Non-carious diseases of hard tissues of teeth

include

1. Colored teeth

2. Abnormal tooth development.

3. Tooth injury

4. Chronic damage to teeth.

5. Dentin allergy

Colored teeth and abnormal tooth development

L Developmental abnormalities with great clinical significance include enamel hypoplasia, dental fluorosis, tetracycline teeth, dental invagination, central apex abnormality, etc. It is necessary to master their clinical manifestations and prevention principles.

L according to the etiology is divided into:

(1) Inherent discoloration or drug-induced enamel dentin coloration is often accompanied by abnormal tooth development. The reasons include:

1) Severe malnutrition or maternal and child diseases during enamel development.

2) Tetracyclines

3) Fluoride

4) trauma

5) Wear of teeth

6) Dental caries

7) amalgam restoration

(2) Exogenous chromotropic pigment is deposited on the tooth surface, and the tooth tissue structure is complete. Mainly food and bacteria. Including:

1) Living habits: such as drinking tea, coffee, smoking or chewing betel nut for a long time.

2) Poor oral hygiene: Plaque retention areas, such as near the gingival margin and adjacent surfaces, are often colored parts.

3) Medicine: gargle with chlorhexidine or potassium permanganate solution for a long time.

Clinical manifestations: Tooth noodles-like, linear or massive pigmentation. Endogenous coloring is often accompanied by developmental defects of tooth structure.

L therapy

(1) Exogenous: change eating habits, brush your teeth effectively, and clean your teeth with ultrasound.

(2) Endogenous: bleaching, resin restoration and porcelain crown.

Dental fluorosis; Dental fluorosis

L overview: also known as dental fluorosis or mottled enamel, it is a prominent symptom of regional chronic fluorosis (an endemic disease), with dental lesions? Dental fluorosis (white plaque and defect on enamel: dental fluorosis, mottled enamel), bone lesions? Skeletal fluorosis

Cause: Excessive fluoride intake during enamel development. Generally speaking, the fluorine content in water is 1ppm( 1mg/L). Drinking water is one of the biggest sources of fluoride intake. After 7 years old, I moved to the high fluorine area, and there was no dental fluorosis.

Pathogenesis: When the fluoride concentration is too high, it inhibits the activity of alkaline phosphatase (hydrolyzing various phosphates and providing phosphorus as raw material for bone salt formation), resulting in hypoplasia of enamel, incomplete mineralization and brittle bone.

L pathology: the columnar matrix is poorly mineralized and the enamel column is excessively mineralized. Enamel pores.

L type

1. chalk type (mild): the tooth surface loses its normal luster and has chalk spots.

2. Colored type (moderate): yellow, tan or tan patches appear on the tooth surface.

3. Defect type (severe): there are shallow pits or pits on the surface of teeth, or the teeth lose their normal shape due to wear.

L clinical manifestations:

(1) Chalk-to-brown plaque on enamel erupts at the same time, and severe cases are accompanied by enamel defect.

(2) Permanent teeth are more common than deciduous teeth (placenta has a barrier effect on fluoride)

(3) Dental fluorosis has poor wear resistance and strong acid resistance.

(4) Patients with severe chronic fluorosis may have osteoproliferative changes.

L prevention and treatment

(1) Improve water sources, reduce fluoride intake, and avoid children under 7 years old living in high fluoride areas for a long time.

(2) Abrasion and acid etching coating method: it is suitable for dental fluorosis without substantial defect. Grind off the dyed enamel? Acid etched teeth? adhesive coating

(3) Composite resin restoration: it is suitable for dental fluorosis with substantial defect. ? Repair? Repair, polishing

Tetracycline stained teeth

L diseases that change the color and structure of teeth during tooth development and mineralization due to taking tetracycline drugs.

Pathogenesis: Tetracycline ions chelate with calcium ions in teeth to form tetracycline orthophosphate complex? Mainly deposited in dentin, because the total surface area of dentin apatite crystal is larger than enamel? Fluorescent yellow causes tooth discoloration, inhibits the synthesis of collagen by dentin cells and inhibits the deposition of mineral salts.

L clinical manifestations

(1) tooth staining: yellow? Brown? Dark gray, permanent dentition can appear in the whole mouth, dentin is the main staining.

(2) The anterior teeth are darker than the posterior teeth, and the deciduous teeth are darker than the permanent teeth.

(3) Severe cases have varying degrees of enamel hypoplasia.

L factors affecting drug coloring

1. Drug type: tetracycline and norchlortetracycline cause deep color, oxytetracycline and chlortetracycline cause light color.

2. Total dose and times of medication: The degree of tooth coloring is directly proportional to the duration and dose of tetracycline treatment; In the case of the same total dose, short-term high-dose administration has a greater impact than long-term administration.

3. Medication period: The closer dentin coloring is to the enamel dentin boundary, the more obvious clinical coloring is.

L prevention and treatment

(1) Pregnant women and children under 8 years old do not use tetracycline drugs.

(2) light-cured composite resin repair

(3) porcelain crown restoration

(4) bleaching

Abnormal tooth structure

Enamel hypoplasia (enamel hypoplasia)

L definition: refers to the abnormal enamel structure caused by systemic diseases \ nutritional disorders or severe periapical infection during the tooth development of deciduous teeth.

L classification:

(1) Enamel hypoplasia: substantial defect.

(2) poor enamel mineralization

L reason:

(1) Systemic factors: severe nutritional disorders, endocrine disorders, infectious diseases of infants and mothers.

(2) Local factors: Severe periapical infection of deciduous teeth caused by local infection or trauma leads to hereditary hypoplasia of permanent enamel, which is called Turner's tooth? S teeth), common in a single tooth.

(3) Genetic factors

L clinical manifestations:

(1) Mild symptoms: the enamel is chalky, basically intact in shape, and there is no substantial defect.

(2) Severe cases: banded or concave, brown defect, thinning of incisal margin and disappearance of cusp.

(3) Both deciduous and permanent teeth can occur.

(4) The affected teeth often appear symmetrically.

(5) easy to wear and rot? Dentin allergy, not beautiful.

(6) According to the location of enamel hypoplasia, the period of pathogenic factors can be inferred.

L prevention

(1) Pay attention to maternal and child health care and prevent systemic and hereditary diseases.

(2) Early treatment of deciduous teeth diseases

L treatment: according to the degree and symptoms of the defect

(1) antiallergic

(2) Appearance improvement and cosmetic restoration: composite resin restoration, veneer restoration and full crown restoration.

Abnormal tooth morphology includes

Abnormal central cusp

Concave tooth

Fusion tooth, double tooth, combined tooth

Enamel pearl

Too big teeth, too small teeth, tapered teeth

Deformed central vertex

Etiology: The deformity of enamel and dentin caused by the protrusion of dental papilla tissue to enamel shaper during tooth development.

L clinical manifestations

(1) mostly occurs in mandibular premolars, especially in second premolars.

(2) symmetry appears

(3) The central fossa of maxillofacial region is conical.

(4) After the central apex is broken or worn, the clinical manifestation is that the central fossa has a circle with a diameter of 2mm, and there is a dark spot in the center, which is the pulp angle exposing dentin and deformed apex.

(5) X-ray examination shows that there is a deformed part protruding from the center of the pulp chamber apex to the center of the occlusal surface, and the apical part is usually undeveloped (the fracture of the central apex causes pulp infection and necrosis, which affects the development of the apical part). The tip of the stop development is trumpet-shaped.

L therapy

1. Circular blunt and clear contact can be left untreated.

2. Sharp and long, which is easy to break or wear out and expose pulp: cover pulp at one time or grind it in stages to stimulate the formation of restorative dentin and protect pulp.

3. Feasible root canal therapy or apexification has led to pulp or periapical diseases.

4. Short roots with severe infection around the apical root? extract a tooth

L apexification: a treatment for young permanent teeth with severe pulp disease or periapical periodontitis before the root is completely formed. On the basis of eliminating infection or curing periapical periodontitis, drugs are used to induce the dental pulp and/or periapical tissue in the apical part to form hard tissue, so that the root continues to develop and the apical part continues to form;

(1) Root canal preparation

(2) root canal disinfection

(3) Drug induction: cementum and cementoid are deposited on the lateral wall of root canal, which prolongs the root and seals the apical foramen.

(4) The cavity was temporarily filled and followed up for 65438 0 times /3~6 months.

(5) conventional root canal filling

L calcium trioxide inorganic polymer (MTA)

(1) has good biocompatibility and is beneficial to dental pulp restoration.

(2) Unique hardening and sealing performance: about 3-4h hardening.

(3) Strong alkali can inhibit the growth of bacteria.

(4) It is used for vital pulp cutting of deciduous teeth, direct pulp capping and root tip induction of young permanent teeth, perforation repair, root tip filling and root absorption repair.

Concave tooth

Etiology: During the tooth development, the enamel maker rolled up excessively or the local overgrowth went deep into the dental papilla.

More common in maxillary lateral incisors.

L clinical manifestations: according to the depth and morphological variation of dental invagination, it can be divided into

(1) Abnormal lingual fossa: the lightest and most common cavity, which is saccular and deep.

(2) Abnormal root canal: coexisting with the upper part, with a longitudinal fissure extending across the lingual carina to the root.

(3) Abnormal lingual cusp: lingual fossa invagination+over-cone lingual protrusion.

(4) the middle tooth: the most serious one. X-ray: the deep depression seems to be a small tooth contained in the tooth.

L therapy

(1) Treatment of dental invagination: Early treatment should be based on deep caries. If the pulp is exposed during caries, the treatment method should be selected according to the pulp state and root development; Patients with pulp diseases and periapical diseases should be treated with pulp therapy.

(2) Treatment of abnormal root canal: According to the depth and length of root canal and its influence on pulp and periodontal tissue, corresponding measures are taken: flap-turning, grinding, dressing, filling and root canal treatment.

A fused tooth is a fusion of two normal tooth germs. Dentin communication; Independent pulp cavity and root canal; Both deciduous teeth and permanent teeth can appear; Common in mandibular deciduous incisors.

Teeth eruption: tooth germ is not completely separated by inward depression; There are * * * roots and root canals; Both deciduous teeth and permanent teeth can appear; Twin deciduous teeth are often accompanied by congenital absence of permanent teeth.

Tooth healing: formed by two developed teeth sticking together; Dentin separation and cementum adhesion

Enamel pearls are firmly attached to the small pieces of enamel on the surface of cementum, which are spherical and mostly located at or near the bifurcation of molar roots.

Megadontia; Giant tooth disease

Micrognathia (complete micrognathia can occur in patients with ectodermal dysplasia, Down syndrome and congenital pituitary hypofunction)

Conical tooth

Abnormal tooth number

More teeth (? Central tooth? Most common)

Congenital tooth loss (individual tooth loss is more common in constant 8,2, lower constant 5 and multiple symmetry)

Toothless deformity: complete or complete loss of most teeth (often accompanied by ectodermal dysplasia, genetic relationship can be found)

Abnormal tooth eruption

L early germination:

(1) Primary teeth: The tooth germ is too close to the oral mucosa.

(2) Permanent teeth: deciduous teeth fall off early.

Delayed eruption, ectopic eruption and difficulty in eruption:

(1) deciduous teeth: rarely ectopic or difficult to erupt, and delayed eruption is related to infection or trauma.

(2) Permanent teeth: delayed eruption and heterotopia are related to retention of deciduous teeth, and difficulty in eruption is related to premature deciduous teeth.