chapter five

Dental non-caries
disease
 1 Dental Fluorosis
Dental fluorosis occurs as a result of
long-term intake of fluoride during
the period of tooth formation.
Characterized by an increasing
porosity of the surface and
subsurface enamel causing the
enamel to appear opaque.
Etiological factors of dental
fluorosis

 Fluorides in drinking water

 Fluorides in foods and drinks
 Fluorides in air, etc.
 The period of risk of developing
dental fluorosis

For many years it was believed that only during

certain stages of tooth formation can fluoride
exert its toxic effect on enamel:
the stage during which enamel is laid down by
the ameloblasts.
So long as a tooth has not yet
erupted
into the mouth,it may be sensitive
to
exposure to fluoride.
The later in the pre-eruptive life of


a tooth that it is exposed to fluoride

the less severe will be the resulting
degree of dental fluorosis.
 Clinical features of dental fluorosis

Permanent dentition:
 symmetrically distributed in the mouth,

but not all teeth are equally affected.

 The least affected teeth are the incisors
and first permanent molars.
 The premolars and other molars are
most severely affected.
 Primary dentition
 Similar clinical features
 Less severely affected than their
permanent successors
 Changes from fine white opaque
lines
running across the tooth on all parts
of
the enamel, to features where parts
of
the chalky white and porous outer
 The loss of surface enamel in the
enamel become detached and
severest
discolored.
cases results in a loss of anatomical
form of
 Indices for measuring dental
fluorosis (the Dean index)

“Normal” (score: 0)
The enamel represents the usual
translucent
semi-vitriform type of structure.
The surface is smooth, glossy, and
usually of
a pale, creamy white colour.
Questionable (score: 0.5)
The enamel discloses slight aberrations from
the translucency of normal enamel, ranging
from a
few white flecks to occasional white spots.
This classification is utilized in those
instance where a definite diagnosis of the
mildest form of fluorosis is not warranted
and a classification of “normal” not justified.
Very mild (score: 1.0)
Small, opaque, paper white areas
scattered irregularly over the tooth but not
involving as much as approximately 25%
of the tooth surface.
Frequently included in the classification
are teeth showing no more than about 1-
2mm of white opacity .
Very mild (score: 1.0)
Mild (score: 2.0)
The white opaque areas in the enamel of the
teeth are more extensive but not involve as
much as 50% of the tooth.
 Moderate (score: 3.0)
All enamel surfaces of the teeth are affected,
and surfaces subject to attrition show marked
wear.

Brown stain is frequently a disfiguring feature.

Severe (score: 4.0)
All enamel surfaces are affected and
hypoplasia is so marked that the general
form of the tooth may be affected.
The major diagnosis sign of this
classification is the discrete or confluent
pitting.
Brown stains are widespread and teeth
often present a corroded-like
appearance.
 The treatment of dental fluorosis

For very mild dental fluorosis:

Physically grinding away the outer porous
fluorotic
enamel until the underlying almost sound and
better mineralized enamel is exposed.
Pronounced opacities and stains can be
removed by alternatively applying
phosphoric acid to enamel surface and
polishing with an abrasive, finished by
applying a mineralizing solution to the
treated enamel.
In the cases of severe dental fluorosis:
-Restoration with composite resins
-Repair with crowns
2 Tetracycline Stained
Teeth

 background
 classification
 clinical features
 prevention and treatment
 Background

 1940s, clinical initial usage of

Tetracycline
 1950s, Tetracycline Stained Teeth
reported
 1970s, brought to attention
 Onset time of the illness
Calcification stage of tooth formation

4 months afterwards placenta Pigmentation of

during gestational period primary dentition

children below tetracycline Stained teeth or

8-year-old enamel hypoplasia
 The classification of the illness
 mild ： yellow or gray staining
no enamel defect
 moderate ： brown-gray staining
no enamel defect
 severe ： brown-gray or black band-like staining

accompanying enamel hypoplasia

 Prophylaxis and treatment

 Prevention of Tetracycline Stained Teeth

No tetracycline for---
pregnant women
breast-feeding women
children below 8-year-old
Treatment of Tetracycline Stained
Teeth
Bleaching technique
Composite resin repair
Crown repair
 3 Enamel
Hypoplasia
 Developmental disturbance of enamel,
which appears as a surface defect, during
the period of tooth formation.
 enamel dysplasia
enamel hypocalcification
 Etiology of Enamel Hypoplasia
 Nutrient: VitA 、 C 、 D ， Ca 、 P
 Endocrine factor: parathyroid gland
 Mother and baby related disease:
chickenpox, rubella
 Local factor:
periapical periodontitis of primary teeth
(Turner teeth)
Clinical feature of Enamel Hypoplasia

 Systemic hypoplasia affect

homologous teeth.
 Several groups of teeth are
involved frequently.
The classic clinical features vary from
a grooved line across the tooth
surfaces to
a wider band of faulty deformed
enamel.

Always characterized by having

smooth rounded and well-demarcated
borders.
Enamel hypoplasia
Mild :
 Hypomineralization
 No alteration in enamel integrity
 Color and pellucidit change
 Chalk-like enamel
Severe:
 Band- or groove-like enamel defect
 Pit or honeycomb appearance enamel
 Thinned Incisal edge
defected cusp
 Symmetry lesion of Enamel
hypoplasia

1yr after birth 1 to 2yr after birth 3yr after birth

 Prophylaxis of enamel
hypoplasia

related disease prevention during the

period of dental development.
Treatment of enamel hypoplasia

anti-caries treat
cover with resin
ceramic restoration
Differential diagnosis
 Enamel hypoplasia
well-demarcated borders
along incremental line
one or one group tooth/teeth
 Dental fluorosis
long-term lesion
no borders
high fluoride region
Dental fluorosis Enamel
hypoplasia
 4 Dental morphologic
abnormality

 Microdontia, macrodontia, conic shaped teeth

 Fused teeth, geminated teeth,
concrescence of teeth
 Abnormal central cusp
 Dens invaginatus
Microdontia
Macrodontia and conic shaped
teeth
Fused teeth
two dental
germ
Geminated teeth
one tooth germ
Concrescence of teeth
Abnormal central
cusp
The treatment of abnormal central
cusp

 Grinding
 Pulp capping
 Apexification
 Root canal therapy
Dens invaginatus

Dens–in-dente is the result of

invagination of the coronal aspect of
the enamel organ down into the
dental papilla.
 Clinically, giving the appearance of
a tooth within a tooth

Maxillary lateral incisors are most commonly involved

Classification of Dens invaginatus

 Invaginated lingual fossa

 Invaginated root groove
 Talon cusp
 Dens-in-dente
Invaginated lingual fossa Invaginated root groove
Dens-in-dente
The treatment of Dens
invaginatus

 Indirect pulp capping

 GIC restoration
 Endodontic treatment
 Periodontic treatment
 Tooth extraction
5 Abnormal number of teeth

Supernumerary tooth
Partial anodontia
Congenital anodontia
 Supernumerary teeth
Teeth that develop from accessory tooth buds.
The mesiodens is most commonly, a small cone-
shaped
tooth located between the maxillary central incisors
Also, distomolars and premolars.
Treatment: None, unless for esthetic or occlusal
interference.
Supernumerary teeth
 Anodontia

 Congenitally missing teeth

 Complete(anodontia ) or
partial missing (oligodontia)
 Third molars, lateral incisors,
second premolars
 Anodontia

Hereditary ectodermal dysplasia and

head-
and-neck radiation therapy are
associated
with anodontia or oligodontia.
Partial anodontia
Congenital
anodontia
Anodontia of ectodermal
dysplasia
6 Dental eruptive
disorder
 Early eruption of tooth
deciduous or permanent
teeth
natal tooth and neonatal
tooth
 Delayed eruption of tooth
 Ectopic eruption of tooth