Caries & Non-Caries Lesions PDF

CARIOUS AND NON-CARIOUS LESIONS What is Dental Caries….. How it Starts….. It is an infectious microbial multifactorial transmissible oral disease How it Starts….. Venn diagram Types of Dental Caries? 3- Residual caries  Pits and Fissure...

CARIOUS AND NON-CARIOUS LESIONS What is Dental Caries….. How it Starts….. It is an infectious microbial multifactorial transmissible oral disease How it Starts….. Venn diagram Types of Dental Caries? 3- Residual caries  Pits and Fissures Morphology Statement of the problem A Fissure is incomplete fusion of 2 lobes of cuspal enamel in the developing of the tooth , the complete fusion is called Groove. A Pit is a small pin point depression, it is incomplete fusion of 3 lobes of cuspal enamel in the developing of the tooth, complete fusion is called Fossa. Caries lesions are more likely to occur Five times in occlusal fissures. Pits and Fissures Morphology Fissure classification according to Nagano the localization of a primary lesion and the form and depth of the fissure: V-type Caries starts from the bottom U-type Caries starts from halfway down I-type and IK-type Caries starts from the top Caries penetration in pits & fissures caries: Smooth surface caries Less favorable site for plaque attachment, usually attaches on the smooth surface that are near the gingiva or are under proximal contact. Root caries: Its depth is small (shallow, and saucer-shaped), due to fewer dentinal tubules than coronal dentin. Acute Caries (Rampant Caries) Chronic Caries  Bottle feeding before sleep , pacifiers dipped in honey NON- CARIOUS LESIONS Non-Carious Tooth Surface Loss is also termed Tooth Wear (NCTSL)  Tooth wear is a general term describing the loss of dental hard tissues from surfaces of the teeth caused by factors other than dental caries, trauma, and developmental disorders.  Severely worn dentitions present one of the greatest challenges in dentistry. Yet the treatment planning process for severe wear can be simplified if the rules for programmed treatment planning are precisely adhered to in correct sequence. Physiological Pathological Physiological Wear All occlusions wear to some degree causing what is called physiological wear which is considered an AGE RELATED normal process. As teeth continue to function throughout life and suffer from oral cavity challenges, highly variable degrees of tooth surface loss Physiological Wear Very slow loss of Some wear facets convexity on the cusps Loss of mamelons in anteriors Flattening of cusp tips Pathological Wear Tooth wear may be regarded as pathological if the rate of wear is greater than expected or atypical for the patient’s age pain Discomfort Functional Esthetic problem problem Pathological Wear Excessive or Severe wear when it reach a If there is substantial level that require loss of tooth structure corrective and significant loss intervention in ( ≥1/3) of the clinical order to preserve crown with dentin the dentition exposure Occlusal wear occurs seven times faster when dentin is exposed. Classification & Etiology Classification & Etiology Identification of the etiology is essential for the SUCCESSFUL MANAGEMENT of the pathology. Classification & Etiology According to Grippo classification established in 1991, four types of surface loss have been identified by the different causes Azouzi I, Kalghoum I, Hadyaoui D, Harzallah B and Cherif M (2018) Principles and guidelines for managing tooth wear: a review. Internal Medicine and Care 2(1): 1-9 NON- CARIOUS LESIONS Classification & Etiology Attrition Attrition is defined as the mechanical wear of tooth structure due to tooth to tooth contact without any foreign substance intervention Classification & Etiology Parafunctional habits Physiological Opposing Age dependent Attrition porcelain process Lack of posterior support Intracapsular TMJ disorders CLINICAL APPEARANCE Signs & Symptoms 1) Tooth Surface Loss IN CASE OR ATTRITION Attrition Occlusal Attrition Proximal Attrition Signs & Symptoms 1) Tooth Surface Loss IN CASE Of ATTRITION a-Occlusal surface attrition Flattening , faceting or reverse cusping Flattening of incisal edges Peripheral, ragged, sharp enamel edges Well defined wear facets ,enamel worn off , Loss of mamelons dentin exposure Signs & Symptoms 1) Tooth Surface Loss IN CASE Of ATTRITION a-Occlusal surface attrition It leads to loss of both tooth substance and restoration. Hanif, A., Rashid, H., & Nasim, M. (2015). Tooth surface loss revisited: Classification, etiology, and management. Journal of Restorative Dentistry, 3(2), 37. Signs & Symptoms 1) Tooth Surface Loss IN CASE Of ATTRITION b- Proximal surface attrition Mesiodistal dimension of the teeth is decreased widening of the proximal contact areas Mesial drifting Overall reduction in dental arch Classification & Etiology Abrasion Classification & Etiology It describes the pathological wearing off of dental hard tissue via mechanical processes involving foreign or exogenous objects. The foreign objects are said to be repeatedly introduced in the mouth and cause the condition. Classification & Etiology Classification & Etiology Tooth Brushing Patient Related Factors Material Related Factors Brushing Technique Bristle type & Stiffness Brushing Frequency Abrasiveness of toothpaste Force Applied PH of toothpaste CLINICAL APPEARANCE Signs & Symptoms 1) Tooth Surface Loss IN CASE OF ABRASION Depending on the Etiology , the patterns may vary from localized to diffuse. Localized lesions may be the result of a habit The tooth wear pattern will fit the shape of the object causing the wear. Signs & Symptoms 1) Tooth Surface Loss Tooth brushing Abrasion Cervical Region Rounded grooves or v-shaped defects Right handed pts on left & vice versa Localized : Canine & Premolar Generalized: wrong brushing technique Hanif, A., Rashid, H., & Nasim, M. (2015). Tooth surface loss revisited: Classification, etiology, and management. Journal of Restorative Dentistry, 3(2), 37. Signs & Symptoms 1) Tooth Surface Loss Tooth brushing Abrasion Simulated 7 years of a horizontal tooth brushing technique Bhundia, S., Bartlett, D., & O’Toole, S. (2019). Non-carious cervical lesions-can terminology influence our clinical assessment?. British Dental Journal, 227(11), 985-988. Classification & Etiology Classification & Etiology It describes a wedge-shaped defect at or near to the cemento-enamel junction of a tooth. Lesions due to abfraction are also termed as ‘cervical stress lesions’ in the literature. Classification & Etiology The theory of abfraction sustains that tooth flexure and bending in the cervical area is caused due to occlusal compressive forces and tensile stresses, resulting in microfractures of the hydroxyapatite crystals of the enamel and dentin Classification & Etiology Abfraction lesions are said to be facilitated by the thin structure of the enamel and the low packing density of the Hunter–Schreger band (HSB) at the cervical area. CLINICAL APPEARANCE  Signs & Symptoms 1) Tooth Surface Loss IN CASE OF ABFRACTION Similar to toothbrushing abrasion lesions More angular Well defined internal & external angles Wedge or V-shaped lesions Nascimento, M. M., Dilbone, D. A., Pereira, P. N., Duarte, W. R., Geraldeli, S., & Delgado, A. J. (2016). Abfraction lesions: etiology, diagnosis, and treatment options. Clinical, cosmetic and investigational dentistry, 8, 79.  Signs & Symptoms 1) Tooth Surface Loss IN CASE OF ABFRACTION Contributing factors leading to erosion or abrasion can also modify the clinical appearance of these lesions by making the angles less sharp and the outline broader and more saucer-shaped Nascimento, M. M., Dilbone, D. A., Pereira, P. N., Duarte, W. R., Geraldeli, S., & Delgado, A. J. (2016). Abfraction lesions: etiology, diagnosis, and treatment options. Clinical, cosmetic and investigational dentistry, 8, 79. EROSION Classification & Etiology It is the chemical loss of dental hard tissues by non-bacteriogenic acid following the drop in pH of the oral cavity below critical pH, ie 5−5.5. Classification & Etiology Grippo and Simring have descried the use of this term. They suggest that erosion refers to loss of material from action of fluids against a structure, as in beach erosion from water, This means that it refers to loss of a material from a solid surface due to mechanical interaction between that surface and a fluid. So, it is inappropriate terminology or a The term BIOCORROSION is more misnomer. appropriate Hemmings, K., Truman, A., Shah, S., & Chauhan, R. (2018). Tooth wear guidelines for the bsrd part 1: aetiology, diagnosis and prevention. Dental Update, 45(6), 483- 495. Classification & Etiology Extrinsic Intrinsic Classification & Etiology Extrinsic Erosion 1) Acidic food and drink intake It has been reported that any food substance with a critical pH value of less than 5.5 can become a corrodent and demineralize the teeth. d’INCAU, E., & Saulue, P. (2012). Understanding dental wear. Journal of Dentofacial Anomalies and Orthodontics, 15(1). Classification & Etiology Extrinsic Erosion 2)Medications: Hemmings, K., Truman, A., Shah, S., & Chauhan, R. (2018). Tooth wear guidelines for the bsrd part 1: aetiology, diagnosis and prevention. Dental Update, 45(6), 483- 495. Classification & Etiology Extrinsic Erosion 3)Exposure to acid in the work: Hemmings, K., Truman, A., Shah, S., & Chauhan, R. (2018). Tooth wear guidelines for the bsrd part 1: aetiology, diagnosis and prevention. Dental Update, 45(6), 483- 495. Classification & Etiology Extrinsic Erosion 4) Swimming : Hemmings, K., Truman, A., Shah, S., & Chauhan, R. (2018). Tooth wear guidelines for the bsrd part 1: aetiology, diagnosis and prevention. Dental Update, 45(6), 483- 495. Classification & Etiology Extrinsic Erosion 5) Chronic alcoholism: Hemmings, K., Truman, A., Shah, S., & Chauhan, R. (2018). Tooth wear guidelines for the bsrd part 1: aetiology, diagnosis and prevention. Dental Update, 45(6), 483- 495. Classification & Etiology Intrinsic Erosion Intrinsic erosion results from the gastric content (hydrochloric acid and the proteolytic enzyme pepsin ) entering the oral cavity as the stomach acid has a pH of approximately 2, which is highly erosive to the dentition. Dawson, Peter E. Functional occlusion-e-book: from TMJ to smile design. Elsevier Health Sciences, 2006. Classification & Etiology Pregnancy GERD laxity in the lower esophageal sphincter Involuntary Hiatus weakness in the diaphragm hernia Intrinsic Erosion Alcoholism Anorexia Voluntary nervosa food restriction Bulimia Binge eating nervosa CLINICAL APPEARANCE Signs & Symptoms 1) Tooth Surface Loss In case of Erosion Translucent Rounded and smooth lesions Darker Glazed Dished out, Broad, shallow Concavities Enamel Chipping or fracture Cupping or Cratering Shorter teeth Hanif, A., Rashid, H., & Nasim, M. (2015). Tooth surface loss revisited: Classification, etiology, and management. Journal of Restorative Dentistry, 3(2), 37. Signs & Symptoms 1) Tooth Surface Loss In case of Extrinsic Erosion Clinical presentation as the LOCATION & SEVERITY differ acc. to etiology The tissue loss location modifies following the areas related to the passage of the corrosive element. Buccal cervical surfaces of the maxillary teeth Occlusal surfaces of the mandibular with upper premolars are the most affected posterior dentition. Hanif, A., Rashid, H., & Nasim, M. (2015). Tooth surface loss revisited: Classification, etiology, and management. Journal of Restorative Dentistry, 3(2), 37. Signs & Symptoms 1) Tooth Surface Loss In case of Intrinsic Erosion Palatal surfaces of the maxillary anteriors Posterior lingual & occlusal surfaces equally on both arches Hanif, A., Rashid, H., & Nasim, M. (2015). Tooth surface loss revisited: Classification, etiology, and management. Journal of Restorative Dentistry, 3(2), 37. Signs & Symptoms 1) Tooth Surface Loss In case of Erosion Restorations stand proud from the teeth. Amalgam restorations will be raised above or higher than the eroded surface which is called AMALGAM ISLAND. El Wazani, B., Dodd, M. N., & Milosevic, A. (2012). The signs and symptoms of tooth wear in a referred group of patients. British dental journal, 213(6), E10-E10. Classification & Etiology Tooth wear usually has a mixed multifactorial etiology of attrition, erosion and abrasion. Combining the etiologies probably reflects the true clinical scenario. Hanif, A., Rashid, H., & Nasim, M. (2015). Tooth surface loss revisited: Classification, etiology, and management. Journal of Restorative Dentistry, 3(2), 37. Discoloration  What is Discoloration….. Shift from normal teeth shade and color  stains extrinsic intrinsic internalized local systemic DISCOLORATION TYPES… Discoloration: According to type of discolorations / stains: 1. Extrinsic stains: Accumulation of chromogenic substances on tooth surface (pellicle). Chromogenic bacteria Bad oral hygiene iron containing CHX stains medicament Indications 1. Extrinsic stains: Removed by prophylactic procedures. With time, they darken and become more persistent, still are highly responsive to bleaching. 2. Intrinsic stains: Local Causes: B. Dentist related: Remnants of pulp tissue left. Root canal sealers: incomplete removal. Intra-canal medicaments: Phenolic or iodoform-based. 2. Intrinsic stains: Systemic Causes (MILD FORM) A. Drug related: Tetracycline staining or Fluorosis B. Developmental defects: Enamel hypoplasia / hypocalcification Amelogenesis / Dentinogenesis imperfecta 2. Intrinsic stains: Cannot be removed by prophylactic procedures. Yellowish aging stains are fastest to respond, brown fluorescent stains are moderately responsive blue–grey stains are the slowest to respond (time). Tetracycline stains Generalized Aging staining 3. Internalized stains: External stains are internalized into tooth: Presence of cracks Caries: orange to brown discoloration. Leaky Restorations. Reduced salivary flow enhances the staining deposition  Peg shaped lateral Malformations Is a deviation from normal shape or size of the tooth. Fracture Is a loss of tooth structure as a result of trauma from a fall, a blow or sudden biting on a hard substance. Enamel hypoplasia  Defective enamel development can be the result of an inherited condition called amelogenesis imperfecta, or congenital enamel hypoplasia. improper enamel matrix formation due to injury of ameloblasts during enamel formation.  Enamel hypocalcification  Is a condition where enamel has an insufficient amount of calcium. Due to injury of ameloblasts occurs during mineralization of the formed matrix Enamel still covers the tooth's surface but parts can be thin and weak, giving teeth an opaque or chalky appearance