Minimal intervention Dentistry

To access case histories for the treatment of each type of lesion click on the 'Back to Grid' button at the top of this page.

There are several different causes for lesions in the gingival one third of the crown of a tooth and, as suggested above, treatment should always commence with removal of the cause.

Rampant caries is the logical reason for active lesions on the buccal surfaces in particular. With normal reasonable oral hygiene procedures such lesions are unlikely but modifications to salivary flow can leave a patient very susceptible. This means that the development of active lesions on the buccal or lingual surfaces should be regarded as a signal for deeper investigations into the state of the patient’s general and oral health.

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Root surface caries is a specific problem generally noted in the aging patient whose epithelial attachment has migrated some distance and exposed the dentine of the root. As the dentine contains only about one half of the mineral content of the enamel it is far more susceptible to demineralisation and the damage is more difficult to identify. There will be no specific limited area with a loss of translucency such as seen in the enamel and the lesion will often be hidden away in interproximal areas of difficult access. Again modification of the saliva flow will often be associated with these lesions and the patient’s pharmaceutical requirements should be investigated.
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Finally, a very common cause of cervical problems now is chemical followed by mechanical erosion of both coronal enamel and root dentine. This will lead to hypersensitivity of the dentine because of the open demineralised tubules and this in turn may interfere with regular hygiene routines.

There are many topical applications available to overcome the problem but the best cure is to educate the patient to remove the cause. The cause is often frequent ingestion of food or drink with a low pH which will lead to surface demineralisation. If this is followed immediately by vigorous cleaning the exposed collagen fibres will be destroyed and remineralisation will no longer be possible.

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