Active stage of tooth erosion. Erosion of tooth enamel: causes, symptoms, prevention. Causes of the formation of the disease

- This is a type of non-carious lesion, characterized by the formation of defects in enamel and dentin on the vestibular surface of the teeth. Sites of erosion of the teeth are localized symmetrically: on the incisors, canines, premolars; their formation leads to a change in the color of the enamel, hyperesthesia of the teeth, and a cosmetic defect. Erosion of the teeth is detected by visual inspection, after drying the surface of the tooth and treatment with iodine tincture. Treatment of dental erosion includes complex remineralizing therapy (ingestion of calcium, phosphorus, vitamin and mineral complexes; local applications, electrophoresis), if necessary, filling defects or covering teeth with crowns.

ICD-10

K03.2

General information

Erosion of the teeth is a lesion of the hard tissues of the tooth, characterized by a progressive loss of enamel and dentin. In practical dentistry, dental erosion refers to non-carious lesions, along with wedge-shaped defects, enamel hypoplasia, acid necrosis, pathological abrasion, and dental fluorosis. Enamel erosion is detected in 10-23% of patients who are not employed in hazardous industries. The disease occurs predominantly in middle-aged women; has a long (up to 10-15 years) course. Tooth erosion is not only an aesthetic defect, but also a serious dental problem that needs immediate treatment.

Causes

Among the concepts of the etiology of dental erosion, the most popular are mechanical, chemical and endocrine, although none of these theories is exhaustive.

1. Mechanical theory. A number of researchers associate tooth erosion with excessive mechanical action on the enamel, namely, the use of hard toothbrushes, whitening toothpastes and powders with increased abrasiveness.
2. Chemical theory. As the leading reasons, he considers the impact on the enamel of aggressive chemical agents - acid-containing foods and drinks (marinades, pickles, citrus fruits, juices, carbonated drinks, etc.). At risk for the development of dental erosion are workers in hazardous industries associated with the inhalation of acid fumes, particles of metal and mineral dust. A number of medicines, for example, with a high content of ascorbic acid, have a damaging effect on tooth enamel. Tooth erosion may be due to chronic gastroesophageal regurgitation in gastroesophageal reflux disease.
3. endocrine theory. It is based on studies that have identified the relationship between tooth erosion and hyperthyroidism. It has been established that in patients with thyrotoxicosis, tooth erosion occurs 2 times more often than in persons with a normal functioning thyroid gland, and every year the course of hyperthyroidism increases the risk of erosive damage to the teeth by 20%.

Classification

The classification of tooth erosion was based on the criteria for the activity of the process and the depth of the lesion. In the clinical course of tooth erosion, 2 phases are distinguished: active and inactive.

1. In the active phase, there is a particularly rapid destruction of enamel; the size of erosion changes every 1.5-2 months; increased sensitivity of the teeth.
2. In the inactive phase, there is a relative stabilization of the process within 9-11 months; reduction of hyperesthesia of the teeth.

Depending on the depth of the defect, tooth erosion of 3 degrees is distinguished:

• I degree(superficial, initial) - with damage to only the upper layer of enamel
• II degree(medium) - with enamel damage throughout the depth to the enamel-dentin border
• III degree(deep) - with the defeat of the entire enamel and the upper layer of dentin.

Symptoms of tooth erosion

In the initial stage, there is a loss of enamel luster in the region of a limited area of ​​the vestibular surface of the tooth. At this stage, it is possible to notice signs of an erosive process that has begun only after drying the surface of the tooth with a jet of air or applying 5% iodine tincture to the affected area - in this case, yellow-brown staining of the erosion site occurs.

Initially, the erosive defect is a round or oval bowl-shaped focus with a hard, smooth and shiny bottom. As the focus expands and deepens, there may be a complete loss of the enamel layer and exposure of the dentin. With I and II degrees of tooth erosion, the defect has a whitish color; at the III degree of the pathological process, light yellow or brown pigmentation appears.

At the initial stage of tooth erosion, with a stabilized course, there are no pain sensations. In the active phase, with an average and deep degree, hyperesthesia is noted when brushing teeth, the action of chemical and thermal stimuli. The most common lesions are symmetrical incisors, canines and premolars. Enamel erosions are often combined with pathological abrasion of hard dental tissues. The course of dental erosion is chronic, progressive, characterized by gradual damage to new teeth.

Diagnostics

Tooth erosion is diagnosed during a dental examination. A clearer localization of the defect is facilitated by drying the surface of the tooth crown, iodine test. Tooth erosion requires differentiation with wedge-shaped defects, enamel hypoplasia, superficial caries.

To identify concomitant endocrine disorders, patients suffering from dental erosion may need to consult an endocrinologist, conduct an ultrasound of the thyroid gland, study thyroid hormones. To exclude GERD, an examination by a gastroenterologist is recommended.

Treatment of dental erosion

An integrated approach to the treatment of dental erosion consists of local and general therapeutic measures. In the active phase, the efforts of dentists-therapists are aimed at achieving stabilization of the process and stopping the progressive loss of hard tissues of the tooth. or an artificial crown.

In the stabilized stage, continued intake of vitamins and trace elements is shown. In order to eliminate hyperpigmentation, it is possible to polish the tooth with a paste, gentle whitening, followed by the application of fluorogel or fluorine varnish to the erosion.

Forecast and prevention

Unlike caries, the development of dental erosion is in no way associated with poor oral hygiene. However, against the background of the progression of an erosive defect, a secondary attachment of a carious lesion of the teeth may be noted. Therefore, the treatment of dental erosion should be timely and complete. After achieving stabilization of erosion, patients require dispensary observation of a dentist-therapist.

Prevention of dental erosion consists of the correct selection and use of dental care products, limiting the use of foods with a high erosive potential, and eliminating concomitant endocrine disorders. The use of phosphate-containing toothpastes 2-3 times a week is very effective.

Erosion of tooth enamel is a process of destruction of dental tissues with the appearance of destroyed areas in the form of rounded cavities. The defect resembles a carious infection, but in fact it has nothing to do with caries.

The process begins with the fact that a small cavity appears in the cervical region of the tooth, which gradually increases in size. At the initial stage, it is difficult to notice the problem, since it is close to the color of the tooth enamel and does not manifest itself in any way. Symptoms begin to appear as the cavity gets deeper, causing discomfort and tooth sensitivity. The patient feels a sharp pain with mechanical irritation, sweet or sour food on the tooth, as well as under the influence of high or low temperature. An independent visual examination is confusing, since there are no signs of caries. In this case, the cause of discomfort may be erosion of tooth enamel.

Risk factors

There are several main reasons that can provoke the occurrence of erosion.
These include:

mechanical pressure;

teeth grinding (bruxism);

abuse of sour food;

diseases of the gastrointestinal tract.

Uneven load distribution

Wearing a bracket system can be one of the factors that creates favorable conditions for the appearance of such a defect on the teeth as erosion of tooth enamel.

When a person is missing one or more teeth, not everyone is in a hurry to do prosthetics. Patients are not always willing to resort to orthodontic treatment, even when there are clear indications. Some are intimidated by the prospect of wearing braces, as well as the cost of corrective construction. These circumstances can become favorable conditions for the appearance of such a defect on the teeth as erosion.
The fact is that when chewing food, a person does not think about how this load is placed on his teeth. It may seem that only 2-3 teeth are involved in the process, on which a particular piece of food falls, but this is not so. In fact, the stability of the dentition and high-quality grinding of food is achieved by a uniform load on the entire dentition. This is ensured by the presence of all teeth that support each other, being a support for neighboring ones.

Important! Often a person, having several extracted teeth on one side, uses predominantly the other side for chewing, thereby causing its double overload. This is fraught with weakening of the teeth and, in particular, the occurrence of erosion.

mechanical pressure

Tooth brushing is in itself an uneven mechanical pressure on tooth enamel in order to remove plaque. And the use of a toothbrush with hard bristles can exacerbate the impact, leading to mechanical damage.

Many are surprised by the fact that you can damage your teeth with an ordinary toothbrush. When buying a tool for daily cleaning of the oral cavity, it is necessary to pay attention to the specified stiffness of the bristles. For regular hygiene, products with bristles of medium hardness should be preferred. Some buyers do not pay attention to the labels on the packaging, while others deliberately choose a brush with a high stiffness, considering it to be the most effective. However, such a brush will not help to achieve the best result, but on the contrary, it will have a negative effect on the teeth. From hard bristles, the enamel can be erased, and the sensitive cervical region is easily injured.

Important! The technique of brushing your teeth is also of great importance. A common mistake is intensive movements in a horizontal plane along the outer side of the dentition. Such cleaning is not effective and, in addition, can cause trauma to the tooth enamel in the neck area.

Dentists never tire of repeating that brush movements should be vertical, in the direction from the gum to the edge of the tooth. Thus, dirt is effectively swept from the surface of the enamel.
When using a toothbrush, one should not forget about the applied force. Do not think that excessive pressure on the handle of the brush will help to clean your teeth properly. In fact, the quality of cleansing from this does not increase at all, and the risk of injury increases many times over. A sign of excessive zeal is the rapid wear of the brush. If the product becomes loose after a few weeks, you should think about changing the technique of the procedure.
The key to good hygiene is careful proper technique and regular procedures. It is recommended to brush your teeth twice a day.

teeth grinding

Bruxism - paroxysmal contractions of the chewing muscles that occur periodically in a dream, which are accompanied by clenching of the jaws and grinding of teeth, the attacks are repeated many times and may be accompanied by respiratory failure, changes in blood pressure, and heart rate.

Involuntary clenching of the jaws and grinding of teeth is what dentists call bruxism. It is quite difficult to notice such a problem on your own. In the daytime, the grinding of teeth manifests itself infrequently. But if you observe yourself, you will notice that in emotional moments there is an involuntary contraction of the jaw with a noticeable effort. This is what is called bruxism.

Attention! Bruxism is more pronounced at night. During REM sleep, the jaw tightens and the sound of teeth grinding can be heard. It is unlikely that a person will notice him at home, rather, relatives who are nearby in the bedroom will help to do this.

There are also external signs of bruxism. If you carefully examine the surface of the teeth, then on their crowns you can see horizontal stripes and cracks located longitudinally. This sign is indirect, but indicates the possible likelihood of the presence of teeth grinding.
This habit is not a serious medical problem. Bruxism to one degree or another is observed in many modern people, since the rhythm of life is often associated with emotional overload. However, such a habit is not entirely harmless, because a strong mechanical load on the teeth can lead to damage, including erosion.

acid environment

Eating a large amount of vegetables and fruits can provoke the maintenance of a constant acidic environment in the oral cavity, leading to erosive destruction of tooth enamel.

Currently, one of the fashion trends is a raw food diet and other diets that involve eating a large amount of raw vegetables and fruits. It should be understood that in addition to vitamins and nutrients, such products often contain a large amount of acids that can adversely affect the teeth.
With increased sensitivity of the teeth and a tendency to erosion, you should be careful about the products you use.

Attention! Many folk recipes for teeth whitening involve the use of substances that are highly acidic. You should not get carried away with applications from fresh strawberries, lemons and similar products, otherwise, instead of the expected result, you can get increased sensitivity and erosion of tooth enamel.

It is unlikely that such bleaching will please.

Diseases of the gastrointestinal tract

Gastrointestinal disease can lead to a violation of the integrity of tooth enamel, gastric juice entering the oral cavity disrupts the acid-base balance and leads to zero protective function of saliva produced.

The state of the gastrointestinal tract most directly affects the health of the teeth. The oral cavity is located in close proximity to the stomach and is directly connected to it through the esophagus. To carry out the process of digestion of food in the stomach, gastric juice is constantly present, which is an acidic environment. Various kinds of diseases can lead to an imbalance in the acid balance and the ingress of acid into the oral cavity. As mentioned above, an acidic environment can adversely affect the teeth, causing erosion. In addition, chronic gastritis can change the composition of saliva produced, disrupting its protective function.

Important! Erosions that appear on the teeth as a result of gastrointestinal diseases often have a characteristic brownish color.

A separate category is occupied by patients with eating disorders. Anorexia and bulimia, accompanied by constant vomiting, lead to a pathology of such magnitude that the patient's smile turns into a continuous brownish erosion.

Therapeutic measures

In order for teeth to be healthy, hygiene alone is not enough, it is necessary to exclude “food debris”, which worsens the functioning of the body as a whole, destroying its protective reactions.

Before you begin to eliminate the consequences of the resulting erosion, you need to get rid of the reason why it arose. Thus, the main therapeutic measures are:

• Restoration of missing units of the dentition with the help of prosthetics or implant technologies.
• Correction of bite defects with orthodontic constructions.
• Control over the correct observance of hygiene rules. Dental care should be regular, and teeth should be brushed gently with the right toothbrush. Toothpastes should be chosen taking into account individual characteristics, while it is better not to use products marked “whitening” at all.
• Examination of the gastrointestinal tract and the necessary treatment of identified diseases.
• Proper nutrition, including foods rich in minerals and vitamins. Eliminating highly acidic foods from the diet, limiting fast food and sweets, avoiding coffee abuse - all this contributes to maintaining a healthy smile.
• Solving the problem of teeth grinding. In this case, the complex work of a dentist and a neurologist is required.

To help the patient, natural sedative complexes of plant origin can be prescribed, which contribute to relaxation before bedtime. Stress management and control over your own emotions help reduce the manifestations of bruxism during the daytime. If all efforts are in vain, then you can use individual mouthguards made of silicone. These products are worn at night and protect teeth from injury by acting as a soft buffer between the upper and lower jaws.

Attention! If erosion has already formed, then it is impossible to restore the lost dental tissues in a natural way. The defect requires treatment in the dental office using modern filling techniques.

Most often, light-curing composite materials are used for these purposes, which are matched to the shade of tooth enamel.
Such a filling not only solves the aesthetic problem of erosion, it also eliminates the patient's discomfort caused by increased sensitivity in the affected area of ​​the tooth. Local anesthesia is used to ensure complete painlessness. It should be noted that the use of a drill in the case of erosion treatment is minimal, since the tissues surrounding the defect are not infected, as is the case with caries.
Properly carried out treatment will return the smile to naturalness, but do not forget that it will not protect against the risk of recurrence of the disease if the cause of tooth enamel erosion is not eliminated.

Treatment and prevention of tooth enamel erosion

Tooth erosion is a destructive non-carious process inside the oral cavity. Erosion of tooth enamel is accompanied by the appearance of increased sensitivity of the incisors to sweet, sour, salty and hot. With the development of the disease, the process of destruction reaches the internal tissues, exposes the hard dentinal part, and causes pain. The tooth becomes thinner and breaks off.

What factors lead to the formation of enamel erosion, and what methods are most effective for treatment and prevention? You will find answers to these and other questions in this article.

Tooth erosion begins with discomfort. On the hard surfaces of tissues that do not have signs of caries, dull areas of a rounded shape appear. The color change is due to the loss of mineral composition (demineralization). More often, erosion is formed on the surface of the front teeth and canines symmetrically, that is, on the teeth of the same name (on the two front or two thirds, fourths, counting from the center). There is practically no erosional destruction on the lower molars. Often occurs on the anterior upper incisors.

Microscopic examination of erosive areas confirms that the enamel loses its crystalline structure, becomes amorphous at the site of stain formation. At the same time, the stain retains a smooth surface, which distinguishes erosion from caries with a characteristic roughness.

With the further development of destruction, a small depression is formed. Over time, it increases in depth and breadth, takes the form of a notch, reaches the hard tissues of the tooth. Erosion becomes brown and widespread. Necrosis (necrosis) of hard dental tissues develops.

If erosion occurs on the cutting edge of the tooth, with its development, the edge becomes transparent, thin and breaks off during chewing load. Chips are formed.

Dentists divide the disease into three stages:

• tooth erosion of the first degree: only the upper layers of the enamel are affected, which is manifested in the loss of luster in some areas of the surface;
• tooth erosion of the second degree: the entire thickness of the tooth enamel is affected;
• erosion of the third degree: deep damage to the enamel, reaches hard tissues (dentin).

Timely treatment prevents the spread of spots and depressions. At the same time, not only measures inside the oral cavity are important, but also the treatment of the underlying disease, which is accompanied by enamel erosion.

Conducted medical studies allow us to conclude that enamel erosion is related to metabolic disorders. The destruction of enamel and its spread into the space of hard tissues often occurs in middle-aged and elderly people with diseases of the thyroid gland, gonads.

Also, tooth erosion occurs with frequent exposure to acid on the enamel. The acid that destroys the surface of the enamel can be contained in foods or thrown into the oral cavity from the stomach (gastric juice).

The composition of saliva in a healthy body should have a weak alkaline reaction. This provides protection for the tissues of the tooth and oral cavity. In case of digestive disorders, the normal composition of the salivary secretion changes, sometimes it acquires an acid reaction and itself becomes the cause of the destruction of hard tissues. Dental treatment in this case is ineffective, complex therapy is necessary, aimed at normalizing the activity of the digestive system.

Erosion is possible with daily exposure to low-quality tooth powder or paste (for example, with a whitening effect).

Separate statistics on erosive destruction identifies athletes who regularly swim in a chlorinated pool as a risk group. Among them, the frequency of enamel destruction is also increased as a result of constant exposure to bleach on the surface of the tissues of the anterior teeth.

Risk factors

Erosion of tooth enamel often accompanies the following painful conditions:

• hormonal disorders;
• diseases of the thyroid gland (hypothyroidism, thyrotoxicosis) and other endocrine glands;
• osteoporosis (erosion may indicate the initial stage of the formation of this disease);
• diseases of the digestive system (gastritis, peptic ulcers, acid disorders).

Also, the following external factors increase the likelihood of erosion:

• vegetarian diet with lots of sour fruits;
• pregnancy (if accompanied by intoxication);
• frequent use of alcohol;
• work in hazardous industries associated with the inhalation of vapors of aggressive acids (nitric, sulfuric, acetic, lactic);
• radioactive radiation (territories near nuclear power plants or the state after a therapeutic course of radiation therapy);
• electromagnetic radiation (often when exposed to computer screens with a weak degree of protection).

Treatment of the disease in the early stages is performed with fluorine (fluorogel or fluorine varnish). Assign enhanced vitamin-mineral complexes. Separately, calcium glycerophosphate is used as the main supplier of building material for the restoration of tooth enamel. In order to provide calcium to tooth enamel, electrophoresis with calcium gluconate is prescribed.

Deeper damage is sealed (similar to caries), covered with crowns or veneers (porcelain, composite plates).

In the early stages, effective treatment of superficial tissues is carried out with the help of remineralization of the teeth. What it is?

Remineralization provides an artificial analogue of a natural process that must occur in the human body all the time. The mineral composition of the teeth must be replenished from food and not destroyed by the aggressive influence of environmental factors (whitening paste, polluted air, artificial food). During remineralization, the teeth are treated with a chemical compound (gel) containing phosphates and calcium. It is these substances that are responsible for the health of dental tissues.

The gel is applied in special trays that are put on the teeth. Primary treatment is carried out by a dentist. In the future, you can perform it yourself by putting mouth guards on your teeth and keeping them for a predetermined amount of time (from 15 to 30 minutes).

As a result of remineralization, the sensitivity of the enamel stabilizes, the size of erosion spots decreases. The procedure also increases the resistance of the tooth surface to caries.

Preventive remineralization home remedies include mouth rinses and fluoride toothpastes. The procedure is most effective in children and pregnant women.

Prevention

Prevention of erosion and maintenance of enamel and hard tissues of the tooth in a healthy state includes limiting the use of ballast products, taking vitamins and rational nutrition. As well as a healthy lifestyle, control of the intake of hormonal drugs (possibly refusing them), timely treatment of the endocrine and digestive systems of the body.

Foods to limit when early signs of dental erosion appear:

• sour juices (you can drink through a straw, if the condition of the gastrointestinal tract allows);
• sweet carbonated drinks;
• preserves, marinades, fermented products.

The acid reaction should not remain in the oral cavity after eating. It is recommended to finish the meal with an alkaline product (for example, eat a piece of cheese or drink milk at the end of a meal).

Erosion of the tooth surface is a disease shrouded in many myths, but this is not a sentence. It can be treated and prevented, it can be prevented, development can be stopped at an early stage, or the surface of the tooth can be protected in case of deep erosive destruction.

Finally: watch a short video about fluoridation of teeth:

Read also:

Treatment of white spots on teeth

Restoration of tooth enamel at home

The reasons why enamel erosion occurs are not fully understood, however, the main risk factors for the onset of the disease can be identified:

The consequences of erosion are deplorable

Erosion affects mainly middle-aged people. This process is characterized by a long-term course and can last from 10 to 15 years. We can distinguish the following consequences of damage to tooth enamel:

1. Accelerating tooth wear.
2. As the dentin is exposed, the color of the teeth changes and they become darker.
3. As the enamel is erased, the sensitivity of the teeth from the inner and outer surfaces becomes aggravated, i.e., touches of both the tongue and lips bring discomfort. Dentin is a soft tissue, so pain will inevitably occur when air enters, chewing and exposure to food acids contained in food.
4. The edge of the front teeth may appear more transparent.

Stages and phases of fracture development

Violation is classified not only by stages of development, but also by phases:

It is very important that in some cases there may be a transition of the disease from one phase to another.

There are 3 stages in the development of the disease:

• initial, there is a lesion of a purely upper layer of enamel;
• medium, the enamel is affected so deeply that erosion reaches the dentin;
• deep, the enamel is completely affected, and the top layer of dentin is also affected.

Manifestations of erosion depending on the stage

The process of development of the disease is very rapid and dangerous, since along with erosion, pathological abrasion of the hard tissues of the tooth develops.

The disease is chronic in nature, which over time progresses more and more and affects healthy teeth.

Symptoms as the destruction progresses:

1. At the primary stage, there is a loss of luster of tooth enamel in the area of ​​​​a certain area of ​​\u200b\u200bthe tooth surface. At this time, it is almost impossible to identify the process of erosion development. This can only be done as a result of the procedure for drying the tooth surface with an air jet or when iodine is applied to the affected area, in which case the erosive area will turn brown. Initially, the erosive defect will have an oval or rounded shape with a smooth bottom. Erosion has a whitish color. Pain sensations are absent.
2. In the second stage, discomfort and a change in the color of the affected area begin to appear.
3. At the last stage, there are noticeable pain sensations in the process of eating, brushing your teeth. The pigmentation of the affected areas changes. Brown spots appear on the surface of the tooth.

Three stages of diagnosis

Diagnosis is carried out in the process of dental examination:

1. Identification of the localization of an erosive defect occurs by drying the surface of the tooth with an air jet and applying iodine.
2. The process of differentiation of erosion from the wedge-shaped defect and caries of the primary stage. Erosion from caries will be distinguished by the localization and shape of the lesion, as well as a smooth surface; with caries, the surface becomes rough. The wedge-shaped defect will also differ in shape and localization. It is found in the region of the root of the tooth.
3. In order to identify concomitant pathologies of the endocrine system, an examination is carried out by an endocrinologist and a gastroenterologist, an ultrasound of the thyroid gland is prescribed, and a hormonal analysis of the thyroid gland is performed.

Rehabilitation Therapy

Treatment for erosion of tooth enamel implies the appointment of local and general procedures in order to transfer the disease from the active phase to the stable one. This will stop the loss of hard dental tissue.

If the enamel has already been erased, then they are assigned:

In case of erosion, tooth filling will not always be effective, since there may be a violation of the fit of the filling material, which is fraught with the formation of a defect around the filling itself.

It is easier to prevent than to stop later

Unlike caries, the formation of erosion is not associated with non-compliance with hygiene measures for oral care.

However, this disease can lead to the development of a carious process.

In order to prevent, you should follow some rules:

To prevent the development of the process of erosion of tooth enamel, the treatment must be timely and of high quality. After the transition from the active to the stabilized phase of the development of the disease, the patient should undergo systematic observation by a specialist.

Wedge defect causes

We figured out how the disease develops, but this cannot be its main cause. After all, the teeth of all people are subject to loads and abrasion, and dentists do not often find a wedge-shaped defect, the treatment of this defect is not an easy task. The main cause of the disease, it turns out, is a broken occlusion, or malocclusion. With a problematic bite and a desire to correct it, only some of those who have it turn to dentists. The rest (and this is more than 90% of the world's population) live to a ripe old age, not even suspecting that they have imperfect occlusion. Almost everyone cares about the appearance of their teeth, but only a few worry about whether they function properly. It all starts with the bite: due to its deviations in its structure during chewing, the load on different teeth can vary significantly. Teeth that are under heavy load wear out faster, flat areas form on their surface. When food enters these areas, it cannot be cut, but it must be crushed, which means that great efforts are made and the enamel is subjected to a more serious load. The enamel does not withstand the increased load, cracks and breaks off, and as a result, a wedge-shaped defect, wedge-shaped caries, is formed.

Clinical manifestations of hyperesthesia of the teeth

Severe pain in the teeth can occur during the use of sour, sweet, cold or hot food, as well as drinks. During an exacerbation, outbreaks of acute toothaches can even be caused by a stream of cold air. The nature of the pain varies greatly, from mild and insignificant (such pain does not interfere with normal life), to severe discomfort during the active manifestation of the syndrome.

With a slight level of hyperesthesia, the teeth react only to extreme cold, for example, while eating ice cream, cold drinks. With an average degree of difficulty, irritability begins to manifest itself not only during exposure to temperatures, but also from various chemical stimuli. At this stage, the pain is still not very strong. Deep damage to the tooth enamel leads to hypersensitivity, at this stage, the dental nerves begin to actively respond to anything: chemical reagents, temperature changes, and even tactile impact. The pain is severe and can last for quite a long time. Also, at this stage, increased salivation is noted, the patient can experience unpleasant sensations not only by eating, but even by a simple conversation. The patient tries to keep the cheeks from touching the teeth, which makes the face look ridiculous.

Brushing your teeth at the last stage of hyperesthesia is extremely painful, so normal oral hygiene becomes simply impossible. Lack of proper care leads to the appearance of plaque, in turn, plaque provokes the active development of caries, inflammation of the gums, etc. Thus, if the disease is not cured at its initial stages, then an advanced form can lead to the progression of other diseases of the teeth and oral cavity.

A dentist examines the oral cavity to determine the degree of sensitivity of tooth enamel to various irritants, and based on the results of this analysis, a specific treatment regimen will be prescribed. In the event that it turns out that the hypersensitivity of the teeth arose as a result of their mechanical damage, then the treatment (filling, installation of dental crowns, etc.) is guaranteed to lead to the disappearance of all painful symptoms. At the same time, it is necessary to carry out a professional treatment of the entire surface of the mouth, as well as the localization of carious foci.

One of the methods of treating this disease is the use of preparations that seal or rebuild the structure of the dentin. They form compounds that clog the dentinal tubules and strengthen them. Such funds are applied by applying (available in the form of varnishes or gels) to the surface of the tooth. The procedure should be repeated daily, due to which a high degree of fluorination of the hard tissues of the tooth is achieved. As a result, the response to various external stimuli becomes much less pronounced.

The second method of treatment is therapy aimed at reducing the general sensitivity of the nerve endings located in the tubules of the dentin. In this case, preparations with a high content of calcium salts are used, as a result of their action, calcium ions are diffused into the tubules, and it is they that suppress the sensitivity of nerve endings. A kind of protective sheath is created around them, which prevents the further transmission of nerve impulses.

Oral care for hypersensitive teeth

To care for the oral cavity, you can purchase special products that, with regular (daily) use, can suppress or completely eliminate discomfort, as well as prevent further development of hyperesthesia with a more pronounced pain syndrome. Most often, these are special therapeutic toothpastes. Be sure to check with your dentist!

Read more:

Why teeth are sensitive: the mechanism of pain

To explain why sensitivity occurs, you need to understand a little about the structure of the tooth. On its surface there is enamel, it is very durable and reliable. Enamel protects dentin. It contains microtubules with passing nerve endings. As long as the tubes are closed, you do not feel any discomfort. But if the enamel is damaged or thinned, the dentinal tubules are no longer properly protected and the nerve endings are exposed, causing increased susceptibility. Sometimes a tooth reacts not only to temperature changes and aggressive food, but even to pressure drops and just air. Gingival prolapse and root exposure can also increase sensitivity.

The strength of discomfort depends on the degree of damage to the enamel and access to the nerve endings, as well as on the personal characteristics of the body.

Reasons for sensitivity

Problems with teeth. Caries, the presence of cracks, erosion, increased enamel abrasion, wedge-shaped defects, gum atrophy with root exposure, periodontitis - all this can lead to the development

sensitive

Endocrine diseases. Metabolic disorders and thyroid disease can lead to hyper

sensitive

Other diseases. Diseases of the gastrointestinal tract, infectious diseases, psychoneurosis can lead to discomfort.

Pregnancy, menopause. Changes in the hormonal background can also cause a violation of the metabolism of minerals in the body. The problem is solved by taking dietary supplements and mineral-vitamin preparations.

Nutrition. Due to an unbalanced diet, important vitamins and minerals may not enter the body. Also

raise

sensitive

awn can eat too acidic food, carbonated drinks. Very cold or hot food is harmful. Simultaneous use of cold and hot food can lead to cracks in the enamel.

Improper oral hygiene. Wrong choice of toothbrush and paste. Poor cleaning quality

ov. The use of traumatic elements to remove food particles.

Mechanical damage. Chewing / biting off excessively hard objects or products (nuts, seeds, the habit of chewing stationery pens, etc.).

Sensitivity can also appear after a visit to the dentist. This condition can be provoked by mild inflammation of the pulp. If the discomfort does not go away after one week, you should definitely visit a doctor. In this case, the long-term sensitivity of only one tooth (which was manipulated) serves as alarm signals.

Diagnosis of the causes of the disease

Hypersensitivity is usually just a symptom. For therapy, it is required to determine the exact causes of occurrence. First of all, the dentist conducts a thorough examination of the oral cavity. If there is damage to the enamel, erosion, caries and other dental causes, the doctor will immediately detect this. In the absence of such, the reasons must be sought in the general condition of the patient. To do this, the doctor may advise you to contact a therapist or endocrinologist for an examination for the presence of diseases. The course of treatment is prescribed after establishing the causes.

Hypersensitivity of teeth: treatment

Treatment is complex and depends on the picture of the disease. Typically, therapy includes several components:

therapeutic measures to restore the processes of mineralization of enamel and dentin (reception of vitamin and mineral complexes: phosphorus, calcium, fluorine, magnesium);

restoration of phosphorus-calcium metabolism in the body (normalization of nutrition, intake of dietary supplements, mineral complexes);

the use of specialized varnishes, gels, which act as a protective film on the enamel,

raises

its protective functions;

the use of personal hygiene products at home (special toothpastes, rinses, mineralizing gels) until normal

sensitive

As mentioned above, the cause of sensitivity is first determined and, based on it, treatment is carried out. The price of therapy in Moscow varies depending on the chosen method. In some cases, the treatment consists solely in restoring the enamel and the integrity of the tooth, in others it requires the treatment of internal diseases of the body.

Prevention of tooth sensitivity

Selection of a brush of medium hardness, which will not injure tooth enamel and gums.

Avoiding toothpastes

elevated

the amount of abrasive particles, which leaves scratches on the enamel.

Usage

special

pastes and mouthwashes with fluorine and calcium.

ov without any extra effort, the correct cleaning technique.

Getting rid of the habit of chewing objects (pencils, pens, cocktail tubes, etc.).

You can not crack nuts, click seeds, rejection of all excessively hard foods.

Regular oral hygiene (brushing

ov twice a day, use

thread, rinsing the mouth after eating).

Adjustment of nutrition, rejection of excessive

x and cold dishes, sour, sweet.

Preventive examination at the dentist every six months, professional oral hygiene.

Our clinic in Moscow offers highly effective procedures to restore normal tooth sensitivity at loyal prices. The price of treatment depends on the clinical picture of the disease and the necessary measures. Detailed information on the procedure, as well as prices, can be obtained from the managers of our company. Contact us!

What interesting things can be learned in the heading about dentistry?

Modern dental medicine is constantly developing, new means, medicines, devices for treatment and diagnostics are introduced into use every year. The situation even 20-30 years ago cannot even be compared closely with the modern achievements of dentistry. Going to the dentist is less and less associated with something unpleasant, on the contrary, patients around the world are increasingly aware of how important healthy teeth are today.

Now it has become possible to make the most accurate diagnosis using the latest diagnostic equipment, build up or completely restore a lost tooth, solve the most difficult problems of the jaw, facial bones, get rid of periodontal disease and other painful problems. In addition, even pets already have their own dentists - clinics dealing with oral diseases in our smaller brothers are opening all over the world. You can find out about the latest trends in modern dentistry, new inventions, how to treat and who to contact in case of pathologies on the pages of our portal.

Types of dental care

There is an extensive range of dental specialties, each of which deals with the treatment of a certain type of pathology. Among these areas:

• therapy;
• orthopedic dentistry;
• orthodontics;
• periodontology;
• surgery (including maxillofacial);
• aesthetic medicine.

The task of restorative dentistry is to deal with widespread dental problems with non-surgical methods. These diseases include:

1. non-carious enamel lesions (including, for example, tissue necrosis, enamel erosion, dental trauma, abrasion due to malocclusion, hypoplasia, and many others);
2. caries and all carious complications;
3. diseases of the mucous membrane, the most common of which is stomatitis in various forms.

Caries is the most common dental disease. To prevent it, regular oral hygiene is required. If dental care is insufficient, and the body is subject to stress, stress, if too many foods that destroy tooth enamel are consumed, dark spots appear on the teeth. If they are not removed in time, holes and holes may appear, the lesion will gradually grow, touching new areas.

Dentists treat all forms of caries, however, the treatment procedure at more advanced stages, when depulpation is required, is much more difficult.

Periodontal problems and tartar removal

Periodontitis and tartar are two more serious problems that can worsen a person's quality of life. In the case of periodontitis, the normal structure of tissues is destroyed, which leads to the release of blood and possible loss of teeth. With tartar, plaque that accumulates on the walls of the teeth hardens and turns into a petrified form. These diseases have a very hard effect on well-being, they make the oral cavity open to the emergence and rapid development of a number of infections. By the way, today these diseases, which once traditionally tormented people of mature age, are noticeably “younger”.

However, modern medicine offers many ways to eliminate these problems. Laser treatment, ultrasound treatment is available today. In addition, by following the basic rules of hygiene on a daily basis and leading a healthy full-fledged lifestyle, you will minimize the risk of such ailments.

Orthodontists are engaged in correcting problems of the oral cavity, as a rule, their patients are children, but now more and more adults are resorting to such treatment. Correction of bite and correction of teeth is effective and efficient. The use of braces and removable mouthguards in the best clinics is carried out after a thorough diagnosis and computer simulation of the correction process.

Orthopedics deals with the restoration of natural beauty using artificially created prostheses. In modern orthopedics, not only old (and not always effective) methods are used, such as the installation of bridges and crowns, but also implantation, which can be one-stage or staged.

Also used, for example, clasp prostheses, veneers, removable dentures, which are strengthened by various devices, including special ointments.

Aesthetic dentistry

The most popular type of aesthetic dentistry is teeth whitening. To get that “Hollywood smile”, today laser therapy is used, which provides painless teeth whitening in just a few short sessions.

Other types of aesthetic correction also include reshaping and extensions, the addition of veneers, onlays, as well as such special types of procedures as decoration with rhinestones or jewelry.

Tooth erosion is a progressive loss of tooth tissues (enamel and dentin) of insufficiently elucidated etiology. Some authors believe that tooth erosion, like a wedge-shaped defect, arises solely from the mechanical action of a toothbrush and powder. Others believe that the occurrence of erosion is due to the consumption of large amounts of citrus fruits and their juices. Yu. M. Maksimovsky (1981) assigns an important role in the pathogenesis of erosion of hard dental tissues to endocrine disorders and, in particular, hyperfunction of the thyroid gland.

According to him, one of the symptoms of this disease is an increase in saliva secretion and a decrease in the viscosity of the oral fluid, which cannot but affect the condition of the hard tissues of the tooth. It was established that tooth erosion in patients with thyrotoxicosis occurred 2 times more often than in persons with normal thyroid function. Even with an increase in the duration of the disease by 1 year (from 3 to 4 years), the number of patients with erosions of hard tissues increases by 20%. Yu. A. Fedorov et al. (1990) also found that tooth erosion in more than 40-50% of cases is detected against the background of an increase in the thyroid gland and a violation of its function.

Erosions of the hard tissues of the teeth appear mainly on the symmetrical surfaces of the central and lateral incisors of the upper jaw, as well as on the canines and small molars of both jaws. There are practically no erosions on the incisors and large molars of the lower jaw. The lesion is observed mainly in middle-aged people and is characterized by a long course - up to 10-15 years. With age, there is an involvement in the process of a large number of teeth. Currently, due to the impact of adverse environmental factors, including the Chernobyl disaster, the number of cases of dental erosion in young people (18-25 years old) is increasing.

The cause of enamel erosion has not been finally established, however, undoubtedly, an important role belongs to the chemical factor in combination with mechanical action. At the same time, it is impossible to exclude the weakening of the remineralizing effect of the oral fluid.

Clinical picture of tooth erosion

Erosion is an oval or rounded enamel defect located in the transverse direction of the most convex part of the vestibular surface of the tooth crown. The bottom of the erosion is smooth, shiny and hard. The gradual deepening and expansion of the boundaries of erosion leads to the loss of the entire enamel of the vestibular surface of the tooth and part of the dentin. Sometimes erosion takes on a less regular shape, which is compared to a grooved chisel, i.e. the element of the lesion is slightly concave, and the edges of the erosion gradually pass to the intact surface of the tooth crown. This form of enamel damage is due to the fact that the dentin of the central part of the crown is erased faster, since it is limited from the edges by the preserved enamel of the contact surfaces of the tooth crown.

There are two stages of the lesion: initial (enamel erosion) and severe (enamel and dentine erosion).

According to the depth of the lesion, three degrees of erosion are distinguished:

degree I, or initial, - damage to only the surface layers of enamel;

degree II, or average,- damage to the entire thickness of the enamel cover of the tooth up to the enamel-dentin junction;

degree III, or deep,- when the superficial layers of dentin are also affected.

E. V. Borovsky et al. (1978), as well as Yu. M. Maksimovsky (1981) propose to distinguish between two clinical stages of erosion - active and stabilized, although in general any erosion of enamel and dentin is characterized by a chronic course.

For active stage a rapidly progressive loss of hard tissues of the tooth is typical, which is accompanied by an increased sensitivity of the affected area to various kinds of external stimuli (the phenomenon of hyperesthesia).

Stabilized erosion stage characterized by a slower and more calm course. Another sign is the absence of plaque and tissue hyperesthesia. The preservation of the shiny surface of the enamel in the affected area is noted. The transition of the stabilized stage of erosion to the active one is possible.

Enamel erosion, unlike other types of abrasion, in most cases is characterized by severe pain sensations under the influence of various factors, especially cold air and chemical irritants. There are more complaints in the active stage than in the stabilized one.

Pathological anatomical picture of tooth erosion

Microscopic examination of the area with enamel erosion shows changes in the surface layer. Polarizing microscopy revealed changes in the form of a dark strip on the surface of the enamel without any changes in the subsurface layer, characteristic of caries. Electron microscopic studies established the presence of an organic film on the surface of the lesion, the loss of a clear crystalline structure of the enamel and the appearance of significant amorphous areas.

Polarizing microscopy reveals a significant difference in the nature of focal demineralization during initial caries and erosions. So, if caries in the stain stage is characterized by partial subsurface demineralization, then during erosion it is precisely the surface, as it were, layer-by-layer demineralization of the enamel.

Changes in dentin are also localized in the superficial layers of the affected area. The dentinal tubules are filled with crystalline structures, the correct orientation of the crystals is disturbed in the intertubular areas, and the size of unstructured areas is increased.

Differential diagnosis of tooth erosion

Enamel erosion should be differentiated from superficial caries and wedge-shaped defect. Erosions differ from caries in localization, the shape of the lesion, and most importantly, in their surface (with erosion it is smooth, and with caries it is rough). A wedge-shaped defect differs from erosion in the form of the lesion, localization at the neck on the border of enamel with cement, often when the root is exposed.

Treatment of dental erosion

Treatment for erosion of tooth tissues should be carried out taking into account the activity of the process and the nature of the concomitant somatic disease. In complex dental treatment, one should not forget about the general treatment, which involves the administration of calcium and phosphorus preparations by mouth with a decrease in their level in the blood of patients. Vitamins alone or in combination with trace elements are also useful.

Treatment for a stabilized stage of tooth erosion, which is often accompanied by a change in the color of the enamel in the affected area, should consist of several procedures aimed at tissue depigmentation. For this purpose, it is necessary to treat the affected surface with an abrasive paste, also containing up to 1.23% fluorine, for two or three visits. In the next two visits, fluoride gel or fluorine varnish should be applied to erosion.

In the active stage of the disease, the task is to stabilize the pathological process. This can be achieved with additional mineralization of hard dental tissues by application or calcium electrophoresis. To replenish tooth tissues with calcium and phosphorus salts, patients with erosions of hard tooth tissues are prescribed 3-4 daily (or every other day) applications of the paste with a procedure duration of 15-20 minutes. In the next three visits, an acidified fluorine gel in a 0.1 M solution of phosphoric acid is applied to the erosion area for 2-3 minutes. The treatment is completed by coating the affected surface with fluoride varnish. If several teeth are affected by erosion, it is more convenient to apply fluoride gel using an individually made spoon, and in case of single lesions, you can use a soft brush. Also, in case of erosion of hard dental tissues, it is proposed to use a 10% solution of calcium gluconate and a 2% solution of sodium fluoride for the purpose of remineralization. With the application method, the number of visits is 15-20. For remineralization of hard tissues, a two-component remineralizing solution consisting of 10% solutions of calcium nitrate and ammonium acid phosphate can be recommended.

Electrophoresis of a 10% solution of calcium gluconate on the area of ​​erosion is carried out after isolation of the teeth from saliva, release from plaque and drying of the tooth crown. The active electrode is placed in place of erosion, and the passive electrode is clamped in the hand. When carrying out this procedure, you can also use an apparatus for electric pain relief (ELOS-1) with a current value in the range of 30-50 μA and a duration of the Procedure of 5-10 minutes. After electrophoresis, a swab moistened with a 2% solution of sodium fluoride should be applied to the area of ​​erosion for 2-3 minutes. The course of treatment of erosion by electrophoresis is 10-15 procedures.

According to Yu. M. Maksimovsky (1981), dental filling in case of erosion is often ineffective due to the often occurring violation of the marginal fit of seals and the formation of a defect around the filling. In this regard, it is recommended to carry out remineralizing therapy according to one of the above methods before filling the erosion. Composite materials should be used as filling materials. With a significant area affected by erosion of the tooth crown, it is more advisable to manufacture an artificial crown.

The destruction and loss of hard tissues of the teeth is called "erosion". Most often, the disease manifests itself on the central and lateral incisors of the upper jaw. The disease looks like an enamel defect with a smooth, even bottom.

Causes and etiology of enamel erosion

The problem of erosion is still unresolved. Under the action of acids, demineralization occurs and, as a result, a decrease in hard tissues of the teeth. Most often, the occurrence of erosion refers to the following factors:

• mechanical impact: teeth grinding, use of a brush with hard bristles, etc.;
• excessive consumption of citrus fruits and other foods rich in acids;
• the use of drinks with high sugar content and acidity: energy drinks, sweet soda, tea, juices;
• a consequence of taking medications;
• endocrine disorders also lead to signs of erosion. So, hyperfunction of the thyroid gland is accompanied by increased viscosity of saliva, which leads to the destruction of dental tissues;
• age-related changes, although there is an opinion that with age, on the contrary, the enamel becomes stronger in relation to the influence of the external environment.

Acid can come not only from the outside, but also from the body itself. This process is called reflux and is characterized by the release of gastric juice or vomiting. Sometimes this happens within the normal range, but the frequent manifestation of reflux leads to a violation of the integrity of the tooth enamel.

Forms and degrees of dental erosion

According to the rate of destruction, the active and stabilized stages of erosion are distinguished. In the first case, the surface is quickly erased and high sensitivity to external stimuli appears. The stabilization stage is characterized by slow erosion growth rates and the absence of hypersensitivity.

Professor Maksimovsky singled out three degrees of damage to the hard tissues of the teeth:

• initial (physiological) - the upper layers of enamel are eroded;
• medium (transitional) - the entire enamel layer is affected;
• deep (pathological) - erosion reaches the upper layers of the dentin and is divided into 3 degrees of the depth of the lesion: I - up to 1/3 of the length of the crown, II degree - from 1/3 to 2/3 of the length of the crown, III degree - from 2/3 to the gum .

Diagnosis of damage to hard tissues of teeth

At the stage of diagnosis, the doctor collects an anamnesis, examines the lesions, and, if necessary, differential diagnosis.

The patient may complain about:

• tooth hypersensitivity;
• aesthetic inconvenience when talking or smiling;
• problems with the pronunciation of the sounds "s", "z".

It is important to distinguish erosion from a wedge-shaped defect, in which the lesion extends along the neck of the tooth, and superficial caries, which is expressed as a rough enamel lesion.

Erosion of milk teeth

In children, erosion of the hard tissues of the teeth can also occur. This is mainly due to a long stay in the child's mouth of a bottle of milk or juice, which contain a large amount of acid and sugar. Children should have regular oral hygiene procedures and, if the child cannot fall asleep without a bottle, replace its contents with water.

Erosion can occur in children with malocclusion or crowded teeth. When the first signs of the disease appear, consult a doctor to select the optimal method of treatment.

Photos "before" and "after" the treatment of erosion of tooth enamel

Treatment of tooth enamel erosion

The main methods of treatment of increased abrasion of teeth can be called therapeutic and orthopedic.

Therapeutic include:

• medical method based on the use of drugs and pastes;
• restoration method associated with the restoration of the enamel surface with filling material.

At a stabilized stage, procedures are carried out to depigment the affected tissues.

The orthopedic method consists in restoring teeth with the help of prostheses, onlays or crowns.

In the complex, preparations containing phosphorus and calcium, multivitamin complexes are prescribed. The choice of treatment method depends on the degree, speed and magnitude of tissue damage.