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Operative Dr.

Mohamed Atef 4th yr dentistry

Rayanne Jamaleddine 201103393

NONCARIOUS LESIONS: 1. Erosion: This is the loss of tooth substance by a nonbacterial chemical process. 2. Abrasion: Dental abrasion is the pathological wearing away of teeth due to abnormal processes, habits or abrasive substance. 3. Abfraction: This is the pathologic loss of tooth substance due to biomechanical loading forces that result in flexure and ultimate fatigue of enamel and dentin at a location away from loading. ETIOLOGY OF NONCARIOUS CERVICAL LESIONS: Non-carious cervical lesions are associated with erosion, abrasion and abfraction. 1. Erosion: a. Extrinsic: - Environmental erosion, wine tasting, metal plating, battery, manufacture. - Dietary acids, citrus fruits, carbonated drinks, pickled food. b. Intrinsic: - Gastric disorders, gastrointestinal ulcers, hiatus hernia, chronic alcoholism. - Eating disorders, anorexia vervosa, bulimia nervosa, chronic vomiting, pregnancy morning sickness. 2. Abrasion: a. Tooth brushing: - Over vigorous brushing - Use of a hard toothbrush

- Improper brushing technique b. Abnormal habits: - Biting a pipe stem - Biting finger nails - Opening bobby pins 3. Abfraction: a. Excessive occlusal stresses b. Parafunctional habits. - Bruxism - Clenching

Saliva: The quantity and quality of saliva may also have a role in the development of non-carious cervical lesions. Drugs and conditions which reduce salivary flow can accelerate the loss of tooth structure in the cervical region. Currently it is accepted that no carious cervical lesion have a multifactorial etiology and are not related to any one factor. A combination of erosion, abrasion and abfraction may operate in the initiation and progression of these lesions. CLINICAL FEATURES OF NON-CARIOUS LESIONS: 1. Erosion: - Appears facially or lingually - Broad, shallow, or saucer shaped - Not well defined - Smooth and polished like - Many teeth are affected, usually lingual surfaces of maxillary anteriors

2. Abrasion: - Appears facially - Notched, wedge shaped or v-shaped - Sharp and well defined - Smooth - Many teeth are affected, usually facial surfaces of maxillary left canine to molar regions in right handed persons and vice versa 3. Abfraction: - Appears facially - Wedge-shaped - Sharp - Initial stages-rough, later stages may show grooves. - May even be seen in single tooth. - Subgingival location is possible

DIAGNOSIS OF NON-CARIOUS CERVICAL LESION: - Note down history of intrinsic or extrinsic erosion. - Dentist must identify digestive problems. - Dentist must also question about abnormal habits like clenching or grinding.

CLINICAL EXAMINATION:

1. Clinical signs of occlusal problems: - Tooth mobility - Open contacts - Atypical occlusal wear - Overerupted teeth - Cross bites, deep bites and open bites - Fewer number of occluding teeth 2. Radiographs: - Identify altered lamina dura and periodontal space - Identify evidence of hypercementosis and resorptions - Identify pulpal calcifications

CLINICAL MANAGEMENT OF NON-CARIOUS CERVICAL LESIONS: Non-carious cervical lesions require clinical attention if any of the following factors exist: 1. 2. 3. 4. 5. 6. Tooth sensitivity Compromised esthetics Risk of tooth fracture Pulpal damage Caries Poor periodontal health

TREATMENT OPTIONS:

Treatment options include: 1. 2. 3. 4. Dentin desensitisation Restorations Endodontic therapy Periodontal therapy 1. Dentin desensitisation: Its a viable treatment option for those situations where minimal amount of dentin is exposed, and the patient experiences hypersensitivity. This may be managed by any of the methods suggested for dentin desensitization such as: - Fluoride varnishes - Dentin-bonding agents - Use of desensitising tooth pastes 2. Restorative treatment: - Considerable loss of enamel and dentin. - Esthetics is compromised - Deep lesions affecting the strength of the tooth and pulp integrity - Caries beginning in the cervical lesion - Significant sensitivity of the exposed dentin 3. Endodontic therapy: When cervical tooth loss is extensive resulting is pulpal involvement, endodontic therapy is necessary followed by post placement and full coverage restoration in the form of a crown. 4. Periodontal therapy: Periodontal therapy is required when noncarious cervical lesions are associated with considerable gingival recession and mucogingival defects.

It consists of root coverage procedures using free gingival grafts or connective tissue grafts, and root coverage using non-grafting procedure like rotational and coronally advanced flaps or guided tissue regeneration.

PREVENTION: 1. Die counselling 2. Use of sodium bicarbonate mouth rinse 3. Use of fluoride mouthrinse and xylitol 4. Psychiatric consultation 5. Correct brushing technique 6. Correct occlusal stresses 7. Provide mouth guards 8. Correct abnormal oral habits

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