FINAL EXAMINATION QUESTIONS

1. Enamel does not have reparative capabilities. Cite examples of instances/ situations where enamel
can be injured, loss or fractured. Likewise give ways/ clinical procedures where lost enamel can be
replaced. 10 pts

Cite examples of instances/ situations where enamel can be injured, loss or fractured.
SITUATIONS ENAMELS CAN BE INJURED:
*Enamel erosion can be caused by what we are eating, particularly on eating sugary foods, such as ice
cream, syrups, and caramel, starchy foods, such as white breads, acidic foods, such as apples, citrus
fruits, berries, and rhubarb, fruit drinks and juices, sodas, which typically contain damaging citric acid
and phosphoric acid in addition to sugar, excess vitamin C, found in citrus fruits, & some alcoholic
beverages that are high in sugar such as red wines that tend to be very acidic which reduces saliva.
*Other causes of enamel erosion includes teeth grinding, chronic acid reflux, also known as
gastroesophageal reflux disease (GERD), low salivary flow, also known as xerostomia, which is a
symptom of conditions such as diabetes, regular use of certain medications, such as antihistamines and
aspirin, & eating disorders like bulimia, which disrupts the digestive system and exposes teeth to
stomach acid.
*Enamel loss includes brushing too soon after a meal, particularly after eating acidic foods, can
contribute to enamel erosion and the sensitivity that awaits underneath. You must wait at least 30 mins.
*Brushing too vigorously can lead to enamel erosion, which causes enamel loss too. Conditions such as
bruxism (tooth-grinding) can also wear away the enamel. Genetics and inherited conditions play a role
too in enamel erosion.
*Environmental factors are other factors of enamel erosion such as anything from friction, wear and
tear, stress, corrosion, or any combination of this.
*To be clear enamel erosion can be caused by this factors; Excessive soft drink consumption (high levels
of phosphoric and citric acids), Fruit drinks (some acids in fruit drinks are more erosive than battery
acid), Dry mouth or low salivary flow (xerostomia), Diet (high in sugar and starches), Gastrointestinal
problems, & Medications (aspirin, antihistamines).
*The environmental causes of tooth surface erosion includes “Attrition” This is natural tooth-to-tooth
friction that happens when you clench or grind your teeth such as with bruxism, which often occurs
involuntary during sleep & “Abrasion” that is physical wear and tear of the tooth surface that happens
with brushing teeth too hard, improper flossing, biting on hard objects (such as fingernails, bottle caps,
or pens), or chewing tobacco & “Abfraction” which occurs from stress fractures in the tooth such as
cracks from flexing or bending of the tooth and lastly “Corrosion” that occurs chemically when acidic
content hits the tooth surface such as with certain medications like aspirin or vitamin C tablets, highly
acidic foods, GERD, and frequent vomiting from bulimia or alcoholism.
*Erosion of tooth structure due to extrinsic causes is primarily due to the introduction of acids via
external sources such as “Beverages with low pH value” the Drinks such as cold drinks and fruit juices
usually have a low pH value which ranges from 2.0-3.5. Frequent consumption of these drinks induces
high acids and makes teeth more prone to acid attack. According to research natural fruit juices,
carbonated soft drinks and acidic foods have been found to increase the risk of dental erosion. &
“Certain lifestyles” by frequent intake of acidic fruits and drinks is another major cause of dental
erosion. For example, athletes performing extreme physical activities, frequently consume sports drink,
which in turn increases the chances of erosion. Also, a decreased salivary flow and dehydration are
other contributory factors for erosion. “Occupational Hazards” that exist also pose a risk of dental
erosion. Workers who work in factories, particularly in munitions, battery, and fertilizer plants are prone
to dental erosion. Also, erosion has been reported in swimmers who remain in chlorinated water for
long hours. Chlorinated water also has a lowered pH leading to gradual erosion of dental structure.
“Consumption of certain Medicines” such as Medicines that are acidic in nature also causes dental
erosion. A direct contact of these medicines or chewing them for a longer period might lead to erosion
of enamel. Some examples are medicines having high Vitamin C content and medicines with
hydrochloric acid preparations. Another major example is “Intrinsic causes of dental erosion” results
when the source of acid is inside the body and affects the tooth structure such as “Gastroesophageal
Reflux Disease (GERD)” during this disease ejection of acids occurs which are mainly produced in
stomach. A regular regurgitation is a normal procedure post consumption of meals, which usually occurs
for about one hour during daytime. However, in people affected with GERD gastric, acids are
regurgitated in the oral cavity even during the night. This mostly affects the posterior teeth and a regular
flow of acids washes away the outer layer of the tooth. Also, teeth are not naturally protected by saliva
primarily because salivation and swallowing get restricted in the supine position. Another one is
“Bulimia Nervosa” is an eating disorder in which a person performs a self-induced vomiting after
consumption of meals causing a typical loss of enamel on the lingual-palatal aspect of the anterior
maxillary teeth, primarily due to the ejection of acids on the front teeth due to self-induced vomiting.
*Tooth fractures is caused by Wear and tear due to cavities and chewing or biting down on hard
objects, such as pencils, ice cubes, nuts, and hard candies. Moreover, “Dental Injuries” includes broken
teeth (fractured teeth), teeth totally knocked out of the mouth, or teeth displaced by unexpected
external forces, these dental injuries may include swelling of the gum and oral tissue.
*” Enamel Damages” at different locations of the tooth for example “Erosion” is the general wearing
away of tooth enamel, ore of a chemical process, happening on the surface and subsurface of the teeth.
It is caused by high acid levels in the saliva. This may be due to acidic foods or drinks, dry mouth, or
health conditions that cause frequent vomiting. And “Abfraction” it is a wedge-shaped flaw on the tooth
at the point it meets the gumline, caused by friction and pressure on the tooth and gums, which causes
the neck of the tooth to start breaking off. Another is “Abrasion” found on the teeth closest to your
cheeks, it is caused by friction from foreign objects, such as pencils, fingernails, or mouth piercings.
Using a hard toothbrush, abrasive tooth products, and improper brushing technique can also lead to
abrasion. Cause of abrasion may arise from interaction of teeth with other objects such as
toothbrushes, toothpicks, floss, and ill-fitting dental appliance like retainers and dentures. Apart from
that, people with habits such as nail biting, chewing tobacco, lip or tongue piercing, and having
occupation such as joiner, are subjected to higher risks of abrasion.
*Types of toothpastes can also damage enamel and dentine due to the abrasive properties. Specific
ingredients are used in toothpaste to target removal of the bio-film and extrinsic staining however in
some cases can contribute to the pastes being abrasive. Whitening toothpastes are found to be one of
the most abrasive types of toothpastes, It is believed that dental abrasion due to the whitening process
is caused by a combination of both mechanical and chemical irritants, for example, using whitening
toothpaste and at home bleaching kits together.
Give ways/ clinical procedures where lost enamel can be replaced.
*If the damage to your enamel is “minor”, your dentist may just recommend treating it at home with a
“remineralizing toothpaste”, helping to replenish the natural calcium that makes up your tooth
enamel.
*”Dental bonding” which is More acute or advanced issues may prompt your dentist to recommend
repairing your enamel with dental bonding, which uses a tooth-colored resin that can be applied to your
tooth to protect a weakened area. The application of dental bonding is fairly simple. First, your dentist
prepares your teeth by etching the surfaces of the teeth that need to be treated. A conditioning liquid is
then painted onto the teeth (these steps are important because they help the bonding stick to your
tooth). Once your teeth are prepared, your dentist will apply the bonding. This putty-like material can be
molded into the appropriate shape to cover your enamel, allowing your dentist to finally harden it in
place with a special curing light. This process can be used in cases of milder erosion and is a cosmetic
procedure. A resin that’s tinted to match your tooth is applied to the damaged area. Once it hardens, it’s
bonded to your tooth and trimmed and polished to fit into your mouth correctly. This entire process
takes an hour or less and usually takes just one appointment.
*”Veneers” which dentists may also suggest if only the front surfaces of your enamel are damaged.
Veneers are thin pieces of tooth-colored porcelain that are permanently cemented to the surfaces of
your teeth that face outward. As counterintuitive as it seems, your dentist prepares you for this material
by removing a small amount of enamel from the surfaces of your teeth. He or she will then take an
impression of your teeth and send the impression to a laboratory. Your veneers will be custom-made to
fit in your mouth and, when they are ready, sent to your dentist who can then adhere them to the teeth
that need restoring.
*”Crowns” are another option for tooth enamel repair is the application of a crown. Crowns are caps
that usually fit over damaged molars, and because they cover the teeth completely, your dentist may
recommend them if they are severely misshapen or discolored due to enamel damage that built up over
time. To apply a crown, your dentist first needs to prepare the tooth by filing it down. Similar to veneers,
he or she then takes an impression of your tooth with dental putty. The impression will be sent to a
dental laboratory so that a crown can be made custom for you. Often, you'll wear a temporary crown
while you wait for your permanent crown. Once the permanent crown is ready, you'll return to your
dentist for him or her to remove your temporary crown and cement your permanent crown in place.
Your tooth will look and feel as good as new, with no signs of your previous enamel damage. Crowns
may be made of gold, high strength porcelain, resin, porcelain fused to metal or other materials.
*”Fluoride treatments” If your cavity just started, a fluoride treatment may help restore your tooth's
enamel and can sometimes reverse a cavity in the very early stages. Professional fluoride treatments
contain more fluoride than the amount found in tap water, toothpaste and mouth rinses. Fluoride
treatments may be liquid, gel, foam or varnish that's brushed onto your teeth or placed in a small tray
that fits over your teeth.
*”Fillings, also called restorations”, are the main treatment option when decay has progressed beyond
the earliest stage. Fillings are made of various materials, such as tooth-colored composite resins,
porcelain or dental amalgam that is a combination of several materials.
*” Root canals”. When decay reaches the inner material of your tooth (pulp), you may need a root
canal. This is a treatment to repair and save a severely damaged or infected tooth instead of removing it.
The diseased tooth pulp is removed. Medication is sometimes put into the root canal to clear any
infection. Then the pulp is replaced with a filling.
*”Dental Implants or Bridge” Some teeth become so severely decayed that they can't be restored and
must be removed. Having a tooth pulled can leave a gap that allows your other teeth to shift
*” Taking vitamin D and calcium supplements” are other ways to protect enamel. Vitamin D and
calcium naturally promote bone growth and strengthen your teeth. Lastly, you can try brushing your
teeth with a “fluoride toothpaste” or using a fluoride rinse to strengthen your enamel. Fluoride is known
to protect your teeth from demineralization caused by acid erosion from bacteria and sugar.
*For one, “maintaining healthy oral hygiene” can help ensure that you do not lose excess enamel from
acid erosion caused by bacteria. “Remineralization” introduces minerals, especially calcium, to the
teeth. These minerals bond to the surface of the teeth and are drawn to weak points in the enamel. This
is especially effective in cases of dental erosion since tooth surfaces might be weakened without being
cracked or chipped. Enamel’s chief ingredient is calcium phosphate, also known as hydroxyaptite.
Products with high concentrations of calcium phosphate or with fluoride, a common additive, are best at
helping teeth to remineralize naturally before damage exceeds the point of no return.
*Dental materials such as amalgam, glass ionomer (GI), resin-modified glass ionomer (a variant of GI)
and resin composite are the types of restoration materials available when active treatment by means of
restoration is appropriate.

2. What causes sensitivity in the dentin? Gives ways/ procedures to help address or decrease
sensitivity in dentin. 10 pts
*What causes sensitivity in the dentin?
-Dentinal hypersensitivity is caused by exposed dentin in which stimuli trigger dentinal tubule fluid
movement that activates nerve fibers to cause pain. The relationship between surface and intratubular
precipitation and moderation of sensitivity is not straightforward. It is not the quantity of precipitate,
but, rather, the quality, density, porosity, depth of penetration, and strength of attachment to the
dentin that affects the results. Ultimately, treatment efficacy is determined by how long the diminution
or elimination lasts.
-Periodontal disease, gingival recession, cracked teeth, erosion, abrasion, abfraction and tooth
fracture may cause “Dentin Hypersensitivity. All of these conditions result in exposed dentin, which
creates an environment in which stimuli cause dentinal tubular fluid movement that activates nerve
fibers, causing pain. The exposed dentin may result from removal of cervical cementum during scaling
and root planing, finishing and polishing of restorations, or extreme toothbrushing — especially after the
ingestion of acidic food or drinks.
-Open dentinal tubules demonstrate high hydraulic conductance, thus contributing to sensitivity;
conversely, fluid flow decreases if tubules are blocked. This provides a means for various approaches to
treatment.
-Hydrodynamic theory is the most commonly agreed upon cause of dentinal hypersensitivity. The use
of a rubber dam can be helpful when attempting to isolate the tooth — or teeth — subject to
hypersensitivity.
-Gingival recession results in exposure of root surfaces and possible sensitivity. Buccal bone provides
most of the blood supply for the buccal gingiva, and any loss of buccal bone will result in a decrease in
gingiva. Thin or fenestrated bone, tooth anatomy, tooth position or orthodontic movement may result
in recession. Excessive toothbrushing with dentifrice can also cause recession.
-Abrasion is the loss of tooth structure by mechanical forces from a foreign element, and it may cause
sensitivity. Attrition is tooth-to-tooth contact, which results from occlusal function or parafunction —
such as bruxism — and can cause loss of tooth structure on the occlusal surfaces and incisal edges.
-Tooth whitening often causes dentinal hypersensitivity. The use of hydrogen peroxide or carbamide
peroxide may infiltrate through enamel and dentin to the pulp. The glutathione peroxidase and catalase
in the pulp do not have enough time to inactivate the hydrogen peroxide, which may cause sensitivity.
-Tooth bleaching is a common cosmetic procedure, whitening agents can penetrate tooth structure and
release oxygen radicals that are capable of oxidizing chromogens. In-office whitening may result in
dentin hypersensitivity as a result of oxidative stress caused by hydrogen peroxide and its associated
hydroxyl radical formation. Home bleaching can also lead to sensitivity.
-Dentin sensitivity is the sequel to dentin exposure. One of the chief causes of dentin exposure is a
receding gum line which exposes the roots of the teeth. Unlike the tooth crown, the roots are not
covered by the hard-protective layer referred to as enamel. Roots are primarily composed of tiny
tubules, which act as a link to the nerve supplying the tooth. When they are exposed to stimuli such as
sweet, cold or hot foods and drinks, the affected person experiences an extreme sensation which is
referred to as dentin hypersensitivity.
-This disorder usually occurs as the result of loss of enamel and cementum or exposure of dentinal
tubules [1, 3-4, 9]. The intensity and degree of sensitivity depends on different factors and are different
in different people.
-Dental procedures. Teeth may be sensitive after professional cleaning, root planing, crown
replacement and other tooth restoration procedures. Usually the pain will disappear in four to six
weeks.
- Long-term use of mouthwash. Some over-the-counter mouthwashes contain acids. If dentin is
exposed dentin, the acids can make existing tooth sensitivity worse and also further damage the dentin
layer and Brushing too hard or using a hard-bristled toothbrush. This can wear down enamel, causing
dentin to become exposed, or encourage gum recession.
-Gum recession. This often happens in people suffering from periodontal disease, and it exposes the
dentin. Gingivitis. Inflamed and sore gum tissue can result in exposure of the tooth's root.
-Cracked teeth. These can become filled with bacteria from plaque and cause inflammation in the pulp
of the tooth. In more severe cases, it may lead to abscess and infection. Teeth grinding or clenching.
This can wear down enamel. Plaque buildup. Acidic foods. These can encourage enamel reduction.
-“Tooth sensitivity after filling” Some people may experience tooth sensitivity after having a cavity
filled or a filling replaced, according to the Columbia University College of Dental Medicine. The tooth
decay that causes cavities irritates the tooth, and the filling procedure, while necessary, can lead to
further sensitivity. Sometimes after a filling, teeth become sensitive when biting down. This can be
fixed with a simple bite adjustment. Additionally, the filling may be too high, according to Columbia
University. In this case, the dentist could lower the filling. Composite fillings may cause tooth sensitivity
when chewing. There is no pain when the teeth are clenched together, however. This tooth sensitivity is
usually fixed by adjusting the bite or replacing the filling with another composite, according to Bear Peak
Dental, a private practice in Boulder, Colorado.
* Gives ways/ procedures to help address or decrease sensitivity in dentin
*The most commonly used therapies include anti-inflammatory agents, protein precipitants, tubule-
occluding agents and tubule sealants. Clinicians can recommend a variety of treatments for at-home
use or in office application. The mechanism of action is typically nerve desensitization, protein
precipitation, plugging dentinal tubules, sealing dentin, or ablating dentin with a laser.
*Home treatments such as “Desensitizing toothpaste” There are several brands of toothpaste for
sensitive teeth available. Your dentist may recommend one or you may have to try different brands until
you find the product that works for you. Be sure to use fluoridated toothpaste for sensitive teeth, not
tartar-control toothpaste. Also by using a soft-bristled toothbrush, avoiding highly acidic foods & using a
fluoridated mouthwash daily. By yourself avoid teeth grinding and Consider getting a mouth guard.
*Dental procedures that may reduce tooth sensitivity includes
“Bonding, crowns or inlays”-These may fix a tooth flaw or decay
that is causing sensitivity, Fluoride gel or varnish, “Surgical gum
graft”-This will protect the root and reduce sensitivity if the gum
tissue has eroded from the root, “Root canal” This is a last-resort
treatment for severe tooth sensitivity that has not been helped
by other methods and also getting dental sealants applied to the
exposed root surface.
*Educate patients about risk factors, advise patients to remove
excessive acid from their diet, recommend brushing their teeth
before eating, and demonstrate less aggressive brushing
techniques.
*As a first line of defense against sensitivity, clinicians may wish
to recommend a dentifrice with potassium salts (e.g., potassium
nitrate, potassium chloride or potassium citrate), strontium salts
(e.g., strontium chloride or strontium acetate), or fluoride.
Potassium ions diffuse along the dentinal tubules, which block
nerve action and dull the pain associated with hypersensitivity.
Potassium salt dentifrices are effective, but may require two
weeks of consistent use for patients to feel the effects.
*Fluoride in various forms is an effective strategy for at-home
relief of sensitivity. Sodium fluoride, stannous fluoride, and
sodium monofluorophsophate all block dentinal tubules,
reducing sensitivity. Prescription fluoride dentifrices and tray
application may also be helpful. Calcium phosphate technologies
are another option for treating hypersensitivity.
*Tricalcium phosphate (TCP) is the most recent addition to the family of calcium phosphate
technologies. Providing a slow release of calcium to the tooth surface, TCP is designed to boost the
remineralizing effects of fluoride, which may also decrease sensitivity.
*Clinicians can apply a desensitizing prophylaxis paste formulated with 8% arginine and calcium
carbonate to occlude tubules with plugs of arginine, calcium, phosphate and carbonate. It has been
shown to endure normal pulpal pressure and acidic challenges, successfully minimizing dentinal tubule
fluid flow and, thus, sensitivity, without harming bond strength.
*Extended-contact varnish is a photocured fluoride varnish that can be utilized to decrease dentinal
hypersensitivity. It consists of a resin modified glass ionomer that incorporates glycerophosphate with
fluoride release. It also encourages resin tag formation, allowing instantaneous and long-term occlusion
of the tubules. Chlorhexidine varnish forms a mechanical barrier after drying, which reduces sensitivity,
while providing an antiplaque and antibacterial action.
*Oxalates have also been shown to diminish dentinal permeability and block tubules. The oxalate reacts
with the calcium ions in dentin to form calcium oxalate crystals in tubules and on the surface. The effect
is reduced over time, however, as the crystals are removed by brushing and dietary acids. Etching
improves the infiltration of calcium oxalate crystals into the tubules.
*Clinicians can also use a light-cured desensitizer that reduces sensitivity through the reaction of the
monomer with calcium in the tooth and resin tag formation, resulting in tubule occlusion. A curing light
subsequently polymerizes the resin layer. It can be used for immediate dentin sealing of prepared teeth.
*Bonding, grafting and laser treatment may provide relief from dentinal hypersensitivity. Bonding
agents can be used to simultaneously desensitize and bond. Depending on the product used, a potential
disadvantage to this approach is the need for phosphoric acid prior to placing the bonding agent, which
may require the use of anesthesia.
3. Which among the tissues of the teeth do you consider the most important? Support your answer.
For me the most important tissue of the teeth is the “Enamel” because The enamel is the protective
outer shell that protects the teeth. Without the enamel, the teeth would sustain serious amounts of
damage and an increased amount of risk for infection. It is the most mineralized and hardest substance
in the body. It protects the teeth from the extreme pressure of chewing and the corrosive acids of the
bacteria in the mouth. The enamel on the teeth is also the body's first defense against one of the most
common dental diseases: tooth decay. Also, the enamel of your teeth is semi-translucent, so it is
partially responsible for the color of the teeth so we must protect it. It protects the inner layers of teeth
from being damaged by dietary acids and helps keep your teeth looking white. Enamel is particularly
important because it plays a very important role when it comes to keeping tooth decay at bay. That is
one of the reasons why it is so important that people do everything possible to prevent the enamel from
eroding. The enamel serves as a barrier that protects the inner layers of a person's teeth, known as
dentin, from the acids and other debris in the mouth. The enamel of the teeth also protects the dentin
from the temperatures of the beverages and foods one consumes. Also, enamel does not have
regenerative capabilities, which means when the enamel weakens, the body is not capable of making a
new one to replace it. Tooth enamel does not contain living cells, so it is not possible to regenerate it the
same way the body regenerates damaged bone tissue. It also acts as the substance that forms a shell
around the top of every tooth. It is an extraordinarily hard substance that is specifically designed to
protect the teeth from damage. The enamel is a shield that protects the vulnerable area on the side of
the teeth which can sustain damage due to decay. Tooth enamel is important because Protecting a
person’s enamel is one of the primary functions that dentists take seriously. Every time a person puts
something into their mouth, bites or chews, there is a risk of damaging the teeth. It is only the strength
of the enamel that stops the teeth from breaking apart. Despite being an extraordinarily hard surface,
enamel can easily sustain damage. Once the enamel sustains damage, it allows for decay or other
problems to lead to additional damage to the underlying tooth. When the enamel wears out, chips or is
broken, there is nothing standing between the bacteria in the mouth and the easily susceptible tooth
from terrible infections. Another critical function that the enamel performs is insulating the incisor teeth
from potentially painful changes in temperature, or chemicals. Although enamel is a hard protector of
the teeth, it is prone to chipping and cracking. Once enamel sustains damage, the body has no means of
repairing itself. Since the enamel has no living cells and the body cannot go to work repairing chips or
cracks in the enamel. So, It is critically important to protect the enamel because this is essentially the
first step in protecting the teeth themselves from conditions like decay, gum disease, periodontal
disease and other conditions that may result in severe infections, chronic pain or even tooth loss. Our
tooth enamel may be strong but Letting acid wear away at this protective layer will expose the sensitive
dentin underneath. Tooth enamel needs to guard the inner layers of your teeth against acids that spur
the formation of uncomfortable cavities. Furthermore, tooth enamel will make it easier to tolerate cold,
hot, acidic and sugary foods/beverages. Preserving the integrity of tooth enamel now means less
worrying about exposed dentin in the future.
https://www.colgate.com/en-us/oral-health/basics/threats-to-dental-health/tooth-enamel-repair-approaches-0915
https://www.mayoclinic.org/diseases-conditions/cavities/diagnosis-treatment/drc-20352898
https://mytempesmiles.com/can-dentist-tooth-enamel-loss/