Wedge defect

Often, on the front surface of the dentition units (mainly fangs and premolars), you can find a kind of deepening near the gums in the form of the letter V. This is a wedge-shaped tooth defect, a violation in hard tissues that brings both aesthetic and physiological discomfort. Is it necessary to treat a wedge-shaped defect, and how to remove it quickly, without complications and with minimal losses (both psychological and material)? The answers to these and other popular questions are further in the article.

Why does pathology arise

The disease refers to non-carious lesions, since it is caused not by cariogenic bacteria, but by a number of other factors. And experts for a long time could not come to a consensus on the causes of this pathology. However, over time, it was found that the main causes of a wedge-shaped defect lie immediately in several provoking circumstances - abrasive (most frequent), abrasive and erosive. Based on these reasons, classification is carried out, and treatment is also prescribed. You must agree that the words are incomprehensible to a simple layman, so we will consider these points in the next section of the article.

Good to know! The cause can also be general diseases of the body, especially those associated with disruption of the endocrine system, digestive tract, calcium metabolism, and the production of sex hormones.

Classification according to the causes of the disease

Wedge-shaped defects of tooth enamel are classified depending on provoking factors. We suggest that you familiarize yourself with them in the table.

Type of violationCauses and features of pathology
Abfraction (translation - "breaking off")
  • violation of the relationship between the dentition: leading to excessive load on certain units,
  • pathology of the bite (including deep bite),
  • excessive pressure of the tongue on the row from the inside: if the patient has a small oral cavity, a narrow jaw bone,
  • masticatory hypertonicity: leading to excessive jaw compression,
  • bruxism
Abrasive (enamel is essentially erased)
  • frequent use of whitening pastes with a high degree of abrasion (above 100 RDA),
  • excessively hard toothbrush
  • horizontal cleaning
Erosive (erosion formed)
  • arises under the influence of acids: the source of which may be food, drinks (fruit juices, wine),
  • gastric juice: discharged into the oral cavity with gastrointestinal pathologies,
  • lack of saliva enzymes,
  • cigarettes: the effects of toxins and the heat of smoke drying enamel

It's important to know! Most often, pathology develops under the influence of a complex of causes. For example, when after cleaning with a very stiff brush in a horizontal direction or with a paste with high abrasion, a person eats citrus fruits or apples. If there are problems with bite and hormonal disorders, then the structure of hard tissues changes, and it is possible to predict with certainty the formation of pathology in the future.

Stages of the disease and their features

A disease such as a wedge-shaped tooth defect develops in four stages - from mild and invisible forms to pronounced manifestations in the last stages. Let us dwell on them in more detail.

StageFeatures of the pathology
InitialDamage to the enamel layer is detected only with strong magnification with a special device
SurfaceVisually, the pathology looks like a shallow crack on enamel up to 3 mm long and up to 0.2 mm thick. Accompanied by a feeling of soreness and increased sensitivity of enamel
AverageDamage increases to 4 mm in length, penetrating deep into the tissues, reaching approximately 0.3 mm. Two planes are clearly visible, which deepen in the form of a wedge, the sides of which converge at an angle of about 45 °. There may be a slight decrease in the gums.
DeepDestruction extends to the dentin layer, and with a severely neglected version, to the tooth cavity (pulp bundle). The anomaly acquires a pronounced yellow or brown color (as the dentin layer is several tones darker than enamel). The gum rises noticeably, which makes the pathology very noticeable from the side. If untreated, the last stage, as a rule, leads to the destruction of the crown of units of the dentition

Interesting fact! The disease has a pronounced prevalence of 1 by age. So, in children and adolescents it is diagnosed in only 0.5-2% of cases, in people over 20 years old - in 15% of cases, and in patients over 55 years old - in 38% of cases. Moreover, stage 1 and 2 are more often diagnosed in patients younger than 40 years, and stages 3 and 4 affect mainly people over 45 years old.

What are the symptoms of the disease?

The wedge-shaped defect of tooth enamel is characterized by the following symptoms:

  • hypersensitivity of the damaged unit of the dentition to external influences: “reacts” with short-term aching pain to temperature factors, sweet or sour food, mechanical stress,
  • the presence of a V-shaped recess in the enamel,
  • enamel color change: at the beginning of the disease, it has a normal shade, subsequently loses its shine, darkens,
  • gum loss
  • the lesion is usually present at once on several teeth in a row: moreover, the deeper the stage, the greater the number of elements “suffering”.

Good to know! Painful and uncomfortable sensations depend on the individual sensitivity of a person, the characteristics of his nervous system (conduction of nerve impulses), the structure of enamel, and so on. Therefore, in some patients with a wedge-shaped defect, the tooth hurts without any effect, and in some cases the disease can proceed without pronounced symptoms.

How is the diagnosis

Diagnosis of a wedge-shaped defect of the neck of the tooth is carried out by the dentist by examining, conducting tests for temperature sensitivity, hygiene of the dentition, the presence of mineral deposits and bacterial plaque. Without fail, the doctor pays attention to the bite, revealing a violation of occlusion. Pathology is differentiated from cervical or interdental caries (using caries indicators or a laser), enamel erosion. If necessary, the patient is referred to other specialists, for example, an endocrinologist, neurologist or gastroenterologist.

Methods for treating the disease

How a wedge-shaped defect is treated, whether it is necessary to fill in or a different method is required depends on the cause of the development of the pathology and the degree of tissue damage. Of course, the goal of therapeutic measures is to restore the integrity of the unit of the dentition, however, first of all, it is necessary to find out and eliminate the cause of damage to the enamel (especially the case of multiple defects).

1. General therapeutic treatment

General therapeutic treatment of a wedge-shaped tooth defect can be carried out using the following methods:

  • calculus removal and Air-Flow cleaning,
  • enamel remineralization: using applications of medicines with fluorine or calcium, which reduce the sensitivity of the enamel layer and make it stronger, as well as prevent further destruction,
  • physiotherapeutic effect: laser, electrophoresis,
  • filling of the defect: with the use of fluid and microfilic composites, glass-ionomer cements (SIC),
  • the appointment of calcium-containing preparations, vitamin and mineral complexes,
  • teaching the patient the skills of using a toothbrush, counseling and recommendations on the choice of toothpaste.

“If the recess is not large, the filling may not be used, and the emphasis is on strengthening the strength of the enamel layer by fluoridation and remineralization both in the clinic and at home. An exception is the rapid progression of pathology. In this case, a liquid composite is used to restore the wedge-shaped defect. With a significant amount of pathology, the dentist seals the flaw with glass ionomer cement, microfilm composite or uses the sandwich technique, according to which both materials are used to restore the shape of the unit ”- comments expert, dentist Orlova Elena Vladimirovna.

2. Orthodontic treatment

If the cause of the disease is an incorrect bite, the patient is sent to the orthodontist to establish braces. Only the use of orthodontic systems can stop the destructive process in the future. Braces are selected individually based on pathology. It is important that the doctor has experience working with similar problems, as accurately as possible took the impression and correctly installed the system.

Read on: what age is best for installing bracket systems - is it necessary to be a teenager in order to correct a bite?

3. Orthopedic treatment

In the presence of multiple wedge-shaped defects (on the front teeth, fangs, premolars), severe destruction of their crowns, the risk of enamel cleavage, and in other cases, orthopedic treatment of pathology is indicated. It is carried out using veneers or crowns. Before treating the wedge-shaped effect with prosthetics, the doctor carries out strengthening procedures (fluoridation, remineralization), if necessary, establishes a seal, eliminates caries. An important step is the grinding of certain areas of enamel, necessary to eliminate abnormal contacts when closed.

4. Surgery

Pathology is often accompanied by prolapse of the gum tissue, exposure of the neck and even the root of the tooth. With this development of events, surgical intervention is required - with the help of patchwork technique the doctor raises the gum to a normal level. The operation is performed using optical instruments (microscope) after filling under local anesthesia.

The result before and after the treatment of a wedge-shaped tooth defect, accompanied by a gum recession, can be seen in the photo.

Untreated complications

The longer the destructive process develops, the stronger the sensitivity of the enamel layer will manifest itself: pain and discomfort will bother more often and more acutely. If at the initial stages of the development of the disease, the tissues reacted, for example, to mechanical action under strong pressure, then in the future even breathing can provoke such a reaction.

In the absence of treatment, the destructive process penetrates deep into the tooth, and also spreads to the surrounding soft and hard tissues. Negative consequences may be:

  • pulpitis,
  • gingivitis, periodontitis,
  • periodontitis and cysts,
  • neck fracture
  • complete destruction of the crown.

“I was very afraid to go to the dentist when they discovered a wedge-shaped defect. Often rinsed her mouth with herbal solutions, well, and other means. As a result, the tooth broke, the spine remained, which then had to be removed ... In addition, malocclusion was revealed. I would go right away, and possibly save it ... ”

Elena R., from a message from the dental forum stomatologclub.ru

Preventive measures and prognosis of the disease

To prevent a wedge-shaped tooth defect, you must adhere to the following recommendations:

  • consult a specialist in time to correct the bite,
  • to clean the dentition in a vertical direction with scrubbing movements,
  • avoid the use of whitening highly abrasive pastes for cleaning: especially without first consulting a doctor,
  • monitor your diet: limiting foods and drinks with a high acid content,
  • timely detect and treat diseases of the gastrointestinal tract, endocrine system

The prognosis of treatment depends on the timeliness of a visit to a doctor, on the quality of the procedures performed, the elimination of the causes of pathology and other factors. Unfortunately, not all dentists guarantee a complete solution to the problem forever. For example, very often a composite seal installed over time shrinks / cracks, falls out and requires replacement, and prosthetics of damaged units do not protect neighboring ones. Therefore, treatment is recommended to be carried out in a comprehensive manner - first establish the true cause of the pathology and eliminate it, then perform a filling according to the “sandwich technique”, and then install a prosthesis (veneers or crowns).

Traditional medicine

Treatment of a wedge-shaped tooth defect with folk remedies is used as an additional method. In no case can it eliminate the already visible changes in the enamel, but it helps to strengthen the gum tissue, reduce the sensitivity of the enamel layer, prevent the inflammatory process, and reduce the acidity of saliva. To do this, rinse with various solutions, decoctions and water infusions based on propolis, calendula, chamomile, oak, salt flowers.

What toothpastes can I use

In order to avoid further tooth decay and the occurrence of a wedge-shaped defect in neighboring ones, special attention should be paid to the choice of toothpaste. It should not contain bleaching and other aggressive substances, have an abrasion index (RDA) of no more than 80. For permanent use, toothpastes such as: Forest Balm, PresiDENT sensitive, LACALUT sensitive, SENSODINE F and others are suitable. To restore the mineral composition of enamel at home with a wedge-shaped tooth defect, the doctor may recommend special remineralizing gels, for example, of R.O.C.S.

How much is the treatment

The price for the treatment of a wedge-shaped tooth defect consists of many factors:

  • degree of tissue damage,
  • treatment method and cost of consumables,
  • necessary diagnostic procedures
  • features of the anatomy of the dentition, tissue properties,
  • possible detection of additional problems with teeth during therapy,
  • clinic pricing policy,
  • doctor qualifications.

Therefore, not a single doctor can name the full cost of treating a pathology. However, if we consider the price of some manipulations, we can say that filling 1 tooth will cost 2000-3500 rubles (depending on the depth of the cavity), installing a metal-ceramic crown costs 10-12 thousand, and you can put veneer for 15-17 thousand.

Which doctor should I contact

If there are signs of a wedge-shaped tooth defect, you must first contact a dentist (if the pathology occurs in children, then a pediatric dentist). In the process of diagnosis, clarification of the cause and treatment, the doctor, if necessary, will write out a referral for consultation of other specialists: an orthodontist, orthopedic dentist, gastroenterologist and others.

Thus, the treatment of pathology must be carried out comprehensively, taking into account all possible causes and features.

  1. Sjomchenko IM, Prevalence and localization of wedge-shaped defects of teeth / Sjomchenko IM, Pavlyushchik L.A. // Stomatol. journal - 2001. - No. 2. - S. 48–49.

I have already been filled with a wedge-shaped defect on the same tooth three times (((The seal falls out! What should I do? I live in the countryside, I often have no opportunity to go to the city to see a doctor.

Hello, Alexander. Failure of the filling may be due to insufficient quality of diagnosis (violations of occlusion were not detected if any), poor-quality filling materials, non-compliance with the rules of brushing your teeth, and so on. You need to undergo a full examination by a therapist, and possibly contact another dentist.

Clinical manifestations

In the initial stage, pathology is weakly visually manifested, but greater sensitivity to cold, heat, sweets, toothbrush touches, and other irritants may appear.Defects are localized in the cervical region of the tooth, initially they have the form of a gap, and then V-shaped or wedge shape (where their name comes from). All teeth can be affected, but more often fangs, premolars and molars. Single defects rarely occur, as a rule, they appear symmetrically on the teeth of the same name. There are four clinical stages of the disease, passing from initial to deep, which are characterized by different depths of the defect from 0.1 mm to 5 mm or more. : 115
In the next stage, the defect may increase to 3.5 mm, and the neck of the teeth will become even more sensitive. With severe lesions, a wedge-shaped defect (up to 5 mm) affects the deepest layers of dentin, sometimes the lesions reach the pulp chamber, and even with a light load, the crown of the tooth may break off. And only due to deposition in the form of replacement dentin does not open the pulp chamber, and the sensitivity to stimuli can also be absent or significantly dulled.

There are differences in the terminology of the wedge-shaped defect, especially in foreign literature. So, for its designation, the following terms are used: non-carious cervical defect, cervical defect of unspecified etiology, cervical erosion, cervical abrasion, abrasion of the cervical region, abrasive wear of the teeth in the cervical region, depletion-abfraction, abrasion abfraction, corrosion-abfraction, stress corrosion, cracking or breaking off (to break away). An extensive list of names reflecting different variants of pathogenesis, but defining the same defect in the hard tissues of teeth, indicates the ambiguity of the opinion of scientists on the etiopathogenesis of the disease. : 56

Etiopathogenesis

The main reason for the occurrence of such defects has not yet been clarified. But most experts are inclined to the version of mechanical impact, often a toothbrush. It is believed that hard bristled toothbrushes and improper horizontal toothbrushing will erase hard tooth tissues. Fangs and premolars protruding in the dentition most often suffer from pathology of the wedge-shaped defect. Another fact confirming the theory of damage with a toothbrush is a defect that occurs on the left side of the right-handed people and on the right side of the left-handed person.

Poor oral hygiene. The presence of soft plaque and dental deposits in the cervical areas leads to demineralization of tooth enamel, i.e. loss of enamel minerals - primarily calcium. This is due to the fact that cariogenic microflora in the composition of soft plaque and tartar (especially in the presence of food residues in the oral cavity after eating) begins to actively release organic acids. These acids come in contact with the tooth surface and dissolve it, gradually washing out calcium from it. Weakened enamel is very sensitive to mechanical stress, such as improper brushing techniques.

Additional factors that affect the appearance of pathology are gum recession and periodontitis. In such cases, when the gums fall or rise, the necks of the teeth are exposed, and they, in turn, are quite sensitive to factors that cause wedge-shaped defects.

The relationship of such defects with a number of somatic diseases and some diseases of the human psyche, such as neurosis, depression, schizophrenia, etc., has also been noticed.

A systematic approach to justifying the etiopathogenesis of non-carious dental lesions in general (erosion, wedge-shaped defects, pathological abrasion and hyperesthesia), their further development, as well as a complete algorithm for examining and treating patients was first introduced by G.E. Solovyova-Savoyarova in the dissertation “Non-carious lesions of the teeth as markers of hormonal-metabolic disorders in women” (2006-2009), and then in the specialized monograph “Estrogens and non-carious lesions of the teeth” (2012). Recent studies by Russian scientists and doctors indicate that the most important role in the pathogenesis of non-carious dental lesions in women is played by systemic hormonal-metabolic disorders, and in the first place, a decrease in the basal level of estradiol in the blood. : 53-54.
At women with non-carious lesions of the teeth revealed a low content of ionized calcium and magnesium in the blood, an increase in biochemical markers of bone resorption, a decrease in the mineral density of bone tissue (according to densitometry). : 152 A low concentration of estrogen in the blood is the leading pathogenetic cause of erosion, wedge-shaped defects, and pathological tooth abrasion in women. At the same time, women with this pathology are at risk of developing osteoporosis. It is because of this themselves non-carious lesions of the teeth (erosion, wedge-shaped defects, pathological abrasion) are considered early markers, “alarms” of the formation of osteopenia and osteoporosis. : 131

Treatment

A wedge-shaped defect is treated in the early stages. In advanced cases, specialists can offer only one option - prosthetics. At the beginning of treatment, the cause of the appearance of a wedge-shaped defect is primarily eliminated. The doctor teaches the patient the rules of proper brushing, selects a toothbrush with an optimal level of bristle stiffness, and the patient must comply with all the recommendations and instructions of the doctor to achieve a positive result. Further, remineralizing therapy can be performed. Then, depending on the degree of tooth damage, the defect is closed with a veneer, a crown or a composite material. Since the wedge-shaped defect has a multifactorial etiology, before proceeding with its treatment, it is necessary to identify the causes that are most responsible for the occurrence of this lesion. Another important point is the severity of the disease at present. The patient’s complaints (or lack thereof) and the level of anxiety regarding the future state of the tooth is the third necessary condition for choosing the optimal individual treatment method.

Wedge-shaped tooth defect: causes

I must say that the term "wedge-shaped defect" exists as a separate disease only in Russian medicine, and describes only the geometric shape of tooth damage. Abroad, to classify such non-carious defects, terms are used that imply the causes of their occurrence (for example, abfraction, abrasion, erosion).

Important : and believe me, this is not just a classification issue, but the question of why, when you treat wedge-shaped defects in Russia, then all fillings then fall out, plus the same defects also appear in other teeth. The fact is that most doctors treat wedge-shaped defects, regardless of the cause of their appearance, simply filling them. But this in most cases is not enough.

As you will see below: the wedge-shaped tooth defect causes and treatment are very interconnected, and treatment in most cases should not only consist of a trivial filling of the defect itself. There are 3 main reasons for the development of such defects.

1. Wedge-shaped defects of abfraction type -

Such wedge-shaped defects are also called abrasion defects. The root cause of the formation of wedge-shaped defects of this type is the incorrect relationship of the upper and lower teeth during their closure, which leads to the appearance of atypical types of load on the tooth. As a result of such a load, a so-called “bending stress” occurs in the cervical region of the tooth, which is accompanied by a piezoelectric effect (the essence of this process is that hydroxyappatite molecules push out calcium ions from itself, which leads to the destruction of this enamel area).

The second most important factor in the occurrence of defects of this type is tongue parafunction (strong mechanical pressure of the tongue on the inner surface of the teeth), which occurs with a small volume of the oral cavity, for example, with narrowed jaws, a deep bite, etc.

The third most important factor is the presence of bruxism, in which there is an increased tone of the masticatory muscles, leading to an increase in the duration and pressure on the teeth when they are closed. All this also leads to the appearance of atypical loads on the tooth tissue, which is accompanied by the destruction of enamel.

Important : if you do not take into account pathological occlusal interactions between the teeth by antagonists, but simply fill in the defect, then the seal will inevitably fall out. This will happen because if the wrong contacts between the teeth and the pathological load on the tooth are retained, “bending stress” will remain in the area of ​​the tooth neck, which will lead to the destruction of the joint / tooth and the tooth to fall out.

2. Wedge-shaped defects of an abrasive nature -

A wedge-shaped defect of this type occurs in response to the impact of abrasive materials on the tooth. First of all, it should be said about toothpastes (especially whitening), which have a very high coefficient of abrasiveness RDA. Normally, adult toothpaste should have an RDA of 60-70 units, but most whitening toothpastes have significantly higher abrasion ratios.

Secondly, the reasons may be brushes with too stiff bristles (medium recommended), as well as improper brushing techniques. In no case should you make horizontal movements with a toothbrush on the front surface of the teeth, brush movements should only be sweeping.

3. Wedge-shaped defects of erosive nature -

In this case, chemical factors — acids that are found in foods, fruits and juices, and wine — lead to the formation of defects. Very often, wedge-shaped defects are formed in patients with gastritis and heartburn, because they constantly have partial ingestion of gastric juice in the oral cavity. Also often, such defects are formed in people working in chemical industries (24stoma.ru).

It is very important to know that after consuming acidic drinks and foods it is undesirable to brush your teeth during the first hour (you can floss). The fact is that acid leaches calcium enamel from the surface layer, making the enamel porous and less resistant to mechanical stress. It is necessary to wait about an hour until the enamel is partially remineralized by absorption of calcium ions contained in saliva.

Summary : I must say that most wedge-shaped defects are formed precisely due to the process of abfraction (i.e. as a result of malocclusion, parafunction of the tongue or bruxism). However, it must be borne in mind that several factors can influence at once. For example, as soon as you damage the enamel with highly abrasive whitening pastes, the acid factor immediately completes the job (and vice versa).

In addition to the main, there are also predisposing factors -

  • poor oral hygiene
  • the presence of soft and hard dental deposits,
  • the presence of gingivitis or periodontitis,
  • thyroid disease
  • diseases of the central nervous system.

Wedge-shaped tooth defect: treatment

If you or your dentist found a wedge-shaped tooth defect in you - the treatment will certainly consist primarily in restoring the integrity of the tooth. However, if you carefully read about the reasons for the development of such defects, then you will immediately realize that this alone is not enough. First of all, it is necessary to exclude the cause of the appearance of the defect associated with improper contacts between the upper and lower teeth.

If you have several wedge-shaped defects (which indicates a large amount of problems), then it is best to visit a good orthopedic dentist, as only these doctors can qualitatively make selective grinding of teeth and normalize contacts between them. In addition, it is the orthopedic dentist (prosthetist) who will help you eliminate other causes of the development of wedge defects, for example, with tongue parafunction and bruxism.

As for the wedge-shaped defects of the abrasive and erosive types, in these cases the patient is selected with hygiene products, they are taught the correct technique for brushing their teeth, they help determine the diet, and if necessary, they are prescribed for consultation with an endocrinologist and gastroenterologist. Ideally, only after all this they begin to restore the integrity of the tooth.

In the treatment of wedge-shaped defects, methods are used

  • filling of a wedge-shaped defect,
  • grinding contacts of teeth-antagonists,
  • fluoridation and remineralizing therapy,
  • sometimes orthodontic treatment.

Wedge-shaped tooth defects - why enamel is destroyed and how to stop this process

A wedge-shaped tooth defect is a common pathology, which, unfortunately, more and more patients face every year. The symptomatology of the disease is visually similar to the manifestations of cervical caries, therefore, a thorough diagnosis is required to recognize the disease. Pathology leads to a gradual destruction of enamel, however, it often proceeds painlessly. But this is the danger, because often the patient seeks help from specialists when the disease has already passed the initial stage. Further in this article we will talk about what constitutes this dental phenomenon, about the causes of its occurrence and treatment methods.

How does it manifest

The appearance of such a defect is accompanied by the destruction of hard tissues in the area of ​​contact with the gum, due to which the neck of the tooth is gradually exposed, forming a kind of triangle - a wedge. Often this phenomenon is confused with cervical caries, and this is a big mistake, since the etiology of the disease in question is completely different. For a clearer understanding of what a wedge-shaped defect looks like on the surface of the teeth, take a look at the photo below.

Wedge-shaped tooth defects can be confused with cervical caries

Also, a wedge-shaped defect is often confused with erosive damage to tooth enamel. Despite similar visual manifestations, these diseases develop for various reasons and, accordingly, require the use of different methods to solve the problem. Therefore, it is so important to conduct a thorough diagnosis and determine the true cause of the destruction of dental tissue.

On a note! In children, this disease is very rare. But at risk are patients of mature age - from 30 to 35 years.

Causes of the appearance of a wedge-shaped defect

To date, specialists have not yet fully figured out the exact causes leading to the development of this pathology. However, experts still managed to compile a list of factors that can provoke a similar dental phenomenon:

  • Poor quality oral hygiene: improper brushing technique, a brush with too stiff bristles and a paste with abrasive particles, excessive consumption of acid-containing food products without subsequent cleansing of enamel,
  • disturbances in the functioning of the gastrointestinal tract, leading to malfunctions of the acidity of the oral cavity,
  • dentition anomalies,
  • aggressive whitening too often, especially if it is done at home,
  • disruptions on the hormonal background - during pregnancy and lactation, the risk of developing any dental diseases will inevitably increase
  • inflammatory processes in the gingival tissues,
  • damage to the integrity of hard and soft tissues of the oral cavity,
  • bad habits - smoking and excessive drinking,
  • lack of balance in the diet, lack of calcium and fluorine intake with food,
  • individual diseases of an infectious nature,
  • treatment of cancer patients - radiation and chemotherapy,
  • natural aging of the body
  • damage to gums and enamel during orthodontic treatment using bracket systems.
Wearing braces can cause a problem

“I also had such a diagnosis. I myself did not notice any changes in the teeth, and did not feel any pain. And only then the doctor showed me how much the gums got off! And a wedge-shaped defect appeared in me just after the braces. Of course, I do not want to say anything, my teeth are all aligned, my bite is corrected, but there is not much pleasant in such a side effect. Then the doctor told me that this was the fault of the orthodontist. As a result, I had to do fluoridation, and this, I tell you, is not very pleasant. ”

Nikolya, Moscow, from correspondence on the forum 24atoma.ru

According to the opinions of doctors and patients, the presence of a similar problem in close relatives should also alert and cause increased attention to the prevention of the disease. If the parents had been diagnosed with a wedge-shaped defect at one time, it is better to abandon such risk factors as smoking, abuse of alcohol and acid-containing products. Experts in the field of dentistry and periodontics advise choosing a brush with soft bristles or medium hardness for everyday procedures, abandoning home-based methods for whitening enamel and aggressive toothpastes with abrasive particles in the composition.

Characteristic symptoms

  1. initial stage: enamel color change, loss of natural shine. At the same time, the tooth does not hurt, but pigmentation may appear on it over time,
  2. middle stage: gradual subsidence of the gums and exposure of the neck of the tooth. At this stage, hyperesthesia appears, the enamel begins to respond to hot and cold food,
  3. progressive stage: there is an increased susceptibility to temperature irritants, acidic food products. Unpleasant pain can occur during brushing. The defect depth reaches 4 mm, a wedge-shaped form with a pointed angle of 1 is clearly visible,
  4. neglected form: the depth of the "wedge" reaches 5 mm, there is a clear pigmentation of the outer layer of the tooth, the lesion reaches the dentin.
If treatment is not started on time, the pathology will progress at a rapid pace.

Prices for the treatment of a wedge-shaped defect

A wedge-shaped defect is a non-carious lesion in the neck of the tooth. The price includes filling material, if necessary, preparation. In rare cases, additional anesthesia or a disposable conservator may be required. The cost depends on the filling material.

Not only practitioners, but also research scientists cannot unambiguously answer the question of why a wedge-shaped tooth defect appears, the causes and treatment of which, as a rule, are determined by various factors.

Poor oral care, in which plaque accumulates in the gum region, often leads to this damage. Gingivitis and periodontitis can also cause non-carious destruction of dental tissues. With their development, the composition and amount of saliva change, which leads to leaching of calcium from enamel.

The initial stage of this disease is difficult to track. But any changes will not be hidden from the eyes of a professional, so it is so important to visit the dentist every six months. If necessary, the doctor will take action immediately, and the cost of treating a wedge-shaped defect will be minimal.

3 theories of disease development

3 theories of disease development

Among most professionals, three main theories of the origin of this pathology have been recognized:

  • Chemical. One of the risk factors for the appearance of a wedge-shaped defect is a change in the properties of the environment in the oral cavity. In particular, the enamel is affected by the high acidity of the oral fluid. Such a change in its characteristics can be explained by the frequent use of sweets, carbonated drinks with sugar content. Sometimes the cause of the pathology of hard tooth tissues is also gastrointestinal diseases, in which the contents of the stomach are thrown into the oral cavity.
  • Mechanical Wedge-shaped damage can occur due to systematic gross exposure with a stiff brush on the cervical region of the tooth. The mechanical theory of the origin of the disease explains the fact that right-handed people often suffer from fangs and premolars located on the left side of the jaw, and vice versa.
  • Physical and mechanical. A pathology of the bite, in which the load on the teeth changes and is incorrectly distributed, can also become a factor in the development of a wedge-shaped defect. However, some of them experience too much stress. As a result, the most vulnerable part of the crown, the cervical, suffers. Enamel in this place is damaged and chips. So begins the formation of a wedge-shaped defect.

Symptoms and stages

The area of ​​the lesion with a wedge-shaped defect increases gradually. Each stage of the development of this disease has its own symptoms and signs:

  • The first stage (initial changes). Closer to the neck of the tooth, damage that is barely visible to the eye appears at the border with the gum. At this point, the enamel fades slightly. Sensitivity to irritants is negligible or absent.
  • The second stage (the formation of a surface defect). At the site of the lesion, enamel decreases, which changes color. Along the border with cement, slit-like depressions up to 0.2 mm in size and up to 3-3.5 mm in length also appear. The neck of the tooth begins to be exposed. During this period, severe hyperesthesia (tooth sensitivity) may be noted.
  • The third stage (medium degree of damage). The length of the affected area increases to 3.5-4 mm, the depth to 0.2-0.3 mm. Its shape begins to clearly resemble a wedge with an upward pointed tip. The damaged area takes on a tan color. There is discomfort during a meal, there is a clear reaction to temperature and mechanical stimuli.
  • The fourth stage (deep wedge-shaped defect). The lesion covers not only enamel, but also dentin, the length of the defective area reaches 5 mm. Pigmentation becomes even more pronounced. In severe cases of destruction, they reach the cavity of the pulp chamber, which can lead to inflammation of the neurovascular bundle located in it. This is accompanied by sharp bouts of toothache.

At the very beginning of the development of a wedge-shaped defect, the color of the enamel and the structure of the tooth can be preserved. But the spread of damage to a greater depth of hard tissue seriously violates the aesthetics of a smile. In severe cases, the tooth may break off.

Diagnostics

To recognize non-carious lesions, modern dentistry uses various methods and means. In the first place among them remain the traditional clinical examination methods. These include:

  • History taking, visual inspection, sounding. A wedge-shaped defect is easier to recognize in the later stages, when the lesion acquires a characteristic V-shaped notch in the gums.
  • Thermal test. The study is used to determine the sensitivity of the damaged area to temperature effects. With this pathology, the tooth does not always respond to cold and hot, especially in the initial stages.
  • Vital staining. Wedge-shaped defects can be stained with 5% iodine solution. But, unlike carious lesions, they do not change color when treated with methylene blue.

Differentiation from other diseases

A wedge-shaped defect may have manifestations and symptoms similar to other dental diseases. Therefore, before the start of treatment, the specialist conducts differential diagnostics in order to identify the differences of this non-carious lesion from pathologies such as:

  • Enamel erosion. It develops not only on the border of enamel with cement, but also on the rest of the tooth surface. The shape of the lesion resembles a saucer.
  • Cervical sphenoid caries. The lesion site responds to stimuli and does not have smooth outlines, in contrast to a wedge-shaped defect. The form can be any.
  • Enamel necrosis. Like erosion, it develops on any part of the surface. Damage has a rounded shape, dark color.

After making a diagnosis and determining the degree of damage to hard tissues, the doctor determines an action plan to eliminate the pathology. At this stage, the patient may be voiced and the price of treatment of a wedge-shaped tooth defect in his case. The total cost depends on the type of procedures that will have to be carried out to obtain the optimal result.

What it is

A wedge-shaped defect refers to non-carious lesions. It occurs on the hard tissue of the tooth and is a defect near the neck of a wedge-shaped shape.

Outwardly, it looks like a kind of “step” of a V-shaped on the surface of the enamel near the gums. The enamel surface is smooth and shiny.

The disease is manifested by aesthetic disorders, as well as increased sensitivity of enamel. This pathology is most often localized on incisors from the vestibular side, but canines and premolars can also be affected. This defect can be expressed in different ways - from a small formation in the cervical part of the tooth to a complete cleavage of the entire crown part. Mostly middle-aged and elderly people suffer from this pathology.

Four stages of the formation of this defect are distinguished:

  1. Stage I - the formation is not visible, it is distinguishable only by increase,
  2. Stage II - is defined by eye as a surface abrasion or crack on the neck of the tooth, its thickness can be up to 0.2 mm and length up to 3.5 mm. There is an increased sensitivity in the affected area.
  3. Stage III - the depth of the cavity is up to 0.3 mm, its length is up to 4 mm. It resembles two planes that converge at an angle of 45 degrees.
  4. Stage IV - enamel damage can reach the chamber where the pulp is located. It exceeds 5 mm, the lesion extends to the deep layers of dentin.

There are several types of this pathology.

These include:

  1. Type A - cervical. It is localized at the border of enamel and cement, characterized by a slow development, it is often found - in half of all cases.
  2. Type B is the root. They are located on the enamel-cement border, but extend to the root zone, occurrence - 30% of all cases. Incisors, premolars are more often subject to it.
  3. Type C - crown. It is located on the surface of the tooth crown. It is characterized by rapid development. It occurs in 20% of cases. Incisors, fangs of the upper jaw and premolars of the lower jaw are more often affected.
  4. Type D - mixed forms.

Why do wedges form on the teeth and what to do with it

A wedge-shaped tooth defect is a non-carious lesion of hard tissues, which is characterized by the formation of defects of a certain shape. They affect the cervical region, that is, in the area of ​​contact with the gum. Most often, there is a lesion of the frontal group of teeth from the outside, that is, the visible side. Therefore, patients with such an ailment also experience psychological discomfort associated with a violation of the aesthetics of the smile.

The defect has the appearance of a step that resembles a wedge - hence the name of the disease originates from. The sizes of defects can be various - from barely noticeable to a complete split of the crown part in the future.

Prevention

To prevent non-carious damage to the tooth, compliance with simple recommendations that are aimed at eliminating the causes of pathology will help. In particular, it is necessary:

  • Properly choose a toothbrush. Particular attention should be paid to the selection of stiffness of the bristles. Recommendations on this issue for a particular patient are given by the dentist.
  • Move the brush correctly when brushing your teeth. The movements should be low amplitude and not too strong. Direction - from the gum to the cutting edge or chewing surface. The nature of the movements is sweeping.
  • If necessary, undergo preventive procedures. If the doctor recommends a course of remineralizing therapy to prevent the development of a wedge-shaped defect, it is worth agreeing.
  • Correct a broken bite. To do this, consult a doctor orthodontist. The specialist will establish the presence of pathology and prescribe treatment.
  • Timely treat somatic diseases. Elimination of disorders of the digestive, nervous, endocrine systems will help normalize the acidity of the oral fluid.

Pathology Description

A wedge-shaped tooth defect is a lesion of the cervical region of tooth enamel, resembling a protrusion in the shape of a triangle or wedge. The characteristic form of the affected area is one of the main signs of the disease.

Usually, pathology occurs on teeth that experience maximum load when chewing - fangs and premolars. In most cases, the disease affects the tissues of not one tooth, but several nearby dental units. The likelihood of developing pathology increases with age.

The clinical manifestations of the disease are similar to signs of cervical caries, enamel erosion and acid necrosis. However, the etiology of this disease is different, and it is treated differently than caries or other dental diseases.

What does a wedge-shaped defect look like?

The symptoms of the disease are difficult to confuse with other pathologies: upon examination, it is easy to notice enamel changes that have a smooth, shiny surface. Small defects do not have a characteristic color, since they affect only the enamel itself. But if dentin is affected, the enamel surface becomes pigmented, most often brown. Look at the photo, it will immediately become clear what this pathology looks like.

Other typical symptoms include hyperesthesia - increased sensitivity to temperatures, chemicals (for example, acids when eating fruits), and mechanical stresses. But this symptom may not appear at all.

Medicines

For the treatment and correction of a wedge-shaped defect, various varnishes, ointments and solutions are used. Drug treatment is most often performed in the initial stages of the disease. The purpose of this therapy is to remineralize the dental tissue in the affected area and, as a result, stop the progression of the defect. The action of these drugs is to introduce trace elements (calcium, phosphorus, potassium, magnesium, fluorine) into the enamel tissue to saturate its demineralized surface layers.

For this purpose, topically apply:

  • reminiscent preparations with a high content of glycerophosphate (Glycerophosphate, R.O.C.S. Medical Minerals),
  • calcium preparations (Calcium Gluconate, Calcium Glycerophosphate),
  • fluorine-containing varnishes followed by drying (Belak-F, Fluorlac, Fluocal gel),
  • electrophoresis of a solution of calcium and fluorine.

Inside, calcium-phosphorus preparations are prescribed to the patient. In addition, the patient is recommended to carry out hygiene measures of the oral cavity using special pastes that reduce tooth sensitivity. For this purpose, use desensitive, remineralizing tooth gels (Tus Mousse, Mexidol, Splat, Biomed and others). They mechanically clog the dentinal tubules, normalizing the pressure in them and reducing the sensitivity of the enamel.

Filling

In the late stages of the disease, when there is already a significant damage to the enamel, filling is used. However, it is difficult to make fillings in the cervical zone, since the zone is subject to increased pressure. They are simply squeezed out of the defect. In addition, it is a very sensitive area and it is difficult to isolate it from saliva.

To get rid of these difficulties, dentists use liquid filling material with increased elasticity (fluid form of photopolymer fillings). And also for better adhesion of the material, special enamel notches are made. So the seal is fixed better.The combination of various types of materials is successfully applied (filling in the sandwich technique).

Causes of a wedge-shaped tooth defect

The exact causes of the wedge-shaped defect are unknown to modern medicine. Doctors identified five main theories that explain why pathology can develop:

  • Visceral. Diseases of the nervous, digestive and endocrine systems can have a negative effect on dental health. Such pathologies can lead to a violation of the acid-base balance in the body, including in the oral cavity. An increased level of acidity is fraught with a decrease in the enamel layer, which can provoke the formation of pathology.
  • Erosive (chemical). The presence of acid in food and drink leads to thinning of enamel. In addition, excessive consumption of salty and acidic foods, carbonated drinks and the use of whitening hygienic pastes contribute to an increase in the fragility of enamel.
  • Mechanical Incorrect hygiene and the wrong choice of hygiene items and oral care products. Too hard bristles of the toothbrush irritate and injure the gums during toothbrushing, and too soft can not completely clean the teeth of food debris. Enamel thinning is facilitated by improper plaque cleansing of dental tissues and toothbrushing immediately after consuming high acidity products.
  • Load theory. Chewing load is unevenly distributed, especially if the situation is complicated by an incorrect bite.
  • Periodontic. Inflammation of the near-tooth tissues (gingivitis, periodontitis) can provoke the prolapse of the gingival margin. As a result, the neck of the tooth is exposed, and a wedge-shaped defect occurs.

In addition to the above, the development of pathology is facilitated by:

  • Hormonal diseases, especially those that cause a violation of calcium metabolism (diabetes mellitus, osteoporosis). In women, pregnancy and lactation may be additional risk factors, accompanied by hormonal changes and leaching of calcium from the body. Also, hormonal failures can lead to stress, depression.
  • Mechanical damage to teeth as a result of constant consumption of solid food, improper selection of toothpastes and brushes.
  • Inadequate nutrition, leading to insufficient intake of fluoride and calcium.
  • Smoking and drinking. Nicotine increases fragility of blood vessels, which entails malnutrition of periodontal tissues and their degeneration. Alcohol in large quantities leaches calcium from the body, which leads to thinning of enamel.
  • Age-related changes in the body.
  • Incorrect selection and inaccurate removal of braces.
  • Radiation and chemotherapy.

Whether there is a genetic predisposition to the development of a wedge-shaped defect is reliably unknown. Therefore, if such a pathology was detected in one of the relatives, you should consult a doctor to determine the degree of risk, and pay attention to the prevention of the disease.

Symptoms and stages of development of a wedge-shaped tooth defect

The defect develops gradually. Each stage of the disease is characterized by special symptoms and is treated with various methods.

Defect development stages:

  1. First stage. A faint crack appears on the neck of the tooth, there is no discomfort and pain. A slight sensitivity to irritants and a slight decrease in enamel gloss may appear. It is impossible to detect a problem at home, only an attentive specialist can detect a defect during a routine dental examination.
  2. Surface stage. A slight indentation with an area of ​​about a millimeter appears in the surface layer of the tooth. A characteristic visual sign of the disease is the gradually increasing enamel pigmentation and the gradual exposure of the tooth neck, down to the root.
  3. Middle stage. The affected area increases, its depth can exceed 3 mm. Progresses the process of destruction of the tooth surface. The wedge-shaped form of the affected area with a pronounced tip is clearly visible. There is discomfort during eating, pain occurs in response to irritants and brushing your teeth.
  4. Deep stage. The depth of the affected area increases to 5 mm, enamel pigmentation is expressed, the dentin layer of the dental tissue is affected. The pathological process can reach the pulp, in which case sudden pain attacks appear due to inflammation of the neurovascular bundle. If the body has activated the compensatory mechanism, which led to the formation of dentin, the symptoms of the disease may be absent.

Diagnostic Methods

To cure the disease, it is important not only to detect the defect in time, but also to differentiate it from other diseases with similar symptoms, which are much more common in dental practice. As diagnostic measures apply:

  • Visual inspection In the later stages, the wedge-shaped tooth defect is more easily recognized, since the wedge-shaped notch at the neck of the affected tooth reaches a solid size and is visible to the naked eye.
  • Mechanical diagnosis - the effect on the affected area with irritants. The method is not always indicative, because pathology can be asymptomatic.

The difference between a wedge-shaped defect and similar pathologies

Kind of pathologyHard tissue erosionEnamel NecrosisCervical (sphenoid) cariesWedge-shaped tooth defect
Localization of the lesionCan develop on any surfaceCan develop on any surfaceDevelops in the cervical region of the teethDevelops in the cervical region of premolars and canines
Defect bottom characteristicDenseThe bottom is loose, the enamel layer, dentin, part of the pulp are destroyedThe fabric is soft, the edges are unevenEnamel is destroyed, clear edges near the lesion
The formSaucer-shapedRounded black or dark spotsAnyFrom the third stage, the wedge is clearly visible
Irritant responseExpressed reaction to cold and sweet / sourTooth reacts to any irritantsThe affected area responds to any stimuli, painful on palpationThere may be no reaction to stimuli

Photo of a wedge-shaped tooth defect and similar pathologies

Hard dental tissue erosion

Enamel necrosis

Cervical (sphenoid) caries

The benefits of treating a wedge-shaped defect with us

You can safely entrust to our specialists the beauty and health of your teeth. The network of dental clinics "Cariesu.net" is equipped with modern medical equipment and instruments. The treatment of a wedge-shaped defect and aesthetic restoration are carried out by experienced dentists - therapists, orthodontists, orthopedists.

Specialists of our two clinics are receiving not only adults, but also children. At the first signs of tooth enamel damage, contact your dentist and bring your child if you notice any defects in his teeth. Early detection of the disease helps to cope with it much faster, with minimal cost.

Make an appointment with a specialist of our clinic by phone, which is listed on the site. You can also enter contact details in the online form, after which our staff will call you back.

Reasons for the development of pathology

The causes of the disease are ambiguous: unfortunately, the researchers have no common opinion on this matter. The following theories are common in modern dentistry:

  • theory of mechanical abrasion: the cause is a constant mechanical effect associated with the use of a brush with a rigid bristle, as well as horizontal movements during cleaning,

It is interesting! One of the theory's justifications is the fact that in left-handed people, a wedge-shaped defect is expressed on the right, and in right-handed people, on the contrary. However, the evidence is only indirect and there is no consensus among experts, since they have the right to exist and other reasons.

  • erosion theory: the main reason for the formation of defects is also considered enamel weakening as a result of exposure to food acids. They contribute to the leaching of calcium and the violation of the mineral balance,
  • physico-mechanical, load theory or occlusal theory: according to it, the main factor is an incorrect bite. The incorrect position of the teeth and the ratio of the jaws entails an uneven distribution of chewing load. This is explained by the fact that defects often affect teeth undergoing maximum tension during chewing,

Important! According to this theory, not only malocclusion, but also other phenomena that contribute to a change in the distribution of masticatory load can lead to the appearance of a disease: bruxism, dystonia of masticatory muscles, etc.

  • visceral theory: this dental disease is also often associated with systemic disorders, diseases of the gastrointestinal tract, endocrine and nervous systems,
  • periodontal theory: the disease can also be the result of inflammatory processes of periodontal tissues (periodontitis, periodontal disease), which are accompanied by exposure of the necks of the teeth. It is worth noting that the mechanism of the formation of the disease is similar to that which the theory of erosion adheres to: naked thin enamel of the necks is exposed to acids, bacteria, plaque, which leads to demineralization of this area with subsequent destruction.

Laser

It is used in case of preparation for filling. The laser cleans surfaces better and kills microorganisms. The procedure is expensive, but after such treatment the fillings do not fall out at all.

  • enamel compaction,
  • pain reduction
  • blocking hypersensitivity.

Folk remedies

For the treatment of non-neglected cases and prevention at home, folk remedies are used.

Some of the most effective recipes for treatment:

  1. Infusion of calendula. Take 1 tbsp. l flowers of this plant, pour it with one glass of boiling water. Let it brew for at least half an hour. Use this infusion as a mouthwash after each meal.
  2. Gruel from cranberry berries - crush fresh or thawed cranberry berries in a blender to a puree state. Rub into the gums daily several times a day.
  3. Defect treatment with a solution of sea salt. For 100 g of water, take 1 tsp. sea ​​salt, wait until it is completely dissolved. Use to treat teeth and gums after brushing with toothpaste.
  4. A mixture of honey and cinnamon. Take equal parts of honey and cinnamon powder, mix thoroughly. Rub into the gums daily.

Efficiency

Treatment of the disease takes a long period of time - up to two years. Therefore, all folk remedies for this pathology will give a positive effect only with prolonged use.

In addition, alternative medicine can only help in the initial stages of the depletion of the layer of tooth enamel. If the process is running, then home remedies are used only as part of complex therapy.

Stages of the pathological process

It is customary to distinguish four stages of a wedge-shaped tooth defect:

  1. initial changes - the violation is imperceptible during a normal visual examination, it can only be diagnosed with a magnifying device,
  2. superficial damage - the defect is visible visually, looks like an abrasion or a small crack. Depth is up to 0.2 mm, often at this stage there is a symptom of hypersensitivity,
  3. moderate changes - the damage depth reaches 0.3 mm, the length is up to 4 mm, the characteristic shape of the wedge is already noticeable here, the violation is formed by two planes that converge at an angle of 45 degrees, pigmentation occurs,
  4. deep distribution - the height is more than 4 mm, there is a lesion of dentin, and sometimes even pulp. Pigmentation is expressed, there is a strong exposure of the neck of the tooth.

Dental Tips

Before you begin treatment, you must definitely find out the cause of the disease. If this is a bite defect, it is necessary to correct it. If the cause is a violation of the integrity of the dentition, then prosthetics should be performed.

Success in treatment depends on the stage of the disease, and the individual characteristics of the patient's oral cavity play a large role. Restoration of filling material is short-lived - it requires replacement. Veneers and crowns remove only a cosmetic defect, but do not prevent the continuation of the pathological process.

Therefore, the rest of the treatment must necessarily be combined with:

  • installation of bracket systems
  • Selective grinding of individual teeth
  • setting crowns on some teeth.

Dentists are also advised to pay attention to the method of proper brushing. Do not allow horizontal movements of the toothbrush.

Reviews

I have long been diagnosed with sphenoid defects in my anterior teeth. They are constantly filled, and the fillings fall out. I turned to another clinic and my teeth were filled with modern elastic light-curing material. Seals have been standing for more than a year and, in my opinion, are not going to fall out.

I got wedge-shaped defects on the upper canines from two sides. They react to hot and cold, it is impossible to eat fruit. In addition, it looks very ugly, I can not smile. My doctor and I decided to close these defects with veneers. This should strengthen them and reduce sensitivity. They will become beautiful, moreover, defects will cease to progress. Veneers made and installed. Six months have passed - I have a beautiful smile again, and my teeth do not respond to hot and cold.

I began to worry about the sensitivity of the front teeth to hot and cold. I went to the dentist. He said that I have wedge-shaped defects of the teeth in the initial stage. He offered to be treated with a laser. Made several courses of laser therapy. Hypersensitivity has passed. The dentist said that it is necessary to observe whether the defect will not progress. Scheduled examinations every six months.

Watch the video: Tooth neck defect - Wedge Shaped Defect (April 2020).