Differential Diagnosis

Non-cavitatated lesions two types

Early Carious Lesions (Decalcification) and Non-carious lesions

Two types of non-carious (non-cavitated) lesions

Fluorosis and Devepmental Defects (hypoplasia and hypocalcificaiton)

combination/decalcification

Fluorosis

Hypocalcification

Hypoplasia

Decalcification is caused by ___, fluorosis is caused by __

active caries leison (early), excess fluoride

Fluorosis occurs when? and where?

During development/eruption, incisal edges and cusp tips

Decalcification usually occurs along __ and _. basically in ? areas

gingiva and inter-proximal area, plaque stagnation

Hypocalcification is a condition where ?

ameloblasts cells are affected resulting in hypocalcification

Hypocalcification is caused by __

trauma, fever, malnutrition, hypocalcemia during formation

Fluorosis usually affects ?

incisal edges and cusp tips

Hypocalcification:

front teeth and 6 year molars: occurred when?

bicuspids and second molars: ?

1st year, age 3

Hypoplasia is ?

developmental enamel defect

Which often results in caries due to difficulty in maintaining oral hygiene?

what is this caused by?

hypoplasia, genetic disorders + systemic diseases

Decalcification is __ at eruption

Fluorosis is ___ at eruption

Hypocalcification is __ at eruption

not present, may not show stain, pigmented

Decalcification teeth affected

canines, pre-molars, molars

Frosted cusp tips?

Fluorosis

Fluorosis and Hypocalcification colors

light white to dark brown

Hypocalcification color

creamy yellow to dark reddish orange, or white/brown spots

Fluorosis is most frequently on ? Often in ?

teeth that calcify slowly (canines, premolars, molars), same spot on contra-lateral tooth

What teeth does hypocalcification occur on

any tooth, frequently on labial surfaces of incisors, (often singly)

what color is hypoplasia

white, yellow, brown pitted and rough spot lesions

what teeth for hypoplasia

often contralateral tooth as wel as same tooth on opposing arch (ie all central incisors)

Shape?

Decalcification: well-defined borders

shape?

fluorosis: lattice pattern

fluorosis

Fluorosis

shape?

hypocalcification: oval or round

hypocalcification

Hypoplasia

does it respond to bleaching?

Tetracycline: no

Can non carious lesions progress into a caries lesion?

yes if not cleansable

Tooth wear: 3 A’s

2 other

Abrasion, erosion, attrition

physiological (age), pathological

Mechanical forces by foreign element:

Chemical reduction:

Tooth to tooth wear:

abrasion, erosion, attrition

Abfraction causes tension and compression → ?

cervical tooth breakdown wedge: shape cerivical lesions

Abfraction is caused by?

bruxism (grinding), occlusal function mastication, parafunction

occlusal and incisal surfaces: shiny well defined facets, myofacial pain disfunction and stiff jaw, often due to bruxism

attrition

Glazed, smooth, round and edged surfaces, looks scooped out. No well defined facets, sensitivity, often due to bulimia and GERD

erosion

Pitted, scratched surface, if extreme will have facet or scooped out dentin. Patient usually does not have sensitivity, most often due to tooth brush and tooth paste

abrasion

most often occurs on ? Where most common?

abfraction: single tooth (abrasion is multiple), most common on buccal of canines and posterior teeth

abrasion resulting in caries lesion

erosion

Bruxism and Attrition

Bruxism and Attrition

Attrition

Abfraction

Clinical factors to consider (6)

• Age

• Diet

• Oral Hygiene

• Occlusion

• Habits

• Bruxism and Parafunction

2 kinds of cavitated lesions

non carious lesions or carious lesions

3 kinds of non carious cavitated lesions

tooth wear (E,A,A,A), enamel and dentin dysplasia, trauma

3 kinds of carious lesions

cavitation in enamel, in dentin, rampant caries