A lesion on a tooth refers to an area of damage or abnormality. These dental issues are common and vary in nature and extent, from minor surface changes to more extensive damage that penetrates deeper into the tooth.
Understanding Tooth Lesions
A tooth lesion is an alteration in the tooth’s structure, often beginning with the outermost enamel layer. One prevalent type is dental caries, commonly known as a cavity, characterized by localized destruction of tooth tissue. This occurs due to acids from plaque bacteria, which demineralize enamel and dentin.
Another category includes non-carious cervical lesions (NCLs) near the gum line, not caused by bacterial acid. These manifest as abrasion (mechanical wear like aggressive brushing), erosion (chemical dissolution from dietary or gastric acids), or abfraction (loss of tooth structure at the gum line due to excessive biting forces leading to tooth flexure). Early signs like white spot lesions represent subsurface enamel demineralization before cavity formation.
Lesions are classified as active (currently losing mineral, appearing softer or discolored) or arrested (stable, no longer losing structure, appearing harder and darker). This distinction guides treatment, as arrested lesions may only require monitoring.
Common Causes and Warning Signs
Dental caries primarily arise from the interaction of specific bacteria, fermentable carbohydrates, and a susceptible tooth surface over time. Streptococcus mutans and Lactobacillus species are key bacteria that metabolize sugars from food and drinks, producing acids that dissolve the tooth enamel. Frequent consumption of sugary or acidic foods and drinks, combined with inadequate oral hygiene, creates an environment conducive to this demineralization process. This continuous acid attack can lead to the formation of small pits or holes in the tooth surface.
Non-carious cervical lesions stem from different origins. Abrasion is often linked to improper or overly vigorous tooth brushing techniques, particularly with hard-bristled toothbrushes, which physically wear away tooth structure. Erosion results from exposure to non-bacterial acids, such as those found in acidic beverages like sodas and fruit juices, or from gastric acids due to conditions like acid reflux or bulimia. Abfraction is thought to be caused by sustained or repetitive occlusal stresses, where the bending of the tooth under chewing forces leads to microscopic fractures and loss of tooth material at the gum line.
Recognizing the warning signs of a tooth lesion is important for timely intervention. Common symptoms include increased tooth sensitivity to hot, cold, or sweet stimuli, which may indicate that the lesion has reached the dentin layer. Pain when chewing or biting down can signal a deeper lesion or one affecting the tooth’s pulp. Visible changes like brown or black spots, white chalky areas, or a noticeable hole in the tooth surface are direct indicators. Sometimes, a rough spot that catches floss or feels uneven to the tongue can also be an early sign.
Diagnosis and Treatment Options
Diagnosis
Dental professionals employ several methods to accurately diagnose tooth lesions, beginning with a thorough visual examination of the tooth surfaces. They use a dental explorer, a small instrument, to gently probe for soft spots or irregularities on the enamel, indicating demineralization or cavitation. Radiographs, commonly known as X-rays, are routinely used to detect lesions between teeth or beneath existing fillings that are not visible during a clinical examination. These images can reveal the extent of decay within the tooth structure. Transillumination, which involves shining a bright light through the tooth, can also help identify cracks or carious lesions by making them appear as shadows.
Treatment Approaches
Once a lesion is identified, the treatment approach is tailored to its type, size, and activity. For early-stage white spot lesions, fluoride application (varnish or gel) promotes remineralization and can reverse demineralization. This non-invasive approach helps strengthen the enamel and prevent further progression.
If a cavity has formed, restorative treatments are performed. Small to medium-sized cavities are treated with dental fillings. The decayed portion is removed and filled with materials like composite resin, amalgam, or glass ionomer. Composite resin fillings are tooth-colored and bond directly to the tooth, while amalgam fillings are durable and silver-colored. For more extensive damage, a dental crown may be necessary to cover and protect the entire tooth.
Non-carious cervical lesions require addressing the underlying cause alongside restorative treatment. For abrasion, modifying brushing techniques is advised. Erosion management involves dietary changes and, if medically related, addressing conditions like acid reflux. Abfraction may necessitate adjusting occlusal forces, possibly through orthodontic treatment or nightguards. Dental bonding with composite resin can be used to restore lost tooth structure in NCLs, improving both function and appearance.
Preventing Tooth Lesions
Preventing tooth lesions centers on consistent oral hygiene practices. Brushing teeth twice daily for at least two minutes with a fluoride toothpaste effectively removes plaque and food debris, thereby reducing the production of acids by bacteria. Flossing daily is equally important, as it cleans between teeth and below the gum line where toothbrushes cannot reach, disrupting plaque accumulation in these susceptible areas.
Dietary choices play a substantial role in preventing lesions, particularly dental caries and erosion. Limiting the consumption of sugary foods and drinks, such as candies, pastries, and sodas, reduces the readily available fuel for acid-producing bacteria. Reducing the intake of acidic beverages and foods, like citrus fruits and vinegar-based dressings, minimizes the direct acidic attack on tooth enamel, thereby helping to prevent erosive wear. Rinsing the mouth with water after consuming acidic items can also help neutralize acids.
Fluoride strengthens tooth enamel and makes it more resistant to acid attacks. In addition to fluoride toothpaste, many community water supplies are fluoridated, providing a continuous low level of fluoride exposure that benefits tooth health. Professional fluoride applications during dental check-ups offer a higher concentration of fluoride, providing additional protection, especially for individuals at higher risk of developing lesions.
Dental sealants offer an effective preventive measure, particularly for children and adolescents. These thin, protective coatings are applied to the chewing surfaces of back teeth, where pits and grooves can easily trap food particles and bacteria. By sealing these vulnerable areas, sealants create a smooth surface that is easier to clean and less prone to decay. Regular dental check-ups and professional cleanings are also important, allowing dentists to identify and address early signs of lesions before they progress, and to remove hardened plaque (calculus) that brushing alone cannot remove.