Non-carious lesions of the teeth: types, causes, treatment

Non-carious lesions of the teeth are a frequent occurrence in dental practice. This concept includes a wide range of diseases with different etiology and clinical manifestations.

General concept

Non-carious lesions of the teeth - an extensive group of diseases and pathologies. These include all damage to enamel, dental tissue, a disease of non-bacterial nature. In prevalence, they occupy the second place after tooth decay. These kinds of lesions can have a variety of symptoms and a clinical picture, they have different causes and causes. But they are all congenital or acquired.

They can have a different distribution - to hit one or all of the teeth in a row, individual patches in a certain order. Many of these diseases are difficult to diagnose, as the signs of different pathologies are similar and difficult to distinguish from each other. This may be due to insufficient knowledge of the disease, which complicates its detection and increases the risk of complications. In this situation, only the best dental clinics can help, where they will choose the right treatment option (for example, "SM-Clinic", which has several branches in Moscow, "Diamed" or "DentaLux-M").

Classification of non-carious lesions

Due to the variety of diseases that are related to the concept of "non-carious lesions of the teeth," their classification does not have one generally accepted standard. If you summarize all the data, you can get a generalized list of types of lesions.

1. Pathology of development with teething :

• Anomaly of shape, size.
• Fluorosis (speckled teeth).
• Hypoplasia of enamel (developmental disability).
• Pathology of the structure of the teeth of a hereditary character (odontogenesis, amelodentinogenesis).
• Syphilis (congenital).
• Other developmental pathologies associated with external factors (taking antibiotics, rhesus conflict).

2. Pathological changes in hard tooth tissues:

• Complete tooth loss.
• Erosion.
• Color change after eruption.
• Hypersensitivity of tissues.

3. Changes in the internal structure of the tooth :

• Fracture of the root.
• A dislocation of the root.
• Fracture of the tooth crown.
• Opening of the pulp.

In our country more often use another classification, proposed in 1968 by VK Patrikeev. According to it non-carious lesions of the teeth are divided into two groups.

1. Disorders occurring before eruption:

• Abnormality of eruption and development.
• Hypoplasia of teeth.
• Hyperplasia.
• Fluorosis.
• Hereditary pathologies.

2. Disorders that occur after eruption:

• Erosion.
• Wedge-shaped defect.
• Necrosis of hard tissues.
• Hyperesthesia of the teeth.
• Erasing.
• Injury of teeth.
• Pigmentation.

Hypoplasia

This is the name of the pathology of the development of dental tissue during its formation, that is, in children before teething. This disorder is caused by insufficient mineralization of tissues. The main feature is the complete absence of an organ or an abnormally small development. Hypoplasia of the teeth can be both congenital and develop after the birth of the child. There are several reasons for this:

• Conflict of Rh factor in mother and child,
• Mother-borne infectious disease during pregnancy, infection in a child after birth,
• A strong toxicosis accompanying pregnancy,
• Premature birth, trauma during childbirth,
• Pathology of child development after birth,
• Dystrophy, diseases of the gastrointestinal tract,
• metabolic disease,
• Impaired brain activity,
• Mechanical damage to the jawbone.

There are two types of hypoplasia - systemic and local. The first is characterized by the defeat of all teeth, low thickness of enamel or its absence. Appears yellow spots. The local one is affected by one or two organs. Here there is a lack of enamel (partial or complete), structural defects of the teeth - they can be deformed. Such violations cause pain. Hypoplasia in severe form causes increased abrasion of the teeth, destruction of tissues or complete loss of the organ, development of an incorrect bite. Treatment of hypoplasia includes teeth whitening (at an early stage) or filling and prosthetics (with severe disease). Simultaneously, remineralization of the enamel with medical preparations (for example, calcium gluconate solution). In order to prevent the onset of hypoplasia in children, pregnant women are recommended a balanced diet containing vitamins for teeth (D, C, A, B), calcium and fluoride, as well as strict hygiene of the oral cavity.

Hyperplasia

Hyperplasia - non-carious lesions of teeth associated with excessive formation of tooth tissues. Their appearance is due to an anomaly in the development of epithelial cells, enamel and dentin. It appears in the form of "drops", which are also called "enamel pearls". They can reach 5 mm in diameter. The main area of localization is the neck of the tooth. Such a drop consists of tooth enamel, inside it can be dentin or soft connective tissue resembling pulp. There are five types of such formations according to their structure:

• True-enamel - consist only of enamel,
• Enamel-dentinal - the enamel sheath contains inside the dentin,
• Enamel-dentinal drops with pulp - inside is a connective tissue,
• Drops Rodriguez-Ponty - enamel formations in the periodontium between the root and the alveolus,
• Intradentinal - located in the thickness of the dentin.

Hyperplasia of dental tissues does not manifest itself clinically, it does not cause pain, inflammation or any discomfort. You can only highlight the aesthetic factor if the anomaly affects the front teeth.

In this case grinding and leveling of the surface is carried out. In other cases, if the patient does not care, the treatment is not carried out. Preventive measures consist in protection of dental teeth from caries, as their destruction can cause disturbances in the development of permanent teeth.

Fluorosis

Fluorosis occurs during the formation of dental tissue due to increased intake of fluoride into the body. It changes the correct structure of the enamel and causes its external defects - the appearance of spots, streaks, furrows, dark inclusions. In the development of such pathology, the role is played not only by the excess of fluoride, but also by the lack of calcium. In children's body, fluoride accumulates more and faster than adults, with food and water. There are such forms of fluorosis:

• Dashed - manifested by the appearance of white bands without a clear contour;
• Spotted - characterized by the presence of yellowish spots with a smooth surface;
• Melovid-speckled - matte or shiny spots, having white, brown or yellow color (can affect all teeth);
• Erosive - multiple erosion of the enamel surface;
• Destructive (the tooth broke or completely collapsed) - the harmful processes associated with fluorosis.

Methods of treatment of fluorosis vary depending on the form of the disease. So, with spotted form, whitening and remineralization are carried out, if necessary - grinding of the upper layer of enamel. But the erosive form can not be cured in such ways, it is necessary to restore the teeth with veneers or crowns. General methods of treatment include remineralization, restoration of the shape and color of the organ, local effects on the body, control of fluoride intake.

Erosion

Non-carious lesions of the teeth include such damage to the enamel as erosion. Its formation leads to a discoloration, aesthetic damage to the tooth, as well as increased sensitivity. It is revealed during visual inspection. Erosion of the tooth is characterized by progressive destruction of enamel and dentin, the course of the disease is chronic, can take a long time. The cause of the pathology can be of a mechanical nature, for example, when using hard brushes or pastes with abrasive particles. Also, erosion can be caused by chemical exposure to enamel when consuming foods and drinks with high acidity (pickles, marinades, citrus juices and others). Workers of production, associated with the constant inhalation of harmful substances, most often suffer such damage to the teeth. The use of certain medicines may contribute to the onset of the disease (for example, a large amount of ascorbic acid adversely affects the enamel).

The cause of erosion of the teeth can also become abnormalities in the work of the stomach (increased acidity of its environment) or the thyroid gland. Detect the disease at an early stage is difficult, since it manifests itself only by loss of shine on a separate small tooth segment. The further course of the disease leads to a gradual decrease in enamel and dentin. It looks like erased teeth, more often at the bottom. Treatment is based on stopping the destruction of dental tissues. Includes the use of applications with a content of fluorine and calcium for about 20 days, then the affected area is covered with fluorine. It is possible to use veneers or crowns to restore aesthetic appearance. The complex therapy includes calcium and phosphorus preparations, as well as vitamins for the teeth. If you do not treat erosion, it can cause hyperesthesia of the teeth.

Hyperesthesia

Hyperesthesia of teeth is manifested by increased sensitivity of enamel and in most cases is a concomitant symptom of other non-carious diseases. The prevalence of this pathology is great: about 70% of the population suffers from hyperesthesia, women are more likely to suffer from it. Manifestation is a sharp, severe pain that lasts no more than thirty seconds and appears when external factors influence the enamel. Hyperesthesia is divided into species according to several criteria:

1. Distribution:

• Limited form - affects one or more teeth;
• Generalized - characterized by the sensitivity of all organs.

2. Origin:

• Form of hyperesthesia associated with loss of dental tissues;
• Not associated with loss, is due to the general condition of the body.

3. Clinical picture:

• Pains arise as a reaction to the temperature of external stimuli (cold water);
• Teeth react to chemical irritants (sweet or acidic foods);
• Reaction to all stimuli, including tactile ones.

Treatment of hyperesthesia is appointed by a specialist, depending on the cause of its occurrence, the complexity of the problem and the form of the disease. In some cases, surgical intervention is necessary (for example, in the case of a pathological lowering of the gum and denudation of the cervical area of the tooth), and sometimes therapeutic procedures, such as applying fluoride-containing applications to the damaged areas, can be avoided. Orthodontic therapy may be required for hyperesthesia due to increased erosion of the teeth. Preventive measures include the use of all necessary minerals and vitamins to strengthen dental tissues, regular and proper use of oral hygiene products, and an annual check-up with the dentist.

Wedge-shaped defect

A wedge-shaped defect is a tooth lesion, in which its base is destroyed. Externally manifested damage to the neck of the tooth in the form of a wedge. Fangs are most often prone to defect. At the initial stage is invisible, it is difficult to diagnose. With a long course of the disease, a dark shade appears in the area of the lesion. The main symptom of the wedge-shaped defect is that the teeth react painfully to the influence of high or low temperatures, sweet food, physical effects (cleaning). The cause of the development of the disease may be non-compliance with oral hygiene, improper use of the brush - if after cleaning at the base of the bone formation remains a bacterial plaque, it destroys the enamel, leading to a wedge-shaped defect. Also, gum disease such as gingivitis and periodontitis, thyroid dysfunction, increased gastric acidity, causing heartburn may also be the cause. Treatment of a wedge-shaped defect depends on the severity of the lesion.

With a slight disruption, it is sufficient to carry out restorative procedures that will replenish calcium and fluoride in the tooth enamel and reduce its susceptibility to external factors. With severe damage, you can not do without installing a seal. Because of the inconvenient location of the defect, such seals often fall out. The best dental clinics are able to solve this problem by drilling a hole of a certain shape that holds the seal, and using a material of special elasticity.

Necrosis of hard tissues

Necrosis of hard tissues of teeth at an early stage is manifested by loss of gloss of enamel, appear small stains. In the process of developing the disease, they become dark brown. In the affected area, softening of the tissues occurs, the enamel loses its strength, the patient can complain that the tooth has split off. There is pigmentation of dentin. Usually not just one organ is affected, but several. Sensitivity to external stimuli increases. It is localized mainly at the neck of the tooth, as well as the wedge-shaped defect and erosion. But, despite similar symptoms and the area of the lesion, an experienced dentist can easily distinguish these diseases from each other and make the correct diagnosis. This pathology occurs against the background of hormonal disorders in the body. Treatment is aimed at strengthening the dental tissues, eliminating hypersensitivity (hyperesthesia), and with severe lesion appoint orthopedic therapy.

Injuries to teeth

The concept of "tooth trauma" combines the damage to the mechanical nature of the outer or inner parts of the tooth. The causes of their occurrence can be called falls, jabs on the jawbone during sports, fights, accidents. With prolonged exposure to the tooth with foreign objects or solid food, tissues become thinner and become brittle. In this case, trouble can happen even when chewing food.

Dental injuries can result from improper dental procedures, for example poor pin installation. Some diseases, such as hypoplasia, fluorosis, cervical caries, and root cysts can lead to damage. The injuries include fractures of the crown or root, dislocation, bruised tooth. Treatment of injury is based on the exclusion of physical effects on the diseased organ, the refusal of solid food. In the treatment of dislocation, the tooth returns to the well for further engraftment. If such an operation has no prospects, according to the dentist, prosthetics or implantation is performed. Fracture of the crown requires immediate treatment to restore not only chewing functions, but also aesthetic appearance, especially if the front teeth were damaged. In this case, non-removable crowns are installed. With a fracture of the root, a complete tooth extraction is usually performed to establish the pin or implant.