Regressive alterations in dentistry

1. DR. SUHASINI GP
SENIOR LECTURER
DEPT. ORAL &MAXILLOFACIAL PATHOLOGY AND MICROBIOLOGY
SUBHARTI DENTAL COLLEGE AND HOSPITAL
SWAMI VIVEKANAND SUBHARTI UNIVERSITY
MEERUT. UP
Subject: Oral Pathology

2. They represent the lesions of a retrograde nature
None of the lesions discussed here are
developmental abnormalities or an inflammatory
lesions

3. DEFINITION –
The physiologic wearing away of a tooth as a result
of tooth to tooth contact, as in mastication or
parafunction.
ETIOLOGY-
o Enamel hypoplasia
o Diet coarseness
o bruxism
o tobacco chewing
o certain occupations

4. Clinical features –
 site – occlusal, incisal, and proximal
surfaces of teeth
Age – physiologic process associated with
old age
Manifest as appearance of small polished
facet on a cusp tip or flattening of an incisal
edge (match)
Sex - male>female

5. OTHER FEATURES-
•Facets at contact points on proximal
surfaces
•Reduced cusp height
•Shortening of length of dental arch
•Yellow/brown staining of dentine -
advanced cases
•Secondary dentine formation to protect
pulp

8. Treatment
restoration of lost tooth structure with
composite resins, veneers, onlays, or full crowns
Mouth guards for nocturnal attrition
t/t of dentinal sensitivity with varnishes,
mouthwashes, toothpastes, iontophoresis

9.  Definition
Abrasion is the pathologic wearing away of tooth
substance through some abnormal mechanical process.
 Etiology-
i. Use of an abrasive dentrifice
ii. Injudicious use of toothbrush
iii. Items like pencils, toothpicks, pipestems, bobbypins
iv. Chewing tobacco, biting thread, inappropriate use of
dental floss

10. Clinical features
Site-cervical areas of tooth
Teeth affected – premolars and cuspids
Manifest as – V-shaped or wedge shaped ditch
on the root side of the CEJ in teeth with recession
Premolar and cuspid
Toothbrush abrasion manifest as horizontal
cervical notches on buccal surface

11. More common on the left side of the
mouth in right handed people and viceversa
Notching of incisal edge of incisors seen
in carpenters, shoemakers, tailors who hold
nails, pins, tacks b/n their teeth
Improper use of floss and tooth picks may
produce lesions on proximal exposed root
surface

12. Localized abrasion is found in occupations in
which the teeth are used for the holding of
object.
For eg. Seamstresses will show fine notches on
the incisal edges of their anterior teeth as a
result of biting thread or holding needle between
the teeth.

13. Fine notches on the incisal edges of their anterior teeth as a result
of biting thread or holding needle between the teeth

14. Tooth wear in shoemaker Tooth wear as seen in
Plumbers

16. In Glass blowers, Players of wind instruments and
Policemen a definite pattern of wear on the teeth
will result, depending on where the pipe,
instrument or whistle is placed.

21.  Demastication- tooth wear is accelerated
by chewing an abrasive substance between
opposing teeth.

22. Treatment
Restore lost tooth structure with GIC,
composite resins, etc
Dentinal sensitivity treatment

27.  Hcl- the lingual surfaces of the teeth are affected first.

28. The ‘Diana Effect’
 Bulimia and anorexia are both psychological stress related disorders
 Bulimia was revealed as Princess Diana’s “secret disease” in early
90s
 Because of Princess Diana’s courage to combat her eating
disorder, many people also confronted their problems and sought
treatment

29. Dental erosion is defined as irreversible
loss dental hard tissue by a chemical
process that does not involve bacteria.

30. Etiology
I. Extrinsic causes – acidic beverages, foods,
medication or environmental acids like chromic,
hydrochloric, sulfuric and nitric acid vapors as in
industrial electrolytic processes
II.Intrinsic causes – diseases like GERD, chronic
excessive vomiting-peptic ulcers, gastritis,
alcoholism, pregnancy, drug side effects, diabetes
or nervous system disorders.

34. Clinical features
•Broad concavities within smooth surface enamel
•Cupping of occlusal surfaces
•Increased incisal translucency
•Wear on non occluding surfaces
•Clean non tarnished appearance of amalgam
•Raised amalgam restorations
•Loss of surface characteristics of the enamel
surface
•Preservation of the enamel ‘cuff’ in gingival
crevice
•Hypersensitivity
•Pulp exposure in deciduous teeth

36.  Perimolysis- erosion from dental exposure
to gastric secretion.
 Salivary buffering capacity
 Bicarbonates- regulate pH
 xerostomia

37. Treatment
Diminish the frequency and severity of acid
challenge
Increase salivary flow-oral pilocarpine
Antacid tablets
Use soft toothbrush and dentifrices low in
abrasives
Application of composite and direct bonding
Topical fluorides,
Use of occlusal splints

38. Abfraction refers to the loss of tooth
structure that results from repeated
tooth flexure caused by occlusal
stresses.
forces
static
swallowing clenching
cyclic
chewing

39.  Clinical features
wedge shaped defect in cervical area of
tooth
defects are deep narrow and ‘v’ shaped
often affects a single tooth
Site – facial surfaces
mandibular dentition more affected
increased prevalence in bruxism pts

41. Think of holding a bunch of uncooked spaghetti in your two
hands. If you flex the spaghetti back and forth, some of
them will start to crack. This is what happens to the tooth.
The top is held together by the hard enamel crown. The
bottom is held together by the bone. The part by the
gumline is the part that starts to break away
 These lesions are often diagnosed as
toothbrush abrasion, but they differ as
their angles are sharper

42. Abfractions and abrasions appear
very much the same—both are
notches at the gumline. The
difference is what causes them.
Abfractions that have been present for awhile may
become rounded through the abrasive action of a
toothbrush, especially if the teeth are continually exposed
to an acidic environment.
Ruling out abfractions can save the patient time, money
and unnecessary treatment. However, misdiagnosing an
abfraction as an abrasion can prevent a patient from
receiving needed care, and cause treatment of the
abfraction to be unsuccessful.

43. Treatment
Restoration of defect with GIC materials
because of their greater resilience that
allows the material to flex with tooth

44.  Definition
Dead tracts are manifested as a black zone by
transmitted light but as a white zone by reflected light
when seen in ground section of teeth.
optical phenomenon-diff. in the R.I.of the affected and
normal tubules

47. Dentinal sclerosis
(transparent dentin)
Sclerosis of primary dentin is a regressive
alteration in tooth substance that is
characterized by calcification of the dentinal
tubules.
Etiology
•Normal ageing process
•Injury to dentin by caries or abrasion

48.  Sclerotic dentin
Stimuli- calcification within tubules
Tubule lumen- obliterated
Refractive index equalized-
Transparent
Seen in,
Elderly people
Slowly advancing caries
Apical third of the root
Decreases permeability of dentin-
protects pulp

50.  Source of calcium- dental lymph

51. Sclerotic dentin
 Harder
 Smaller crystal size
 Less permeable
 More fracture resistant
Normal dentin
 Less harder
 Larger crystal size
 More permeable
 Less fracture resistant

52. Secondary dentin is dentin that is
formed and deposited in response to
a normal or slightly abnormal
stimulus, after the complete formation
of tooth

53.  Irregular dentinal tubules
 Less calcium, phosphorous, collagenous matrix
per unit area
 Less mineralized (6-10%)

54. 2 types
Physiological
Regular uniform
layer of dentin
around the pulp
chamber laid down
through out the life
Reparative
It is the dentin that forms
around the pulp chamber
as a result of irritation or
attrition

55.  Physiological
 Result of physiological process- age, tooth eruption
 Reparative
 Attrition (bruxism) loss of tooth structure
development of natural protective measures
secondary dentin

57. Clinical features
•Decreased tooth senstivity
•Decreased size of pulp chambers and canals
(insulating layer)
•Delayed pulpal involement
•Yellow discoloration of crown
•Xray-
•Pulphorn areas
•Proximal wall of teeth with proximal caries

58. Histopath features
1.Physiological secondary dentin – regular
tubular dentin applied onto primary dentin.
Becomes irregular with age.
2.Reparative dentin – dentin is localized to the
pulpal end of odontoblastic processes that
were affected. In severe damage formation is
rapid, irregular dentin with widely scattered
disorganized tubules.

60. Demarcated from primary dentin by a
deeply staining resting line

61. Osteodentin
Maximum rate – approx. 3.5 u/day
Treatment
Endodontic therapy if periapical pathosis is
present.