future additions and repairs (using direct composite) if the erosion continues or
restarts. However, if there is an element of attrition or signs of parafunction composite
onlays will not be adequately durable in the posterior segments, so cast restorations
are recommended.
Long-term review
All patients with tooth surface loss should be reviewed regularly for three reasons:
(1) to monitor future tooth surface loss;
(2) to maintain the existing restorations; and
(3) to provide support for the patient.
Patients with eating disorders in particular are prone to periods of relapse and the
dentist is in an ideal position to diagnose these periods. The dentist can develop a
special and trusting relationship with the young patient over the longer term, which is
based not simply on seeing the patient when they are 'ill' and therefore to admonish
them, but also when they are well to support and encourage them. Likewise in patients
with dietary erosion, continual reinforcement of good dietary habits is needed
throughout the child's life and into adulthood. People change their diet as they get
older⎯one example is the young adolescent who manages to stop drinking Coca Cola
but starts drinking lager to excess instead and the erosion continues!
582H
.
Fig. 10.20 (a) and (b) Cast palatal veneers on upper central incisors. Note the 'shine
through' despite placement of labial composite veneers