Lecture 4: Non Carious Lesions

Identification

• Attrition:

  • Dental attrition is the loss of tooth structure or tissue caused bytooth-on-tooth contact. Although this type of tooth wear isconsidered part of the normal aging process, more rapid dentalattrition may be due to larger dental problems.

  • Overtime, if dental attrition is left untreated, it can wear awaythe enamel, exposing the dentin of the tooth. This can lead totooth sensitivity and decay

  • If significant abnormal attrition is present, an evaluation shouldbe made to determine cause(s):

    • Bruxism

    • Agricultural society – dirt / dust abrading teeth, diet high in grain

    • Opposing abrasive porcelain (ceramic) restorations

    • Using anterior teeth as scissors

  • Causes

    • The most common cause of dental attrition is bruxism, the grinding and clenching of the teeth that occurs during sleep, usually due to muscle hypertonicity or tension. Bruxism can lead toother health problems, such as sleep apnea and temporomandibular joint disorders (TMJ) within your jaw

    • Another cause of dental attrition is bite misalignment. If your teeth are not aligned properly, they could be rubbing together. Overtime, the surface of one tooth can start to wear away the tooth surface and enamel of the other. If not treated early on, the damaged tooth enamel can start to accumulate bacterial deposits and lead to cavities, as well as tooth sensitivity and pain.

  • As cusp tips/incisal edges wear, incisal enamel is lost

  • Exposed dentin is softer than enamel and wears more quickly than peripheral enamel

  • Teeth become “cupped out”

  • Peripheral enamel becomes sharp and jagged

  • Unsupported enamel fractures

  • Signs

    • In addition to tooth sensitivity and decay, other signs and symptoms of dental attrition include:

      • Changes in tooth shape

      • Loss of tooth structure

      • Tooth pain

      • Sore gums

      • Tooth discoloration

      • Damage to dental fillings and restorations

      • In severe cases, tooth loss can occur.

  • Nightguard can protect for about 1/3 of the day

  • Restorative measures should be taken to slow or intercept process that occurs other 2/3 of day

  • Most commonly, dental attrition treatment will involve a combination of orthodontic treatment to fix tooth alignment (e.g., Invisalign)

• Abrasion:

  • Defined as:

    • The loss of tooth structure from: repetitive mechanical means such as brushing

  • Characteristic lesion:

    • Sharp, angular defect at gingival third of tooth

    • Results from direct frictional forces between tooth and external object or abrasive

    • Typically, caused by toothbrush used improperly or too vigorously

    • Treatment is not automatic, instead

    • ID and elimination of cause is primary concern

• Erosion:

  • Defined as: The chemical dissolution of tooth structure from: dietary, environmental, or gastric acids

  • Intrinsically:

    • Bulimia

    • Hiatal hernia / GERD

      • Could be nocturnal

    • Usually occurs on occlusal & lingual surfaces of teeth

  • Extrinsic

    • Increase citrus fruit/citrus fruit drinks

    • increased carbonated beverages

    • increase acidic beverages

    • employment in an acidic environment

    • long term exposure to an improperly chlorinated swimming pool

    • may occur on any or al surfaces of the teeth

• Abfraction:

  • Defined as: The loss of tooth structure from: repeated flexure caused by occlusal tensile stresses, literally meaning breaking away→ fracture

  • Characteristics

    • Sharp, angular, wedge-shaped

    • Similar in appearance to abrasion

    • Heavy occlusal forces and interferences create:

    • Flexure in the teeth leading to microfractures in the gingival third(abfractions)

  • It may be difficult to determine the primary etiology since many factors are now contributing to the destruction

  • For all of these conditions, once the progression starts, the loss of tooth structure is accelerated because the softer dentin or cementum is now exposed

  • Accurate diagnosis of the primary cause is important in order to slow the progression, before restorative treatment is begun

Diagnosis

• Requires evaluation of bruxism, occlusal factors, and enamel wear due to opposing abrasive materials.

Treatment of Abfraction

• Focus on identifying early causes to slow progression before restorative treatment starts.

Clinical Cases

• Describes various patient presentations and surgical outcomes alongside restorative measures taken.

Summary

• Early recognition and intervention lead to the least complicated treatments and best outcomes for patients suffering from non-cariuos lesions.