Cervical Lesions: Carious and Non-Carious, Erosion, Abrasion, Treatment, and Sensitivity

DCD - Dr. Cube Dentistry

Fourth Stage: Operative

Cervical Lesions (Carious and Non-Carious)

  • Presented by: Dr. Meelad Joffery

  • Edition: 2025

Introduction to Cervical Lesions

  • Definition: Cervical lesions, also known as class V lesions, comprise both carious and non-carious defects located in the gingival third of the facial and lingual surfaces of teeth.

  • Class V Carious Lesions:

    • Result from bacterial plaque adherence to tooth surfaces.

    • Produce acids leading to demineralization of the enamel and dentin.

  • Non-Carious Cervical Lesions (NCCLs):

    • Develop from factors other than dental caries.

    • Increasingly recognized for their complex multifactorial etiology including stress, friction, and biocorrosion.

Detection of Cervical Lesions

Visual Detection

  • Class V Enamel Lesions:

    • Easily detected due to change in color seen visually.

  • Limitation of Color as a Predictor:

    • Tooth color does not reliably indicate the extent of root caries damage.

    • A discolored root surface can still have a hard sclerotic surface that does not require treatment unless acidity causes patient issues.

    • Conversely, root caries may appear healthy yet be soft when assessed by dental tools.

Challenges with Detection

  • Caries Disclosing Dyes:

    • May yield inconsistent results in identifying demineralized cementum and dentin on root surfaces.

  • Best Clinical Indicator:

    • The softness of the tooth surface tested with a dental instrument is currently the best indicator of carious lesions on root surfaces.

Non-Carious Cervical Lesions (NCCLs)

  • Prevalence:

    • Reported prevalence ranges from 5% to 85% in contemporary populations.

    • Most common in premolars and molars; severity increases with age.

Erosion

  • Definition: Loss of tooth structure resulting from chemical actions.

  • Common Causes:

    • Frequent consumption of acidic foods and beverages.

    • Activities such as swishing acidic drinks or exposure to gastric acids from gastrointestinal issues.

  • Early Stage Presentation:

    • Smooth, silk-like appearance of enamel surfaces.

    • Lesions occur coronal to CEJ with intact enamel along the gingival margin.

Intermediate Stage Erosion

  • Characteristics:

    • Development of shallow flat concavities with rounded edges.

    • Possible complete enamel removal resulting in dentin exposure.

    • Rounding of cusps and incisal edges noticeable.

Advanced Erosion

  • Biological Response:

    • Reactionary and reparative dentin formation may occur in response to continued loss of dentin, ultimately affecting dentinal tubules.

Factors Accelerating Dental Chemical Degradation

Box 5-2: Habits to Avoid

  • Avoid Frequent Intake of Acids:

    • Swishing acidic drinks before swallowing.

    • Consuming acidic beverages before sleep; reduces protective saliva effects.

  • Post-Acid Brushing:

    • Brushing immediately after acid exposure increases enamel wear due to abrasiveness of toothpaste on softened enamel.

Abrasion

  • Definition: Loss of tooth structure by mechanical or frictional forces.

  • Common Causes:

    • Excessive tooth brushing.

    • Damage from dental floss, toothpicks, or removable dental appliances.

  • Visual Presentation:

    • Abrasion lesions typically appear as V-shaped notches.

  • Factor Influencing Abrasion:

    1. Brushing technique

    2. Type of toothbrush

    3. Abrasiveness of toothpaste

    4. Duration and intensity of brushing

Abfraction

  • Definition: Loss of tooth structure due to flexural forces.

  • Theory:

    • Proposed to explain the development of V-shaped notches.

    • Stresses from occlusal loading are transmitted to the cervical area, causing fractures of cervical enamel rods.

  • Associated Conditions:

    • Most often seen in patients who exert heavy occlusal forces or exhibit signs of bruxism.

Access and Isolation for Treatment

Access Challenges

  • Supragingival vs. Subgingival Cervical Lesions:

    • Supragingival lesions are easier for access and treatment.

    • Subgingival lesions require careful isolation to remove carious material adequately and to prepare and finish restorations effectively.

    • Failure to obtain full access may result in retention of carious structure and, subsequently, restoration failure.

Isolation Techniques

  • Methods Used:

    • Cotton rolls, retraction cords for adequate access in supragingival lesions.

    • Rubber dams are preferable for subgingival lesions for better visibility and access.

  • Surgical Approach:

    • If rubber dam does not provide adequate access, may resort to gingivoplasty.

    • Surgical approaches should ideally occur 6 weeks before restorative treatment for optimal healing.

Treatment of Cervical Lesions

Active Caries

  • Required Action: Initiate treatment to control active disease and prevent further progression.

Non-Carious Cervical Lesions

  • Treatment Indications:

    • Protect remaining tooth structure if significant tooth loss exists.

    • Address cosmetic concerns if aesthetics are compromised.

    • Lower sensitivity issues.

    • Facilitate design for removable partial dentures.

Asymptomatic Non-Carious Lesions

  • Preferred Management: Prophylaxis through various measures:

    • Tooth wear management

    • Thorough diagnosis and causal therapy

    • Prophylactic adjustments in potential causative factors

    • Use of fluoride

    • Documenting and following up treatments

Restorative Procedures

Decision-Making for Restoration

  • Cavity Preparation:

    • Determine extent of restoration based on lesion size.

    • Remove all demineralized and unsupported enamel.

Materials Used in Class V Restoration

  1. Composite Materials:

    • Resin composite (with dentin bonding systems)

    • Flowable resin composite

    • Composite with glass-ionomer base (sandwich technique)

    • Glass ionomer

    • Resin-modified glass ionomer

    • Compomer

    • Porcelain inlay (less common)

  2. Non-Esthetic Materials:

    • Amalgam

    • Direct gold foil (less common)

    • Gold inlay (less common)

  3. Esthetic Advancements:

    • Glass-ionomer to fill dentin, reduce microleakage, and improve retention.

    • Composite resin to enhance aesthetics and polishability.

Sandwich Technique (Laminated Technique)

  • Purpose: Combine advantages of glass ionomer cement and composite resin.

  • Techniques:

    1. Open Technique: Glass ionomer at gingival margin is exposed.

    2. Closed Technique: Glass ionomer entirely covered by resin composite.

  • Function: GIC serves as an intermediate layer between dentin and resin composite.

Dentinal Sensitivity

  • Association: Often related to gingival recession and NCCLs.

  • Cause of Sensitivity: Exposure of dentinal tubules transmits signals to the pulp, resulting in pain.

  • Influential Factors: Number and size of open tubules; fluid movement within the tubules changing in response to stimuli.

Treatment Options

  • Surgical Treatments:

    • Root coverage techniques like connective tissue grafts for gingival recessions.

  • Desensitizing Agents:

    • Stannous fluorides show promising results.

    • Potassium nitrate found in dentifrices or gels reduces sensory nerve activity rather than occluding tubules.

Other Treatment Options

  • Occlusion of Tubules:

    • Dentin adhesives provide temporary relief.

    • Oxalate solutions used alone or with electrophoresis show success in occlusion.

Conclusion

  • Final Note: If a practitioner knows the current condition and desired outcomes, executing effective treatment plans becomes more manageable, as underscored by the emphasis on informed clinical practices.

  • Acknowledgments: Presented by Dr. Cube Dentistry, a key educational platform in Iraq for medical students.