Week 4 - Operative Procedures for Non carious Cervical Lesions (NCCL) Flashcards
(32 cards)
What is tooth surface loss to or a combination of
- Stress
- friction
- biocorrosion
What is attrition
This loss of tooth structure by mechanical forces from opposing teeth
wear may also occur interproximal causing mesial drifting and broadening of proximal contacts
what do teeth with attrition look like
areas may exhibit a yellowish brown discolouration if the wear has penetrated the enamel
What is abrasion
the physical wear as a result of mechanical processes involving foreign abrasive substance (not other teeth)
e.g. food, tooth cleaning
- dentine sensitivity in an abraded area suggests the presence of superimposed acid erosion
- if the wedge shaped cervical lesions caused by the action of tooth paste and tooth brush on acid-softened surfaces are painful = cervical hypersensitivity
what do teeth this abrasion look like
Abrasion areas have not well defined cusps and cutting edges are rounded or blunt.
Exposed dentine is scooped out but relatively shallower and broader than for erosive wear areas
Is dentine exposed by abrasion alone sensitive
No
because its covered by a smear layer and dentine tubules can be burnished by the mechanical action which closes them over
The rate of loss of tooth structure depends on what (4)
- abrasively
- magnitude of the force
- contact time
- frequency of contact
Distribution and extent of wear over the dentition is dependent on what
- type of occlusion
- diet
- lifestyle
- age (high correlation between age and wear)
What is abfraction
the flexure of the tooth at the cervical margin while under load is responsible for the breakdown of the brittle dental tissues
- evidence growing that excessive buccal and lingual forces on teeth may be responsible for some cervical lesions
- high correlation between the presence of wear facets on cusp inclines related to the cervical lesions and the lesions themselves
- the effect of acid can enhance the damage
What do teeth with abfraction look like
dish or saucer shaped, whether in enamel only or extending into dentine and the root surface
more specific notch or larger wedge shaped lesion occuring at the cervical margins
what is the impact of acids on the structure of a tooth
- Acids such as citric acid in orange juice can soften the surface of enamel by a few microns in just a few minutes, while it takes the enamel in the order of 12 hours to harden
- tooth brushing with a dentifrice immediately after eating will accelerate tooth brush abrasion
What is dental corrosion
superficial loss of dental hard tissue due to chemical demineralization by acids of non bacterial origin
Dental corrosion occurs when the rate of demineralization exceeds the rate of remineralization as acidity has exceeded the buffering capacity and neutralizing functions of normal saliva and salivary proteins
What are the 2 sources of acid
Intrinsic
- recurrent vomit
- gastro-oesophageal reflux disease - regurgitation,
Extrinsic
- diet
- medication
- environmental (occupational)
What is erosion
the superficial loss of dental hard tissue due to a chemical demineralisation not involving bacteria
What are factors influencing erosion
- Acid source - extrinsic/intrinsic including GORD
- Direction of acid movement within mouth
- Pattern of eating
- Saliva - variations in saliva flow, low quality of saliva, low quantity of saliva
Salivary pellicle is important as a protective factor
What are symptoms of dental erosion
- increased sensitivity
- Tooth discoloration
- chips, cracks and divots in the teeth
When would would you treat a non carious cervical lesion
- inability to eliminate or greatly reduce the rate of lesion progression through elimination of etiologic factors
- Lesion is esthetically unacceptable to the patient
- significant sensitivity of exposed dentin to cold liquids, food, and air that cannot be handled more conservatively
- Depth of the lesion threatens the strength of the tooth and integrity of the coronal radicular unit
What are some preventive measurement for non carious cervical lesions
- dietary counselling
- medical attention; gastric reflux or bulimia
- anti acid lozenges, alkaline mouth rises, or sugar free gum
- proper oral hygiene techniques
- control of occlusal forces
What are preventative measures for non carious cervical lesions
- dietary counselling
- medical attention: gastric reflux or bulimia
- Anti acid lozenges, alkaline mouth rinses or sugar free gum
- proper oral hygiene techniques
- control of occlusal forces
How to provide dentin desensitization
aim to occlude dentinal tubules
- toothpastes, mouth rinses, varnishes and solutions containing:
potassium nitrate (most popular)
- a product containing casein CPP ACP has been used with little efficacy for densensitisation
What are restoration treatment for non carious cervical lesions
- unsuccessful treatment by preventive or dentin desensitization
- correct selection of biomaterials
- isolation
- substrate preparation
- perio/resto intervention
What are signs of active moderate caries
- surface of enamel is whitish/yellowish: opaque with loss of luster, feels rough when probed
- the lesion may be covered by thick plaque prior to cleaning
What are signs of active extensive caries
Dentine feels soft or leathery on gentle probing
What is a sign of inactive moderate caries
- surface of enamel is whitish, brownish or black
- feels hard and smooth when probed
- lesion may not be covered by thick plaque prior to cleaning
