Topic 23.

Pathomorphology, clinic and diagnostics of non-carious teeth lesions,

which arise after teeth eruption: clinoid defect, enamel erosion, traumatic defeats,
chemical defeats, hyperesthesia. Modern desensitizers for treatment of
hyperesthesia: kind, composition
1. A 35-year-old woman has complaints of cosmetic defects of the front upper
teeth crowns. The defects have been aggravating for the last 10 years. The patient
suffers from unpleasant sensations when brushing her teeth, and when chemical
stimuli are applied. Objective examination revealed defects localized in the enamel
of the front upper teeth vestibular surface. The defects are oval, saucer-shaped, and
have clear margins. Response to probing and cold stimuli was positive. Make the
diagnosis:
Enamel erosion
Enamel hypoplasia
Cuneiform defect
Chemical necrosis of the tooth
Hyperesthesia of tooth hard tissues

Algorithm solution:
1. Pay attention to complaints. Cosmetic defect and unpleasant sensation from
irritants (causal short-term pain or hyperesthesia from mechanical and chemical
irritants) are characteristic for caries and non-carious teeth lesions;
2. Pay attention to the duration of the pathological process. Carious lesions develop
over a period of 1 month to 1 year. In this case, the duration is about 10 years,
which indicates a non-carious lesion.
3. Pay attention to the location of defects. Carious cavities are localized in places
of food retention, in this case - a convex vestibular surface of the upper front teeth,
which is characteristic of non-carious lesions;
4. Pay attention to the shape of the defects. In the case of carious lesions - a defect
in the form of a cavity, in this case, the defect has a saucer-shaped shape, which is
characteristic of enamel erosion.

2. A 40-year-old man, a chemical industry worker, notes the sour sensation in his
mouth, pain response to thermal and chemical stimuli. On examination: on the
vestibular surface and cutting edge of the front teeth there are chalky enamel
defects with uneven scalloped margins. Make the diagnosis:
Acidic necrosis of enamel
Superficial caries
Enamel hypoplasia (erosive form)
Fluorosis (erosive form)
Median caries

Algorithm solution:
1. Pay attention to complaints. Cosmetic defect and unpleasant sensation or causal
short-term pain from irritants (thermal and chemical) are characteristic for caries
and non-carious teeth lesions;
2. Pay attention to the patient's life history. He works at a chemical factory, the
industrial hazards of which can provokes non-carious damage to the hard tooth
tissues;
3. Pay attention to the location of defects. Carious cavities are localized in places
of food retention, in this case - a convex vestibular surface and the cutting edge of
the crowns of the upper front teeth, which is characteristic of non-carious lesions;
4. Pay attention to the shape of the defects. In the case of carious lesions, it is a
defect in the form of a cavity, in this case the defect within the enamel has uneven
scalloped edges and a chalky color, which is characteristic of chemical necrosis of
the enamel.

3. A 35-year-old man complains of sour sensation in his mouth and front teeth
sensitivity to thermal and mechanical stimuli. Objective examination revealed
visible changes in the enamel of 13, 12, 11, 21, 22, and 23. The enamel is dull,
rough, missing on the cutting edge. Probing of the vestibular surface of these teeth
is painful, response to thermal stimuli is positive. The patient’s medical record
states his occupation in industrial production of inorganic acids. What is the most
likely diagnosis?
Necrosis of dental hard tissues
Fluorosis
Enamel erosion
Pathologic teeth grinding
Enamel hypoplasia
Algorithm solution:
1. Pay attention to complaints. Cosmetic defect and unpleasant sensation or causal
short-term pain from irritants (thermal and chemical) are characteristic for caries
and non-carious teeth lesions;
2. Pay attention to the patient's life history. He works at a chemical factory, the
industrial hazards of which can provokes non-carious damage to the hard tooth
tissues;
3. Pay attention to the location of defects. Carious cavities are localized in places
of food retention, in this case - a convex vestibular surface and the cutting edge of
the crowns of the upper front teeth, which is characteristic of non-carious lesions;
4. Pay attention to the shape of the defects. In the case of carious lesions, it is a
defect in the form of a cavity, in this case the enamel is dull, rough, missing on the
cutting edge, which is characteristic of chemical necrosis necrosis of dental hard
tissues.

4. A 48-year-old patient has addressed a hospital with complaints of defects in the

paragingival area and slight sensitivity to thermal stimuli. Objectively there are
hard tissue defects that resemble a wedge with smooth polished walls on the
precervical vestibular surface of the 23 and 24 teeth. Thermal test is slightly
positive. What is the most likely diagnosis?

Cuneiform defect
Enamel necrosis
Acute deep caries
Enamel erosion
Endemic fluorosis

Algorithm solution:
1. Pay attention to complaints. Cosmetic defect and unpleasant sensation from
irritants (causal short-term pain or hyperesthesia from mechanical and chemical
irritants) are characteristic for caries and non-carious teeth lesions;
2. Pay attention to the location of defects. Carious cavities are localized in places
of food retention, in this case - a convex vestibular surface of the upper canine and
premolar, which is characteristic of non-carious lesions;
3. Pay attention to the shape of the defects. In the case of carious lesions - a defect
in the form of a cavity, in this case, the defects are wedge shaped which is
characteristic of cuneiform defect.
5. A 47-year-old female patient complains of inability to eat hot and cold food, as
well as of intense pain caused by sour, sweet and salty food. Objectively: there is a
slight loss of enamel on the molars and incisors. Probing and cold test cause acute
pain. What is the most likely diagnosis?

Hyperesthesia of dental hard tissues

Enamel hypoplasia
Enamel necrosis
Enamel erosion
Pathological abrasion of dental hard tissues

Algorithm solution:
1. Pay attention to complaints. Cosmetic defect and unpleasant sensation from
irritants (causal short-term pain or hyperesthesia from mechanical and chemical
irritants) are characteristic for caries and non-carious teeth lesions;
2. Pay attention to the location of defects. Carious cavities are more often single
defects localized in places of food retention, in this case – there are a lot of defects
on a convex vestibular surface of the incisors and molars, which is characteristic of
non-carious lesions;
3. Pay attention to the shape of the defects. In the case of carious lesions - a defect
in the form of a cavity, in this case there is slight loss of enamel which is
characteristic of hyperesthesia of dental hard tissues.