Pathophysiology of Demineralization, Part I: Attrition, Erosion, Abfraction, and Noncarious Cervical Lesions

Abstract

Purpose of the Review Compare pathophysiology for infectious and noninfectious demineralization disease relative to mineral maintenance, physiologic fluoride levels, and mechanical degradation. Recent Findings Environmental acidity, biomechanics, and intercrystalline percolation of endemic fluoride regulate resistance to demineralization relative to osteopenia, noncarious cervical lesions, and dental caries. Summary Demineralization is the most prevalent chronic disease in the world: osteoporosis (OP) >10%, dental caries ~100%. OP is severely debilitating while caries is potentially fatal. Mineralized tissues have a common physiology: cell-mediated apposition, protein matrix, fluid logistics (blood, saliva), intercrystalline ion percolation, cyclic demineralization/remineralization, and acid-based degradation (microbes, clastic cells). Etiology of demineralization involves fluid percolation, metabolism, homeostasis, biomechanics, mechanical wear (attrition or abrasion), and biofilm-related infections. Bone mineral density measurement assesses skeletal mass. Attrition, abrasion, erosion, and abfraction are diagnosed visually, but invisible subsurface caries <400μm cannot be detected. Controlling demineralization at all levels is an important horizon for cost-effective wellness worldwide.

Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration

“…Tooth flexure (deformation) of a mandibular first premolar using FEA revealed that occlusal loads of 200 N are 10‐fold greater for nonaxial loading compared to axial loads 72 . Also, the deepest aspect of a wedge lesion is the stress riser so it is the most susceptible to the progressive fatigue failure that advances the lesion 73 when the tooth is flexed 3 . These data suggest the mineralized tissue at the base of a NCCL is failing under surface compression 3 .…”

“…Natural fruit tannins (tannic acid) are prevalent in higher quality wine which may have a pH of 3.5 or less. The European culture of wine and cheese consumed together is a wise social strategy since the cheese buffers the acidity of the wine, tends to adhere to enamel surfaces, and supplies both calcium and phosphate ions for remineralization 3 …”

“…Other acidic items have been identified and they include acidic lozenges, tablets, and mouth rinses that may potentiate demineralization 42,43 . Most foods, including those with phytoliths (minute mineral particles) in plants, are known to be abrasive 3 . Superimposing an acidic environment with mechanical factors such as toothbrush abrasion and a coarse diet increases the prevalence of cervical lesions.…”

“…Also, the deepest aspect of a wedge lesion is the stress riser so it is the most susceptible to the progressive fatigue failure that advances the lesion 73 when the tooth is flexed 3 . These data suggest the mineralized tissue at the base of a NCCL is failing under surface compression 3 . It is also thought that delamination of enamel from dentin at the dentin‐enamel junction (DEJ) occurs in the cervical area as a result of undermining the enamel and may occur from a repeated oblique load of 100 N which is well within the range of normal function 70 .…”

Microstructural Transformation, Qualitative and Quantitative Microelemental Restructuring of Enamel in a Wedge-Shaped Tooth Defect of Classes I and Ii

“…12 | num. 4 | in the medical literature [5][6][7][10][11][12]. Restoration of tooth tissues with such defects presents certain difficulties, as a special approach to dissection, treatment, and the right choice of filling material is required.…”