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Enamel Dentin Cementum Pulp

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Enamel Dentin Cementum Pulp Dr./ Basant Hamdy PhD, MSc, BDS Oral Pathology Lecturer Email [email protected] References & suggested reading Regressive • Becoming or making something less advanced (Oxford dictionary) • Return to former or earlier state (Medical dictionary) DR_Basant Hamdy DR_Basant Hamdy Enamel Dentin Wear (Attrition, Dead tracts Abrasion, Erosion) Sclerotic dentin Permeability Secondary dentin Discoloration Tertiary dentin Cementum Pulp Hypercementosis Pulp calcification Cementicles Fibrous change Permeability Cementum in pulp Resorption & repair DR_Basant Hamdy DR_Basant Hamdy Tooth wear • Non-specific term refers to the process of non-carious tooth damage/ tooth surface loss. • Attrition, abrasion & erosion causes tooth wear. • A combination of these processes may be active in the same patient. DR_Basant Hamdy DR_Basant Hamdy Attrition • Definition Progressive loss of tooth structure due to tooth-to-tooth contact during occlusion & mastication. DR_Basant Hamdy Attrition • According to severity 1. Physiologic → advances with age 2. Pathologic → excessive tooth loss – interferes with esthetics or function DR_Basant Hamdy Sites: incisal, cusp tips, inter-proximal. Males < females DR_Basant Hamdy Factors affecting rate of tooth attrition 1. Poor quality or absent enamel (e.g. fluorosis, hypocalcification, amelogenesis imperfecta, dentinogenesis imperfecta). 2. Premature contacts (edge-to- edge occlusion). DR_Basant Hamdy Factors affecting rate of tooth attrition 3. Intraoral abrasives, erosion & grinding habits (Bruxism). 4. Habits such as tobacco & betel chewing. DR_Basant Hamdy Wear facets ✓ Large, flat, smooth & shiny facets. ✓ Affects deciduous & permanent teeth. ✓ Proximally, arch length & mesial drifting. DR_Basant Hamdy Radiographic features • Change in normal outline. • Loss of mammelons. • Flat occlusal plane. • Decreased Pulp chamber/ canal size. • Hypercementosis. DR_Basant Hamdy Microscopic features • Formation of reactionary dentin (C) protects pulp. • Formation of dead tracts (A) & sclerotic dentin (B). DR_Basant Hamdy DR_Basant Hamdy Abrasion • Definition Pathologic loss of tooth structure due to the action of an external agent “non- masticatory physical friction”. DR_Basant Hamdy Etiological factors 1. Abrasive toothpaste with heavy pressure. 2. Toothbrush trauma (horizontal strokes). 3. Improper use of dental floss DR_Basant Hamdy Etiological factors 4. Other items: pencils, toothpicks, pipe stems & bobby pins (hair grips). 5. Chewing tobacco or betel DR_Basant Hamdy Toothbrush abrasion • Horizontal cervical notches on buccal surface of exposed cementum & dentin. • Degree of loss is greatest on prominent teeth (i.e.: cuspids, bicuspids). DR_Basant Hamdy Pipe stem Bobby pin Rounded or V-shaped incisal notches conform to outline of the object DR_Basant Hamdy Toothpick abrasion • Radiolucent defects at cervical region. • Well-defined semilunar defects (loss of proximal dentin/ cementum). • Pulp chambers sclerosed. DR_Basant Hamdy DR_Basant Hamdy Erosion • Definition o Loss of tooth structure caused by a non- bacterial chemical process. Etiology 1. Extrinsic 2. Intrinsic 3. Idiopathic DR_Basant Hamdy 1. Extrinsic a. Dietary • Food/ beverages with acidic pH: ✓ Citrus fruits & carbonated soft drinks (ex. Cola). pH 3.5 pH 2.5 DR_Basant Hamdy 1. Extrinsic b. Occupational (environmental) - Exposure to industrial gases + saliva → pH. - Acidic swimming pool water c. Medication (ex. Some tooth whitening products has acidic pH, xerostomia potentiates effect) DR_Basant Hamdy 2. Intrinsic o Acid reflux or chronic vomiting (GERD, patients on chemotherapy, bulimics) 3. Idiopathic o Increased levels of citric acid in saliva DR_Basant Hamdy Extrinsic • Smooth, saucer-shaped concavities on labial surfaces. • Loss of translucency (opaque). DR_Basant Hamdy Intrinsic ‘Perimolysis’ • Flattened, concave palatal surfaces. • Loss of occlusal enamel with relative elevation of occlusal amalgam above remaining DR_Basanttooth Hamdy surface. DR_Basant Hamdy • Dead tracts. • Sclerotic dentin. • Secondary dentin. • Reparative & Reactive dentin. DR_Basant Hamdy ➢ Write an assignment on Pulp stones indicating: - Types - Mechanism of formation - Signs (clinical/ radiographic) - Microscopic features - Clinical significance DR_Basant Hamdy DR_Basant Hamdy • Hypercementosis (cemental hyperplasia) ✓ Non-neoplastic deposition of excessive cementum, continuous with the normal radicular cementum. • Cementoblast precursors lie in PDL & are recruited in normal turnover + repair root fractures or resorption defects. • New cementum is added without significant resorption → cementum increases slightly with age. DR_Basant Hamdy Etiological factors 1. Local factors 2. Systemic factors - Abnormal occlusal trauma - Acromegaly & gigantism - Unopposed teeth - Thyroid gioter - Adjacent inflammation - Paget disease of bone (pulpal, periapical & - Rheumatic fever periodontal) - Arthritis Localized Generalized (single tooth/ multiple teeth) (entire dentition) DR_Basant Hamdy Radiographic features • Blunting of apex. • Rounded outline of the root. DR_Basant Hamdy Radiographic features • Normal lamina dura. • Normal periodontal ligament space. • D.D.: Cementoblastoma DR_Basant Hamdy Microscopic features • Dense bone-like cementum (osteocementum) formed over regular acellular cementum. DR_Basant Hamdy Complications / clinical significance • May delay eruption. • May cause root curvature. • May cause fusion of adjacent roots. • Difficult extraction. • If generalized, it can point to a more serious condition. DR_Basant Hamdy DR_Basant Hamdy • Resorption of roots of deciduous teeth prior to shedding. DR_Basant Hamdy • Mediated by cells: Located in dental pulp (i.e., In periodontal ligament (PDL) internal resorption) (i.e., external resorption). DR_Basant Hamdy • Occurs at any site that contact vital pulp tissue, may be: 1. Secondary to pulpitis. 2. Idiopathic (most cases). • Usually asymptomatic. • Pain if significant pulpitis present. • Two main patterns: a. Inflammatory b. Replacement (metaplastic) DR_Basant Hamdy Inflammatory resorption • Dentin replaced by inflamed granulation tissue. • Cervical zone is affected most frequently. • Inflammation usually due to bacterial invasion. • Resorption continues as long as vital pulp remains. An Insight into Internal Resorption DR_BasantPriya Thomas, Hamdy Rekha Krishna Pillai, Bindhu Pushparajan Ramakrishnan, and Jayanthi Palani Inflammatory resorption • In crown: Pink tooth of Mummery (Pink spot). • Radiographically: - Balloon-like/ fusiform enlargement of the canal. DR_Basant Hamdy Microscopic features • Loose CT with increased vascularity & few inflammatory cells. • Cases associated with pulpitis, “granulation tissue”. • Odontoclasts-giant cells. DR_Basant Hamdy • Affects external surface of the root. • Radiographically: moth-eaten radiolucent defects. • Dental trauma • Periodontal treatment • Excessive mechanical forces • Peri-radicular inflammation (e.g. orthodontic therapy) • Pressure from impacted teeth • Excessive occlusal forces • Reimplantation of teeth • Grafting of alveolar clefts • Cysts • Hormonal imbalances • Tumors DR_Basant Hamdy Several forms of external resorption: 1. Idiopathic lesions (in the cervical areas) 2. Traumatic incidents (midroot area) 3. Inflammatory or neoplastic lesions (usually at the apex) DR_Basant Hamdy Several forms of external resorption: 4. Impacted teeth (mottled radiolucent areas in the crown) 5. Aggressive orthodontic movement (localized or generalized pattern) DR_Basant Hamdy DR_Basant Hamdy • Internal resorption • Removal of all soft tissue from site of resorption. • Endodontic treatment before perforation. • Placement of calcium hydroxide paste. • Extraction if untreatable. • External resorption • Identification and elimination the accelerating factor. DR_Basant Hamdy سُبحانَكَ اللهُمّ وبِحمدِك نَشهَدُ أن ﻻ إله إﻻ أنت نَستَغفِرُكَ ونتوبُ إليك DR_Basant Hamdy.
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