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Root Caries Factors
- Poor oral hygiene, attachment loss and inappropriate plaque control
- Gingival recession exposed CEJ (highly irregular surface)
- Plaque retention
- Lesion development
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RC Factors in the Elderly
- Aging population
- Increased tooth retention into old age
- Chronic medical conditions
- More medications
- Cognitive impairment
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Do lesions originate in deep pockets?i.
- No, pH of pocket exudate is >7 (basic)
- ii.
- More likely:
- 1. Lesion initiated near FGM
- 2. Gingival inflammation and swelling
- 3. Gingiva covers lesion
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Diet and Root Caries
- Minimize fermentable dietary substances
- Non-fermentable sweeteners
- Aspartame, saccharine
- Polyols (xylitol, sorbitol)
- Anticariogenic?
- Reduced acid production by S. mutans
- Better than chlorhexidine in elderly? Maybe!
- Diarrhea--> dehydrationi)
- Caution! Adverse GI effects
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Clinical presentation Root Caries
- Occurs where plaque accumulates
- Soft (active caries)
- Hard/leathery (arrested caries)
- Transition from active to arrested can be slow (years!)
- 1)Hard upon gentle probing
- 2)Shiny
- 3)Dark/black
- 4)No plaque
- 5)Variable color-- yellowish, brownish, blackv.
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How can we treat RC?
- non-operatively
- Active recurrent root caries lesions
- Plaque control
- Topical fluoride
- Polish restoration margins
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How do root caries arrest?
- 1. Diet Management
- 2. Plaque control
- 3. Remineralization therapy
- Restorations not always needed
- Restorations may even cause more harm and increase risk of recurrence!
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Restorative Considerations for Root Surface Caries Lesions.
- Esthetics
- Reduce plaque retention
- Replace lost structure (volume)
- Tradition
- Ability to monitor
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Amalgam Properties
- Durable
- Good resistance to microleakage Not tooth-colored
- Mildly tolerant of moisture contamination
- Disadvantages:
- INVASIVE-Retention/Resistance form
- Not-tooth colored
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Composite Resin properties:
- Polymerization shrinkage will try to open up the margins.a)
- Durable
- Adhesive: Less invasive
- Highly esthetic
- Excellent resistance to microleakage on enamel
- •Disadvantages
- Hydrophobic
- Intolerant of moisture contamination
- Polymerization shrinkage
- Long-term resistance to microleakage on dentin? Not really!
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Glass Ionomer Advantages
- (releases fluoride)3)
- Excellent seal on enamel AND dentin
- Chemical bond to tooth structure
- Can uptake and release fluoride over time
- Hydrophilic
- Rechargeable fluoride release
- Mildly tolerant of moisture contamination
- Tooth-colored
- Transitional restorations
- Better resistance to microleakage at dentin margins vs. resin
- Less technique sensitive
- Inhibitory activity on cariogenic bacteria
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Glass Ionomer Limitations
- Handling
- Surface finish
- Opacity (some types)
- Shrinkage may cause problems with seal of margin
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"Sandwich Technique"
- Use glass ionomer to replace dentin
- Use composite resin to replace enamel
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Composite vs. Glass Ionomer
- For a deep region, you will have to put the composite material in several increments (layers) and will take longer.
- Incremental layering will compensate for polymerization shrinkage
- Wide variability in how the resin is going to bond to the dentin.
- Need to etch the dentin
- What happens if you don't get a perfect seal?
- This problem has been associated with pain and sensitivity
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Glass Ionomer
- Using a base of glass ionomer into the deep region means you don't have to use the phosphoric acid etching
- Glass ionomer will bond to the calcium of the tooth structure
- Can put all material in with one load
- Can put the composite resin over top of the glass ionomer
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Etiology of Non-Carious Cervical Lesions
- Entire etiology has not been determined
- Some controversy over possible causes and their degree of involvement
- Evidence and consensus for this in dental scientific literature
- Cause is most likely MULTIFACTORIAL!
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What are the causes of non-carious tooth structure loss?
- Attrition: Tooth-tooth contact
- Abrasion: CHEMICAL
- Erosion: friction of exogenous agent
- Abfraction: Loss of cervical tooth structure due to occlusal forces
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What are some causes of cervical abrasion?
- Overzealous tooth brushing: opposite side of dominant hand? Not verified with clinical studies?
- Hard tooth brush? signifacnt factor of initialtion adn progression yet degree unverified
- Abrasive Dentrifice-no longer used
- Tooth brusing & acid exposure more susceptible
- biting on stuff
- masticatory abrasion
- differential wear rates on dentin and enamel
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What should you not brush after eating?
- Enamel sensitive after demineralization (allow remineralization factors first)
- DO NOT brush immediately after meal or acid challenge
- 1. Wait 1 hour
- 2. Rinse or floss (properly) first to remove food debris
- 3. Milk, cheese, yogurt good buffers
- 4. Floride rinse
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Erosion
- Loss of tooth structure by friction between tooth and exogenous agenti)
- Causes:
- Extrinsic acid sources:
- Dietary:
- 1. Soft drinks-- most frequent source in US population
- Per capita consumption in US in 2000=2000 53 gallons
- 2. Wine
- 3. Fruits and fruit juices
- 4. Sports drinks
- Occupational:
- 1. Industrial gases containing acid
- 2. Galvanizing, plating
- Athletic: Competitive swimmers
- Bulimia
- Gastroesophageal reflux disease (GERD)
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Erostion Diagnosis
- Dietary information
- Diet components
- Frequency of consumption (# of acid exposures per day)
- Habits (ex. Soda swishers)
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Bulimia Clinical appearance
- Lesion location reflects position of head when vomiting
- Palatal surfaces of maxillary anterior teeth
- Buccal surfaces of mandibular molars (in more severe cases)
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GERD Clinical Appearance
- Slower movement of gastric acid than in bulimics
- Longer acid exposure than in bulimics
- Thin, translucent enamel
- Enamel loss on palatal of maxillary anteriors and occlusal of mandibular molars
- Cupping of exposed dentin on occlusals
- GERD during sleep-- more lesions on favored sleeping side
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Dietary erosive clinical appearance
- Broad concavities within smooth enamel
- Labial and buccal surfaces
- Maxillary and mandibular teeth
- Thin, translucent enamel
- Preservation of enamel "cuff" in gingival crevice is common
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Abfraction
- Loss of cervical too structure due to occlusal forces
- Theory: Occlusal loading forces--> tooth flexure--> microfractures--> tooth substance loss in cervical area
- Abfraction= stress corrosion or stress-induced non-carious lesions
- Posterior "interference" contact occurring during lateral jaw movement may cause this
- Clinical appearance:
- Wedge-shaped or saucer-shaped
- Not conclusive
- Only an aid to determining etiology
- Association with occlusal or incisal wear facets
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Treating Non-carious cervical lesions
- Don't base treatment on an assumed cause: Ex. NCCLs + wear facets = unifactorial
- Think MULTIFACTORIAL
- Detailed health history
- Thorough examination (including occlusal analysis)
- Evaluate oral hygiene
- Diet analysis (including frequency)
- Should inform patients of a.Possible etiologies, implications of the presence of lesions,Prevention methods, Treatment alternatives
- First goal= eliminate primary cause(s) of NCCLs
- Change etiologic factors where possible
- Desensitizing teeth
- Periodontal grafting to cover and protect affected areas
- Restorative treatment
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When do you do class V restorations for NCCLs?
- Inability to halt lesion progression by elimination of etiologic factors
- Esthetic unacceptability of lesion to patient
- Intolerable sensitivity to cold, food, and air
- Threat to strength/structural integrity of tooth because of lesion depth
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