Non-carious lesions of the teeth are a frequent occurrence in dental practice. This concept includes a wide range of diseases with different etiologies and clinical manifestations.
General concept
Non-carious lesions of the teeth are an extensive group of diseases and pathologies. These include all damage to enamel, dental tissue, diseases of a non-bacterial nature. In terms of prevalence, they rank second after caries. Such lesions can have a variety of symptoms and clinical picture, they have different causes and causes. But they are all congenital or acquired.
Can have a different distribution - to affect one or all teeth in a row, certain areas in a certain order. Many of these diseases are difficult to diagnose, since 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 such a situation, only the best dental clinics can help, where they will select 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 belong 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. Developmental pathology during teething:
- Anomaly of shape, size.
- Fluorosis (mottled teeth).
- Enamel hypoplasia (developmental disorder).
- Pathologies of the structure of the teeth of a hereditary nature (odontogenesis, amelodentinogenesis).
- Syphilis (congenital).
- Other developmental pathologies associated with external factors (antibiotics, Rh conflict).
2. Pathological changes in the hard tissues of the tooth:
- Total loss of a tooth.
- Erosion.
- Change in color after teething.
- Increased tissue sensitivity.
3. Changes in the internal structure of the tooth:
- Root fracture.
- Root dislocation.
- Fracture of the crown of the tooth.
- Opening the pulp.
In our country, another classification proposed in 1968 by V. K. Patrikeev is more often used. According to it, non-carious lesions of the teeth are divided into two groups.
1. Lesions occurring before eruption:
- Anomaly of eruption and development.
- Hypoplasia of the teeth.
- Hyperplasia.
- Fluorosis.
- Hereditary pathologies.
2. Lesions occurring after eruption:
- Erosion.
- Wedge-shaped defect.
- Necrosishard fabrics.
- Hyperesthesia of teeth.
- Erase.
- Tooth injury.
- Pigmentation.
Hypoplasia
This is the name of the pathology of the development of dental tissue during its formation, that is, in children before teething. Such a violation is caused by insufficient mineralization of tissues. The main symptom is the complete absence of an organ or its abnormally small development. Hypoplasia of the teeth can be either congenital or develop after the birth of a child. There are several reasons for this:
- conflict of Rh factors of mother and child,
- maternally transmitted infectious disease during pregnancy, infections in the child after birth,
- severe toxicosis accompanying pregnancy,
- preterm birth, trauma during childbirth,
- pathology of child development after birth,
- dystrophy, diseases of the gastrointestinal tract,
- metabolic disorder,
- developmental brain disorder,
- 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. Yellow spots appear. Local is characterized by damage to one or two organs. Here, there is a lack of enamel (partial or complete), structural defects of the teeth - they can be deformed. Such disturbances cause pain. Severe hypoplasia causes increased tooth wear, tissue destruction, or complete organ loss,development of malocclusion. Treatment of hypoplasia includes teeth whitening (at an early stage) or filling and prosthetics (for severe disease). At the same time, the enamel is remineralized with medications (for example, calcium gluconate solution). In order to prevent the occurrence 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 oral hygiene.
Hyperplasia
Hyperplasia - non-carious lesions of the 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 be up to 5 mm in diameter. The main area of localization is the neck of the tooth. Such a drop consists of tooth enamel, inside there may 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 shell contains dentin inside,
- enamel-dentine drops with pulp - connective tissue is inside,
- drops Rodriguez - Ponti - enamel formations in the periodontium between the root and the alveolus,
- intradentinal - located in the thickness of the dentin.
Hyperplasia of the tissues of the teeth does not manifest itself clinically, it does not cause pain, inflammation or any discomfort. Canonly 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 is not bothered by anything, treatment is not carried out. Preventive measures are to protect milk teeth from caries, as their destruction can cause disturbances in the development of permanent ones.
Fluorosis
Fluorosis occurs during the formation of dental tissue due to increased intake of fluoride in the body. It changes the correct structure of the enamel and causes its external defects - the appearance of spots, stripes, furrows, dark blotches. In the development of such a pathology, not only an excess of fluorine plays a role, but also a lack of calcium. In the children's body, fluorine accumulates more and faster than in adults, coming from food and water. There are such forms of fluorosis:
- dashed - manifested by the appearance of white stripes without a clear outline;
- spotted - characterized by the presence of yellowish spots with a smooth surface;
- chalky mottled - dull or shiny spots that are white, brown or yellow (may affect all teeth);
- erosive - multiple erosions of the enamel surface;
- destructive (a tooth broke off or completely collapsed) - the detrimental processes associated with fluorosis.
Treatments for fluorosis vary depending on the form of the disease. So, with a spotted form, bleaching and remineralization are carried out, if necessary, grinding of the upper layer of enamel. But erosivethe shape cannot be cured by such methods; here 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 fluorine intake.
Erosion
Non-carious lesions of the teeth include enamel damage such as erosion. Its formation leads to discoloration, aesthetic damage to the tooth, as well as increased sensitivity. Detected by visual inspection. Tooth erosion is characterized by progressive destruction of enamel and dentin, the course of the disease is chronic, and can take a long time. The cause of the pathology may be mechanical in nature, for example, when using hard brushes or pastes with abrasive particles. Also, erosion can be caused by a chemical effect on the enamel when eating foods and drinks with high acidity (picks, marinades, citrus juices, and others). Workers in industries associated with the constant inhalation of harmful substances most often suffer from such damage to the teeth. The use of certain drugs can contribute to the onset of the disease (for example, a large amount of ascorbic acid adversely affects the enamel).
Erosion of the teeth can also be caused by disturbances in the work of the stomach (high acidity of its environment) or the thyroid gland. It is difficult to identify the disease at an early stage, since it is manifested only by a loss of luster in a separate small area of the tooth. Furtherthe course of the disease leads to a gradual decrease in enamel and dentin. It looks like worn teeth, most often at the base. Treatment is based on stopping the destruction of dental tissues. It includes the use of applications containing fluorine and calcium for about 20 days, then the affected area is covered with fluorine varnish. It is possible to use veneers or crowns to restore the aesthetic appearance. The complex therapy includes calcium and phosphorus preparations, as well as vitamins for teeth. If left untreated, erosion can cause tooth hyperesthesia.
Hyperesthesia
Tooth hyperesthesia is manifested by increased sensitivity of the enamel and in most cases is a concomitant symptom of other non-carious diseases. The prevalence of this pathology is high: about 70% of the population suffer from hyperesthesia, more often women are affected by it. Manifestation - a sharp, severe pain that lasts no more than thirty seconds and appears when exposed to external factors on the enamel. Hyperesthesia is divided into types according to several criteria:
1. Distribution:
- limited form - affects one or more teeth;
- generalized - characterized by sensitivity of all organs.
2. Origin:
- a form of hyperesthesia associated with loss of dental tissue;
- not associated with loss, due to the general condition of the body.
3. Clinical picture:
- pain occurs as a reaction to the temperature of external stimuli (cold water);
- teeth react to chemical stimuli (sweet or sourproducts);
- reaction to all stimuli, including tactile ones.
Treatment of hyperesthesia is prescribed 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, with pathological gingival recession and exposure of the cervical region of the tooth), and sometimes therapeutic procedures can be dispensed with, such as the application of fluorine-containing applications to damaged areas. Orthodontic therapy may be required for hyperesthesia due to increased tooth wear. Preventive measures - eating all the necessary minerals and vitamins that strengthen dental tissues, regular and proper use of oral hygiene products, as well as an annual check-up at the dentist.
Wedge-shaped defect
Wedge-shaped defect - tooth damage, in which its base is destroyed. Outwardly, it is manifested by damage to the neck of the tooth in the form of a wedge. Most often, fangs are defective. At the initial stage, it is invisible, it is difficult to diagnose. With a long course of the disease, a dark shade appears in the affected area. The main symptom of a wedge-shaped defect is that the teeth react painfully to the influence of high or low temperatures, sweet food, physical impact (cleaning). The reason for the development of the disease may be non-compliance with oral hygiene, improper use of the brush - if after cleaning, bacterial plaque remains at the base of the bone formation, it destroys the enamel, leading to a wedge-shaped defect. Alsothe cause can be gum disease, such as gingivitis and periodontitis, a malfunction of the thyroid gland, increased acidity of the stomach, causing heartburn. Treatment of a wedge-shaped defect depends on the severity of the damage.
In case of minor damage, it is enough to carry out restorative procedures that will replenish calcium and fluoride in tooth enamel and reduce its susceptibility to external factors. In case of severe damage, a seal cannot be dispensed with. Due to the inconvenient location of the defect, such fillings often fall out. The best dental clinics are able to solve this problem by drilling a hole of a certain shape that holds the filling and using a material of special elasticity.
Hard tissue necrosis
Necrosis of hard tissues of the teeth at an early stage is manifested by a loss of enamel luster, chalky spots appear. As the disease progresses, they turn dark brown. Softening of the tissues occurs in the affected area, the enamel loses its strength, the patient may complain that his tooth has broken off. Dentin pigmentation occurs. Usually not one organ is affected, but several at once. Sensitivity to external stimuli increases. It is localized mainly at the neck of the tooth, as well as a wedge-shaped defect and erosion. But, despite the similar symptoms and the affected area, 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 atstrengthening of dental tissues, elimination of hypersensitivity (hyperesthesia), and in case of severe damage, orthopedic therapy is prescribed.
Tooth injuries
The concept of "dental injury" combines damage to the mechanical nature of the external or internal parts of the tooth. The reasons for their occurrence can be called falls, blows to the jawbone during sports, fights, accidents. With prolonged exposure to a tooth with foreign objects or solid food, its tissues become thinner and become brittle. In this case, trouble can happen even when chewing food.
Dental injuries can be the result of improper dental procedures, such as poor-quality pin placement. Some diseases, such as hypoplasia, fluorosis, cervical caries, root cyst, can also lead to damage. Injuries include fractures of the crown or root, dislocation, bruising of the tooth. The treatment of a bruise is based on the exclusion of physical impact on the diseased organ, the rejection of solid food. In the treatment of dislocation, the tooth is returned to the hole for further engraftment. If such an operation does not have prospects, according to the dentist, prosthetics or implantation is performed. A crown fracture needs immediate treatment to restore not only chewing functions, but also an aesthetic appearance, especially if the front teeth have been damaged. In this case, fixed crowns are installed. Root fractures usually require total tooth extraction to place a post or implant.
