Minimal intervention Dentistry

Cervical
Lesions around the circumference of the tooth at the cervical margin are the result of either active caries or chemical erosion aggravated by mechanical abrasion from a toothbrush or similar.

Root surface lesions generally represent active caries and these lesions can move relatively rapidly because the exposed dentine contains only about one half the actual concentration of mineral ions relative to enamel.

Loss of calcium ions therefore creates more rapid and widespread damage than occurs in enamel so the operator needs to be very careful in identifying the problem before it advances too far.

The preferred treatment is remineraliseation and this is possible if the lesion is identified soon enough.		figure1		figure2

Note that these are essentially sub-surface lesions where the surface remains relatively intact particularly in the presence of fluoride applications. The fluoride ion will form fluorapatite on the surface and then will not be capable of penetrating further so there will remain a rather porous layer below.

Remineralisation with CCP-ACP is probably the most effective treatment because this provides both calcium and phosphate ions in a form capable of penetration to the depths of the lesion.

Chemical erosion is becoming relatively common because of the increase in the intake of acid food and drink. If the teeth are cleaned vigorously within the next hour or two following intake the surface 2-3 micron of collagen framework of the demineralised dentine can be readily removed.

This is likely to leave open dentine tubules, and subsequently, sensitivity to temperature change and chemical stimuli. Again, removal of the cause is the preferred treatment

Click on images to view full size.

figure1	The cervical margin of the upper right canine is hypersensitive but the lesion is not really deep enough to justify a restoration. The first bicuspid is to be crowned shortly because of the depth of the lesion and the cause of these examples of erosion should be determined to prevent a recurrence. Eliminate the cause and the lesion on the canine need not be restored.
figure2	There are early signs of root surface caries at the cervical of the upper right canine. There is no great depth in the lesion and as long as the cause can be determined and eliminated it may be possible to simply polish and remineralise the lesion to prevent further plaque accumulation and the carious process will cease.
figure3	This elderly patient presented with a modified salivary flow and rampant caries. The lesions at the cervical of the two lower centrals were classified Site 3, Size 1 and restored with glass ionomer. The lesions on the lateral and canine were regarded as Size 0. The patient was treated with chlorhexidine and topical fluoride and his medication was modified to restore the salivary flow. He was kept under careful observation..
figure4	The same patient as shown in Figure 3 five years after treatment was commenced. The lateral and canine show little change at this time but treatment had to continue with frequent recalls.

Top^