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Non-caries dental disease (1)

Non-caries dental disease (1)

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03/18/2014

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Dental non-caries disease

1 Dental Fluorosis
Dental fluorosis occurs as a result of long-term intake of fluoride during the period of tooth formation. Characterized by an increasing porosity of the surface and subsurface enamel causing the enamel to appear opaque.

Etiological factors of dental fluorosis
 Fluorides in drinking water  Fluorides in foods and drinks  Fluorides in air, etc.

The period of risk of developing dental fluorosis
For many years it was believed that only during certain stages of tooth formation can fluoride exert its toxic effect on enamel: the stage during which enamel is laid down by the ameloblasts.

So long as a tooth has not yet erupted

into the mouth,it may be sensitive to exposure to fluoride.

The later in the pre-eruptive life of a tooth that it is exposed to fluoride the less severe will be the resulting degree of dental fluorosis.

Clinical features of dental fluorosis
Permanent dentition:  symmetrically distributed in the mouth, but not all teeth are equally affected.  The least affected teeth are the incisors and first permanent molars.  The premolars and other molars are most severely affected.

Primary dentition  Similar clinical features  Less severely affected than their permanent successors

Changes from fine white opaque lines

running across the tooth on all parts of the enamel, to features where parts of the chalky white and porous outer  The loss of surface enamel in the enamel become detached and severest discolored. cases results in a loss of anatomical form of

Indices for measuring dental fluorosis (the Dean index)
“Normal” (score: 0) The enamel represents the usual translucent semi-vitriform type of structure. The surface is smooth, glossy, and usually of a pale, creamy white colour.

Questionable (score: 0.5) The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is utilized in those instance where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of “normal” not justified.

Very mild (score: 1.0) Small, opaque, paper white areas scattered irregularly over the tooth but not involving as much as approximately 25% of the tooth surface. Frequently included in the classification are teeth showing no more than about 12mm of white opacity .

Very mild (score: 1.0)

Mild (score: 2.0) The white opaque areas in the enamel of the teeth are more extensive but not involve as much as 50% of the tooth.

Moderate (score: 3.0) All enamel surfaces of the teeth are affected, and surfaces subject to attrition show marked wear.

Brown stain is frequently a disfiguring feature.

Severe (score: 4.0) All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected.

The major diagnosis sign of this classification is the discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded-like appearance.

The treatment of dental fluorosis
For very mild dental fluorosis:
Physically grinding away the outer porous fluorotic enamel until the underlying almost sound and better mineralized enamel is exposed.

Pronounced opacities and stains can be removed by alternatively applying phosphoric acid to enamel surface and polishing with an abrasive, finished by applying a mineralizing solution to the treated enamel.

In the cases of severe dental fluorosis: -Restoration with composite resins -Repair with crowns

2 Tetracycline Stained Teeth
   

background classification clinical features prevention and treatment

Background

1940s, clinical initial usage of Tetracycline 1950s, Tetracycline Stained Teeth reported 1970s, brought to attention

Onset time of the illness
Calcification stage of tooth formation

4 months afterwards placenta Pigmentation of during gestational period primary dentition
children below 8-year-old tetracycline Stained teeth or enamel hypoplasia

The classification of the illness

mild : yellow or gray staining no enamel defect moderate : brown-gray staining no enamel defect severe : brown-gray or black band-like staining accompanying enamel hypoplasia

Prophylaxis and treatment

Prevention of Tetracycline Stained Teeth No tetracycline for--pregnant women breast-feeding women children below 8-year-old

Treatment of Tetracycline Stained Teeth

Bleaching technique Composite resin repair Crown repair

3 Enamel Hypoplasia

Developmental disturbance of enamel, which appears as a surface defect, during the period of tooth formation. enamel dysplasia enamel hypocalcification

Etiology of Enamel Hypoplasia
  

Nutrient: VitA 、 C 、 D , Ca 、 P Endocrine factor: parathyroid gland Mother and baby related disease: chickenpox, rubella Local factor: periapical periodontitis of primary teeth (Turner teeth)

Clinical feature of Enamel Hypoplasia

Systemic hypoplasia affect homologous teeth. Several groups of teeth are involved frequently.

The classic clinical features vary from a grooved line across the tooth surfaces to a wider band of faulty deformed enamel. Always characterized by having smooth rounded and well-demarcated borders.

Enamel hypoplasia

Mild :
   

Hypomineralization No alteration in enamel integrity Color and pellucidit change Chalk-like enamel

Severe:
  

Band- or groove-like enamel defect Pit or honeycomb appearance enamel Thinned Incisal edge defected cusp

Symmetry lesion of Enamel hypoplasia

1yr after birth

1 to 2yr after birth

3yr after birth

Prophylaxis of enamel hypoplasia

related disease prevention during the period of dental development.

Treatment of enamel hypoplasia
anti-caries treat cover with resin ceramic restoration

Differential diagnosis

Enamel hypoplasia well-demarcated borders along incremental line one or one group tooth/teeth Dental fluorosis long-term lesion no borders high fluoride region

Dental fluorosis hypoplasia

Enamel

4 Dental morphologic abnormality
 

Microdontia, macrodontia, conic shaped teeth Fused teeth, geminated teeth, concrescence of teeth Abnormal central cusp Dens invaginatus

 

Microdontia

Macrodontia and conic shaped

teeth

Fused teeth
two dental germ

Geminated teeth
one tooth germ

Concrescence of teeth

Abnormal central cusp

The treatment of abnormal central cusp
   

Grinding Pulp capping Apexification Root canal therapy

Dens invaginatus
Dens–in-dente is the result of invagination of the coronal aspect of the enamel organ down into the dental papilla.

Clinically, giving the appearance of a tooth within a tooth

Maxillary lateral incisors are most commonly involved

Classification of Dens invaginatus
   

Invaginated lingual fossa Invaginated root groove Talon cusp Dens-in-dente

Invaginated lingual fossa

Invaginated root groove

Dens-in-dente

The treatment of Dens invaginatus
    

Indirect pulp capping GIC restoration Endodontic treatment Periodontic treatment Tooth extraction

5 Abnormal number of teeth
Supernumerary tooth Partial anodontia Congenital anodontia

Teeth that develop from accessory tooth buds. The mesiodens is most commonly, a small coneshaped tooth located between the maxillary central incisors Also, distomolars and premolars. Treatment: None, unless for esthetic or occlusal interference.

Supernumerary teeth

Supernumerary teeth

Anodontia
 

Congenitally missing teeth Complete(anodontia ) or partial missing (oligodontia) Third molars, lateral incisors, second premolars

Anodontia
Hereditary ectodermal dysplasia and headand-neck radiation therapy are associated with anodontia or oligodontia.

Partial anodontia

Congenital anodontia

Anodontia of ectodermal dysplasia

6 Dental eruptive disorder

 

Early eruption of tooth deciduous or permanent teeth natal tooth and neonatal tooth Delayed eruption of tooth Ectopic eruption of tooth

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