Topicality.

Date: 2015-10-07; view: 448.

Non- carious lesions of the hard dental tissues in children: hypoplasia, fluorosis. Etiology, clinical picture, diagnostics, differential diagnostics, treatment, prevention.

Non-carious dental disease of the solid tissues in children are not numerous but various by its clinical manifestations and origin. The majority of the diseases isn't studied well enough and this complicates their diagnosing and treatment.

Aims: To master the methods of diagnosis, differential diagnosis and treatment of the diseases of hard dental tissues of non-carious origin.

Study material:

Non- carious lesiona of the teeth hard tissues are divided into two groups: (Ju. Fiodorov 1995):

I. Lesions that appeared during the follicular tooth development, before their eruption:

1. Enamel hypoplasia;

2. Enamel hyperplasia;

3. Teeth fluorosis;

4. Congenital defects of teeth tissue development;

5. Drug and toxical defects of teeth development.

II.Dental lesions that appeared after their eruption:

1. Abrasion of hard dental tissues;

2. Wedge-like defects;

3. Dental erosion;

4. Drug and toxical effect onto the hard dental tissues;

5.Traumatic dental injuries;

6. Necrosis of hard dental tissues;

Enamel hypoplasia – is a disordered development of dental enamel which is characterized by its insufficient formation and mineralization resulting from the disordered ameloblast functioning. This may result from disordered metabolism in the child's body under the action of various diseases or after impaired metabolism in certain follicles under the mechanical trauma, infection action. According to the cause, the lesions may appear in the teeth which are formed during one period – the systemic hypoplasia, in some closely located teeth – the focal hypoplasia, on one tooth- local hypoplasia.

Hypoplasia is met on both permanent and temporary teeth, though it is rare on the temporary teeth.

According to the clinical manifestations, there are three forms of a systemic hypoplasia:

1) Changed enamel color - on the vestibular surface on the vestibular surface of symmetrical teeth, they are symmetrical, we can detect them as multi-shaped white stains, opalescent, they aren't colored with a methylene blue and during life their size, color and shape aren't changed.

2) Insufficient enamel development – clinically it is manifested as spots, waves and sulci.

3) Aplasia – absolute absence of enamel.

Focal hypoplasia. This pathology occurs rarely and develops after a trauma or malformation of the facial- maxillary area in children with disordered development of some closely located teeth, both permanent and temporary.

The crowns of these teeth are decreased in size for the insufficient enamel development, they are yellowish and have rough surface.

Local enamel hypoplasia is characterized by the impaired development of one, or rarely two teeth. The cause of its appearance is mechanical trauma of a developing follicle or an inflammatory process in it under the action of infection from the chronic periodontitis of a purulent tooth.

The mechanical trauma and inflammation affect enameloblast functioning, and this leads to formation of stains on the enamel ( ranging in color from grey to yellow- brown) with distinct or vague contours.

The local hypoplasia isn't observed on the temporary teeth.

The treatment of hypoplasia of the enamel depends on the degree of hypoplasia severity. The stain hypoplasia may be left untreated or we may apply preparation and sealing with the composite materials. For treatment of the stain and sulcus hypoplasia we use the restorative technique, for the enamel aplasia- prosthetic crowns. It is recommended to perform the remineralizing therapy after commonly accepted methods to prevent caries at all forms of the enamel hypoplasia.

Fluorosis of the teeth.

Fluorosis is a kind of the enamel hypoplasia which develops after excessive supplying with fluorine ions into the child's body ( first of all, with drinking water). The excessive fluorine inhibits functioning of ameloblasts and alkaline phosphatase during intra-mandibular formation and mineralization of the teeth.

The optimum concentration of fluorine in drinking water makes 0,8-1,2 mg/l.

Increased concentration of fluorine in the drinking water up to 2mg/l and higher than this lead to fluorosis and its severe development. Fluorosis affects permanent teeth in children who live in endemic areas or who have lived since their early childhood, when the permanent teeth were on stage of intramandibular development.

Clinical forms of fluorosis:

1. stroke;

2. stain;

3. chalk- spotty;

4. erosive;

5. detructive .

The differential diagnosis of non-carious lesions is to be performed with the enamel hypoplasia and acute initial caries.