Your first visit with us
If you are visiting Dr Shepperson because you are worried about tooth wear, or you have been referred by another dentist, our first step is to listen and understand your concerns and desires. Our next step is to do some detective work. We start with some paperwork - medical/dental/symptom history and based on our initial observations we add other checklists and tests, reviewing that together to understand the factors that might be contributing to tooth wear. What has happened to your teeth in the past has a bearing on our diagnosis today, and tells us about the likely cause of tooth wear and the rate of wear. We will take xrays and a scan in advance of your clinical examination. Be prepared to come 20 minutes early to your appointment, to allow time for paperwork.
Clinical examination
An in-depth oral exam, we will take photographs and examine your mouth, teeth, gums, joint, muscles, tongue and throat and nose. We might check signs of sleep apnoea or reflux, if your history and wear patterns suggest it. We look at saliva and if you have enough; review eating and drinking patterns; medication; oral habits such as clenching or grinding and capture the way you chew in video or with jaw tracking technology. We use AI to evaluate xrays and may request a 3D CT scan of your jaws for complex wear cases and heavily filled mouths.
Dr Shepperson will summarise her findings initially, discussing broad treatment options and fees. If your case involves severe wear or complex planning, she may request additional test before formulating a plan. We often have an online discussion by Zoom to explain her findings and discuss options with you, before proceeding to treatment.
Additional Tests or Referrals
3D CT Scans: These provide a full view of bone and hidden structures in 3D, important in evaluating very heavily filled mouths and damaged bites.
Jaw Tracking: We are one of only 5 practices in Australasia with MODJAW - high tech mapping of the unique way you use your teeth. This has a huge bearing on treatment decisions and outcomes.
Deprogrammer: If we need to open the bite as part of re-engineering a very worn mouth we might recommend a deprogrammer - a small appliance worn for 2-3 weeks to relax tight, overclosed muscles and interrupt bad biting habits. This gives a much more stable and predictable bite as we design new tooth shapes, and ensures dentistry will last longer.
Orthodontic Referral: Sometimes correction of tooth wear goes hand in hand with orthodontic repositioning of teeth. We might recommend an orthodontic consultation or preview the impact of Invisalign planning to improve the bite and put worn teeth in a better position before final repair restorations.
Gastroenterology or ENT referral: Patients who have signs of reflux, or silent reflux, and worn teeth may need further investigation and management of this significant health concern. We may recommend specialist medical referral.
Sleep Studies: Some patterns of tooth wear correlate with symptoms of sleep disordered breathing, or sleep apnoea. If we suspect it, we will screen you and may suggest a home sleep test. A definitive diagnosis is always made by a medical specialist after an overnight sleep study. If we have evidence to suggest your sleep patterns might be related to tooth wear we will suggest a referral.
Joint MRI Referral: Patients with TMD or joint pain may require further investigation with an MRI, arranged through an Oral Surgeon with a radiology group.
Additional Fees: Additional diagnostic costs may be involved for these services. Not all patients will require additional tests. We will advise you in advance of anticipated costs.
Does all tooth wear need treatment?
Early tooth wear requires only measurement, monitoring and preventive strategies. We use digital scans and photographs, and a measurement index called the BEWE, taken at intervals to measure active wear and changes in tooth shape.
Preventive approaches might include changes in diet, liaising with medical colleagues to manage reflux, use of remineralising pastes, mouthwashes and gum and fluoride treatments to harden teeth.
Each case will be unique, and treatment is designed to preserve and protect remaining teeth.
Treatment Options
Like all projects, good design and planning is critical to success. You want a smile that feels like 'you' and a bite that perfoms well. And you want to see the results before we do the work.
Our planning is done with precision using digital design and testing, building a virtual 3D prototype of your case. We 3D print a 'Test Drive' to try in your mouth before we carry out any treatment. Reassurance, confidence and comfort are essential before we rebuild worn teeth.
Whether we provide a 2D simulation, or a 3D test drive in your mouth, there will be opportunities to have input into the plan at every step of the way.
Book your appointment today!
We assess tooth wear and its causes in depth, making sense of a hidden issue, providing solutions and peace of mind.