Caries and

non caries
lesion
By
Nora Al-zayyat
Lecturer in conservative department
The British University in Egypt
Agenda Style
0 Introduction
1
0 Tooth structure
2
0 Caries lesion
3
0 Non-caries lesions
4
Introduction
Indications
Indications of Operative Dentistry
Procedures:
A)Bacterial: E) Developmental:
Dental caries Enamel hypoplasia
B) Mechanical: Enamel hypocalcification
Abrasion, Abfraction Amelogenesis imperfecta
C) Chemo-mechanical: Malformed
Erosion F) Acquired:
D) Physiological: Discoloration
Attrition Fluorosis
G) Trauma
G) Esthetic Improvement
H) Replacement or Repair of
Restoration
 Tooth
structure
Enamel vs Dentine
Cervical
lesion
Caries
lesion
 Caries
lesion
It is an infectious microbiological
disease

caused by acid producing bacteria.

CHO + Microorganisms  fermentation 
acids  caries
characterized by episodes of alternating
phases of demineralization &

remineralization( dynamic process)

 Decision-making tree for dental caries including
activity assessment as a key factor in the decision
process

The flow diagram promotes the concept that active lesions (cavitated and non-cavitated as well as
recurrent lesions) need professional management, whereas inactive lesions do not need treatment
besides self-performed tooth brushing with fluoride toothpaste.
Non-caries lesion
 Poor esthetics of the worn teeth & ⇧
sensitivity or pain.

Severe tooth loss  non-vital tooth 

infection.

⇩ masticatory function  difficulty in

eating.
Sequela TMJ disorders.

e Problems in phonation (anterior teeth).

Although discoloration is not

destructive, yet it has social and
psychological effect.
1.

1.

1. Discoloration
2. Cracks
3. Malformations
4. Fracture
5. Dentinogenesis
imperfecta
6. Amelogenesis
imperfecta
7.
 Most teeth show signs of wear by the time individuals
reach their middle age.

Non-caries This wear has been described as “the cumulative loss

of mineralized tooth substance due to physical or

lesion chemophysical processes” resulting from attrition,

erosion, and abrasion.
The term “tooth wear” has been used to encompass all
three of these causes.
 Wear Tooth wear refers to loss of
tooth substance by means
other than dental caries.
Definitio Tooth wear is a very common
n condition that occurs in
approximately 97% of the
population.
This is a normal physiological
process occurring throughout
life, but accelerated tooth wear
can become a problem.
 wear

Physiological Pathological
The physiological
loss of hard dental
tissues is
characteristic for
elderly individuals
and it is conditioned
by natural wear and
tear due to the teeth
function.
Physiological tooth
wearAs proximal
contacts wear in a normal
dentition, there is a
compensatory occlusal
adjustment.
This may happen
naturally if the diet is
abrasive i.e. this is as a
result of function, not
parafunction, and so
should be not be
considered pathological
tooth surface loss caused
by bruxism.
Pathological
loss of hard
dental structures
is a condition in Musculat
which wear has ure
reached such Lips, tongue and cheeks
level that the
teeth can not
fully perform their Periodonti
function or um
seriousaesthetic Teet
problems are h
present . Salivary
glands
Bone and TMJ
 Epidemiology
The proportion of adults with severe tooth wear
generally rises from approximately 3% in young
people in their early 20s and to 17% in those over
the age of 70.
A large survey of middle‑aged adults showed that
increasing tooth wear was observed with age
particularly at the occlusal and incisal surfaces of
teeth.
 Epidemiology

Epidemiological studies of young adults

reported that prevalence of tooth wear
ranged from 6 to 45%.
In older individuals, the severity of tooth
wear have been shown to be consistent.
Etiology
Examinati• Aid in distinguishing between physiological and
on pathological TSL• Reveal any features which may
indicate the aetiology• Indicate whether or not
treatment should be carried out• Highlight any pot
difficulties anticipated in treatment.
• Sensitivity to thermal stimuli• A loss in vertical h
• A history of frequent fracture of teeth or restorat
Hypermobility and drifting.
 Tooth
1.
Wear
1.

1. Abrasion
2. Attrition
3. Demastication
4. Abfraction
5. Resorption
6. Erosion
Definition
 Attrition

Attrition is defined as the

wearing away of tooth
substance (or restoration) due
to tooth-to-tooth contact.

It can be mostly remarkable

in patients with a vegetarian
diet. It is generally
associated with
parafunctional activity.
Attrition

The wear from attrition may be

localized on the occlusal surfaces
of posterior teeth, the palatal
surfaces of maxillary anterior
teeth, the labial surfaces of
mandibular anterior teeth, and the
incisal edges of anterior teeth.
Attrition
The affected surfaces are
usually hard, smooth, and
shiny. In certain cases, they
may be sharp and jagged.
The areas of attrition may be
associated with a
yellowish-brown
discoloration if the wear
has penetrated the enamel.
Wear may also concern
interproximalsurfaces
leading to mesial drifting
and broadening of proximal
contacts
Attrition

Clinically, occlusal wear attributable to

attrition will produce equal and
matching wear facets on opposing
teeth.
In early stages, there appears a
smallpolished facet on a cusp tip or
slight flattening on an incisal edge,
while severe attrition leads to
dentineexposure, which may result
in
an increased rate of wear
Attrition

It is related to aging, but

may be accelerated by
extrinsic factors such as
parafunctional habits
of bruxism, traumatic
occlusion in the partially
edentulous dentition, and
malocclusion
Bruxis
m
What is ‘Bruxism’?

Bruxism is an important factor related

to tooth surface loss. It is defined as
the grinding of teeth during non
functional movements of the
masticatory system: it is a mandibular
parafunction.
 Bruxism
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 The wear is usually
uniform when
opposing teeth are
affected.
If bruxism is severe,
either marked wear of
occlusal surfaces will
occur or, in cases of
compromised
periodontal support,
tooth mobility may
result.
Bruxism can also be
associated with
muscle spasm,
Bruxism fractured teeth and
restorations.
What causes
bruxism?

Two aetiological models have been

proposed:(i) The structural model,
which is based uponthe role played by
malocclusion or by analteration in
maxillo-mandibular relationship.
(ii) The functional model, which
highlights theeffects of physiological
stress as
a predominant cause.
Pathological
Attrition
Pathological
Attrition

Occlusal
Facets
Pathological Anterior Cup Shaped
Lesions
Attrition
Abrasion

Abrasion is the loss of tooth

substance through
mechanical means,
independent of occlusal
contact.
The site and pattern of
abrasion wear can be
diagnostic as different
foreign objects produce
different patterns of abrasion
wear
 Factors affecting the severity
of tooth-brush abrasion

Patient factors Material factors

1. Brushing technique. 1. Type of material.

2. Frequency of brushing. 2. Stiffness & end-rounding of
3. Time of brushing. bristles.
4. Force applied during 3. Tuft design.
brushing. 4. Flexibility & length of tooth
5. Where on brushing is brush.
started. 5. Abrasiveness, PH & amount of
Clinical Signs and
Symptoms
Proximal
Abrasion
Abrasion the abrasion of interdental areas
may be the result of extensive use
of interdental brushes or
tooth picks.
Abrasion

The most common cause of

dental abrasion found in the
cervical areas is
toothbrushing and the severity and
distribution of toothbrushing
abrasion wear may be related to
brushing
technique, time, frequency,
bristle design and the abrasiveness
of the dentifrice
Habitual
Abrasion
Abrasion Some forms of abrasion may be associated with habit or
occupation, such as a rounded ditch on the cervical
aspects of teeth due vigorous horizontal
toothbrushing
or incisal notching caused by
pipe smoking or nail biting
 Abrasio
n
Environmental factors: they
include exposure to dust and gritin
some working places
Occupatio
nal
Abrasion
Iatrogenic
abrasion
Diagnose the cause of abrasion to remove it before ttt &
restoration.

Knowing the causative factor first and try to prevent the

patient from practicing the causative habits. (Correct or
replace the iatrogenic dental work if it is present).

It is preferable to desensitize the exposed dentin before

restorative treatment is started, as if the sensitive teeth are
restored immediately they will remain sensitive to
thermal changes forever.
Desensitization can be
and the patient isdone
recommended by:
 Topical application of 10% stannous fluoride for 4 to 8 min
not to rinse his mouth or eat for
15 min after application.

 Ionophoresis using an electrolyte containing fluoride ions can

also be used.
Restorative
treatment

If the lesions are

multiple, shallow,
wide and involve
ENAMEL only  no
need to restore. Only,
The edges at the defect
should be eradicated to
provide  smooth
margin  Fluoride to
improve caries
resistance
Restorative
treatment
Definition

Wearing of tooth
substance during the
mastication of food with
the bolus intervening
between opposing teeth.
Wear is influenced by the
abrasiveness of the-individual
food.
Demastication is a
physiological process
affecting primarily the
occlusal and incisal surfaces
but may be pathological
when occurring due to
abnormal hard food
consumption.
Pathological Demastication
Abfraction
Abfraction Abfraction
means the
pathological loss
of tooth structure
resulting in
wedge-shaped
lesions with
sharp line angles
which may be
located
completely
beneath the
marginal gingiva
Definition
Abfraction tensile and compressive stresses from
mastication and malocclusion play a major
role in the formation and progression of
wedge-shaped abfraction lesions.
 Abfracti
on

abfraction is related to atypical

occlusal loading
Abfraction
It is a consequence of
eccentric forces on
the natural dentition,
which were
theoretically said to
have been caused by
tooth fatigue, flexure
and deformation via
biomechanical
loading of the tooth
structure.
Abfraction

Cusp flexure, due to lateral occlusal forces

during mastication and parafunctions,
causes tensile stress. This disrupts the
chemical bonds presented by induced
cracks in the enamel and dentin in the
region of concentrated stress
at the cervical region.
Treatment
of
Abfraction
Definition

The clinical terms dental

resorption and root resorption
are biological removal of
dental hard tissue by
dentinoclastic and
cementoclastic activity.
This can be either
physiological process, as in the
case of root resorption of
deciduous teeth, or a
pathological process such as
resorption due to trauma,
cysts or neoplasms.
Cracked Tooth Syndrome
presence of The tooth will be painful
incomplete on bite release and/or
cracks or eating citrus fruits and
foods.
fractures of the
enamel or This sharp pain will
disappear when pressure
enamel and is released
dentin in a
tooth.
Diagnosis of
CTS
Diagnosis of
CTS
Management
of CTS
Enamel
Hypoplasi
a
 Enamel
Hypoplas
ia
a defect in enamel due to
improper matrix formation
caused by injury to ameloblasts
opaque white or brownish areas,
pitted & grooved
Etiology Systematic disorders ……..Fevers , malnutrition
Localized disorders ………infection or trauma
of deciduous teeth
Excessive amounts of systemic fluoride
( fluorosis)
pits, tiny groves, depressions, and
fissures
white spots
yellowish-brown stains (where the
underlying layer of dentin is
exposed)
sensitivity to heat and cold
lack of tooth contact, irregular
wearing of teeth
susceptibility to acids in food and
drink
retention of harmful bacteria
increased vulnerability to
tooth decay and cavities
Mild

White opaque area on tooth surface

Flecking or spotting of enamel
Moderate

Pitting of the surface

Tendency to wear
Severe

Brownish staining of the surface

Corroded appearance of tooth
Treatment of
enamel
hypoplasia
Treatment of
enamel
hypoplasia
Treatment depends on the severity of
the problem. Goals of treatment are to:
prevent tooth decay
maintain a good bite
preserve tooth structure
keep teeth looking their best
Some of the smaller
defects that aren’t
causing decay or
sensitivity may not need
treatment right away.
They still require
monitoring, though.
Regular visiting to dentist
to apply topical fluoride
to help protect teeth.
Treatment of enamel hypoplasia

Sensitivit restoratio Esthetics

y n
What are the
potential
complications
Hypo-calcified
Enamel
Proper diagnosis
Dental & Medical history
History of neonatal or early
childhood illness, use of drugs and
medications, past infections or
trauma related to primary teeth
and fluoride exposure
Clinical examination
 Treatment of
hypocalcification

Proper and timely brushing

and flossing is the best
preventative,but drinking
water versus soda or acidic
juices also helps. Visit the
dentist every six months.
Remember that fluoride is
a strong cavity-fighter and
that ACP (Amorphous
Calcium Phosphate) found
in toothpastes aids in
remineralizing teeth
 Treatment of
hypocalcificati
Soft on
spot, chalky
spot, or white spot.
The MI is short for Minimal
Intervention. It can reduce the acid
destruction of the enamel and
prevent decay. This reduces
sensitivity and aids in the removal of
white spots. MI Paste replaces the
lost calcium and phosphate from
teeth when they begin the decaying
or demineralization process.
 Bleachin
g:
The most conservative
management
an attempt to blend the
lesion in with the natural
dentition
Involves diffusion of the
bleaching material into the
enamel and dentin to
interact with stain
molecules
 Enamel
microabrasi
on
It is indicated for superficial
defects,
contraindicated in lesions with
dentin involvement and
deeper opaque stains as in
severe hypoplasia
fluoridated prophylaxis paste
should be applied to aid
remineralization of the treated
surface
Preoperative view of teeth
fluorosis

Post operative view after bleaching &

microabrasion
A combination of microabrasion followed by resin infiltration can also be
used
to improve the esthetic outcome

Unesthetic white spot

lesion
post-treatment view after
microabrasion and resin
Selection of proper
treatment method
Restorative
treatment
Molar Incisor Hypomineralization(MIH)
 Molar Incisor
Hypomineralizatio
nMIH
Prevalence

The prevalence figures

range from 3.6–25% and
seem to differ between
countries
The frequency of MIH
molars was not evenly
divided among children
 Clinical
Features
Mild Moderate Severe
Demarcated opacities are Demarcated opacities are Post-eruptive enamel
in nonstress-bearing areas present on occlusal/incisal breakdown is present
of the molar third of teeth There is a history of dental
No enamel loss is present Post-eruptive enamel sensitivity
There is no breakdown/caries are Caries is associated with
hypersensitivity limited to 1 or 2 surfaces the affected enamel
There are no caries without cuspal involvement Crown destruction can
associated with the affected Dental sensitivity is advance to pulpal
enamel generally reported as involvement
Incisor involvement is normal Aesthetic concerns are
usually mild if present expressed by the patient or
parent
Management
of MIH
 The
objective
is to:
maintain
function
preserve tooth
structure
plan for any
required
orthodontic
care
Management of
MIH
Enamel fluorosis
It is a public health
problem caused by excess
intake of fluoride through
drinking water/food
products/industrial
pollutants over a long
period. Ingestion of excess
fluoride, most commonly
in drinking-water affects
the teeth and bones
 According to
severity

A. Micro/Macro abrasion
B. Bleaching
C. Composite restorations
D. Veneers
E. Full crowns
 Hypoplasia
Regular cavity margin

Fluorosis
Caries resistant

MIH
Caries progression
Cavity margin irregular
 Definition

Pathologic,
chronic, localized
and painless loss of
dental hard tissue
chemically etched
away from the tooth
surface by acids
without bacterial
involvement.
Erosion Vs
Caries
Erosion Erosive defects according to stages are divided into the
initial, advanced and severe.
The initial erosive lesions affect only the enamel surface
layer and appear as beginning demineralization.
There is a loss of surface relief of enamel, vanish of
perikymata the enamel is smooth and dull
Erosion Advanced erosion is characterized by extensive loss of
enamel. In the cervical region the loss may extend over
the dentin. In posterior teeth the reduction in the cusps
height, pitted depressions on the occlusal surface as well
as protrudingpolishing shiny amalgam filling can be
observed
Erosion Dental erosion in severe stages is characterized by large
enamel defects with exposure of dentin. Erosive defects with
exposed dentin are usually accompanied with dentin
hypersensitivity.
Advanced and severe erosive defects are often aesthetic problem
for the patient. In the case of bite height loss a number of
symptoms of stomatognathic system disfunctions as well
as pain of chewing muscles or temporomandibular joint
disorders can be often occurred.
Classification of Erosion
 EROSIO
N
Extrinsic Idiopathic

Intrinsic
b- Dietary
factors
c- Medications
e- Behavioral
factors
f- Professional tooth cleaning
Management of
Erosion

Preventive
Restorative
Prevention of
Erosion
 Remineralizing solutions containing ca, ph
3. Enhancing acid & Flouride
resistance, Topical application of NaF solution for 48hs
remineralization and protects enamel from erosion
re-hardening
 4. Measures to
provide chemical
Protection
5. Measures
to minimize
abrasive
influences
6. Providing
mechanical
protection
 Lesions limited to
enamel
Lesions extended
to dentin
Sensitive
Dentin
Non-Sensitive
Dentin
Desensitizi
ng Agents

Fluoride
Potassium nitrate
Oxalate
Calcium
phosphates (ACP)
Adhesives and
resins
Ionto-phoresis
Lasers
Dentinal Tubules Occlusion
Desensitizing gel with potassium
nitrate
 Teeth
Discoloration
Hematologi
cal stains
Fluorosis
Tetracycli
ne
Amelogenesis & dentinogenesis
imperfecta
Amalgam Blues
Trau
ma
Internalized
Discoloratio
n
Leaky Restorative
materials
Tooth wear
Cracked tooth
Manageme
nt of
Discoloratio
n
Wear Indices
 Wear Indices

There is both a clinical and scientific need to be able to measure

tooth wear, and the literature abounds with many methods which
can be broadly divided into quantitative and qualitative in nature
 Wear Indices

Quantitative methods tend to rely

on objective physical measurements,
such as depth of groove, area of facet
or height of crown
Qualitative methods, which rely on
clinical descriptions, can be more
subjective
 Wear Indices

Quantitative and qualitative methods

typically utilise grading or scoring
systems designed to identify
increasing severity or progression of a
condition; these are described as
indices and are usually numerical
Wear Indices
Wear Indices
Wear Indices
Infographic Style

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