Among non-carious dental diseases, necrosis of hard tooth tissues is quite dangerous. Let's talk about its causes and methods of treatment. In no case should such a problem be ignored, since this threatens with a complete loss of the entire dentition and loss of chewing function.

The danger of this pathology lies in the fact that the infection in the mouth constantly enters the internal organs with food and saliva, thereby provoking the appearance of other diseases. For any of the symptoms described below, you should immediately consult a doctor to eliminate the problem.

What is dental necrosis?

This pathology is formed under the influence of many aggressive external or internal factors. The destruction process is a gradual death of hard tissues - enamel and, which leads to the loss of their chewing function. If the disease develops and it is not affected in any way, then everything will end with a violation of diction and loss of teeth.

Necrosis develops quite actively and can affect a variety of areas of hard tissues, quickly spreading throughout the entire series. This is an irreversible process, difficult to treat. It is found with the same frequency in men and women of different ages. Among non-carious diseases, it is common in 9% of all cases of visiting a doctor.

Causes

Why does hard tissue necrosis appear in the oral cavity? There are many factors contributing to this, they can be internal or external. People who work with radiation, complex devices, chemicals, metals and other hazardous industries are at the greatest risk. Let us briefly describe the main causes of tooth necrosis:

• problems of functioning of the central nervous system;
• hormonal disorders, which often occurs in adolescence or during pregnancy;
• hypothyroidism, when the thyroid gland malfunctions;
• constant intoxication of the body;
• hereditary factors;
• frequent exposure to high acids or their fumes on the oral cavity (this includes work in hazardous industries, and frequent vomiting, acid-base imbalance in the stomach, etc.);
• high doses of radiation, for example, in the treatment of cancer;
• electromagnetic impulses;
• taking certain medications that contribute to the destruction of enamel.

Doctors have noticed that if the cause is internal problems, then cell death begins from the root or cervical area. And in cases of the main factor lying outside the body, tooth necrosis affects the outer part of the crown. The incisors, canines and premolars are most often affected by this type of disease, because they are susceptible to direct aggressive effects (for example, harmful fumes).

Exogenous factors lead to a violation of the composition of saliva and the alkaline balance of the oral cavity, reduce blood microcirculation, which ends with destructive processes due to malnutrition at the cellular level and poor protection from external influences.

Symptoms

When diagnosing, doctors are helped by such signs of the disease, which make it possible to determine the onset of necrosis of hard tissues:

• hypersensitivity, manifested as an irritable reaction to;
• causeless formation, which cannot be explained by the use of sour fruits;
• a significant decrease in gloss on the surface of the enamel, it becomes pale and dull;
• the appearance of white chalk spots, which darken over time and sometimes even become black;
• such pigmented formations may have an uneven shade, when it is darker in the center and lightens towards the edge;
• the affected areas of hard tissue are rough to the touch, acquire a heterogeneous structure;
• with a diagnostic impact with a probe, peeling of individual sections of the enamel is observed;
• in some patients, the disease is accompanied by constant aching pain;
• the cutting edge of the tooth is quickly destroyed, which significantly reduces the chewing function and leads to abrasion of its surface, malocclusion and loss of part of the crown;
• with advanced pathology, units in a row decrease so much that their edge is rapidly approaching the gum.

Depending on the specific impact, you can also notice a certain change in the shade of the tooth. So, if hydrochloric acid has become the main pathogenic factor, then the color of the enamel becomes yellow-gray, and if sulfuric acid, then black. The concentration of nitrogenous substances leads to the formation of chalky spots and loosening of the solid structure.

Kinds

There is a classification that distinguishes a certain type of tooth necrosis depending on its cause and localization:

1. Cervical - as the name implies, it affects the cervical region of the enamel, closer to the gum, and sometimes goes under it. It all starts with an inconspicuous white spot, similar to chalk. But the disease progresses rapidly and the affected area darkens, turning brown or even black. The pathogenic formation is actively growing, covering ever larger volumes and adjacent units. When exposed to dental instruments, the surface of the enamel is easily scraped off, exfoliating in the affected areas. The patient complains of hypersensitivity when eating hot or cold food.
2. Acidic - appears from the impact of aggressive acids or their vapors on the dentition. Most often, this type of disease is observed in people working in hazardous industries, where there is constant contact with such substances. Often it also appears in pregnant women or patients with gastritis, as vomit settles on the teeth and rapidly destroys them with their chemical composition. Hard tissue necrosis begins in this case with small separate affected areas on the dental crown, where demineralization processes take place. Calcium is quickly washed out of the enamel structure, the tooth surface is destroyed and exposes unprotected dentin. From thinning under the influence of acids, hard tissues are quickly erased and lead to a violation of the cutting edge. In this case, a painless course of the pathological process is characteristic.
3. Radiation - appears as a result of harmful radiation. It is observed most often in two groups of people. The first are those who work with the relevant instruments and apparatus for a long period. The second are patients with oncological formations undergoing radiation or other type of therapy. Irradiation destroys not only the dental structure, but also affects the condition of all organs and the general well-being of a person. The intensity of the disease directly depends on the dose, frequency and duration of the negative impact. In addition to the destructive processes in the enamel and dentin tissues, other problems also occur - the condition of the mucous membrane worsens, periodontal inflammation occurs, there is a feeling of numbness or burning, anemia is diagnosed, increased dryness or, conversely, swelling is observed in the mouth. Necrosis is located in the cervical region, closer to the edge of the gums.
4. Computer - a relatively new type of pathology diagnosed in people who spend most of the day at the computer. Due to its harmful radiation, a destructive process occurs in the enamel on the frontal part of the row. Those who work at the computer for 3-5 years or longer are at risk of the disease. In this case, the symptoms of necrosis are smoothed and unexpressed. In addition to changing the shade of the enamel, nothing bothers the patient. But a significant area is immediately affected - almost the entire smile zone, constantly facing the monitor. The pathological process begins from the outer part of the crown, but over time it passes to the root region and even to the jawbone. The pulp begins to suffer most quickly from necrosis, and the teeth acquire a gray tint.

Diagnostics

To accurately establish the diagnosis, the doctor needs to carefully examine the condition of the patient's oral cavity, collect an anamnesis, complaints, and also use additional indicators. It is important to distinguish hard tissue necrosis from other non-carious diseases. In this case, the main diagnostic symptom is the lack of gloss of the tooth surface, since, for example, it remains with a wedge-shaped defect and erosion of the enamel.

Differential diagnostics involves the definition of a specific destructive process:

• hard tissue necrosis is characterized by rapid development, which does not allow it to be confused with Stanton-Capdepon syndrome or marble disease;
• there is asymmetry of the affected areas, the appearance of symptoms at any age and obvious changes in the structure of the enamel, which distinguishes necrosis from fluorosis or hypoplasia of the tooth surface;
• caries, on the other hand, is characterized by locality, the predominant destruction of only one area, without rapid spread throughout the entire row, and necrotic tissue death immediately affects a vast area.

With the help of some x-ray studies (sighting radiography, computed tomography or) it is possible to accurately determine the affected areas and distinguish necrosis from other similar diseases.

It is also important to establish the main factors that caused the pathology. To do this, refer to other specialists, for example, an endocrinologist. Polarizing microscopy is also used, which helps to determine the structural changes in the enamel.

If we talk about the causes, then radiation necrosis is accompanied by other symptoms of a general weakening of the body and the corresponding radiation exposure, which the patient should mention. With a chemical or acid disease, sharp cutting edges form on the chewing surface. With a computer variety, the pulp of the tooth is initially affected.

What distinguishes hard tissue necrosis from most other pathological processes is the loss of luster and violation of the structure of the enamel, not only in the affected area, but also over the entire surface of the dentition.

How is necrosis of hard tissues of the tooth treated?

When choosing a therapeutic tactic, you need to consider what exactly caused the necrosis:

1. With a cervical lesion, they first try to reduce the sensitivity that has arisen. The surface is covered with a special healing composition, and the tooth is sealed.
2. If the pathology was the result of working at a computer, then the specialist carefully cleans out all the necrotic particles, and fills the resulting cavity with a special calcifying compound. After a month and a half, a second procedure is carried out, and then the tooth is sealed to preserve its functionality.
3. If tissue necrosis appeared as a result of acid exposure, then it is necessary to first eliminate the provoking aggressive factor and only after that engage in remineralizing therapy.

The most important thing in the treatment process is to reduce the pathogenic effect of the underlying cause. Then they try to make up for the destroyed volume of dental tissues as much as possible in order to prolong the chewing function of the row. Therefore, the most basic method of treatment is remineralizing therapy, aimed at restoring the enamel structure and increasing its protective properties.

For this, the following drugs and procedures are prescribed:

• ingestion of calcium glycerophosphate for a month;
• Klamin is also prescribed for at least two weeks;
• in diluted form, you need to use phytonol for at least two months in a row;
• obligatory general strengthening therapy with the intake of vitamin-mineral complexes;
• applications with special pastes enriched with phosphates.

If the destructive process is not stopped in a timely manner, this will lead to a complete loss of the dentition and the need to engage in prosthetics. But this is not the only danger of necrosis. With food, the infection enters the internal organs, which leads to various diseases and a general deterioration in the patient's condition. If additional symptoms appear, antibiotics and other targeted medications may be required.

Video: medical history of Yulia Kuzmina.

Preventive measures

To avoid such a disease and its unpleasant symptoms, you should try to maintain healthy teeth. For this:

1. Carefully monitor the cleanliness of the oral cavity daily.
2. If possible, reduce the effect of pathogenic factors.
3. Visit your dentist every six months and follow his recommendations for caring for your teeth and gums.
4. In production, strengthen protective measures and observe safety rules for working with aggressive substances or devices.

Acid (chemical) necrosis of teeth appears as a result of local influence. This defeat, as a rule, is observed in long-term workers in the production of inorganic (nitric, hydrochloric, sulfuric) and a little less often - organic acids. The formation of this pathology is primarily associated with the direct effect of acids on tooth enamel. In the air of the workshops of such industries, gaseous hydrogen chloride and acid vapors accumulate, which, getting into the oral cavity, dissolve in saliva. Saliva acquires an acidic reaction and destroys the hard tissues of the tooth. Mild forms of acid necrosis can be observed in patients with achilic gastritis, who should be treated with a 10% hydrochloric acid solution orally. At the same time, there is an increased abrasion of the chewing surface of the large molars and the cutting edges of the incisors. To prevent this, it is necessary to take acid through plastic or glass tubes.

treatment

In the event of damage, measures are taken that help eliminate hyperesthesia and strengthen tooth tissues. To do this, use remineralizing therapy with a 2% solution of sodium fluoride, fluoride paste is rubbed into the teeth. Inside, calcium gluconate is prescribed in courses of 3-4 weeks with an interval of 2-3 months. With significant tooth decay, orthopedic treatment is recommended.

prevention

Prevention of acid necrosis of teeth is carried out primarily by designing supply and exhaust ventilation in workshops, installing columns with alkaline water for rinsing the mouth. It is recommended that workers carry out this procedure every 1/2-2 hours. All workers in chemical industries must be registered with the dispensary. Preventive treatment of teeth with remineralizing solutions and fluoride preparations should be carried out in the process of clinical examination.

symptoms

One of the initial clinical signs of acid necrosis is a feeling of soreness, increased sensitivity to mechanical and thermal stimuli. Sometimes there is a feeling of sticking together of the teeth when they are closed. The formation of chemical necrosis of hard tissues of the tooth leads to a transformation in the appearance of the enamel of the teeth of the frontal group: it becomes rough and matte. Sometimes the enamel becomes a dirty gray tint or dark pigmentation. Erasing of tissues of teeth is sharply shown. In acid necrosis, the canines and incisors are most severely affected. Enamel disappears in the region of the cutting edges of the crowns, while sharp, easily breaking sections of the tooth crown are formed. Then the process of destruction and abrasion passes to the enamel and dentin of not only the vestibular, but also the lingual surface of the canines and incisors. The crowns of these teeth become shorter, the incisal edge becomes oval, and the crown becomes wedge-shaped. Little by little, the crowns of the anterior teeth are affected up to the gingival margin, and the group of molars and premolars is subjected to strong abrasion.

The impact of negative factors is often the main reason for the development of most dental pathologies.

All of them require timely therapeutic therapy, otherwise the further progression of the disease is fraught with the loss of the affected organ.

One of these diseases - necrosis, will be discussed in this article.

Tooth necrosis is a non-carious violation of the structural content of the hard surface of the tooth and dentin due to the influence of endogenous and exogenous provocateurs.

This pathology accounts for 10% of all cases of non-carious enamel lesions. And this statistic is on the rise. The range of its varieties and forms, which have not yet been thoroughly studied, is expanding.

In most cases anomaly localization zone- the cervical part of the frontal jaw segment of the teeth. Damage to the indigenous organs of this disease is diagnosed extremely rarely.

The main danger posed by the diagnosis is gradual loss of chewing function.

Reasons for the development of pathology

The reasons that can cause the formation of atypical focal lesions of the enamel are classified in two directions - endogenous (internal factors) and exogenous - external circumstances.

The first group includes:

• endocrine dysfunction- against the background of the disease, the structural mineral content of hard tissues changes qualitatively, necrosis develops;
• damage to the central nervous system of a chronic nature- they inhibit the processes of tissue regeneration and lead to their rapid destruction;
• severe and long-term intoxication- poisonous processes affect the most vulnerable tissues of the body, and with thin and sensitive enamel, they can provoke a disease;
• gestation- pregnancy is an additional burden on the main organs and systems of life, teeth are no exception;
• genetic factor- it has been proven that the predisposition to this disease has a genetic code that can be transmitted even at the stage of gestation, and not manifest itself for a long time;
• problems with the gastrointestinal tract- a malfunction in the intestines causes the destruction of the organ through the action of gastric acid, which is released in a larger quantity than required by the norm.

For the second group:

• unbalanced diet- excessive consumption of food acids adversely affects the condition of the hard tissues of the oral cavity;
• harmful production- interaction with acid components provokes the development of necrosis;
• radiation exposure- irradiating streams, when in contact with air, produce toxins that adversely affect organs located in the open area of ​​​​the oral cavity;
• electromagnetic rays- the risk group includes people whose occupation is associated with computer equipment.

Classification

This type of disease in dental practice is usually classified in terms of damaging ability.

There are several stages of destruction:

• chalky spot- this is how focal demineralization of an organ fragment in its cervical part manifests itself. At the same time, the patient does not experience any discomfort;
• dentine exposure- the phenomenon is facilitated by chips on the surface, in the place of demineralization, which, without ending in full, brightens and exposes the dentin;
• pulp injury- externally manifests itself as an anomaly with a funnel-shaped depression. This sharply reduces the size of the pulp chamber, the tissues become fragile, and pain occurs upon contact with them. The tooth becomes grayish.

Kinds

There are the following types of disease:

1. Cervical necrosis - affects the tooth neck. The enamel fades, whitish focal manifestations appear, the hard tissue loses its strength, crumbles and becomes loose. Rapidly progressing, the disease is able to completely destroy hard tissue. The main reason is hormonal imbalance.
2. Acidic, where the provoking development factor is acid vapors. They actively wash out the calcium component responsible for the strength of the enamel. Clinical manifestations - surface roughness, change in color pigment to dull gray. The body becomes extremely susceptible to temperature changes.
3. Postradiation- is considered a consequence of exposure to radiation. In advanced stages, the tooth can become almost black. In this case, the pain syndrome is completely absent. The insidiousness of the disease lies in the fact that if you do not urgently start treatment, you can lose a whole fragment of the jaw row.
4. computer necrosis- the disease progresses against the background of the negative influence of ionizing radiation fluxes coming from the monitor. This form of pathology is characterized by dark brown enamel pigmentation and a matte, rough surface.

Symptoms

The first thing a person suffering from this diagnosis begins to complain about is a change in color pigment. When affected by hydrochloric acid, the shade changes to yellowish-gray, against the background of the influence of sulfuric acid vapor, the pigment becomes almost black, and when toxic with nitrogen, it becomes snow-white.

At the same time, the enamel itself becomes dull, when probing, its roughness is felt. This is the initial stage of the disease.

Gradually, the shade changes to a darker one, forming replacement dentin. The first discomfort appears in the form of soreness.

Hard tissues lose strength, focal destruction fragments appear. When eating cold or too sour food, pain occurs, which, however, quickly passes.

As the necrosis progresses, discomfort occurs more and more often, it becomes difficult to brush the organs with a toothbrush. Any mechanical pressure causes severe discomfort.

The damaging processes, rapidly growing, begin to have an increasingly bright color - the outlines of the formation are uneven, the bottom of the cavity is dull, its probing is too painful. The teeth begin to wear in all directions, which causes partial chewing dysfunction.

Diagnostics

High-quality and timely diagnostics is the most important condition for preventing damaging processes from acting globally, leading to irreversible consequences.

Their main signs are massive destruction of teeth, up to complete loss. To prevent this from happening, the following methods of detecting a defect are used.

Visual inspection and equipment

When conducting a clinical examination of the patient, the doctor will certainly notice the external manifestations of the diagnosis, and after collecting a complete history and listening to the patient's complaints, he will quickly give the correct conclusion.

If the information received is not enough, an X-ray examination is performed. The problem area is carefully studied for the structural state of hard tissues.

In the image, the organs affected by the necrotic lesion will have blurred borders, which are a direct consequence of demineralization.

Differential Diagnosis

Despite the fact that the pathology does not belong to the category of complex diseases, necrosis is often confused with others, such as erosion or wedge-shaped anomaly.

And although they have the same localization, there are still differences:

• with necrosis, the surface will always be dull, and the shine is completely absent;
• another focal formation is observed.

Determination of the type of pathology

In order to accurately understand the type of pathology, in addition to the signs described above, it is differentiated according to the following indications:

• computer necrosis has an instant damaging effect on the pulp, which is unusual for other types of disease. This difference can be easily seen on x-ray results. The same form of anomaly is characterized by a complete loss of luster of the entire tooth, and not of the affected area;
• acid type progresses several times slower, it is practically latent for a long time. This is uncharacteristic of the radiation form, the main difference of which is the sharp edge parts. In addition, this type of anomaly is associated with a general deterioration in the health of the patient and has more pronounced symptoms.

Consultation of specialists of other profiles

In some cases, it is simply necessary to listen to the opinion of specialized specialists, such as a gastroenterologist, an endocrinologist.

Their consultation will help shed light on the true cause of the progression of the disease and develop the correct therapeutic regimen.

Treatment regimen

Depending on the type of disease, various schemes for its elimination are used. In any case, this is a complex event, consisting of a number of sequential manipulations.

At the stage of the formation of the disease, the principle of treatment is to eliminate the factors that provoked it, as well as to return the tissues to their former hardness. At the stage of progression, the emphasis is on the restoration of pronounced organ defects.

• Calcium glycerophosphate- means for internal use. The daily dose is 1.5 g at a time. Strengthens tissues, prevents their further loosening;
• Klamin- a drug for systemic use, has a cumulative effect. Drink for 14 days, 2 tablets;
• Fitonol- the suspension is dissolved in water and consumed 15 minutes before meals. The course of treatment is 60 days. Single dosage 30 drops. Restores dentin at the cellular level;
• Multivitamins- a drug with a general strengthening spectrum of action. Drink 3 tablets for a month;
• Pastes- are applied by application. Strips saturated with phosphate are applied to the affected area for several minutes. The procedure is repeated daily until the result improves.

After 90 days, the course of treatment is repeated.

Therapy of necrosis is strictly sequential and includes the following steps:

• gentle cleansing of the affected fragments;
• complex treatment according to the above scheme;
• in a difficult clinical situation - orthopedic measures, including the preparation of the affected fragments and the application of special mixtures of strengthening action. They put a temporary filling;
• after 40-45 days, the cavity will be opened, re-cleaned, freed from the filling material and a permanent glass ionomer will be placed.

Prevention

Basic disease prevention- prevention or minimization of the impact of factors that provoke its development, causing partial death of solid fragments.

Often this can be achieved by adjusting the diet in the right way, eliminating sweets and foods that are too acidic.

Oral hygiene and regular visits to the dentist will also reduce the risk of developing the disease., especially when the initial moments of its formation are already present. If at this stage you go to the clinic, the progression can be stopped.

Price

The approximate cost of treatment, taking into account the average value by region, is as follows:

It should be noted that this list does not include the cost of medicines and aids used in the treatment process. They must be paid separately.

The video provides additional information on the topic of the article.

Tooth enamel necrosis is a pathology in which damage and destruction of hard tissues of the teeth occurs. The emergence and development of the pathological process is influenced by external and internal factors. Acid necrosis of the teeth in the initial stage manifests itself as chalky spots, which eventually become cavities with jagged edges. The enamel of the teeth is gradually destroyed, the patient feels pain from temperature changes in the oral cavity. In therapeutic dentistry, the method of radiography, clinical examination data is used to diagnose necrosis of hard tissues of the tooth.

Treatment is applied both therapeutic and orthopedic.

Acid necrosis of the teeth - complete destruction of tissues

Characteristics of acid necrosis of the teeth. Causes, symptoms. Stages of defeat

Necrosis of the hard tissues of the teeth - damage to the teeth of a multiple nature, leading to the appearance of defective areas on the smooth surface of the enamel and under it (the dentin layer). The destruction of tooth enamel occurs under the influence of harmful factors, is non-carious in nature. Pathology is equally observed in men and women.

People who are at increased risk of developing necrotic lesions of the oral cavity:

• Workers in hazardous chemical industries.
• Cancer patients.
• Suffering from hormonal disorders.
• With disorders of the digestive tract.

If left untreated, the disease leads to loss of chewing function and complete destruction of the teeth. The sooner the doctor diagnoses the disease and identifies the cause, the better for the patient.

Initial necrosis of dental tissues

Reasons for the appearance

The reasons for the formation of enamel necrosis are divided into:

• Internal processes of the body (endogenous).
• Exogenous (acting from outside).

Internal factors contributing to the destruction of enamel are based on changes in hormonal levels. With endocrine disorders, a qualitative change in the composition of the enamel occurs, it becomes thinner. And when the gastrointestinal tract is disturbed, tooth enamel is destroyed due to the release of hydrochloric acid into the esophagus and oral cavity.

Wedge-shaped necrosis on the teeth has a different nature

External factors contributing to necrosis are based on the use of drugs that are toxic to enamel, or on the inhalation of toxic vapors from the air. Under the influence of exogenous factors, central teeth and canines are often destroyed.

When toxic chemicals enter the oral cavity, the qualitative composition of saliva is disturbed, trophism in the vascular-nervous apparatus of the teeth decreases. The nutrition of hard tissues with nutrients is reduced, enamel demineralization occurs, tooth tissues become thinner.

Classification of stages of destruction

Doctors divide the stages of necrosis according to the changes that occur in hard tissues. Necrosis is characterized by the following stages:

• Initial. Under the influence of negative factors, demineralization of parts of the teeth occurs, a chalky spot is formed in the cervical part.
• Demineralized areas expose light dentin.
• In the cervical zone, a pigmented funnel appears in place of the exposed dentin. Cariogenic microorganisms multiply in the funnel.
• The patient has individually multiple lesions of the crowns of the teeth at different stages, or single necrotic pathological processes.

Multiple crown lesions in acid necrosis

Necrotic lesions of the hard tissues of the teeth are accompanied by the progression of caries, which leads to the rapid destruction of the deep layers of the crowns.

Symptoms of the disease

Most patients with necrotic lesions of the dental crowns note a strong pigmentation of the tooth enamel. When exposed to various acids, the color of dental crowns differs from the original. Hydrochloric acid stains crowns yellow, and sulfuric acid black. When nitric acid is inhaled, dentine stains an unnatural white color. Under the action of acids, the crowns lose their natural luster, their surface becomes rough, becomes dull.

After aggressive exposure, chalk-like spots are visible on the crowns. Sometimes replacement dentin is formed in their place, the patient experiences discomfort when closing the jaw. The progression of necrosis causes pain. Weak enamel reacts to temperature changes with painful sensations. Often, pain syndrome is present when organic acids (lemon, strawberries, sweet or sticky foods) enter the oral cavity.

Chemical necrosis of dental tissues

The clinical manifestation of the disease is multiple, there is a rapid development of necrotic processes. A non-carious cervical lesion has an uneven edge; no pain syndrome is noted during probing. The chewing efficiency of the teeth is reduced, horizontal abrasion of the enamel is noted.

Diagnosis of the disease and methods of treatment

Diagnostic measures consist of a clinical examination of the oral cavity and the collection of anamnesis. Differential diagnosis consists in distinguishing between the wedge-shaped effect, enamel erosion and necrosis. The differential difference lies in the absence of the natural luster of the enamel and the definition of a different form of the focus.

To exclude damage to the upper layers of the tooth root, doctors use the radiography method (orthopantomogram). And to search for the main cause of necrotic changes in the oral cavity, the patient is assigned a study by a gastroenterologist and an endocrinologist.

Treatment of acid necrosis of the teeth

The goal of treatment of necrotic changes in tooth enamel is aimed at restoring the integrity of the hard tissues of the tooth and increasing their density. The initial treatment is aimed at eliminating the pathological processes in the body that provoked necrosis. After eliminating the cause of necrotic changes and prescribing a treatment regimen, the doctor treats the crowns with minerals. Such treatment allows you to saturate the dental tissues with nutrients and restore trophism.

At more advanced stages, prosthetics or restoration of the crown with polymeric materials is used.

Treatment regimen

An effective treatment regimen is prescribed by a dentist-therapist and includes:

• Oral administration of calcium glycerophosphate. The dose of the drug is calculated individually.
• Supplementation of the diet with multivitamin complexes. The course is calculated individually.
• Klamin drug. The dosage is calculated individually.
• Daily use of applications based on fluorinated pastes.
• The use of the drug fitonol for oral administration.

Klamin to stop tooth erosion

Such a scheme is universal for adult patients, the doctor makes individual changes based on the diagnosis. The scheme is cyclic until the complete disappearance of the symptoms of necrotic changes in the crowns.

Therapeutic dentistry. Textbook Evgeny Vlasovich Borovsky

5.2.5. Necrosis of hard tissues of teeth

clinical picture. The manifestation of necrosis begins with a loss of enamel luster and the appearance of chalky spots, which then turn dark brown. In the center of the lesion, softening and defect formation are observed. In this case, the enamel becomes brittle and is chipped off by an excavator. Dentin is also pigmented. Usually many teeth are affected. At the same time, patients complain of pain from thermal, mechanical and chemical stimuli, which quickly pass after their elimination.

It is believed that such manifestations occur against the background of a violation or restructuring of the functions of the endocrine glands (thyroid, genital), during pregnancy, etc.

The formation of foci of tissue necrosis on the vestibular surface in the area of ​​the necks of the incisors, canines, small molars and much less often large molars is characteristic.

Pathological anatomy. Cervical necrosis is characterized by the appearance of typical zones of superficial demineralization. When studying thin sections of teeth with a white spot with polarizing microscopy, pronounced subsurface changes are found with the preserved outer layer of enamel, Retzius lines are clearly visible, a central dark zone with lighter areas along the periphery is determined, i.e. signs characteristic of a carious lesion. On this basis, we can assume that enamel necrosis is nothing more than a rapidly progressing carious process.

Differential diagnosis. The developed cervical necrosis of the enamel should be differentiated from the pronounced stages of the wedge-shaped defect and erosion, since both diseases are similar only in the localization of the elements of the lesion on the neck of the tooth or near it. However, the appearance of lesions in all three types of pathology has significant and characteristic features.

Treatment. In the event of lesions, measures are taken to help eliminate hyperesthesia, strengthen tooth tissues. With significant tooth decay, orthopedic treatment is indicated.

5.2.5.1. acid necrosis of the teeth

Acid (chemical) necrosis of teeth is the result of local influences. Ego damage is usually observed in long-term inorganic (hydrochloric, nitric, sulfuric) and somewhat less often organic acids working in production. One of the first clinical signs of acid necrosis is a sense of soreness, increased sensitivity to thermal and mechanical stimuli. Sometimes there is a feeling of sticking of the teeth when they are closed.

The occurrence of this pathology is primarily associated with the direct effect of acids on tooth enamel. In the workshops of such industries, acid vapors and gaseous hydrogen chloride accumulate in the air, which, getting into the oral cavity, dissolve in saliva. The latter becomes acidic and decalcifies the hard tissues of the tooth.

The progression of chemical necrosis of hard tissues of the tooth changes the appearance of the enamel of the teeth of the frontal group: it becomes dull and rough. Sometimes the enamel acquires a dirty gray tint or other dark pigmentation. Erasing of tissues of teeth is sharply expressed.

In acid necrosis, the incisors and canines are most severely affected. Enamel disappears in the area of ​​the cutting edges of the crowns; in this case, sharp, easily broken off sections of the crown of the tooth are formed. Then the process of destruction and abrasion extends to the enamel and dentin of not only the vestibular, but also the lingual surface of the incisors and canines. The crowns of these teeth are shortened, the cutting edge becomes oval, and the crown takes the form of a wedge. Gradually, the crowns of the anterior teeth are destroyed to the gingival margin, and the group of premolars and molars is subjected to strong abrasion.

Mild forms of acid necrosis can be observed in patients with Achilles gastritis, who, for the purpose of treatment, are forced to ingest a 10% solution of hydrochloric (hydrochloric) acid. At the same time, there is an increased abrasion of the cutting, edges of the incisors and the chewing surface of large molars.

Treatment. The same as with necrosis of hard tissues of the teeth.

Prevention. Prevention of acid necrosis of teeth is carried out primarily by designing supply and exhaust ventilation in workshops where alkaline water columns are installed for frequent rinsing of the oral cavity. Observations have shown that workers should carry out this procedure every 1 1/2 to 2 hours.

All workers in chemical industries must be registered with the dispensary. Preventive treatment of teeth with fluoride preparations and remineralizing solutions is carried out in the process of clinical examination.

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