Enamel- Clinical Considerations Flashcards
What is enamel dysplasia?
Condition that affects the normal levels of ones tooth enamel
May affect formation of matrix, calcification, and maturation of enamel
Ex. Hereditary, Environmental
Enamel dysplasia due to local infection/trauma
AKA Turners Spots/Turners Tooth
Usually occurs on one tooth- max permanent incisors
Discolored enamel, yellow to brown with pitting
Caused by caries and/or trauma of deciduous teeth
Enamel dysplasia due to fluoride
Mottled enamel/ Fluorosis
Enamel is hard but may fracture easily- restorations not retained
Range of severity: questionable to severe with faint white spots up to brown/black spots w/ severe pitting
Enamel dysplasia due to congenital syphilis
Pitted surface enamel
Hutchinson’s Incisors: screwdriver shape crowns with notched incisal edge
Mulberry molars: Occlusal surface resembles a mass of globules
Extrinsic stains
On outer surface pellicle, biofilm or calculus
Use selective polishing w/ low abrasive agent
Ultrasonics and air polishing
Intrinsic stains
Absorbed into enamel
Some cannot be removed w/ bleaching: fluorosis stains, tetracycline stains
Where is vital bleaching performed?
In office or OTC
Where is non-vital bleaching performed?
In office
What is the caries development process?
Biofilm + acids + susceptible surface= caries
What is an incipient lesion?
Subsurface demineralization of enamel
No restorations done at this point
Needs homecare and remin to arrest lesion
What are frank caries?
Extend into dentin
Must be restored
Visible on radiographs at DEJ
Types of frank caries
Enamel caries: pits, grooves, fissures, smooth surfaces
Recurrent caries/secondary: Around existing restorations
Arrangement of enamel rods and dentin tubules
Lead to pulp
Caries will follow the path of least resistance
Enamel spindles and lamellae
Presence of hypocalcified areas may increase caries susceptibility
May facilitate spread of caries/decay
Pre-eruptive/systemic enamel strengthening
Fluoride forms fluorapatite (stringer than hydroxyapatite)
Must be ingested at a safe level during tooth development
Post-eruptive/topical enamel strengthening
Saliva
Topical fluoride
Saliva for enamel strengthening
Contains calcium/phosphate ions which constantly remineralize enamel
Caries will ocur if demin outweighs the remin of saliva
Topical fluoride for enamel strengthening
Forms fluorapatite on surface of enamel/dentin rather than hydroxyapatite
May remin decalcified areas
May interfere with microbial acid production
What is MI paste?
Minimum intervention paste
Caesin phosphopeptide- amorphous calcium phosphate- contains recaldent and binds calcium to enamel
Replaces minerals lost from enamel
Improves saliva flow
Increased fluoride uptake
Decreased sensitivity
May deminish white areas on formed enamel
What are sealants indicated for?
Caries susceptible individuals.
Seals pits/fissures/grooves on surface of enamel
Prevents food and bacterial acids from demin
