Non-Carious Cervical Lesions

Front 1

Causes of NCCLs

Back 1

-multifactorial

Front 2

Causes of non-carious tooth structure loss

Back 2

-attrition: fxnal wear, tooth to tooth friction
-abrasion:loss of tooth structure by friciton b/w tooth and an exogenous agent
-erosion:loss of tooth structure from non-carious chemical dissolution
-abfraction: loss of cervical tooth structure due to occlusal forces. Caused by tooth flex and cocnentration of stress at cervical area of tooth structure

Front 3

NCCLs multiple factors

attrition?

Back 3

Erosion: loss of tooth strcuture from non-carious chemical dissolution

Abrasion: loss of tooth structure by frictionb/w tooth and exogenous agent
-abfraction: the loss of cervical tooth structure due to occlusal forces

-nope

Front 4

Causes of Tooth erosion

Back 4

extrinsic sources of acid:
Dietary:
-soft drinks: most frequent source of liquid dietary acid in the u.s. population/ per capita consumption in U.S. in 2000=53gallons
wines
fruit/fruit juices
sports drinks

-occupational:
-industrial gases containig acid
-galvanizing, plating

-athelteic:
-competitive swimmers: gain long exposure to swimming pools with acidic pH(laws says need to neutral pH)

intrinsic:

-Gastric: bulimia, GERD

Front 5

erosion diagnosis

Back 5

-Dietary Information
-diet componenets
-frequency of consumption
-habits: soda swishers

Front 6

Erosion diagnosis:
Clinical appearance

Back 6

-Clinical Appearance:
bulimia:
-lesion location reflects position of head when vomiting:
-palatal surfaces of maxillary anterior teeth
-buccal surfaces of mandibular molars(in more severe cases)
-thinning of enamel then smooth glassy dentin, then incisal edges become ragged, development of reverse smile teeth arrangement

GERD:
-slower movement of gastric acid than in bulimics
-burp acid not large amounts as in bulimia
-longer acid exposure than in bulimics
-thin translucent enamel
-enamel loss on palatal of max. anteriors and occlusal mandibular molars
-cupping of exposed dentin on occlusals of lower molars(not leaning over)
-cusp tips lose thier pointiness, dentin becomes exposed
-GERD during sleep-more lesions favored on sleeping side

Front 7

Erisoion diagnosis
Clinical appearance:
Dietary:

Back 7

-broad concavities with smooth enamel
-labial and buccal surfaces
-maxillary and mandibular teeth
-thin, translucent enamel
-preservation of enamel cuff in gingival credvice is common
-gingival tissues comes up and covers CEJ, enamel above has been exposed to acid while enamel underneath is protected/intact

Front 8

Causes of tooth abrasion hypothesis

Back 8

Possible:
-cervical
-overzealous tooth brushing
-hard toothbrush
-abrasive dentifrice

Front 9

Do most TB lesions occur on opposite side of dominant hand

Back 9

no they are just anecdotal claims no verification with clinical studies

Front 10

What we know about abrasion

Back 10

-tooth brushing is a significant factor in intiaiton and progress of NCCLs, but... the degree to which TB causes NCCLs is undefined

-tooth brushing plus acid exposure is bad!(brushing before reminalization though is not carious cervical lesions)

-acid exposure makes tooth more susceptible to abrasion
-enamel is very sensitive to toothbrushing immediatley after demineralizaiton
-demin'd tooth surface can be remin'd after exposure to saliva

Front 11

can demin'd tooth surface be remin'd after exposure to saliva?

Back 11

-only if soften tooth structure is not immediatley exposed to brushing
-the material lost form this cannot be replaced

- need to delay one hour for neutralization

Front 12

Abfraction: The theory
pathway:

Back 12

occlusal loading forces-->flexure-->microfracture-->tooth substances, loss in cervical area

Front 13

Abfraction: the theory
also known as:

Back 13

aka stress corrosion or stress induced non-carious lesion

-bending of the tooth will start lesion the cervical(notich)

Front 14

Abfraction caused by what kind of contact

Back 14

-posterior interference contact occuring during lateral jaw movement:

Front 15

Abfraction: Diagnosis:

clinical appearance?
association with?

Back 15

-Clinical appearance:
-wedge-shaped or saurcer shaped
-not conclusive
-only and aid determining etiology

-Association with occlusal or incisal wear facet(intering contact)

Front 16

Signs of abfraction

Back 16

-wear facets on canines and premolars

-also: history of toothbrush abrasion

Front 17

Treating NCCLs:

Failure to appropriately prevent and treat:

Back 17

-progression of tooth structure loss
-tooth sensitivity
-need for endodontic therapy
-tooth loss
-occurence of additonal lesions

Front 18

treating NCCLs
-can you base treatment on an assumed cause?
-number of causes
-look for?
-conduct a?
-evaluate?
-analyze?

Back 18

-don't base treatment on an assumed cause:
NCCLs + wear facets doesn't equal unifactorial

-think multifactorial
-detailed health history
-thorough exammination(
-oral hygiene
-diet analysis

Front 19

Treating NCCLs

Should inform patients of?

Back 19

-etiologies
-implicaiton of the presence of lesion
-prevention methods
-treatment alternatives

Front 20

Treating NCCLs

-first goal?
-then?
-what should u do to the teeth?

Back 20

-eliminate primary causes of NCCLs

-change etiologic factors where possible

-desensitize teeth, periodontal graft to cover and protect affected areas, restorative treatment

Front 21

Treating NCCLs
-Class V resoration for NCCLs?When?

Back 21

-Inability to halt lesion progression by elimination of etiologic factors

-esthetic unacceptability of lesion to patient

-intolerable sensitivity to cold, food, air

-threat to strength/structural integrity of tooth because of lesion depth