This document discusses various types of injuries that can occur to the oral cavity. It covers physical injuries to teeth from factors like tooth preparation, restorative materials, bruxism and fractures. It also addresses injuries to other structures like soft tissues, bone and the dental pulp from thermal, chemical and radiation sources. A variety of acute and chronic lesions are described that result from traumatic injuries and discusses their diagnosis and management.
This document discusses various physiologic and pathologic processes that can affect teeth, including attrition, abrasion, erosion, abfraction, pulp calcification, tooth resorption, hypercementosis, and cementicles. It defines each term and describes the clinical and radiographic presentation of each condition. It also discusses the etiology, histopathology, and characteristics of different types of resorption and cementum abnormalities like hypercementosis and cementicles.
Tooth resorption is the progressive loss of dentine and cementum by the action of osteoclasts. This is a physiological process in the exfoliation of the primary dentition, caused by osteoclast differentiation due to pressure exerted by the erupting permanent tooth
Dilaceration is a bending or curvature of a tooth root caused by either trauma that displaces the calcified portion during development or a developmental defect. It most commonly occurs in maxillary incisors and is diagnosed radiographically by observing the curved root. Management can be difficult and involves restoring a dilacerated crown to improve function and prevent dental issues, while extraction may require special care due to the root curvature.
This document provides an overview of pulp capping agents and procedures. It begins with definitions of indirect and direct pulp capping. It then discusses various pulp capping agents that have been used historically and currently, including calcium hydroxide, zinc oxide-eugenol, glass ionomer cement, and mineral trioxide aggregate. For each agent, the document outlines their proposed mechanisms of action, advantages, and disadvantages based on literature. Overall, the document provides a comprehensive review of the key considerations and materials used for pulp capping procedures.
Gemination occurs during tooth development when a single tooth germ invaginates, resulting in an incomplete formation of two teeth that appear joined on a single root. It most commonly affects deciduous mandibular incisors and permanent maxillary incisors. Radiographs show a cleft in the crown and enlarged or partially divided pulp chamber within a single root. Treatment involves restoring and reshaping the crown, periodic filing to reduce the width, and eventually preparing a final crown.
This document discusses all ceramic crown preparation. It defines all ceramic crowns as non-metallic full coverage restorations used to restore teeth functionally and esthetically. Advantages include superior esthetics, excellent translucency, and good tissue response, while disadvantages include reduced strength without a metal substructure and difficulty obtaining well-fitting margins. Indications for all ceramic crowns include discolored teeth, teeth with enamel defects, and excessive attrition. Contraindications include posterior teeth and teeth under heavy biting forces. The document outlines the facial, incisal, lingual, and proximal tooth reduction techniques needed to properly prepare teeth for all ceramic crowns.
GLASS IONOMER CEMENT AND ITS RECENT ADVANCES- by Dr. JAGADEESH KODITYALAJagadeesh Kodityala
This document provides an overview of glass ionomer cement, including its definition, history, composition, classification, setting reaction, properties, and recent advances. Key points include:
- Glass ionomer cement was invented in 1969 and first reported in 1971, consisting of a glass powder and aqueous solution of polyacrylic acid.
- It is classified based on its intended use, such as luting cement, restorative cement, or liner/base material.
- The setting reaction involves an acid-base reaction between the glass powder and polyacrylic acid, forming bonds through a calcium polyacrylate matrix that continues to harden over time.
- Properties include adhesion to tooth structure, biocompatibility, fluoride
This document discusses various physiologic and pathologic processes that can affect teeth, including attrition, abrasion, erosion, abfraction, pulp calcification, tooth resorption, hypercementosis, and cementicles. It defines each term and describes the clinical and radiographic presentation of each condition. It also discusses the etiology, histopathology, and characteristics of different types of resorption and cementum abnormalities like hypercementosis and cementicles.
Tooth resorption is the progressive loss of dentine and cementum by the action of osteoclasts. This is a physiological process in the exfoliation of the primary dentition, caused by osteoclast differentiation due to pressure exerted by the erupting permanent tooth
Dilaceration is a bending or curvature of a tooth root caused by either trauma that displaces the calcified portion during development or a developmental defect. It most commonly occurs in maxillary incisors and is diagnosed radiographically by observing the curved root. Management can be difficult and involves restoring a dilacerated crown to improve function and prevent dental issues, while extraction may require special care due to the root curvature.
This document provides an overview of pulp capping agents and procedures. It begins with definitions of indirect and direct pulp capping. It then discusses various pulp capping agents that have been used historically and currently, including calcium hydroxide, zinc oxide-eugenol, glass ionomer cement, and mineral trioxide aggregate. For each agent, the document outlines their proposed mechanisms of action, advantages, and disadvantages based on literature. Overall, the document provides a comprehensive review of the key considerations and materials used for pulp capping procedures.
Gemination occurs during tooth development when a single tooth germ invaginates, resulting in an incomplete formation of two teeth that appear joined on a single root. It most commonly affects deciduous mandibular incisors and permanent maxillary incisors. Radiographs show a cleft in the crown and enlarged or partially divided pulp chamber within a single root. Treatment involves restoring and reshaping the crown, periodic filing to reduce the width, and eventually preparing a final crown.
This document discusses all ceramic crown preparation. It defines all ceramic crowns as non-metallic full coverage restorations used to restore teeth functionally and esthetically. Advantages include superior esthetics, excellent translucency, and good tissue response, while disadvantages include reduced strength without a metal substructure and difficulty obtaining well-fitting margins. Indications for all ceramic crowns include discolored teeth, teeth with enamel defects, and excessive attrition. Contraindications include posterior teeth and teeth under heavy biting forces. The document outlines the facial, incisal, lingual, and proximal tooth reduction techniques needed to properly prepare teeth for all ceramic crowns.
GLASS IONOMER CEMENT AND ITS RECENT ADVANCES- by Dr. JAGADEESH KODITYALAJagadeesh Kodityala
This document provides an overview of glass ionomer cement, including its definition, history, composition, classification, setting reaction, properties, and recent advances. Key points include:
- Glass ionomer cement was invented in 1969 and first reported in 1971, consisting of a glass powder and aqueous solution of polyacrylic acid.
- It is classified based on its intended use, such as luting cement, restorative cement, or liner/base material.
- The setting reaction involves an acid-base reaction between the glass powder and polyacrylic acid, forming bonds through a calcium polyacrylate matrix that continues to harden over time.
- Properties include adhesion to tooth structure, biocompatibility, fluoride
Abrasion ( Regressive Alterations of Teeth)
Reference books:-
Shafer’s Textbook:- https://amzn.to/3eNCqRx
Purkait textbook:- https://amzn.to/30AfTCq
What is Abrasion?
Causes of abrasion
Treatment of abrasion
Clinical features of Abrasion
Definition of Abrasion:- Abrasion is the pathological wearing of dental tissues or dental restorations by friction with foreign substances independent of occlusion.
Etiology and pathogenesis of Abrasion
#abrasion
#educational
#education
#oralpathology
#regressivealterationofteeth
The document summarizes the histopathology of dental caries in enamel and dentine. It describes the four zones seen in enamel caries: the translucent zone, dark zone, body of the lesion, and surface zone. It then discusses the five zones of dentine caries: the zone of sclerosis, zone of demineralization, zone of bacterial invasion, zone of destruction, and reactionary dentine. The zones represent areas of increasing demineralization and bacterial involvement as the caries progresses from enamel to dentine.
Dental amalgam is an alloy used in dental fillings that consists of liquid mercury and a powdered alloy mixture of silver, tin, and copper. It has been used since the 1830s as a dental restorative material. Newer advances include high copper amalgam, bonded amalgam, and gallium-based alloys as alternatives that aim to reduce mercury levels while maintaining strength and durability. However, the use of amalgam remains controversial due to concerns about mercury toxicity.
The document provides an overview of periapical diseases and their classification. It begins with an introduction to periapical diseases and their causes. The document then classifies periapical diseases into symptomatic and asymptomatic categories. Within each category, it describes specific conditions such as symptomatic apical periodontitis, acute alveolar abscess, chronic alveolar abscess, radicular cyst, and condensing osteitis. For each condition, it discusses causes, symptoms, diagnosis, differential diagnosis, and treatment. The document provides a comprehensive review of different periapical diseases and conditions that can affect the tissues around the root apex.
Taurodontism is a condition where the body of the tooth is enlarged at the expense of the root, resulting in an elongated tooth body and short roots. It is caused by a failure of the epithelial root sheath to invaginate properly during tooth development. Taurodontism can range from mild to severe and may affect deciduous or permanent molars either unilaterally or bilaterally. Radiographically, there is an extremely large pulp chamber that extends into the elongated tooth body and short, wide roots. Diagnosis is based on the characteristic rectangular tooth crown and large pulp chamber seen clinically or radiographically. No treatment is needed as taurodontism does not typically cause clinical problems.
This document discusses various non-carious lesions of teeth including attrition, abrasion, erosion, abfraction, dentinal sclerosis, dead tracts, secondary dentin, pulp stones, hypercementosis, and cementicles. It defines each lesion, describes the etiology and pathogenesis, and highlights key clinical features. Attrition is mechanical wear of teeth from tooth contact while abrasion is caused by external frictional forces. Erosion results from chemical dissolution of tooth structure by acids. Abfraction involves stress-induced cervical lesions. Dentinal sclerosis and dead tracts are age-related changes in dentin. Secondary dentin deposition occurs in response to stimuli. Pulp stones, hypercementosis and
This document discusses the history and evolution of dental adhesives from the first generation developed in the 1950s to the latest universal adhesive systems. It covers the various classifications of adhesives based on generation and mechanism of adhesion. The key mechanisms of adhesion to enamel and dentin are described, including the etch and rinse approach and self-etch adhesives. Factors affecting the bonding process and bond strength are also summarized.
Fissure sealants are materials used to seal pits and fissures in teeth to prevent decay. They form a protective layer that blocks bacteria from entering areas in teeth where decay starts. Fissure sealants work best in teeth with deep grooves or pits that are difficult for brushing to clean. The document discusses the ideal properties, types, procedures for application, risks, maintenance and repair of dental sealants. Resin-based sealants are the most common type and involve cleaning, etching the enamel with acid, applying the sealant and curing it with light. Fissure sealants significantly reduce the risk of decay when applied properly to teeth at high risk.
This document discusses dental casting investments, which are materials used to form molds for casting dental restorations like crowns and bridges. It describes the components of investments, including refractory materials like silica, binders like gypsum or phosphate, and modifiers. It explains the properties investments must have like strength, expansion to compensate for shrinkage, and smooth surfaces. It covers the different types of investments including gypsum-bonded, phosphate-bonded, and silica-bonded and their appropriate uses and temperature ranges. It also discusses factors that affect the investments' setting expansion to help compensate for casting shrinkage.
This document discusses young permanent teeth and their characteristics compared to mature teeth. It notes that young permanent teeth are those that have recently erupted and have not completed root development and closure of the apical foramen. The root development process can take 2-3 years after eruption. These young teeth are still developing and possess stem cells that can aid in continued root development. Factors like deep caries or trauma can lead to pulp necrosis in an immature tooth and result in an open apex. The document also discusses various classifications and stages of root development in young permanent teeth.
Dens Evaginatus is a developmental anomaly resulting in the formation of an accessory cusp on a tooth. It most commonly occurs on the lingual surface of maxillary lateral incisors and occlusal surfaces of mandibular premolars. The presence of pulp tissue within the cusp distinguishes it from supplemental cusps. Genetic factors like autosomal dominant inheritance may play a role in its etiology. Clinically, malocclusion can cause traumatic force on the cusp leading to pulp exposure. Treatment involves root canal therapy if exposed, and reducing opposing tooth contact.
This document discusses various mucocutaneous disorders of the oral cavity, including genodermatoses, infective causes, and non-infective conditions. It provides details on specific diseases such as erythema multiforme, pemphigus, and cicatricial pemphigoid. Erythema multiforme is characterized by target lesions that can involve the oral mucosa. Pemphigus is a chronic blistering disease caused by loss of cell adhesion, while cicatricial pemphigoid involves subepithelial blistering that results in scarring.
Amelogenesis imperfecta is a hereditary condition that affects the development of dental enamel. There are three main types - hypoplastic, hypocalcified, and hypomaturation. The enamel is either not fully formed, not properly mineralized, or does not mature correctly. Treatment depends on the specific type but can include preventative care with sealants, bonding, crowns, veneers, and in severe cases, full coverage restorations. Managing the condition over many years using various techniques can lead to excellent functional and aesthetic outcomes.
Dental amalgam is an alloy used in dentistry as a filling material. It contains mercury and other metals such as silver, tin, and copper. Amalgam is used for fillings in back teeth and to restore crowns. There are different types of amalgam based on their composition and particle shape. The properties and performance of amalgam depend on factors like mercury content, alloy composition, trituration, and condensation technique. While amalgam is inexpensive and durable, it also has disadvantages like poor aesthetics, potential toxicity, and marginal breakdown over time.
Regional odontodysplasia is a developmental anomaly affecting the ectodermal and mesodermal components of tooth development, causing teeth to be small, mottled brown, and hypocalcified. It most commonly impacts the central and lateral incisors. Radiographically, affected teeth appear ghost-like with reduced density and large pulp chambers. While the etiology is uncertain, factors like trauma, infection, and vascular defects have been suggested. Clinical diagnosis is based on irregular tooth shape and brown discoloration, while radiographs reveal a shell-like appearance. Treatment typically involves early extraction and prosthetic replacement, though restorative procedures like root canals may attempt to save affected teeth.
This document discusses mineral trioxide aggregate (MTA), including its composition, properties, mechanisms of action, and clinical applications. MTA is comprised primarily of Portland cement and bismuth oxide for radiopacity. It has an alkaline pH, is biocompatible, promotes hard tissue formation, and provides a good seal. The document outlines MTA's uses for pulp capping, apical plugs, root-end fillings, repair of root/furcal perforations and resorptive defects, apexification, and apexogenesis.
The document discusses heat cure acrylic denture base resins. It provides background on the development of denture base materials over time. Polymethyl methacrylate (PMMA) was introduced in 1937 and remains the material of choice due to its superior esthetics, ease of processing, accurate fit, and use with inexpensive equipment. The document describes the composition, chemical basis of polymerization, manipulation techniques including compression molding and injection molding, and physical properties of heat cure acrylic resins. It also compares heat cure resins to self-cure resins and discusses requirements versus clinical performance as well as recent advances in the material.
Resorption of teeth can be either physiological or pathological. It can occur externally on the surface of the tooth or internally within the tooth structure. Tooth resorbing cells called odontoclasts are involved and resemble osteoclasts, containing enzymes that allow degradation of mineral and organic tooth material. Physiological resorption occurs due to pressure or signals from the dental follicle, while pathological resorption can be associated with periapical inflammation, tooth replantation, cysts/tumors, orthodontic movement, impacted teeth, or idiopathic causes. Internal resorption begins within the pulp and spreads outward, while external resorption occurs on the surface and progresses inward.
This document discusses the intimate relationship between dentin and dental pulp and how this relationship has important clinical implications. It notes that the pulp will react when dentin is injured, whether by caries, attrition, abrasion, erosion or operative procedures. It then discusses various irritants that can affect the pulp, including bacteria, iatrogenic factors like thermal changes from procedures, chemicals from materials, aging, trauma and more. It focuses on the pulpal reactions to factors like caries, local anesthetics, restorative procedures, dental materials, bleaching, periodontal procedures and orthodontic movement. It provides details on how each of these can irritate the pulp and the pulp's defensive reactions.
Abrasion ( Regressive Alterations of Teeth)
Reference books:-
Shafer’s Textbook:- https://amzn.to/3eNCqRx
Purkait textbook:- https://amzn.to/30AfTCq
What is Abrasion?
Causes of abrasion
Treatment of abrasion
Clinical features of Abrasion
Definition of Abrasion:- Abrasion is the pathological wearing of dental tissues or dental restorations by friction with foreign substances independent of occlusion.
Etiology and pathogenesis of Abrasion
#abrasion
#educational
#education
#oralpathology
#regressivealterationofteeth
The document summarizes the histopathology of dental caries in enamel and dentine. It describes the four zones seen in enamel caries: the translucent zone, dark zone, body of the lesion, and surface zone. It then discusses the five zones of dentine caries: the zone of sclerosis, zone of demineralization, zone of bacterial invasion, zone of destruction, and reactionary dentine. The zones represent areas of increasing demineralization and bacterial involvement as the caries progresses from enamel to dentine.
Dental amalgam is an alloy used in dental fillings that consists of liquid mercury and a powdered alloy mixture of silver, tin, and copper. It has been used since the 1830s as a dental restorative material. Newer advances include high copper amalgam, bonded amalgam, and gallium-based alloys as alternatives that aim to reduce mercury levels while maintaining strength and durability. However, the use of amalgam remains controversial due to concerns about mercury toxicity.
The document provides an overview of periapical diseases and their classification. It begins with an introduction to periapical diseases and their causes. The document then classifies periapical diseases into symptomatic and asymptomatic categories. Within each category, it describes specific conditions such as symptomatic apical periodontitis, acute alveolar abscess, chronic alveolar abscess, radicular cyst, and condensing osteitis. For each condition, it discusses causes, symptoms, diagnosis, differential diagnosis, and treatment. The document provides a comprehensive review of different periapical diseases and conditions that can affect the tissues around the root apex.
Taurodontism is a condition where the body of the tooth is enlarged at the expense of the root, resulting in an elongated tooth body and short roots. It is caused by a failure of the epithelial root sheath to invaginate properly during tooth development. Taurodontism can range from mild to severe and may affect deciduous or permanent molars either unilaterally or bilaterally. Radiographically, there is an extremely large pulp chamber that extends into the elongated tooth body and short, wide roots. Diagnosis is based on the characteristic rectangular tooth crown and large pulp chamber seen clinically or radiographically. No treatment is needed as taurodontism does not typically cause clinical problems.
This document discusses various non-carious lesions of teeth including attrition, abrasion, erosion, abfraction, dentinal sclerosis, dead tracts, secondary dentin, pulp stones, hypercementosis, and cementicles. It defines each lesion, describes the etiology and pathogenesis, and highlights key clinical features. Attrition is mechanical wear of teeth from tooth contact while abrasion is caused by external frictional forces. Erosion results from chemical dissolution of tooth structure by acids. Abfraction involves stress-induced cervical lesions. Dentinal sclerosis and dead tracts are age-related changes in dentin. Secondary dentin deposition occurs in response to stimuli. Pulp stones, hypercementosis and
This document discusses the history and evolution of dental adhesives from the first generation developed in the 1950s to the latest universal adhesive systems. It covers the various classifications of adhesives based on generation and mechanism of adhesion. The key mechanisms of adhesion to enamel and dentin are described, including the etch and rinse approach and self-etch adhesives. Factors affecting the bonding process and bond strength are also summarized.
Fissure sealants are materials used to seal pits and fissures in teeth to prevent decay. They form a protective layer that blocks bacteria from entering areas in teeth where decay starts. Fissure sealants work best in teeth with deep grooves or pits that are difficult for brushing to clean. The document discusses the ideal properties, types, procedures for application, risks, maintenance and repair of dental sealants. Resin-based sealants are the most common type and involve cleaning, etching the enamel with acid, applying the sealant and curing it with light. Fissure sealants significantly reduce the risk of decay when applied properly to teeth at high risk.
This document discusses dental casting investments, which are materials used to form molds for casting dental restorations like crowns and bridges. It describes the components of investments, including refractory materials like silica, binders like gypsum or phosphate, and modifiers. It explains the properties investments must have like strength, expansion to compensate for shrinkage, and smooth surfaces. It covers the different types of investments including gypsum-bonded, phosphate-bonded, and silica-bonded and their appropriate uses and temperature ranges. It also discusses factors that affect the investments' setting expansion to help compensate for casting shrinkage.
This document discusses young permanent teeth and their characteristics compared to mature teeth. It notes that young permanent teeth are those that have recently erupted and have not completed root development and closure of the apical foramen. The root development process can take 2-3 years after eruption. These young teeth are still developing and possess stem cells that can aid in continued root development. Factors like deep caries or trauma can lead to pulp necrosis in an immature tooth and result in an open apex. The document also discusses various classifications and stages of root development in young permanent teeth.
Dens Evaginatus is a developmental anomaly resulting in the formation of an accessory cusp on a tooth. It most commonly occurs on the lingual surface of maxillary lateral incisors and occlusal surfaces of mandibular premolars. The presence of pulp tissue within the cusp distinguishes it from supplemental cusps. Genetic factors like autosomal dominant inheritance may play a role in its etiology. Clinically, malocclusion can cause traumatic force on the cusp leading to pulp exposure. Treatment involves root canal therapy if exposed, and reducing opposing tooth contact.
This document discusses various mucocutaneous disorders of the oral cavity, including genodermatoses, infective causes, and non-infective conditions. It provides details on specific diseases such as erythema multiforme, pemphigus, and cicatricial pemphigoid. Erythema multiforme is characterized by target lesions that can involve the oral mucosa. Pemphigus is a chronic blistering disease caused by loss of cell adhesion, while cicatricial pemphigoid involves subepithelial blistering that results in scarring.
Amelogenesis imperfecta is a hereditary condition that affects the development of dental enamel. There are three main types - hypoplastic, hypocalcified, and hypomaturation. The enamel is either not fully formed, not properly mineralized, or does not mature correctly. Treatment depends on the specific type but can include preventative care with sealants, bonding, crowns, veneers, and in severe cases, full coverage restorations. Managing the condition over many years using various techniques can lead to excellent functional and aesthetic outcomes.
Dental amalgam is an alloy used in dentistry as a filling material. It contains mercury and other metals such as silver, tin, and copper. Amalgam is used for fillings in back teeth and to restore crowns. There are different types of amalgam based on their composition and particle shape. The properties and performance of amalgam depend on factors like mercury content, alloy composition, trituration, and condensation technique. While amalgam is inexpensive and durable, it also has disadvantages like poor aesthetics, potential toxicity, and marginal breakdown over time.
Regional odontodysplasia is a developmental anomaly affecting the ectodermal and mesodermal components of tooth development, causing teeth to be small, mottled brown, and hypocalcified. It most commonly impacts the central and lateral incisors. Radiographically, affected teeth appear ghost-like with reduced density and large pulp chambers. While the etiology is uncertain, factors like trauma, infection, and vascular defects have been suggested. Clinical diagnosis is based on irregular tooth shape and brown discoloration, while radiographs reveal a shell-like appearance. Treatment typically involves early extraction and prosthetic replacement, though restorative procedures like root canals may attempt to save affected teeth.
This document discusses mineral trioxide aggregate (MTA), including its composition, properties, mechanisms of action, and clinical applications. MTA is comprised primarily of Portland cement and bismuth oxide for radiopacity. It has an alkaline pH, is biocompatible, promotes hard tissue formation, and provides a good seal. The document outlines MTA's uses for pulp capping, apical plugs, root-end fillings, repair of root/furcal perforations and resorptive defects, apexification, and apexogenesis.
The document discusses heat cure acrylic denture base resins. It provides background on the development of denture base materials over time. Polymethyl methacrylate (PMMA) was introduced in 1937 and remains the material of choice due to its superior esthetics, ease of processing, accurate fit, and use with inexpensive equipment. The document describes the composition, chemical basis of polymerization, manipulation techniques including compression molding and injection molding, and physical properties of heat cure acrylic resins. It also compares heat cure resins to self-cure resins and discusses requirements versus clinical performance as well as recent advances in the material.
Resorption of teeth can be either physiological or pathological. It can occur externally on the surface of the tooth or internally within the tooth structure. Tooth resorbing cells called odontoclasts are involved and resemble osteoclasts, containing enzymes that allow degradation of mineral and organic tooth material. Physiological resorption occurs due to pressure or signals from the dental follicle, while pathological resorption can be associated with periapical inflammation, tooth replantation, cysts/tumors, orthodontic movement, impacted teeth, or idiopathic causes. Internal resorption begins within the pulp and spreads outward, while external resorption occurs on the surface and progresses inward.
This document discusses the intimate relationship between dentin and dental pulp and how this relationship has important clinical implications. It notes that the pulp will react when dentin is injured, whether by caries, attrition, abrasion, erosion or operative procedures. It then discusses various irritants that can affect the pulp, including bacteria, iatrogenic factors like thermal changes from procedures, chemicals from materials, aging, trauma and more. It focuses on the pulpal reactions to factors like caries, local anesthetics, restorative procedures, dental materials, bleaching, periodontal procedures and orthodontic movement. It provides details on how each of these can irritate the pulp and the pulp's defensive reactions.
The wasting diseases of teeth, namely attrition, abrasion and dental erosion have taken their toll in the population around the world due to the changing lifestyles, increase in the stress levels and many others factors that were persistent earlier but have suddenly increased drastically. This presentation brings to light the new factors that have attributed to this condition as well as discusses the previous ones.
Pulp is the living tissue inside teeth that contains blood vessels, nerves and connective tissue. It can be irritated by dental procedures and restorative materials. The depth of a cavity preparation directly impacts the amount of damage to the pulp, with deeper preparations causing more damage. Factors like speed of drilling and heat generation must be controlled to minimize pulp irritation. Materials used for restorations or as pulp capping agents can irritate the pulp if acidic, poorly sealed or cytotoxic. Procedures like indirect pulp capping and direct pulp capping are used to protect the pulp from further injury and promote healing when it has been exposed. Success depends on factors like the size of exposure and patient age. Liners, bases,
This document discusses various methods and materials used for pulp protection during restorative procedures. It describes the pulp-dentin complex and factors that can irritate the pulp. Methods for protecting the pulp include indirect and direct pulp capping. Direct pulp capping involves placing a biocompatible material over an exposed pulp. Indirect pulp capping leaves a thin layer of dentin and caries to avoid exposure. Materials traditionally used include calcium hydroxide, zinc oxide eugenol, and glass ionomers. Newer materials like Biodentine, a calcium silicate-based cement, have shown promising results for pulp capping and stimulation of reparative dentin formation.
Pulp protection in operative dentistry Nivedha Tina
This document discusses various materials used for pulp protection and their properties. It describes how remaining dentin thickness, depth of preparation, and prevention of bacterial microleakage are important factors for pulp health. Common pulp protection materials discussed include bases, liners, varnishes, and sealers. Calcium hydroxide and glass ionomer cements are highlighted as they promote reparative dentin formation, adhere to dentin, and release fluoride. The document emphasizes that proper isolation and sealing of restorations is key to preventing pulpal injury from bacteria and toxins.
Pit and fissure sealants are materials placed in tooth pits and grooves to prevent dental caries. They form a protective layer that seals out bacteria. Studies show that occlusal surfaces, though a small percentage of total tooth area, account for 50% of childhood caries. Sealants are effective but their protection decreases over time, so periodic reapplication is important. The sealing procedure involves cleaning, etching with acid, rinsing, drying, applying sealant, and curing with light. Sealants must be monitored for retention and signs of new caries.
Non-carious cervical lesions are caused by a combination of erosion, abrasion, and abfraction and affect half the population. Erosion is chemical wear from acids like those in citrus fruits and drinks. Abrasion is mechanical wear, like from overly vigorous brushing. Abfraction is stress-related wear from forces like clenching. These lesions are diagnosed through history, examination, and radiographs. Treatment depends on the severity but may include desensitization, restorations using composites or glass ionomers, endodontics, or periodontal procedures.
This document provides information on the classification and treatment of tooth discoloration. It begins with an introduction on the importance of properly diagnosing the cause of discoloration in order to determine the appropriate treatment. Tooth discoloration is then classified in various ways, including by location (intrinsic, extrinsic, internalized), etiology (pre-eruptive, post-eruptive causes), and chemistry of the staining agent. Diagnosis involves taking a medical history and pretreatment photos in order to analyze the cause. Potential treatments discussed include prevention methods, scaling, microabrasion, macroabrasion, veneers, bleaching of vital and non-vital teeth, and the use of various agents
Restoration of endodontically treated teethIAU Dent
This document summarizes the effects of endodontic treatment on teeth and considerations for restoring endodontically treated teeth. Key points include:
- Endodontic treatment can result in loss of tooth structure, altered physical properties making teeth more brittle, and discoloration.
- Remaining tooth structure, function, and aesthetics must be evaluated to determine the appropriate restoration. Teeth with minimal structure may be restored with composites while those with heavier function typically need crowns.
- Temporary cements must be completely removed before bonding permanent restorations to avoid inhibiting the bond. Teeth exposed to sodium hypochlorite also require treatment to reverse its oxidizing effects.
- Common restorative
This document discusses pulp protection in restorative dentistry. It outlines the goals of preserving pulp health and various irritants that can harm the pulp. The amount of remaining dentin thickness is an important factor in determining the appropriate protection method. Various protective agents are described, including cavity sealants, liners, and bases made of materials like varnish, resin bonding agents, calcium hydroxide, and glass ionomer cement. Guidelines are provided for selecting the proper agent based on restoration type and cavity depth. Indirect and direct pulp capping procedures are also summarized.
This document provides an overview of tooth discoloration and its management. It discusses classifications of extrinsic and intrinsic discoloration and their causes. Extrinsic stains are located on the tooth surface and can be removed by prophylaxis, while intrinsic stains are within the tooth structure. Tetracycline staining occurs when tetracycline antibiotics are taken during tooth development. Enamel hypoplasia is a defect resulting in less enamel. Management of extrinsic stains involves prophylaxis or macroabrasion. Intrinsic stains are managed using microabrasion, bleaching, composite restorations, or porcelain veneers. A combination of treatments may be used.
Biomimic Dentistry in modern dentistry and dental materialsalinoori55
Biomimetic dentistry aims to preserve natural tooth structure and function by mimicking the properties and biomechanics of natural teeth. It emphasizes using techniques and materials that maximize adhesion while minimizing residual stress. In contrast to traditional dentistry which often requires more tooth preparation, biomimetic procedures preserve intact tooth structure through thin composite layers and indirect restorations. The goal is to restore teeth in a way that is biomechanically and aesthetically similar to natural teeth.
Pulp protection aims to maintain pulp vitality when it is exposed during dental procedures. Conventional direct pulp capping involves cleaning and drying the exposed pulp before placing a biocompatible material like calcium hydroxide over it. Newer materials like MTA, biodentine, and theracal are better at stimulating reparative dentin formation. Indirect pulp capping leaves caries near the pulp and seals it to prevent exposure. Factors like exposure size and patient age affect success rates. Lasers and stem cells may improve future pulp capping methods.
classification of traumatic injury of oral tissue.pptxpikopinochi
This document discusses various classifications of traumatic dental injuries. It begins by defining dental trauma and describing common injury sites in teeth. It then examines several classifications including:
1. Sweets classification (1955) which focuses on anterior tooth anatomy and morphology.
2. Ellis and Davey classification (1960) and modified Ellis classification which classify injuries based on extent of fracture and pulp exposure.
3. Bennett's classification considers injuries to the periodontium and alveolus.
4. Andreasen's classification (1981) examines injuries to hard tissues, periodontium, supporting bone, and soft tissues. It remains the most comprehensive classification system.
The direct sequelae of wearing complete dentures include mucosal reactions like denture stomatitis, candidiasis, angular cheilitis, traumatic ulcers, and flabby ridges. Denture stomatitis is a common inflammation under dentures caused by microbial plaque accumulation and candida species. Candidiasis includes different forms of oral candida infections associated with denture wearing. Angular cheilitis and traumatic ulcers develop from mechanical irritation or nutritional deficiencies. Flabby ridges are caused by excessive bone resorption replacing bone with fibrotic tissue under dentures, compromising denture support. Management focuses on improving denture fit, oral hygiene, and treating underlying causes.
Similar to Physical & chemical injuries in prosthodontics (20)
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ملزمة تشريح الجهاز الهيكلي (نظري 3)
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تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
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3. CONTENTS
• INTRODUCTION
• INJURY
• INJURIES OF TEETH ASSOCIATED WITH TOOTH PREPARATION
• EFFECT OF HEAT
• EFFECT OF RESTORATIVE MATERIALS
• PHYSICAL INJURIES OF TEETH
• PHYSICAL INJURIES OF BONE
4. • EFFECT OF ORTHODONTIC TOOTH MOVEMENT
• PHYSICAL INJURIES OF SOFT TISSUES
• RADIATION INJURIES
• CHEMICAL INJURIES OF ORAL CAVITY
• OCCUPATIONAL INJURIES OF THE ORAL CAVITY
• OCCLUSAL TRAUMA
• CONCLUSION
• REFERENCES
5. INTRODUCTION
• Oral lesions associated with trauma are a relatively common finding in dental
practice. A diverse array of oral mucosal disorders caused by acute and chronic
trauma exists.
• They manifest in the oral mucosa as acute or chronic ulcers, white or red lesions,
mucositis, and reactive hyperplasia or even as bone exposures with
sequestration.
• Such lesions may also impair oral functions to a significant extent and also pose
some difficulties in arriving at a diagnosis especially the chronic lesions.
6. • Similarly chemical injury could result from undue or careless handling of
chemicals and dental instruments during dental treatment procedures.
• A wide array of chemicals and drugs come into contact with oral mucosa and
some of them may cause direct mucosal trauma due to their caustic nature.
• Some people tend to apply certain chemicals as a remedy for their oral
problems such as application of aspirin to ease toothache.
• Health care practitioners are also responsible in applying certain chemicals in
the mouth for treatment or investigative procedures.
Chemical burns
7. INJURY
• It is defined as harm or hurt; usually applied to damage inflicted on the body by
an external force, called as trauma or wound
8. Injuries of the Teeth Associated with Restorative Procedures
Effect of Tooth Preparation:
• The effect of preparation of teeth on dentin and pulp alone is difficult to asses
except in sound teeth since the carious lesion itself produces demonstrable
changes in both these structures.
• Rotary instruments with stainless steel burs, tungsten carbide and diamond burs
of different sizes and shapes are routinely employed to prepare cavities and
crowns.
9. Reactions to Rotary Instrument
• Hence preparation of tooth without adequate cooling or excessive drying of the
dentin after cavity preparation results in excessive heat and evaporation of
tubular contents.
• This leads to displacement of odontoblast nuclei into the dentinal tubules and a
marked disorganization in the organelles of the odontoblasts and in the adjacent
cells, which might include intracellular disorganization, rupture of the nuclear
membrane and lysis of cellular elements.
10. • Effect of air abrasive techniques:
• Aluminum oxide under high pressure is use. It does not allow the stereognostic
ability of the controller. Working time is the most important to determine the
depth of preparation.
• Effect of Ultrasonic Technique:
• It has been advocated as it involves less heat, noise and vibration in contrast to
rotary instruments.
11. • Studies have shown that there is no remarkable differences in the reaction of
dental pulp to steel burs, diamond burs or ultrasonics.
• Lasers
• Carbon and Nd:YAG are most commonly used.
• On tooth it produces a glass like fusion of the enamel and definitive charred
crater on dentin.
• On pulp it shows severe pathologic changes including hemorrhagic changes
with acute & chronic inflammatory cell infiltrations.
12. Effect of Heat
• Thermal changes are influenced by
1. The size, shape & composition of bur or stone
2. The speed of bur or stone
3. The amount & direction of pressure applied.
4. The amount of moisture in the field of operation.
5. The length of time that the bur or stone is in contact with the tooth
6. The type of tissue being cut, enamel or dentin
13. SMEAR LAYER
The cut surface of enamel and dentin, when examined after preparation with
hand instruments or burs reveals the presence of covering layer of cutting
debris from mineralized tissues referred as the “smear layer” which is less than
2μ.
14. Effect of Restorative Materials
• Remaining Dentin Thickness(RDT):
–It is the most important deciding factor before placing the restorative materials.
–2μ or more is sufficient for proper insulation by the dentin itself.
–If its less than 2μ additional agents such as cements or bases are required before
placing the restoration.
Zinc Oxide & Eugenol:
• Eugenol of the cement fixes cells, depresses the cell respiration and reduces the
neural transmission in vitro.
• It is considered as the least injurious of all filling materials to the dental pulp.
Zinc Phosphate cement:
• Majority of investigators have reported significant deleterious effects on the pulp
when the material is placed, the actual injurious agent is supposedly being the
phosphoric acid.
15. Silver Amalgam:
• It is used as filling material which is generally innocuous material, particularly in
shallow cavities.
• However Manley found that there is decrease in odontoblasts number with mild
inflammation of pulp.
• New studies have found that the pulp response is due to the leakage around the
restoration rather than the material by itself. There is slight inflammation of
gingiva when contacted due to the corrosive products & plaque.
16. Glass Ionomer:
• Its is considered as biocompatible and is widely used as filling, lining and luting
agent.
• It has the advantage of chemically bonding to the mineralized tissue and release
of fluorides.
• Pulpal pain may be present for a short period after the filling material due to the
increased dentin permeability after acid etching.
17. • Self Polymerizing Acrylic Resin:
• Extensively used as restorative materials, particularly in anterior teeth.
• Results indicated that these resins provoked odontoblastic damage and pulpal
inflammation which is more severe in deeper restorations.
• Pulpal reaction is mainly due to the shrinkage causing leakage.
Conventional Composite Resins:
• These showed the same irritational characteristics of unfilled resins.
• Hence pulpal protection is required in such cases to prevent damage and calcium
hydroxide base is a preferred.
18. Microfilled Composite Resins:
• It is comparable to those of conventional composite resins hence pulp protection
is required under deep cavities.
Acid Etching:
• Most commonly employed chemical is phosphoric acid.
• This considerably demineralize the dentin exposing collagen. It forms an
interwoven mesh of fibers in which resin is infiltrated forming a “hybrid layer.”
19. Effect of Cement Bases, Cavity Liners, Varnishes and
Primers
• These are generally used for one or more of the following purposes:
1. To serve as bacteriostatic agent.
2. To provide thermal insulation, particularly under metallic restorations.
3. To provide electrical insulation under metallic restorations.
4. To prevent the discoloration of tooth structure adjacent to certain type of
restorative materials.
5. To prevent the deleterious constituents of restorative materials into dentin
and pulp; and
6. To improve the marginal seal of certain restorative materials by preventing
microleakage and the ingress of saliva and debris along the tooth-
restoration interface.
20. PHYSICAL INJURIES OF TEETH
• Bruxism
–It is the habitual grinding or clenching of the teeth , either during sleep
or as an unconscious habit during waking hours.
–Includes both clenching habit & also to the repeated tapping of the
teeth.
– Bruxism is one of the most common sleep disorder.
–According to Nalder and Meklas it described as
i. Local
ii. Systemic
iii. Psychological and
iv. occupational
22. • Local Factors : associated with some form of mild occlusal disturbances which
produces mild discomfort and chronic, even though unrecognized, tension.
• Systemic Factors: it includes gastro-intestinal disturbances, subclinical nutritional
deficiencies etc.
23. • Psychological Factors: it is the most common cause for bruxism. High levels of
anxiety, stress and emotional tension may be expressed through a number of
nervous habits, one of which may be bruxism.
24. • Occupational: certain occupations lead to this habit. Athletes engaged in
physical activities and in occupations in which the work is unusually
precise, such as that of watchmaker it is seen.
25. • Clinical Features:
–According to Glaros and Rao
a. Effects on dentition
b. Effects on periodontium
c. Effects on masticatory muscles
d. Effects on temporomandibular joint
e. Head pain and
f. Psychological and behavioral effects.
• Treatment & Prognosis:
–Underlying cause must be cured first.
–Removable splints which are worn at night to immobilize the jaws or guide the
movement so that periodontal damage may be minimal.
–Botulinum toxin (Botax) is used now a days injected in masseter muscle without
effecting chewing or facial expressions.
–If left untreated, severe periodontal and/or temporomandibular disturbances may
result.
26. • Fractures of Teeth:
–Commonest injury which may arise in variety of situations, the most
frequent of which is sudden severe trauma such as fall, blow, an
automobile accident or any of a large number of incidents in which
children especially are frequently involved.
–It mostly involves boys and anterior maxillary teeth.
27. –Most followed classification is
Ellis & Davis.
• Class 1- simple #(Fracture) of
crown, involving little or no
dentin.
• Class 2- extensive # of the
crown, involving dentin but
not dental pulp.
• Class 3- involvement of pulp
in addition to class 2
28. • Class 4- the traumatized
tooth becomes non vital with
or without loss of crown
structure
• Class 5- teeth lost as a result
of trauma
29. • Class 6- # of root with or without
loss of crown structure.
• Class 7- displacement of a tooth
without # of crown or root.
• Class 8- # of crown en masse and its
replacement
• Class 9- traumatic injuries to
deciduous tooth.
• The treatment is based on whether
there is exposure of pulp or not and
the time elapsed after the trauma.
30. • Root Fractures:
–These are uncommon in young children as
their socket is not much developed with
resilience.
–Mostly seen in between ages 10-20.
–Depending on site of fracture there may be
loss of crown or mobility of crown
structure.
–In some cases there is formation of dentin
barrier and cementum resulting in healing
of the fracture.
31. • Abrasion:
–Wearing away of tooth substance due to mechanical means is known as
abrasion.
–Commonly seen in habits like holding pins, opening bottles with teeth etc., in
some occupations such as tailoring, carpentering etc.
32. • Injuries to the supporting structures of tooth:
–Concussion:
• it is produced by injury which is not strong enough to cause serious, visible
damage to the tooth and the periodontal structures.
• Characterized by increased sensitivity of tooth to percussion in any direction.
• Treatment include selective
grinding of teeth to remove
occlusal contacts.
33. –Subluxation:
• Refers to abnormal loosening of tooth without displacement due to sudden
trauma.
• Tooth is mobile on palpation and sensitive to percussion and occlusal forces
with gingival bleeding in the crevice.
• In time it becomes non-vital due to severance of apical blood supply.
34. –Avulsion:
• Dislocation of the tooth from its socket due to traumatic injury. It can
be partial or total.
• Partial avulsion includes intrusion, extrusion, or facial, lingual, or
palatal, or lateral displacement.
• It is usually associated with fracture of socket.
35. • Partial can be treated by repositioning and splinting of teeth.
Complete avulsion can be treated by re-implantation.
• It success is dependent on time elapsed from injury to the placement
and medium in which it is carried.
36. • Tooth Ankylosis:
–Fusion between bone and tooth, termed ankyloses is an un common
phenomenon in deciduous dentition and even more rare in permanent
dentition.
–Ankylosis ensues when partial resorption of tooth has occurred and
replaced with bone or cementum uniting the tooth with bone during repair.
–Usually becomes apparent during tooth
removal, which considerable difficulty will
be encountered, sometimes necessitating
surgical removal.
–No specific treatment unless removed for
some other reason, should serve well
indefinitely.
37. PHYSICAL INJURIES OF THE BONE
• Fractures of Jaws:
–Most common physical injury involving bone.
–It occurs during accidents such motor vehicles, fall form heights, sports, fights
etc.
–It may be of simple, greenstick, compound, comminuted or impacted.
38. –Fractures of Maxilla:
• These are more serious than mandible
fractures.
• Classified by Le Fort includes
• Le Fort 1 or horizontal #, also known as
floating # is characterized by separation
of body of the maxilla from the base of
the skull, below the level of zygomatic
process.
39. • Le Fort 2 or pyramidal # is
characterized by vertical #
through the facial aspects of
the maxilla and extend
upward to the nasal and
ethmoid bones and usually
extends through the
maxillary sinus.
40. • Le Fort 3 or transverse # is a
high level of # that extends
across the orbits through the
base of the nose and ethmoid
region to the zygomatic arch.
Bony orbit is #ed and the lateral
rim is separated at the
zygomaticofrontal suture.
Zygomatic arch is #ed.
42. –Fractures of Mandible:
• Most common in road traffic
accidents and physical
violence.
• It most commonly involves the
angle of mandible, which is
followed by condyle, molar
region, mental region and
symphysis.
• Displacement depends on the
direction of the line of #,
muscle pull and the direction
of force.
43. • Features are similar to other #s such as pain, abnormal mobility,
lacerations, bleeding etc.
• Treatment includes reduction and immobilization like other #s.
• Complications are malunion, nonunion and fibrous union.
44. –Traumatic Cyst:
• It is pseudo cyst & an
uncommon lesion in bone.
• Many theories have been
proposed but the trauma-
hemorrhage theory is
widely accepted.
• According to the
hemorrhagic theory, the
clot breaks down and
leaves an empty cavity
within the bone.
45. • When cavity is opened surgically
either a small amount of
serosanguinous fluid, shreds of
necrotic blood clot, fragments of
fibrous connective tissue or
nothing.
• Radiographically it reveals a
rather smoothly outlined
radiolucent area of variable size,
some times with a thin sclerotic
border, depending on the
duration of the lesion.
46. • Focal Osteoporotic Bone-Marrow Defect of the Jaw:
–Occurs in angle of mandible, tuberosity etc.
–Unusual demand for blood production causes osteoporosis of marrow and even
thinning the cortex.
–Other theories include unusual healing of the extraction socket(mostly
associated with it).
47. • Surgical Ciliated Cyst of Maxilla:
–Develops after surgical entry into maxillary sinus(Cadwell-Luc
operation) or due to obstruction of ostium.
–Majority of patients belong to middle age group with non-specific, poorly
localized pain, tenderness or discomfort of maxilla.
–Filling defect is seen radiographically.
–Treated by enucleation
48. • Effects of Orthodontic Tooth
Movement:
–General principle in
orthodontic tooth
movement involves
resorption on pressure side
and deposition of bone on
tension side resulting in
tooth movement within the
bone.
49. • Tipping movement:
–The exact movements which a
tooth will undergo and the exact
position it will assume after the
application of orthodontic force
and the position of fulcrum
around which the force acts.
–New bone is formed on the outer
surface of labial cortex if pressure
is applied labially to maintain the
cortical thickness and prevent
perforation of the cortex during
tooth movement.
51. –Extrusive tooth movement:
• It is similar to normal eruption.
• Movement consist in deposition or
apposition of new bone spicules at the
alveolar crest and at the fundus of the
alveolus arranged in a direction
parallel to the direction of force
–Intrusive or Depressive movement:
• Tissue changes result in opposite of
extrusive tooth movement and new
bone formation is minimal.
52. • Tissue reaction during retention period:
• During this period there is gradual reformation of the normal dense pattern of
the alveolar bone by apposition of bone around the bony spicules until they
meet, fuse and gradually remodel.
• The final remodeling and the attainment of absolute bone-tooth equilibrium
following orthodontic tooth movements involve an extremely slow process
and is responsible for orthodontic failure due to relapse during retention
period.
• Studies have found that the
deciduous tooth movement is
followed by the permanent
tooth germ.
53. PHYSICAL INJURIES OF SOFT TISSUES
• Linea Alba:
• It is a white line seen on the buccal mucosa extending from the
commissures posteriorly at the level of the occlusal plane.
• Caused by physical irritation and pressure by the posterior teeth. Seen
bilaterally. Common in bruxism patient or clenching habit.
54. –Toothbrush Trauma:
• This injury occurs to the gingiva and is produced by the tooth brush.
• Appears as white, reddish or ulcerative lesions or linear superficial
erosions,
• involving marginal & attached gingiva of maxillary canine &
premolar region.
55. • Traumatic Ulcer:
–It is caused by some form of trauma.
–This may be due to biting of mucosa, denture irritation, tooth brush
injury, exposure of OMM to sharp tooth or carious lesion etc.
56. • Factitial Injuries:
–These are self-induced injuries.
These may be habitual, accidental
or may have psychogenic
background.
• Lip biting or Cheek biting:
• These injuries are habitual or
psychogenic.
• It involves holding, biting &
tearing of the epithelium of lip,
buccal mucosa or tongue, chewing
of cheek or stripping of the
epithelium using fingers or
creating negative pressure by
sucking the lips & cheeks.
57. –Intra & Perioral Piercing:
• Body piercing is the act of
puncturing or cutting a part of the
human body, creating an opening
in which jewelry may be worn.
• Eye brow, ear, ala of nose, lip,
tongue etc., are used.
• Complications include edema,
hemorrhage and infection,
mucosal or gingival trauma,
chipped or fractured teeth,
increase salivary flow, calculus
build up, gingival recession etc.
58. • Denture injuries:
–Traumatic ulcer:
• Commonly results after insertion of a new denture.
• May be result of over extension of the flanges, sequestration of spicules
of bone under the denture or a roughened or high spot on inner surface
of the denture.
• These are small, painful,
irregularly shaped lesions
usually covered by delicate
gray necrotic membrane
and surrounded by
inflammatory halo.
59. –Generalized Inflammation:
• It occurs in patients who may or may not have a new set of dentures.
• It may not be due to allergy. In some cases it is due to Candidal infections.
• The mucosa beneath the denture becomes extremely red, swollen, smooth or
granular and painful. Multiple pinpoint foci of hyperemia involving maxilla
may occur.
• The redness of the mucosa is
rather sharply outlined &
restricted to the tissue
actually in contact with
the denture.
60. –Inflammatory (Fibrous) Hyperplasia:
• One of the most common tissue reactions to a chronically ill-fitting
denture is the occurrence of hyperplasia of tissue along the denture
borders.
• Characterized by the development of elongated rolls of tissue in the
mucolabial or mucobuccal fold area into which the denture flange
continuously fits.
61. • Inflammatory Papillary Hyperplasia:
–Unusual condition involving mucosa of palate mostly associated with ill
fitting dentures. Often associated with chronic hyperplastic candidiasis
–The lesion presents itself as numerous, closely arranged, red, edematous
papillary projections, often involving nearly all of the hard palate and
imparting to it a
warty appearance.
62. • Denture Base Intolerance or Allergy:
–Plasticizers of the soft liners are cytotoxic and effect many cellular
metabolic reactions in vitro.
–It is very rare.
–This reaction may
be due to sensitivity
to the monomer,
both regular &
self curing types.
63. • Mucous Retention Cyst:
–Generally conceded to be of
traumatic origin.
–Usually results due to the obstruction
of ducts of minor or accessory
salivary glands.
–There may be chronic partial
obstruction by small pieces of dental
calculus or other products.
–These have been classified as:
1. An extravasation mucocele or
2. A retention mucocele (true
retention cyst)
64. • Ranula:
–Mucocele but larger, which specifically occurs in the floor of the mouth in
association with the ducts of the submaxillary or sublingual gland.
–It slowly enlarges painlessly on one side of the floor of the mouth.
–The mucosa may have a translucent bluish colour. It may sometimes
herniates through mylohyoid muscle causing plunging ranula.
65. • Retention Cyst of Maxillary Sinus:
–It is uncommon and because of the possibility of confusing it with a
variety of other lesions occurring in the same location
–Causative factors include sinusitis, allergy and sinus infection but these
are without firm support.
66. • Sialolithiasis:
–A stone in the salivary ducts or
glands is called sialolithiasis.
–They are formed by deposition of
calcium salts around a central nidus.
–It can be complete or partial & may
show recurrence. Many patients
involved with major salivary gland
reported with moderately severe
pain , particularly just before, during
and after meals owing to psychic
stimulation of salivary glands.
67. –Maxillary Antrolithiasis:
• Defined as a complete or partial calcific encrustation of an antral
foreign body, either endogenous or exogenous, which serve as nidus.
• Generally asymptomatic but may present with symptoms like pain,
nasal obstruction &/or foul discharge & epistaxis.
68. Condition Diagnosis Common sites of
occurrence
Management
Linea Alba
clinical Buccal mucosa Explanation and
reassurance, no specific
treatment required
Mucosal Biting Clinical Buccal mucosa, lip and
lateral border of the
tongue
Explanation and
reassurance, advice on
habitual biting
Riga-Fede disease Clinical Tip or ventral surface of
the tongue
Extraction of neonatal
teeth
Eosinophilic ulcer Biopsy Gingiva Spontaneous healing
Ulcers caused by self-mutilation or
self-injury
Clinical Gingiva Psychological
assessment and
counselling
Ulcers due to oral trauma in
patients with congenital
insensitivity to pain
Clinical Lips and tongue Symptomatic
treatment, prevent
trauma from sharp
edges of teeth
Electrical and Thermal Burns Clinical Lips and tongue Surgical excision and
reconstruction
Summary of oral mucosal traumatic lesions and their management
Condition Diagnosis Common sites of
occurrence
Management
Trauma associated with sexual
practices
clinical Soft palate, lips Symptomatic
management
Denture associated hyper keratosis Clinical Alveolar ridge Elimination of irritation
from the denture
Denture associated ulcers Clinical Buccal and lingual sulci Trim the denture to
eliminate trauma
Inflammatory papillary
hyperplasia
Clinical Palate Anti-fungal treatment,
surgical excision
Epulis fissuratum clinical Buccal sulcus Surgical excision and
vestibuloplasty
69. –Radiation Injuries:
• The general term radiation is referred to two different forms of energy
–Electro magnetic radiation and
–Particulate radiation.
• General effects of radiation
–The cellular injury has been postulated to be due to a number of
possible factors
• Toxic effect of protein breakdown products.
• Inactivation of enzyme systems.
• Coagulation or flocculation of protoplasmic colloids.
• Denaturation of nucleoproteins
70. • Effects of Radiation on Oral & Para oral tissues:
–Depend upon great number of factors such as the source, total amount,
period of time of radiation administered, type of filtration & total area of
tissue irradiated.
–There is bilateral parotitis, partial xerostomia and oral mucostitis
following total body radiation.
71. • Effects on Skin:
–Erythema is the earliest visible reaction and begins within a
few days after irradiation.
–Altered sebaceous gland activity resulting in decrease in
secretions and cause dryness & scaling of the skin.
–Superficial blood vessels become telangiectatic or occluded.
72. • Effects on Oral Mucosa:
–Same as those as in skin with erythema and mucostitis follows.
• Effects on Salivary Glands:
–Xerostomia is one of the most commonest and earliest complaints of
all.
–The loss of secretion may be a permanent condition or there may be
gradual return of salivation after several months.
73. • Effects on Teeth:
–Radiation caries is most common problem after radiation.
–Mostly due to altered changes in the salivary glands.
–Developing tooth are particularly very sensitive to X-ray radiation.
–There may be complete cessation of odontogenisis or stunting of
growth of teeth depending upon the time of radiation
74. • Effects on Bone:
–Bone itself is relatively resistant to X-ray radiation, although osteoblasts
are sensitive.
• There is lack of proper response to healing of radiation injuries in bone like
other type of injuries leading to complications like osteoradionecrosis and
longer the period between radiation and extraction less chances are there to
develop osteoradionecrosis.
• Osteoradionecrosis:
–It is an acute form of osteomyelitis caused by damage to the intraosseous
blood vessels & is characterized by a chronic, painful infection and
necrosis accompanied by late sequestrum and some permanent
deformity.
–There is lack of osteoblasts in turn lack the capacity to produce new bone.
75. • The walls of regional blood vessels are thickened by fibrous connective
tissue resulting in devitalization of bone due to lack of reparative
capacity.
• The devitalized bone is not demarcated and occurs throughout the
entire irradiated area of bone.
• Factors leading to osteoradionecrosis is
–Irradiation of an area of previous surgery before adequate healing
had taken place.
–Irradiation of lesions in close proximity to bone.
–A high dose of irradiation with or without proper fractionation
–Use of a combination of external radiation and intra oral implants
–Poor oral hygiene and continued use of irritants.
76. –Poor patient co-operation in managing irradiated tissues or fulfilling
home care programs
–Surgery in the irradiated area
–Indiscriminate use of prosthetic appliances following radiation therapy
–Failure to prevent trauma to irradiated bony areas and
–Presence of numerous physical & nutritional problems prior to therapy.
77. CHEMICAL INJURIES OF ORAL CAVITY
• One of the most commonest reaction to drugs or chemicals is the allergic
phenomenon, the two main types of that are of dental interest being
–Drug allergy or stomatitis medicamentosa and
–Contact stomatitis or stomatitis venenata.
78. • Non-allergic Reaction to Drugs and
Chemicals used Locally:
–Aspirin:
• Used by many people as local
abtundent for the relief of
toothache.
• Within a few minutes after
placement of the aspirin powder
there is burning sensation of
mucosa & the surface becomes
blanched or whitened in
appearance. Healing of painful
aspirin burn take a week or
more.
79. • Endodontic Materials:
–Sodium Hypochlorite
• It produces damage when injected beyond apex.
• On contact with vital tissue it causes hemolysis & ulceration, inhibits
neutrophil migration and damages endothelial and fibroblast cells.
• Life threatening airway obstruction has been reported secondary to
hypochlorite
extrusion.
80. –Hydrogen Peroxide:
• Similar to effects of hypochlorite.
• In addition causes irritation to the cementum & periodontal ligament
leading to cervical root resorption.
81. • Non Allergic Reactions to Drugs & Chemicals
Used Systemically:
–This reaction is often a part of a generalized
epidermal reaction, but other times it occurs
as a specific phenomenon apparently due to
anatomic peculiarity.
–Arsenic:
• Occupational hazard, widely used in
metal industry.
• Inflammation of OMM & severe gingivitis.
• Local contact produces ulceration &
systemic poisoning causes excess
salivation
82. • Bisphosphonate:
–It is a potent anti resorptive agent used in many diseases involving
resorption.
–Osteonecrosis incidence is associated with bisphosphonate.
– Osteonecrosis of jaw
probably results from
the inability of
hypodynamic &
hypovascular bone
to meet an increased
demand for repair &
remodeling.
83. • Bismuth:
–Pigmentation of oral mucosa, particularly gingiva & buccal mucosa
is common oral feature in bismuth therapy especially when
receiving preparations containing metal
–The pigmentation appears as a bismuth line, a thin blue-black line in
the marginal gingiva is sometimes confined to the gingival papilla.
The pigmented granules consists of sulphides.
84. • Dilantin Sodium:
–Extensively used in the control of epileptic seizures.
–Gingival hyperplasia is the side effect which can avoided with good oral
hygiene practices.
–First noted as painless increase in size of the gingiva, starting with
enlargement of one or two interdental papilla.
–The surface of gingiva shows an increased stippling & finally a
cauliflower, warty or pebbled surface.
85. • Lead:
–Lead poisoning(plumbism) occurs chiefly as an occupational hazard
today but occasionally as acute or chronic nature.
–Manifested as serious GIT disturbances which include nausea, vomiting,
colic and constipation.
–Peripheral neuritis may produce characteristic wrist-drop or foot-drop.
86. • Mercury:
–It may be of acute or chronic and acute form are serious.
–Chronic is characterize by gastric disturbances, diarrhea, excitability,
insomnia, headache and mental depression.
–Increased salivation and metallic taste in mouth. Salivary glands may be
swollen and tongue is also sometimes enlarged and painful. Hyperemia
and swelling of the gingiva are occasionally seen.
87. • Acrodynia:
–It is mostly due to mercury poisoning in acute cases or as an idiosyncrasy
to the metal. Source is mainly teething powder or mercury containing
ointments, lotions or disinfectants.
–In young infants below the age of two years.
–The skin particularly of the
hands, feet, nose, ears & cheeks
become red or pink and has a
cold, clammy feeling.
88. •Silver:
–Chronic exposure to silver compounds may occur as occupational hazard
or as a result of therapeutic use of silver compounds.
–Appearance of a slate-blue silver line along the gingival margins arising
due to deposition of metallic silver & silver sulphide pigments is one of
the earliest signs.
–Amalgam tattoo of OMM is a
relatively common finding in
dental practice, generally
occurring in four ways.
89. • Tetracycline:
–Discoloration of either deciduous or permanent teeth may occur as a
result of tetracycline deposition during prophylactic or therapeutic
regimes by pregnant woman or postpartum infant.
–The severity of the staining by tetracycline is determined by the stage of
tooth development at the time of drug administration.
–Teeth affected appear to
have a yellowish or
brownish-gray
discoloration which is
most pronounced at the
time of eruption of teeth.
90. OCCUPATIONAL INJURIES OF THE ORAL CAVITY
• They occur as a result of work or occupational activity.
91.
92. OCCLUSAL TRAUMA
• Occlusal changes can cause in the alveolar bone and periodontal
connective tissue both in the presence and in the absence of
periodontitis.
• Occlusion & local irritants are two factors in the etiology & pathogenesis
of periodontal disease.
93. • Acute trauma occurs when biting hard food substance or a high filling
resulting in pain, sensitivity to percussion and slight mobility.
• When excessive forces occur in different directions results in widening of
periodontal ligament.
• Chronic occlusal trauma is relatively more common than acute forms.
• In this the PDL gradually becomes denser and the periodontal space
widens.
94.
95. CONCLUSION
• As prosthodontist we should be able to diagnose the different
conditions which lead to the trauma and treat the underlying cause.
• All precaution should be taken to prevent injuries to the patient during
the treatment.
• It is best advised to use proper preventive barriers such as rubber dams
to prevent chemical exposure during treatment and also careful
handling of the materials during use.
• Additional care should be taken while using rotary instruments in the
oral cavity. Instrument should be started and stopped in the cavity only
to prevent injury to the adjacent soft tissues.
• Sound knowledge and prompt remedies should be known to the dentist
if any mishaps occur in the clinic.
96. REFERENCES
• Shafer’s text book of Oral Pathology-6th Edition.
• Iatrogenic injury of oral mucosa due to Chemicals: A Case
report of formocresol injury and review - Girish M S, IOSR
Journal of Dental and Medical Sciences Volume 14, Issue 4.
• Traumatic Oral Mucosal Lesions: A Mini Review and
Clinical Update- Ariyawardana Anura, OHDM - Vol. 13 -
No. 2 - June, 2014.
Editor's Notes
These are not uncommon in dentistry. I will be discussing the topic broadly in physical & chemical injuries to the teeth, physical injuries to the bone, radiation injuries, physical & chemical injuries of soft tissue.
Explain few points on each.
AT LAST: However, prompt diagnosis and elimination of the causative factor ensure cure. Injury of the oral mucosa could result from physical, chemical or thermal trauma. They could be originated from accidentally or some injuries also could result from iatrogenic damage during dental treatment or other procedures involving oral cavity.
Physical injuries may be of iatrogenic, self inflicted, traumatic or occupational.
3.Some of such chemicals if used inadvertently can be potentially injurious. However, such injuries are not very common since the introduction of rubber dam in dental practice.
Alternative cutting methods include air abrasion & lasers and are considered separately.
First at opening of slide: Early days of dentistry low speed instrumentation was followed by considerable pressure on the tooth, producing frictional heat, resulting in overheating or burning of the dentin is usually seen as a color change in the margins of the restoration. This drawback has now overcome by the use of high speed equipment designed to supply adequate cooling.
Last: An outward movement or displacement of the contents of dentinal tubules results from exposure of the dentin for the first time in an otherwise unaffected tooth.
Air abrasive: Due to its potential health hazard to both patient & operator it is confined to clean the pits & fissures prior to application of sealants.
Lasers starting: it is an electro-optical device which upon stimulation can convert jumbles of light waves into an intense, concentrated, uniform, narrow beam of monochromatic light with an energy source of greater intensity and exceptional flexibility which can be focused to as small as 1μ in diameter.
Lasers 3rd: chalky spots, craters & small holes in enamel may also be produced under other conditions.
Last: the severity of the response varied with the amount of radiation.
Heat starting: temperatures of over 7000F has been recorded on the cutting surfaces of stones & burs under abusive conditions.
Smear layer last: The presence of the smear layer can be beneficial by physically reducing the flow of fluid through dentin and thus reducing its permeability. This reduced flow of dentinal fluid may have a protective effect on tissues.
However, this smear layer is not a stable structure & must be removed in order to obtain optimal chemical & mechanical bonding between restorative materials & the tooth structure.
Starting: the dentist must be familiar with the advantages & disadvantages of each material from the point of view of its physical & chemical properties & its ability to fulfil the purpose for which it is intended.
Zoe: . At last: not only there is no irritation produced by this substance, but actually it exerts a palliative and sedative effect.
Zinc phosphate: effect is profound when cavity is deep but in shallow cavities it is innocuous. Poly carboxylate or polyacrylate cements have properties comparable but have a low degree of pulpal irritation than ZnPO4.
Silver 3rd : the complication of thermal shock transmitted by deep amalgam restorations is difficult to evaluate, but is a source of potential damage.
GIC: biocompatibility of the glass ionomer is mainly due to the weak nature of polyacrylic acid.
Acid etching: 1st point: resin based restorations are mechanically bonded to the tooth structure by creating micropores by this procedure.
Opening: physical injuries includes bruxism, fractures of tooth, abrasion, injuries to the supporting structure of tooth and tooth ankylosis.
Clenching habit- is during which pressure is exerted on the teeth & periodontium by actual grinding or clamping of the teeth.
Local: In this it becomes a habit as patient tries to establish occlusion with maximum intercuspation.
Psychological: When person suffers from emotions which he/she is unable to express, these become hidden in the subconscious but are expressed periodically by numerous means.
Occupational: Voluntary bruxism is also recognized in those persons who habitually chew gum, tobacco or objects such as toothpicks or pencils. Even this may lead to involuntary or subconscious bruxism.
c/f: when habit is established it causes severe wearing or attrition of teeth which not only includes occlusal but also proximal leading to sensitivity. As it continues there may be loss of integrity of periodontium resulting in drifting of teeth or gingival recession with bone loss. TMJ is said to be affected as a result of traumatic injury of continuous tooth impact without normal periods of rest. Hypertrophy of masticatory muscle especially masseter, may interfere with maintenance of rest position, cause trismus and alter the opening and closing patterns of the jaws. Finally it has been suggested that it may give rise to facial pain and headache as well as psychologic and behavioral effects, these are very difficult manifestations to evaluate and correlate.
Some occur when large restorations are placed leaving thin walls leading to fracture under masticatory stresses. A similar weakening is seen in internal resorption. RCT treated tooth often described as being somewhat brittle and susceptible to fracture.
3. Not all resorption leads to ankylosis.
4. It gives a dull muffled sound on percussion rather than normal sharp sound.
Simple include complete fracture of bone without opening to exterior.
Green stick includes fracture on one side and bend on other side
Compound include fracture of bone associated with external wound opening
Comminuted include breaking of bone into several pieces with or without opening to exterior.
Impacted include one part of the broken bone gets impacted into the other fractured part resulting in decrease in length of the bone.
Comminuted include breakage of bone into pieces which may or may not be exposed to exterior.
Steady expansion of bone occurs secondary to altered or obstructed lymphatic or venous drainage up to the margin of cortical bone.
It is usually treated by opening the cavity, enucleating the cyst and induce bleeding and close it. Healing occurs in 6-12 months. Bone chips are utilized to fill the cavity to aid in filling the defect with good results especially in larger cavities.
It is diagnosed after surgically opening the site and ruling out other possibilities as radiographic investigations are not of much use rather than locating it. No additional treatment is necessary after diagnosing.
In the diag we can see the loss of trabeculations.
2.It is generally recognized that the teeth of young persons respond much more rapidly and with less applied force to orthodontic movement than do the teeth of older adults.
In severe forms it is characterized by clefting and in even more severe forms notching of the tooth & alveolar bone loss is seen.
Tooth pick injury is another form of factitial injury occurs un overzealous oral hygiene practice affecting interdental gingiva.
Cotton roll injury occurs when dry cotton is placed and roughly removed and mucosa adhering to it is torn.
Often seen in lateral borders of tongue when the patient bites himself.
Counselling & psychotherapy are the treatment of choice.
An acrylic resin can be use to prevent teeth contacting lips & cheeks.
In many occasions the piercing is done by non-medical persons who do not know anything about sterilization and disinfection.
Awareness should be created by dentist regarding the complications and problems associated with it.
Ulcer : treatment includes removing the underlying cause, relief of the flanges, removal of tiny sequestrum or relief of high spots.
Treatment include using nystatin powder on tissue surface of the denture or tablets taken orally.
Poorly fitting dentures are used by sterilization during the treatment period until new dentures are made. Tissue conditioners also aid in healing.
Treatment includes surgical excision and either new dentures constructed or the old dentures are rebased to provide adequate retention.
Treatment includes discarding ill fitting dentures and new dentures are made which reduces inflammation but surgical removal followed by new dentures is better method.
The old denture is rebased with the tissue conditioner will result in some improvement of lesion.
Diag: note the reaction confined to the area where denture is placed.
Mostly occurs on lower lip, but can occur any where salivary glands are present.
Treatment is by excision but will be rapidly filled again hence associated gland is removed
Treatment is either marsupialization or more often excision of the entire sublingual gland.
It recurs if the entire gland causing it is not removed.
The majority of these cysts either persists unchanged or disappears spontaneously within a relatively short period & for this reason it has been suggested that no treatment is necessary.
Small calculi are treated by manipulation or increasing the salivation by sucking a lemon, leading to expulsion of the stone.
Antibiotics are given for infection due to persistent chronic obstruction.
Larger stones require surgical removal and in cases where surgical removal is not possible piezoelectric shock wave lithotripsy may be an alternative.
Treated by surgical excision.
Similar variations include Rhinolithiasis in the nasal cavity.
There is a great variation in the radio sensitivity of different types of living cells.
The cells with greater capacity for multiplication is more vulnerable than the cells having low multiplication capacity.
Palliation of radiation mucostitis was achieved with warm salt water or sodium bicarbonate mouth rinses. Administration of lidocaine hydrochloride in a viscous solution, oxethazine, diphenhydramine hydrochloride etc.
Cobalt-60 radiation may have significant bone & skin sparing qualities.
Others includes
Electrical burns which causes permanent disfigurement and wounds heal relatively very slowly.
Anesthetic necrosis due to local anesthetic agent.
Human bite which have a great potential for infection and due to presence of mixed micro-organisms it is difficult to treat.
Others include sodium perborate, carbamide peroxide, phenol, silver nitrate, trichloroacetic acid, volatile oils and any strong acid , alkali, germicidal agent, strong counter irritant or even certain plant & animal irritants may produce injury.
Diag: one of the best ways to detect arsenic poisoning.
Treatment option is very conservative and is limited to sequential removal of sequestrum with minimal epithelial manipulation. Topical and systemic antibiotics are used.
Treatment of bismuth: no specific treatment. Concentrated hydrogen peroxide is used as bleach but oral hygiene should be maintained very well during therapy. If untreated the line disappears over a period of time after discontinuing bismuth.
No treatment is necessary until the enlargement becomes esthetically objectionable. Surgical excision is done if it interferes with function.
Discontinuing the drug will result in gradual diminishing of the bulk of gingiva is permanent solution.
Other drugs which show similar features are cyclosporine and nefidipine which have their own way of presenting the enlargements. They are differentiated from each other histologically.
Formation of lead line similar to bismuth line occurs in lead poisoning. Excessive salivation & metallic taste are reported.
Treatment of the oral lesions is secondary to systemic treatment and the prognosis depends upon the systemic condition of the patient.
Treatment is supportive only secondary to the treatment of poisoning itself.
The prognosis is usually good, although severe periodontal destruction & loss of teeth may occur.
Oral features include excessive salivation often dribbling.
The gingiva becomes extremely sensitive or painful and may exhibit ulcerations. Premature shedding of teeth and difficult in mastication due to pain.
Treatment include removal of source, chelation therapy using dimercaprol, D-pencillamine etc., this has proven effective & symptoms are totally reverse except in heavy prolonged exposure which can do irreversible damage.
Four ways:
Condensation in gingiva during restorative
during removal of old restorations.
From broken pieces introduced into a socket during extraction
Entering surgical wound during RCT treatment with a retrograde amalgam filling.
common locations were gingiva, buccal mucosa & alveolar mucosa.
There are many other cancer chemotherapeutic agents such as alkylating agents, antimetabolites, plant alkaloids etc., having similar effects on the oral mucosa.
Treatment for these is generally not required only considered secondary to the patient’s major problem.
Management: If it is not immediately self-corrective, it is imperative that correction of the occlusal relation, elimination of cuspal interference and fixation or splinting of loose teeth can be carried out to prevent further damage.
Few more diag of chemical injuries.
1st diag: chloroquine
2nd formocresol
3rd tooth whitening agents