Non Caries Cervical Lesions (NCCL)

 NON CARIOUS CERVICAL LESIONS

    Tooth structure loss cannot be occur only by caries/cavities, Non carious cervical lesions also cause destruction of tooth substance at the cervical region [where the tooth and gum together-also called cement-enamel-junction].

Abrasion:-

      It is a non-carious cervical lesion,caused by mechanical wears of tooth from interaction with foreign [outside] objects other than tooth to tooth contact.

                                                             

Etiology:-

• Most common cause is improper brushing method.
• Excessive frequency of brushing.
• More time and force applied during brushing.
• Using hard toothbrush and abrasive toothpaste .
• Using tooth powder - Tooth powder is generally more abrasive than tooth paste.
• Biting or Chewing on fingernails, pen tips or any other hard subjects.
• Ill fitting clasps of partial dentures.[removable dentures]

Abfraction:-

     It is pathological loss of tooth substance caused by bio mechanical loading forces that result in flexure and failure of enamel and dentin at a location away from loading.

                                                           

Etiology-

• Using of excessive force on teeth while chewing or grinding.
• Habit of Bruxisum. [Involuntary grinding of teeth]. 

EROSION:-

  Loss of tooth structure due to acids originated from internal [inside body] or from external source.

Etiology:-

A] Extrinsic/External Factors:

• Environmental/Occupational :- Wine tasters, Swimmers
• Dietary :- Soft drinks, Acidic drinks, Citrus fruits, Carbonated drinks

B] Intrinsic/Internal Factors:

• Gastric disorders:
• Gastric ulcers
• Hiatus hernia
• Chronic alcoholism
• Chronic vomiting
• Pregnancy morning sickness
• Anorexia nervosa
• Bulimia nervosa

CLINICAL FEATURES OF NON CARIOUS CERVICAL LESIONS
	ABRASION	ABFRACTION	EROSION
LOCATION	Facial[outer surface]	Facial	Facial or Lingual[inner surface]
SHAPE	Wedged, Notched or Grooved	Wedge shape	Shallow “U” or disc shape
MARGINS	Sharp	Sharp	Smooth
ENAMEL SURFACE	Smooth, may show scratches	Initials stages: Rough, later may develop grooves	Smooth, may be polished
TEETH AFFECTED	Many teeth involve, usually facial [outer side of tooth] surfaces of maxillary [upper jaw] left canine to molar teeth in right hand person and vice versa.	Single toot involve, sub gingival location	Many teeth involve, usually lingual [inner side of tooth]  surface of maxillary anterior

When  to check with Dentist:

• Teeth sensitivity
• Teeth pain
• Aesthetic problem
• Deep cervical lesions which has more prone to tooth fracture
• Cervical lesions which has more prone to cavities formation
• Infected gingiva[gums] due to caries or accumulation of plaque in the affected cervical lesion

Treatment Options:

• Dentin desensitisation:-

    This treatment is recommended for those people who has very less exposure of dentin and experiences hypersensitivity. This is managed by following methods:

• Using desensitising toothpaste
• Fluoride varnish 
• Dentin-bonding agents

• Restorations:-

     If the affected area is deep/large, the lesion have prone to pulp expose, the person has more sensitivity, aesthetic problem, if caries started at the the cervical lesion, if the lesion seems to cause gingival infection

These lesions are managed by restoration. And most commonly using restorative materials are

• Composite resins
• Tooth coloured resins
• Glass inomer cement [GIC]
• Resin modified GIC and
• A combination of composite and GIC in a sandwich technique.
• Endodontic therapy:-
• When cervical lesion involves pulp exposing and leads to severe pain endodontic treatment [RCT-Root canal treatment] required. 
• The tooth fractured at cervical region is indicated for endodontic treatment followed by post placement and crown preparation. 

• Periodontal Therapy:-
• When Cervical lesions cause severe gingival infection due to more plaque accumulation at that region, sometime it leads to periodontal disease/Infection.
• Based on severity and affected area of gingiva it requires root coverage procedures using grafting and non grafting methods.