Cuneoid defect of hard dental tissues: what to do, how to treat, restoration

Specific form of dental pathology - wedge-shaped defect of teeth, - refers to non-carious enamel damage. This defect occurs in the cervical part of the tooth in its visible region. The upper part of the "wedge" in all cases "looks" inside the dental cavity.

Such damage is found mainly in patients after 30-45 years old and is located symmetrically on the teeth of only the upper or only the lower jaw.

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Epidemiology

The statistical information concerning such a pathology as a wedge-shaped defect is very different. This can be explained by some inconsistencies of the term. Thus, specialists considering any cervical enamel damage, as a kind of wedge-shaped defect, indicate that the disease occurs in almost 85% of patients in dental clinics. However, such a figure is unlikely to correspond to reality.

Another category of dentists in the management of statistics is based only on the registration of clear and deep cervical injuries. According to their data, the disease is found only in 5% of patients.

What information is closer to the truth, one can only guess.

It is noticed that the disease affects mainly men. In this case, the right-handers often have a problem on the right side of the dentition, and the left-handers on the left side.

Among all teeth from the disease, mainly premolars suffer.

[2], [3], [4], [5], [6], [7], [8], [9]

Causes of the sphenoid dentition

The exact causes of the onset of the disease have not been determined to date. Specialists identified individual risk factors, which can become a trigger mechanism in the development of pathology. These are the following factors:

• Violation of the integrity of enamel when using coarse and rigid dental accessories, as well as improper cleaning of teeth. The bottom line is that the enamel coating is particularly thin near the cervix, so it abrasion faster with strong mechanical friction.
• Demineralization processes. The accumulation of plaque in the cervical region leads to the fact that the bacteria producing acid begin to actively multiply in it. Acid, in turn, destroys the calcium present in the enamel coating of the tooth.
• Increased strain on the cervical area of individual teeth. This factor is associated with impaired bite and incorrect jaw movements when chewing food.
• Wearing braces.

Less often, "culprits" are diseases that are accompanied by frequent heartburn, vomiting. The mechanism of the development of the disease in such situations is understandable: the acid from the stomach, getting into the oral cavity, accumulates near the gum and gradually "erodes" the dental tissues.

[10], [11], [12], [13]

Pathogenesis

The pathogenetic characteristic of the disease consists in the gradual damage to the enamel coating. The damage does not occur immediately and passes in its current several stages:

1. The initial stage, in which changes in enamel are not "conspicuous" in the usual examination of the oral cavity. Sometimes the patient may note the presence of tooth sensitivity or a slight opacification of the enamel.
2. The middle stage is accompanied by a pronounced sensitivity of the affected teeth (for example, to high and / or low temperatures, acidic foods, etc.). At this stage, slow destruction of tissues begins.
3. Stage of progress: for this stage, the appearance of a deep defect is typically from 2 to 4 mm. It becomes noticeable characteristic "wedge" with a pointed top.
4. Deep stage: the defect depth exceeds 4 mm. Dentin can be damaged.

[14], [15], [16], [17], [18], [19], [20], [21], [22], [23]

Symptoms of the sphenoid dentition

The main difficulty for dentists is timely recognition of the disease. The fact that the presence of pathology a person does not feel right away: there is no pain, the affected area is covered with a gum and is not visible.

The first signs can appear only when the disease goes to the third or even fourth stage.

Dentists advise in a timely manner to pay attention to such symptoms:

• Dental pigmentation, opacification and blanching of the enamel;
• exposure of the tooth cervix, change of gum borders with respect to the tooth;
• discomfort and hypersensitivity of individual teeth.

A wedge-shaped defect in the enamel of the teeth can affect one tooth or several, located, as a rule, in one row. The wedge-shaped cavity does not turn black as in caries: its walls are smooth and firm. The dental cavity remains closed in all cases (that is why the patient does not feel painful sensations).

The wedge-shaped defect of hard tooth tissues always develops only in the cervical region and on the front surface of the enamel.

The development of the disease can begin with almost any tooth, both the maxillary and the mandibular. The most frequently affected premolars, fangs and first molars - mainly because of their protruding position. A wedge-shaped defect in the front teeth is also possible, but somewhat less frequently.

A sphenoid tooth defect in children is extremely rare: today only a few cases of this pathology are known in patients of childhood.

Complications and consequences

Damage to dentin in the cervical region can lead to such complications:

• to the inflammatory process in the pulp;
• to dystrophic changes in the pulp;
• to periodontitis;
• to hypersensitivity of gums and teeth.

In the case when the dentin is damaged deeply, a pathological breakage of the tooth crown may occur.

With a long-term "wedge", recessive processes in the gums may occur. This, in turn, can cause loosening of the teeth, as well as damage to periodontal disease.

The main consequence that disturbs most patients with such a defect is an unacceptable aesthetic appearance of the teeth.

[24], [25], [26], [27], [28], [29], [30], [31], [32]

Diagnostics of the sphenoid dentition

The disease can usually be easily determined by visual inspection. However, before starting treatment, the doctor may prescribe certain types of examinations and analyzes. For example, an x-ray study is often prescribed.

With a visual examination of the oral cavity, the doctor discovers a tooth defect in the form of a wedge (V-shaped log, or step). The defect has flat boundaries, dense bottom and glossy walls.

The composition of the gingival fluid in the case of a wedge-shaped defect in the teeth is not necessary, but some patients still carry out this type of analysis. The gingival fluid is the physiological mass that fills the gingival groove. In order to obtain this liquid, several methods are used:

• gingival washout;
• use of a micropipette;
• insertion into the groove of a special absorbent paper strip.

The composition of the liquid is usually represented by bacteria and products of their vital activity, elements of blood serum, intracellular fluid of gum tissue, and leukocytes.

The composition can change with the development of periodontal diseases and inflammatory processes.

Analyzes in dental practice are rarely prescribed. In some cases, in the presence of an inflammatory process of unclear etiology, the patient is asked to give a general blood test, as well as an analysis of the secretions (if any).

Instrumental diagnostics in the overwhelming majority of cases consists in conducting an X-ray study. The essence of the method is to obtain a local X-ray image of the affected areas using a radiovisiograph. The image is obtained thanks to X-rays. Sighting radiography allows you to pay attention to many dental features: using this method, you can diagnose latent caries, periodontal pathology, and examine the condition of the dental canals.

Computer tomography is used relatively rarely, only when it is necessary to obtain a three-dimensional image. The method allows you to carefully assess the condition of teeth, periodontal, nasal sinuses, temporomandibular joint, etc.

The procedure for electodiodontics is performed when it is necessary to assess the viability of the tooth pulp. Such a method will help to determine which tooth tissues are affected by a painful destructive process, and also to assess the need for intervention in the root canals.

[33], [34], [35]

Differential diagnosis

The overwhelming number of cases with a wedge-shaped defect does not require differential diagnosis, since it has characteristic distinctive features. Differentiation is carried out only in certain situations.

• Cuneiform defect and caries.

"Wedge" is always localized in the cervical part of the tooth and has a typical shape, corresponding to the name of the disease, and also has a solid and smooth wall. The carious cavity is filled with a soft darkened dentin, which is accompanied by unpleasant sensations from the action of stimuli.

• Wedge-shaped defect and erosion.

Erosion is cupped and located on the entire front surface of the tooth. Increased sensitivity and darkening of dentin, as a rule, absent.

• Cuneiform defect and post-necrosis necrosis.

Post-scalp necrosis is localized on the front teeth: the enamel coating becomes uneven and greyish-dirty, loses its smoothness and shine. Teeth acquire sensitivity and become brittle, with their gradual destruction.

[36], [37], [38], [39], [40]

Treatment of the sphenoid dentition

Regardless of the stage of development of the defect, the doctor will first of all prescribe the treatment aimed at eliminating the provoking factor: they treat the digestive system, correct the incorrect bite, etc.

Then proceed to eliminate the defect itself. At the initial stage of the development of pathology, applicative application of drugs giving dental calcium and fluoride can help. Such procedures are called calcination and fluorination. They are desirable to conduct courses, twice a year: this stops the destructive processes and restores the surface enamel.

At home, you can use special lacquer and gel coatings, which are applied according to the scheme indicated by the doctor. It is recommended to brush your teeth with special pastes - you need to do this regularly, for a long time.

In the remaining stages of defect development, procedures will be required to correct the aesthetic appearance of the affected teeth.

Restoration of a tooth with a wedge-shaped defect

Installation of the seal is carried out with the use of filling masses, characterized by a high degree of elasticity. The area near the neck is always subjected to high loads, so a regular seal will eventually fall out. In order to keep the seal well, special incisions are made on the surface of the defect.

As a seal, a fluid with a high degree of elasticity is used, which is applied using a syringe and polymerized with a special lamp.

Create additional neck protection and improve the aesthetic appearance of the affected teeth by using veneers, or micro-prostheses. Veneers are thin ceramic plates that cover the dental defect. From the minuses of such a restoration can be called the importance of periodic replacement of microprostheses. Although, to date, there are such veneers that can last up to two decades.

Another method of restoration is tooth crowns. They, as well as veneers, do not prevent further destruction of the layers. To do this, it is necessary to conduct appropriate treatment aimed at eliminating the original cause of the defect.

How to close a wedge-shaped defect on the lateral tooth, or on other damaged teeth? Considering the above, it is possible to distinguish such basic variants:

• sealing;
• installation of microprostheses;
• installation of crowns.

Do I need to treat a sphenoid dentition?

Treatment of a defect must be carried out necessarily. And not only to eliminate unpleasant symptoms, but also to block the further aggravation of the disease.

• Fluoridation of teeth is the application of fluorine-containing drugs to the affected areas of the teeth, which contributes to the restoration of tissues. Additionally, the increased sensitivity is eliminated.
• Calcination is the treatment of damaged enamel with calcium preparations, which stops the further development of the disease.
• Laser treatment is the treatment of a defect by a laser. This procedure ensures compaction of enamel, eliminates hypersensitivity.

If treatment is not carried out, then dental prosthesis or the installation of crowns will give only a temporary solution to the problem. In the future, the disease will worsen, which can lead to the breakage of the affected tooth in the area of damage.

[41], [42], [43], [44], [45], [46], [47], [48]

Home Treatment

In addition to the necessary dental treatment, you can try and the effect of alternative means. For example, there are a number of methods that should improve the condition of patients with a wedge-shaped defect:

• Buy alcoholic tincture of propolis in the pharmacy, dilute a few drops in a glass of warm water. Use this water for rinsing, after eating.
• Try to regularly include in the diet kelp, parsley, basil, as well as iodized salt (in the absence of contraindications).
• Ground pearl shells are ground to a powdery state. The resulting powder is applied to the teeth with a brush and held as much as possible without rinsing the mouth.
• Apply lemon or lime leaves to the affected teeth.
• Include in the diet of grated horseradish.
• Lubricate the teeth and gums with a mixture of honey and cinnamon powder.

In addition, it is useful to regularly include in food products with a sufficient content of minerals. For example, calcium can be obtained from dairy products, and fluorine from seaweed, beans, chicken, buckwheat, bananas, citrus, honey.

Toothpaste with a wedge-shaped tooth defect

Dentists advise for tooth cleaning to choose pastes with a desensitizing effect:

• ROCS Medical minerals (remineralizing paste), there is an option for adult patients and children. It reduces the sensitivity of the tooth tissue.
• ROCS Medical sensitive helps to eliminate uncomfortable and painful sensations.
• Doctor Best Sensitive or Elmex Sensitive are fluorine-containing, with reduced abrasive abilities.

Still it is possible to allocate a number of tooth-pastes that help with a wedge-shaped defect:

• Bio Repair;
• Sensigel;
• Oral-B sensitive fluoride;
• Biodent sensitive.

To obtain the effect, any of the listed pastes should be used regularly. With an accurate determination of the duration of use of such drugs, only the attending doctor of the dentist can.

Irrigator for wedge-shaped defect and sensitive teeth

Irrigator is a device that facilitates the care of the oral cavity. He gives a stream of water or medicine, washing his teeth, the space between his teeth, which serves as a good prevention of caries, periodontal diseases and plaque formation. Simultaneous gum massage improves local blood circulation.

Application of the irrigator is particularly recommended:

• with frequent inflammatory processes in the oral cavity, with bleeding gums;
• when wearing braces;
• in the presence of bad breath;
• at a diabetes.

Irrigator can serve as prevention of wedge-shaped defect. If the disease is already present, then with the help of this device you can prevent further development of the disease. Contrary to the opinion of many, the irrigator does not aggravate the problem of dental defects, but it is not able to cure them.

Why do teeth hurt after the treatment of sphenoid defects?

Pain in the teeth after treatment is an atypical situation. This happens relatively rarely and can be due to several factors:

• presence of additional problems with the teeth (caries, damage to dentin and pulp);
• hypothermia, upper respiratory tract diseases;
• poor-quality filling, the development of inflammation at the place of installation of the seals.

Pain can manifest throughout the day, intensifying at night.

Often the pain is associated with an individual's increased sensitivity of the patient, with an increased tone of the vagus nerve, with high blood pressure, with irritation of the trigeminal nerve, as well as with otorhinolaryngological pathologies (eg, sinus inflammation).

Normally, the teeth after the treatment should not hurt. If pain is present, then a diagnosis should be made to determine the source of the pain.

Prevention

In order to prevent the emergence of pathology, it is very important to monitor your own health in general, promptly seek medical help when necessary. This concerns both dental problems and malfunctions in the work of other organs and systems.

In addition, it is equally important to adhere to the basic rules of oral hygiene:

• Cleaning teeth should be done in the morning after breakfast and at night, after the last meal;
• it is advisable to choose a toothbrush with a medium-thick nap;
• It should be remembered that after each episode of food, rinse the mouth;
• it is necessary to exclude any excessive mechanical load on the teeth: you can not crack nutshell, gnaw threads, etc.

Timely consultation of the dentist will help to detect the disease at an early stage of formation. This will eliminate pathology with simpler and more affordable means, which will be less painful and less costly financially.

[49], [50], [51], [52], [53], [54]

Forecast

The wedge-shaped defect of the teeth is considered a relatively safe dental pathology. However, this does not mean that the patient can ignore it. It is necessary to treat the disease, and the earlier, the better for the patient. If the pathology is started, then the treatment will be more difficult and radical.

[55], [56], [57], [58], [59], [60]