Oral Pathology 111714.doc

ORAL PATHOLOGY (Lecture) 11/17/14 HARD TOOTH TISSUE REDUCTION:  A type of a tooth reduction that is brought about or some abnormal bait that will result to a loss of tooth structure. The way a tooth structure is loss may be in diff ways, it may be in: 1. ATTRITION:  A type of loss structure brought about by tooth to tooth contact. Features Of Attrition:  Matching wear occluding surfaces  Shiny facets on amalgam contacts  Enamel and dentin wear at the same rate  Possible fracture of cusps or restorations.  Said to be more on the physiologic side if you use your teeth, or if the loss of tooth structure is a result of mastication  Due to mastication it is physiologic  But if the wearing away of the teeth is fast it is not normal it becomes pathological condition. Two Types Of Attrition:  Physiologic  Pathologic  Depends on the gender. Makes have an increase masticatory forces, means attrition are more marked in males than females.  Depends on type of diet you are exposed to.  Attrition will not be in deciduous dentition, because the deciduous will not remain on the oral cavity.  More on permanent teeth.  An abnormal habit of night grinding, it will enhance the attrition.  Flattening of the incisal. Location Of Attrition: 1. Occlusal 2. Incisal & 3. At The Proximal Surface Degrees Of Attrition: 1st: If only the enamel is involve. 2nd: If the enamel and primary dentin is involve. 3rd: If you have enamel, primary and secondary dentin is already affected. 4th: If there is a possibility of pulp exposure 2. ABRASION

 It is the loss of tooth structure brought by other abnormal mechanical habit (a foreign substance such as faulty toothbrushing technique, also, smoking a tobacco using a pipe stem, can opener)  Loss by wear of dental tissue caused by abrasion by foreign substances (e,g. Toothbrush, dendrites) Prone To Abrasion:  If there is bulk in the crown, like of the bicuspids. Features Of Abrasion:  Usually located at cervical areas of teeth  Lesions are more wide than deep  Premolars and cuspids are commonly affected Treatment:  Stop the habit  Desensitize the tooth 3. ABFRACTION  It is the loss of tooth structure brought about by occlusal forces, repetitive (paulit ulit)lateral occlusal forces  Loss of tooth structure at the cervical areas of teeth caused by tensile and compressive forces during tooth flexure. Features Of Abfraction:  Affects the buccal or labial cervical areas of teeth  Deep, narrow, v-shaped notch  Commonly affects single teeth with excursive interferences or eccentric occlusal loads. ** Suggesting possible cervical flexure forces during bruxism. 4. EROSION  It is the loss of tooth structure because of an acid not necessarily a result of microorganism because of the acid that would be strong enough to remove the; if the cause of removal of the enamel is due to bacteria then it is dental caries. But if it is acid coming from other sources that is called erosion.  Progressive loss of hard dental tissue by chemical processes not involving bacterial action. Expose To Acid:  Factory worker doing sulfuric acid.  Gastroesophageal reflux disease Features Of Erosion:  Broad concavities within smooth surface enamel  Cupping of occlusal surfaces (incisal grooving with

dentin exposure) Increased incisal translucency Wear on non-occluding surfaces "raised" amalgam restorations Hypersensitivity Loss of surface characteristics of enamel in young children  Clean, non-tarnished appearance of amalgam     

Food and drinks below 5-5.7 may cause tooth erosion. ORAL PATHOLOGY (Lecture) 11/17/14 IMPACTION:  Some extra teeth maybe hidden in the bone and that is called impaction. IMPACTED TEETH:  Are any teeth that are unable to erupt into a normal position within the dental arches.  They can be erupted partially or completely. Classification Of Impacted Tooth: SOFT TISSUE IMPACTIONS:  Impacted teeth that lacks adequate space to break through the gum tissue to allow for normal cleaning.  There is a tissue that prevents it from erupting...usually the gums. PARTIAL BONY IMPACTION:  Impacted teeth which does not only have a soft tissue that will cause it hindrances but there is also a considerable amount of bone that will hinder the eruption.  Not only have soft tissue covering the tooth but some amount of surrounding hone still in place over the tooth. FULL BONY IMPACTION:  Impacted teeth not often seen in the mouth, possible symptoms such as pain, swelling..  Are not often seen in the mouth but only on a radiograph (x-ray) although it is possible to have symptoms (i.e. Pain or swelling) associated with these teeth. Problems Related To Impacted Tooth: INFECTION:  As impacted teeth are not cleansible, infection of the surrounding tissue can lead to swelling, redness, and pain around the tooth.  Infections can vary from mild to severe sometimes causing swelling visible on the side of the face. These

infections may also cause difficulty with chewing and swallowing. DAMAGE TO THE ADJACENT TEETH AND BONE:  Impacted wisdom teeth are often in close proximity to the adjacent second molar and can lead to premature bone loss on the distal root of the second molar as well as decay on that root PATHOLOGY:  The majority of cysts and benign tumors that we see occur around impacted teeth including wisdom teeth **Tumors associated with impacted third molars: Ameloblastoma UNEXPLAINED PAIN: Many patients often present with unexplained pain in the retromolar region of the tooth ORTHODONTIC TREATMENT: Presence of impacted third molars may interfere with this proper positioning of the of the permanent molar teeth Dental Crowding??::: MESIANGULAR IMPACTION:  A wisdom tooth may grow at an angle toward the other teeth  May cause irritation of gingiva.  Gums may be infected.  May cause caries.  Inflamed gum affecting the impacted tooth is operculum.  Inflamed gum is pericoronitis. Treatment:  Excised the gum tissue is operculectomy.  Rinse with water and salt.  Surgical removal of impacted tooth is odontectomy. VERTICAL IMPACTION:  A tooth which is in normal direction but still unable to,.due to lack of space is said to be vertically impacted. HORIZONTAL IMPACTION: Wisdom tooth facing your other tooth horizontally is said to be horizontally impacted DISTOANGULAR IMPACTION:  Wisdom tooth that an angle away from your other teeth is said to be distoangularly impacted

Potential Risks And Complications: INFERIOR ALVEOLAR NERVE TRAUMA:  Removal of impacted mandibular wisdom teeth can lead to trauma of this nerve. Paresthesia(?) - damage to the nerve LINGUAL NERVE TRAUMA:  The lingual nerve supplies sensation to the side of your tongue. This can also be traumatized during wisdom tooth surgery although it is rare. MAXILLARY SINUS TRAUMA:  Upper wisdom teeth are often closely associated with the posterior wall of the maxillary sinus.  Complications are and typically not serious. ALVEOLITIS OR DRY SOCKET:  By far the most common problem patients may experience after wisdom tooth removal. POST OPERATIVE INFECTION:  Infections are uncommon but can occur especially in chronically-ill or immunocompromised patients. CONCLUSION: In general, all impacted teeth should be considered for removal, including wisdom teeth we consider the idea, age for removal, of impacted wisdom teeth to be between 15-20