍﻭﻁﺨﻟﺍ ﻰﻠﻋ ﻡﻴﻴﻘﺘﻟﺍ ﻕﺭﻁ ﺕﺯﻜﺭﺘ
1
.ﻎﻀﻤﻟﺍ ﺕﻼﻀﻌﻟ ﻰﺌﺎﺒﺭﻬﻜﻟﺍ ﻁﺎﺸﻨﻟﺍ ﺱﺎﻴﻗ .
VII
. ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﺩﻌﺒﻭ لﺒﻗ ﺔﺤﺍﺭﻟﺍ ﻊﻀﻭ ﻲﻓ.ﺃ

.ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﺩﻌﺒﻭ لﺒﻗ ﺓﻭﻗ ﻰﺼﻗﺄﺒ ﻥﺎﻨﺴﻷﺍ ﻰﻠﻋ ﺽﻌﻟﺎﺒ ﺽﻴﺭﻤﻟﺍ ﻡﺎﻴﻗ ﺀﺎﻨﺜﺃ .ﺏ
2
.ﻰﻘﻓﻷﺍﻭ ﻯﺩﻭﻤﻌﻟﺍ ﻩﺎﺠﺘﻷﺍ ﻲﻓ ﻥﻴﻜﻔﻟﺍ ﺔﻗﻼﻋ ﻲﻓ ﺕﺍﺭﻴﻐﺘﻠﻟ ﻰﻋﺎﻌﺸﻷﺍ ﻡﻴﻴﻘﺘﻟﺍ .
3
.ﺕﺎﺒﻴﻜﺭﺘﻠﻟ ﻰﺌﺎﺼﻘﺘﺴﻹﺍﻭ ﻯﺭﻴﺭﺴﻟﺍ ﻡﻴﻴﻘﺘﻟﺍ .
:ﺞﺋﺎﺘﻨﻟا
:ﻰﻠﻴﺎﻤ ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﻷ ﻯﻭﻤﻔﻟﺍ لﻴﻫﺄﺘﻟﺍ ﺓﺩﺎﻋﺇﻭ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﺞﺌﺎﺘﻨ ﺕﺭﻬﻅﺃ
1
.ﺔﺤﺍﺭﻟﺍ ﻊﻀﻭ ﻲﻓ .

ﺓﺩﺤﺍﻭﻟﺍ ﺔﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﺃ ﻥﻴﺒ ﻙﻟﺫﻜﻭ ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﺃ ﻥﻴﺒ ﺓﺭﻴﺒﻜ ﺕﺍﺭﻴﻐﺘ ﺕﺭﻬﻅﺃ.ﺃ
.ﺕﻼﻀﻌﻠﻟ ﻰﺌﺎﺒﺭﻬﻜﻟﺍ ﻁﺎﺸﻨﻟﺍ ﻁﺴﻭﺘﻤ ﻲﻓ

ﻁﺎﺸﻨﻠﻟ ﻡﻴﻘﻟﺍ ﻁﺴﻭﺘﻤ ﻲﻓ ﺔﻴﺌﺎﺼﺤﻷﺍ ﺔﻟﻻﺩﻟﺍ ﺔﻴﺤﺎﻨ ﻥﻤ ﺭﺜﺅﻤ لﻜﺸﺒ ﺽﺎﻔﺨﻨﺇ ﺭﻬﻅ .ﺏ

.ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ ﺩﺍﺭﻓﺃ ﻊﻴﻤﺠﻟ ﺕﻼﻀﻌﻟﺍ لﻜ ﻲﻓ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﺩﻌﺒ ﻰﺌﺎﺒﺭﻬﻜﻟﺍ
2
:ﺓﻭﻗ ﻰﺼﻗﺄﺒ ﺽﻌﻟﺍ ﺀﺎﻨﺜﺃ .
ﻊﻀﻭ ﻲﻓ لﺎﺤﻟﺍ ﻭﻫ ﺎﻤﻜ ﺓﺭﻴﺒﻜ ﺕﺍﺭﻴﻐﺘ ﺕﻼﻀﻌﻠﻟ ﻰﺌﺎﺒﺭﻬﻜﻟﺍ ﻁﺎﺸﻨﻟﺍ ﺭﻬﻅﺃ .ﺃ
.ﺔﺤﺍﺭﻟﺍ
ﺍﺫﻬﻟ ﻡﻴﻘﻟﺍ ﻁﺴﻭﺘﻤ ﻥﻜﻟﻭ ﻅﻭﺤﻠﻤ لﻜﺸﺒ ﺕﻼﻀﻌﻠﻟ ﻰﺌﺎﺒﺭﻬﻜﻟﺍ ﻁﺎﺸﻨﻟﺍ ﻊﻔﺘﺭﺇ .ﺏ
.ﺔﻴﺌﺎﺼﺤﻹﺍ ﺔﻟﻻﺩﻟﺍ ﺔﻴﺤﺎﻨ ﻥﻤ ﺭﺜﺅﻤ ﻥﻜﻴ ﻡﻟ ﻉﺎﻔﺘﺭﻹﺍ
3
ﺞﺌﺎﺘﻨﻟﺍ ﺭﻬﻅﺃ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻊﻓﺭ ﺩﻌﺒﻭ لﺒﻗ ﺔﻌﺸﻷﺍ ﺭﻭﺼﻟ ﻯﺭﺘﻤﻭﻟﺎﻔﻴﺴﻟﺍ لﻴﻠﺤﺘﻟﺍ ﻡﻴﻗ ﺔﻨﺭﺎﻘﻤ .
:ﺔﻴﻟﺎﺘﻟﺍ
ﻡﻴﻘﻟ ﻰﺌﺎﺼﺤﻹﺍ لﻴﻠﺤﺘﻟﺍ ﺏﺴﺤ ﻰﻘﻓﻷﺍ ﺩﻌﺒﻟﺍ ﻲﻓ ﻅﻭﺤﻠﻤ ﺭﻴﻐﺘ ﻱﺃ ﻙﻟﺎﻨﻫ ﻥﻜﻴ ﻡﻟ .ﺃ
.ﻰﻘﻓﻷﺍ ﺩﻌﺒﻟﺍ ﻰﻠﻋ ﺔﻟﺍﺩﻟﺍ ﺎﻴﺍﻭﺯﻟﺍ
ﻁﺴﻭﺘﻤﻟ ﻰﺌﺎﺼﺤﻷﺍ لﻴﻠﺤﺘﻟﺍ ﻥﻤ ﻥﻴﺒﺘ ﺙﻴﺤ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻲﻓ ﻅﻭﺤﻠﻤ ﺭﻴﻐﺘ ﺭﻬﻅ .ﺏ
ﻪﻴﺌﺎﺼﺤﺇ ﺔﻟﻻﺩ ﺍﺫ ﻉﺎﻔﺘﺭﺃ ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻰﻠﻋ ﺔﻟﺍﺩﻟﺍ ﺔﻤﻴﻘﺘﺴﻤﻟﺍ ﻁﻭﻁﺨﻟﺍﻭ ﺎﻴﺍﻭﺯﻟﺍ ﻡﻴﻗ
.ﻯﺩﻭﻤﻌﻟﺍ ﺩﻌﺒﻟﺍ ﻰﻠﻋ ﺔﻟﺍﺩﻟﺍ ﺔﻤﻴﻘﺘﺴﻤﻟﺍ ﻁﻭﻁﺨﻟﺍﻭ ﺎﻴﺍﻭﺯﻟﺍ ﻡﻴﻗ ﻲﻓ
4
:ﺔﻴﻟﺎﺘﻟﺍ ﺞﺌﺎﺘﻨﻟﺍ ﺕﺭﻬﻅﺃ :ﺔﻴﺌﺎﺼﻘﺘﺴﻻﺍ ﺔﻠﺌﺴﻻﺍﻭ ﻯﺭﻴﺭﺴﻟﺍ ﺹﺤﻔﻟﺍ .
ﺕﻼﻀﻋ ﻲﻓ ﺔﻘﻴﺎﻀﻤﻟﺍ -ﻡﻷﺎﺒ ﺱﺎﺴﺤﻷﺍ ) ﻥﻤ لﻜ ﻲﻓ ﺔﻴﺌﺎﺼﺤﺇ ﺔﻟﻻﺩ ﺕﺍﺫ ﻕﻭﺭﻓ ﺩﻭﺠﻭ ﻡﺩﻋ .ﺃ
.(ﺔﻤﻋﺍﺩﻟﺍ ﻥﺎﻨﺴﻷﺍ -ﻙﻔﻟﺍ ﻰﻠﺼﻔﻤﻭ ﻎﻀﻤﻟﺍ
.ﻪﺠﻭﻟﺍ لﻜﺸ ﻲﻓ ﻅﻭﺤﻠﻤ ﻥﺴﺤﺘﻭ ﺓﺩﻴﺠ ﺔﻴﻐﻀﻤ ﺓﺀﺎﻔﻜ ﺩﻭﺠﻭ .ﺏ

VIII
List of contents

Dedication I
Acknowledgement II
Abbreviation III
Abstract IV
Arabic abstract VII
1.Chapter one: Introduction and literature review
1 . Introduction 1
1.2. Literature review 5
1. 2. 1 Etiologic factors of tooth wear 5
1 .2. 1 . 1 Extrinsic causes 5
1.2.1.2 Intrinsic factors 7
1 .2. 1 .3 Mechanical tooth wear 9
1.2.1.3.1 Attrition 9
1.2.1.3.2 Abrasion 10
1.2.1.3.3 Abfraction 10
1.2.2 Epidemiology of occlusal wear 11
1 .2.3. Diagnosis of tooth wear 13
1 .2.3. 1 Assessment of patient with dental erosion 23
1 .2.3.2 Diagnostic protocol for dental erosion 14
1.2.3.3 Medical history 15
1.2.3.4 Dental history 15
1.2.3.5 Occupational history 16
1.2.3.6 Head and neck/oral examination 16
1.2.3.7 Salivary function assessment 16
1.2.3.8 Erosion grading scale 17
1.2.3.9 Decision tree to diagnose erosion ( chemical ) 119
1.2.3.10 Signs and symptoms of gastroesophegeal reflex
disease (GERD) 20
1.2.3.11 . Risk factors 21
1.2.3.12 Risk factors for erosion 21
1.2.3.13 Decision tree to diagnose mechanical tooth wear 21
1.2.3.1.4 Anterior tooth wear 22