REGRESSIVE ALTERATIONS
OF
TEETH
Dr. zameer pasha
REGRESSIVE ALTERATIONS
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Regressive changes are a group of retrogressive changes of teeth
which occur due to nonbacterial causes resulting in wear and
tear of tooth structures with impairment of function
Regressive alterations bundles up the changes occurring because of :
☻injury to the dental tissues
☻ general aging process
Collectively represent lesions.
These lesions not inflammatory in nature and neither can these changes be
traced to any developmental abnormalities
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Mechanical wear and tear of tooth substance is seen as a consequence to both
physiological and pathological situations and therefore different adaptive
strategies have evolved to tackle this situation. A disease state arises when this
delicate balance is disturbed resulting in early dissolution and loss of tooth
substance with subsequent involvement of pulpal and periapical tissues.
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There are several mechanisms that contribute to tooth wear. These include
abrasion resulting from the friction of exogenous material forced over tooth
surfaces (e.g. masticating food) or the use of teeth as “tools”; erosion resulting
from the chemical dissolution of tooth surfaces and attrition from tooth-to-tooth
contact . These mechanisms most often occur together, each acting at different
intensity and duration, producing immensely variable patterns and degrees of
wear.
ATTRITION
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Attrition may be defined as the physiologic wearing away of a tooth as a
result of tooth-to-tooth contact, as in mastication. This occurs only on
the occlusal, incisal, and proximal surfaces of teeth, not on other
surfaces unless a very unusual occlusal relation or malocclusion exists.
This phenomenon is physiologic rather than pathologic.
Attrition commences at the time contact or occlusion occurs between
adjacent or opposing teeth.
Men usually exhibit more severe attrition than women of comparable
age, probably as a result of the greater masticatory force of men.
The first clinical manifestation of attrition may be the appearance of a
small polished facet on a cusp tip or ridge or a slight flattening of an
incisal edge. As the person becomes older and the wear continues, there
is gradual reduction in cusp height and consequent flattening of the
occlusal inclined planes.
Variation also may be a result of differences in the coarseness of the diet
or of habits such as chewing tobacco or bruxism, either of which would
predispose to more rapid attrition.
ABRASION
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Abrasion is the pathologic wearing away of tooth substance through some
abnormal mechanical process.
Abrasion usually occurs on the exposed root surfaces of teeth, but under certain
circumstances it may be seen elsewhere, such as on incisal or proximal surfaces.
The most common cause of abrasion of root surfaces is the use of an abrasive
dentifrice.
such cases abrasion manifests itself usually as a V-shaped or wedge-shaped ditch
on the root side of the cementoenamel junction in teeth with some gingival
recession.
Other less common forms of abrasion may be related to habit or to the
occupation of the patient. The habitual opening of bobby pins with the teeth may
result in a notching of the incisal edge of one maxillary central incisor. Similar
notching may be noted in carpenters, shoemakers, or tailors who hold nails,
tacks, or pins between their teeth. Habitual pipe smokers may develop notching
of the teeth that conforms to the shape of the pipe stem.
 DEMASTICATION:
when tooth wear is
accelerated by chewing an abrasive substance
between opposite teeth this process is termed
as demastication.
EROSION
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Dental erosion is defined as irreversible loss of dental hard tissue by a chemical
process that does not involve bacteria.
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Dissolution of mineralized tooth structure occurs upon contact with acids that
are introduced into the oral cavity from intrinsic (e.g., gastroesophageal reflux,
vomiting) or extrinsic sources (e.g., acidic beverages, citrus fruits).
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Chronic, excessive vomiting has long been recognized as causing erosion of the
teeth. The patient with an eating disorder such as anorexia nervosa or
bulimia is the classic example.
Patients with erosion were found to have lower salivary buffer capacity when
compared with controls in several studies.
Tooth loss due to erosion results in a smooth, shiny concave surface; in abrasion
it is usually sharp edged.
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ABFRACTION
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It is the pathologic loss of both enamel and dentin caused by biomechanical
loading forces. on the mechanism of stress concentration in cervical
areas concluded that occlusal loading forces result in tooth
flexures which lead to mechanical microfractures and loss of
tooth structure in the cervical areas. This loss was termed them
as abfraction.
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The breakdown was dependent on the magnitude, duration, direction,
frequency, and location of the forces.
this type of tooth loss which is mainly confined to the gingival third of the
clinical crown was thought to be the result of toothbrush abrasion. It is proposed
that with each bite, occlusal forces causes the teeth to flex though little. Constant
flexing causes enamel to break from the crown, usually on the buccal surface.
INTERNAL RESORPTION
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(Chronic Perforating Hyperplasia of the Pulp; Internal Granuloma;
Odontoclastoma; Pink Tooth)
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Internal resorption is an unusual form of tooth resorption that begins centrally
within the tooth, apparently initiated in most cases by a peculiar inflammatory
hyperplasia of the pulp.
Clinical Features: Most cases of internal resorption present no early clinical
symptoms. The first evidence of the lesion may be the appearance of a pink-hued
area on the crown of the tooth, which represents the hyperplastic, vascular pulp
tissue filling the resorbed area and showing through the remaining overlying
tooth substance.
Radiographic examination may provide the first revelation of pulpal disease
when the patient appears for a routine checkup. The involved tooth exhibits a
round or ovoid radiolucent area in the central portion of the tooth, associated
with the pulp.
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If the lesion is in the root of the tooth, perforation of the dentin and cementum
may occur, which, if left untreated, may eventually result in root surface is
perforated, it is impossible to determine whether the lesion began “externally” or
“internally.”
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The resorption is of an irregular lacunar variety showing occasional osteoclasts
or “odontoclasts,” hence the term “odontoclastoma.” The pulp tissue usually
exhibits a chronic inflammatory reaction but little else to explain the cause for
this unusual condition
If the condition is discovered before perforation of the crown or root has
occurred, root canal therapy may be carried out with the expectation of a fairly
high degree of success. Once perforation has occurred, the tooth must usually be
extracted.
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