Poster no. 4 Dr. Lavkesh Bansal

1. TEETH RUINED BY IMPROPER
SLEEPING PATTERN
Introduction: Erosion cavities on teeth are due
to Gastro-Esophageal reflex disease (GERD),
patient habitual to sucking on citrus fruits or to
carbonated drinks. Erosion of facial surface of
only left front teeth with anterior open bite and
patient’s history made us to include sleep
pattern in the etiology of erosion lesions. Dentist
need to be more innovative and intrusive in
cross questioning, to ascertain the reason for
any dental lesion. It will help to serve the patient
better and to curtail the failures of treatment.
Slide No. 1 Dr. Lavkesh Bansal. Poster No. 4

2. Pre-Operative clinical
presentation
Anterior Open Bite
Left anterior teeth are more Proclined
Left canine is not in occlusion
Left teeth has severe erosion of facial surface
Left upper premolars are missing
Slide No. 2 Dr. Lavkesh Bansal. Poster No. 4

3. Pre operative condition
Open bite: Tongue thrust as tongue
has scalloping on left side.
Erosion of facial surface: GERD as patient has
history of gastric acidity. No relevant history of
addiction to citrus fruits or carbonated drinks.
History: 49 yr. old male patient sleeps on his
stomach with his left face on pillow since childhood.
Saliva drools from left corner of mouth on to the
pillow.
Slide No. 3 Dr. Lavkesh Bansal. Poster No. 4

4. Diagnosis and Treatment plan
Diagnosis: Erosion of facial surface of 22, 23, 33,
34; accentuated proclination of left front teeth due
to the GERD and improper sleeping pattern.
Treatment plan: Restoring the facial surface of
22, 23, 33, 34 with composite. Educating the
patient about adverse effects of improper sleeping
pattern and GERD.
Slide No. 4 Dr. Lavkesh Bansal. Poster No. 4

5. Case Discussion
History of drooling in childhood is generally
associated nasal obstruction and mouth breathing
causing open bite. Sleeping with left face on pillow
and lateral spread of tongue in missing premolars
space, increase the pressure of tongue on front
teeth than the counteracting lip pressure. Sleeping
on stomach after dinner would have caused gastric
reflux, causing erosive lesion on teeth in the path of
saliva flow.
Slide No. 5 Dr. Lavkesh Bansal. Poster No. 4

6. Conclusion
Dental disease is multi- factorial and treating the
clinical lesions alone lead to failures and is an under
service to the patient. Erosion, abrasion and attrition
of teeth is very common due to increased incidence
of bruxism and GERD. Restoration of these lesions
with composite is an established most conservative
line of treatment, but recurring erosion cavities
besides restorations is also common. Recognizing
and treating the root cause of disease is as important
as preventing the deleterious effects of habits by
night guard and establishing the occlusal guidance.
Slide No. 6 Dr. Lavkesh Bansal. Poster No. 4

7. Conclusion
Dental disease is multi- factorial and treating the
clinical lesions alone lead to failures and is an under
service to the patient. Erosion, abrasion and attrition
of teeth is very common due to increased incidence
of bruxism and GERD. Restoration of these lesions
with composite is an established most conservative
line of treatment, but recurring erosion cavities
besides restorations is also common. Recognizing
and treating the root cause of disease is as important
as preventing the deleterious effects of habits by
night guard and establishing the occlusal guidance.
Slide No. 6 Dr. Lavkesh Bansal. Poster No. 4