Regressive Alterations Of Teeth Question And Answers

Question 1. What does regressive alteration of teeth mean?
Answer. Regressive alterations are the group of retrogressive changes in teeth, which occur due to non-bacterial causes and results in wear and tear of the tooth structures with impairment of function.

Question 2. What are the causes of regressive alterations in teeth?
Answer.

• Generalized ageing process
• Chronic persistent tissue injury.

Read And Learn More: Oral Pathology Short Notes Question And Answers

Question 3. Name the common regressive alterations of teeth.
Answer.

• Attrition
• Abrasion
• Abfraction
• Erosion.

Question 4. What is attrition of teeth?
Answer. Attrition is a constant form of retrogressive change characterized by wear of tooth substance or restoration as a result of tooth to tooth contact during occlusion, mastication or parafunction.

Question 5. What are the types of attrition?
Answer.

• Physiological attrition
• Pathological attrition.

Question 6. What is physiological attrition?
Answer. It is the continuous wearing of tooth due to normal masticatory function, which occurs over a long period of time. Older individuals often exhibit more physiologic attrition in their teeth as compared to the young.

Question 7. Describe the characteristics of physiological attrition.
Answer.

• The tooth loss in physiological attrition is proportionate to the age of the individual
• The wearing begins with the incisal edge of incisors followed by palatal cusp of maxillary molars and buccal cusp of mandibular molars
• This attrition also occurs in the proximal surfaces of teeth in the contact point areas.

Question 8. What is pathological attrition?
Answer. Pathological attrition is the extensive wearing of tooth due to abnormal chewing habits, disturbance in occlusion and due to structural defects in the teeth causing easy wearing.

Question 9. How pathological attrition differs from physiological attrition?
Answer.

• The loss of tooth structure in pathological attrition is far more extensive than what happens in physiological attrition
• In pathological attrition the degree of attrition is not proportionate to the age of the individual as happens in physiological attrition (a young person may have severe attrition)
• Pathological attrition often causes disturbed dental functions and loss of aesthetics.

Question 10. What are the causes of pathological attrition?
Answer.

• Abnormal occlusion, e.g. crowding of teeth, loss of many teeth causing masticatory overloading on remaining teeth
• Abnormal chewing habits: Bruxism, excessive chewing of coarse food like tobacco and betel nut, etc
• Structural defects in teeth: Amelogenesis imperfecta and dentinogenesis imperfecta
• Excessive strength of masticatory muscles.

Question 11. Does attrition affect only the permanent dentition?
Answer. No, it affects both dentitions.

Question 12. Which surfaces of teeth are vulnerable to attrition?
Answer. Tip of the cusps, incisal edges, proximal contact areas, labial surface of lower anterior and palatal surfaces of upper anterior.

Question 13. In attrition how the affected teeth clinically appear?
Answer. There is formation of flt, smooth, shiny, well-polished facets on those surfaces of teeth,which come in contact with the opposing teeth.

Question 14. How attrition can occur on the proximal surfaces of teeth?
Answer. Attrition on the proximal surfaces of teeth occurs due to vertical movements of tooth within the socket during mastication.

Question 15. What are the effects of extensive attrition on teeth?
Answer.

• Flattening of the entire occlusal surface of teeth
• Severe reduction in the vertical height of teeth
• Once the enamel is lost due to attrition, dentin is exposed, which also gets attrited at an even faster rate
• On the proximal surface the contact points turn into relatively broad and flt contact areas
• Mesial migration of teeth in the dental arch
• Exposure of dentinal tubules with development of hypersensitivity
• Pulp exposure and subsequent pain in few advanced cases.

Question 16. What are the treatments of attrition?
Answer.

• Correction of malocclusion
• Correction of parafunctional habits
• Use of protective occlusal guards
• Construction of artifiial crowns to protect the teeth.

Question 17. What is abrasion of tooth?
Answer. Abrasion is the pathological wearing of dental tissues or dental restorations by friction with foreign substances independent of occlusion.

Question 18. What are the causes of abrasion?
Answer.

• Improper brushing
• Habitual abrasion
• Occupational abrasion
• Ritual abrasions
• Abrasions by prosthetic appliances.

Question 19. How improper or faulty brushing technique causes abrasion?
Answer. It is the most common cause of abrasion and often occurs if:

• Tooth brushing is done in horizontal brushing strokes rather than vertical strokes.
• Excessive force is applied on the teeth during brushing
• Abrasive dentifrices are used during brushing
• Brushing is done unnecessarily several times a day with prolonged brushing time

Question 20. What are habitual abrasions?
Answer. Abrasion of teeth occurs due to some habitual practices, which are as follow:

• Excessive habitual chewing of betel nut, tobacco, and pan, etc
• Chronic pipe smokers may develop abrasion on the incisal edges of upper and lower anterior teeth due to continuous biting on the pipe stem
• Chronic habitual biting of pencils, bobby pins (hair grips) and threads, etc. Improper and habitual use of tooth prick or dental flss.

Question 21. What are occupational abrasions?
Answer. Occupational abrasion develops when objects or instruments are habitually held between the teeth by people during work.

Question 22. Give few examples of occupational abrasion.
Answer.

• If hairdressers grip the hairpins between their teeth for hours during work
• Carpenters often keep small tools or nails between their teeth when they are at work
• Similar occupational abrasions can also be seen among tailors and shoemakers.

Question 23. How abrasions can occur by prosthetic appliances?
Answer. Faulty clasp design in removable partial denture prosthesis may also cause abrasion of tooth.

Question 24. What are ritual abrasions?
Answer. It occurs when deliberate mutilation of teeth is done for some rituals.

Question 25. How the affected teeth clinically appear in abrasion?
Answer. The most common feature of abrasion is the development of a ‘V’ shaped or wedgeshaped horizontal cervical notch on the labial or buccal surfaces teeth; with sharp angles
and highly polished dentine surface.

Question 26. In which teeth abrasion occurs more frequently?
Answer. Canines and premolars being the more prominent teeth are more often affected by abrasion.

Question 27. Which jaw teeth are more frequently affected by abrasion?
Answer. Maxillary teeth are more commonly affected than mandibular teeth.

Question 28. In abrasion due to faulty brushing, which side of the teeth in dental arch are more often affected?
Answer. Teeth on the left side of the arch are more severely involved in right-handed persons and vice-versa.

Question 29. What are the associated problems with cervical abrasion of teeth?
Answer. It is often associated with gingival recession in the affected teeth.

Question 30. In which teeth abrasion is more often seen, in case of pipe smokers?
Answer. In pipe smokers, abrasions develop on the insical surfaces of upper and lower anterior teeth.

Question 31. What is the clinical appearance of teeth, which are abraded by pipe smoking?
Answer. The affected teeth characteristically present a well-polished notch, whose shape typically matches with the shape of the pipe stem used by the smoker.

Question 32. What type of abrasion occurs with habitual holding of nails or hair-pins by the teeth?
Answer. It often produces a small, deep, well polished ditch on the incisal edge of anterior teeth.

Question 33. What are the effects of abrasion if no measures are taken to control the problem?
Answer.

• Development of tooth hypersensitivity
• Formation of reactionary dentin
• Occasional pulp exposure with development of pulpitis.

Question 34. What is the treatment of abrasion?
Answer. Restoration of the affected teeth and correction of brushing habit.

Question 35. What is abfraction of tooth?
Answer. Abfraction is the pathologic loss of enamel and dentin of tooth caused by biomechanical loading forces.

Question 36. Name the various forces, which can cause abfraction of tooth.
Answer. There are two types of forces:

• Static forces: Forces produced during swallowing, tongue thrusting and clinching
• Cyclic forces: Forces produced during chewing.

Question 37. How abfraction occurs in a tooth?
Answer. The static and the cyclic forces cause repeated flxure and ultimate material fatigue to the affected tooth at locations away from the point of loading.

Question 38. Abfraction generally affects which surface of the tooth?
Answer. It affects the enamel on the buccal surface of tooth.

Question 39. Describe the clinical features of abfraction of tooth.
Answer.

• Presence of stress lines on the tooth surface
• Sometimes there is fracture of the tooth
• Repeated failure of restorations on the cervical area
• Sensitivity of tooth with sign of traumatic occlusion
• Wearing on the occlusal surface of tooth.

Question 40. What is erosion of teeth?
Answer. Erosion can be defied as progressive irreversible loss of hard dental tissues by some chemical process that does not involve bacterial action.

Question 41. What is the basic underlying pathology in erosion of teeth?
Answer. In erosion, dissolution of the mineralized tooth structure occurs upon contact with acids,which are introduced into the oral cavity either from intrinsic sources or from extrinsic
sources.

Question 42. Does erosion increases the susceptibility of teeth to other retrogressive changes?
Answer. Yes, erosion can render the teeth more susceptible to other retrogressive changes like attrition and abrasion, etc.

Question 43. Name the extrinsic factors in erosion of teeth.
Answer.

• Acidic foods and beverage, eg fruits, fruit juices, carbonated soft drinks and sport drinks, etc.
• Medicines, eg vitamin C and hydrochloric acid preparations, etc.
• Occupational hazards, eg workers handling lead acid batteries, sanitary cleaners,galvanizing chemicals, etc.
• Moreover, professional wine tasters and swimmers are also prone to erosion of teeth.

Question 44. What are intrinsic factors in erosion of teeth?
Answer. Intrinsic factors are a group of systemic disease in which, acids are produced within the body to cause erosion of teeth.

Question 45. Name the intrinsic factors in erosion of teeth.
Answer.

• Gastroesophageal reflx disease (GERD)
• Chronic alcoholism
• Pregnancy
• Esophagitis
• Gastritis
• Peptic ulcer
• Hyperparathyroidism
• Bulimia
• Nervous system disorder.

Question 46. On which surface of tooth does the acids from extrinsic sources (coming from outside the body) cause erosion?
Answer. Labial or buccal surfaces of teeth.

Question 47. On which surface of tooth does the acids from intrinsic source (generated within the body) are most ofen affected by erosion?
Answer. Lingual or palatal surfaces of teeth.

Question 48. Which surfaces of teeth are most often affected by erosion?
Answer. The commonest site of dental erosion is the gingival third of labial surfaces of maxillary incisors.

Question 49. In case of erosion, how does the lesion appears clinically?
Answer. It presents shallow, broad, scooped-out concavities on the tooth enamel with highly polished surfaces.

Question 50. Describe the changes in teeth in case of severe erosion?
Answer.

• The teeth will appear clear, polished and unstained
• Cupping of the occlusal surfaces of molar teeth
• Grooving of the incisal edges of anterior teeth
• Widespread exposure of dentin and increased tooth sensitivity
• Increased incisal translucency of teeth
• Raised amalgam restorations above the level of the tooth surface
• Increased concavity of the palatal surface of upper anterior teeth.

Question 51. When does a ski-slope like depression occur in a tooth?
Answer. In severe erosion there may be loss of the entire buccal cusp of molar teeth, which results in a ski-slope like depression that extends from lingual cusp up to the buccal
cervical area.

Question 52. What is resorption of teeth?
Answer. Resorption of teeth can be defied as a chronic progressive damage or loss of tooth structures (mostly roots of the teeth or sometimes crowns) due to the action of some
specialized cells called odontoclasts.

Question 53. What are the types of resorption of tooth?
Answer. Resorption may be of two types:

• Physiological resorption
• Pathological resorption.

Question 54. What is physiological resorption of teeth?
Answer. When resorption of tooth occurs as a natural phenomenon it is called a physiological resorption, as in case of root resorption in deciduous teeth.

Question 55. What is pathological resorption?
Answer. If resorption occurs as a pathological entity in relation to the permanent dentition, it is called pathological resorption.

Question 56. What are the types of pathological resorption?
Answer. These are of two types:

• External resorption
• Internal resorption.

Question 57. What is external resorption of teeth?
Answer. It is the pathological resoption that begins peripherally on the surface of the tooth root and moves towards the pulp.

Question 58. Can external resorption affect the crown of a tooth?
Answer. Yes, sometimes external resorption can affect the crowns of an unerupted tooth.

Question 59. What are the causes of external resorption of teeth?
Answer.

• Periapical or periradicular inflmmation
• Trauma in the tooth
• Cysts in the jaw (especially dentigerous cyst)
• Excessive mechanical forces on the tooth
• Excessive occlusal forces
• Tumors in the jaw (especially ameloblastoma)
• Reimplanted tooth
• Periodontal surgery
• Pressure from impacted tooth
• Alveolar bone grafting
• Hormonal imbalance
• Herpes zoster
• Pulpless tooth
• Idiopathic.

Question 60. What is burrowing resorption?
Answer. It is the idiopathic external resorption characterized by borrowing of entire dentine of the affected tooth and thereby producing a labyrinthine network of lacunae and channels.

Question 61. How does the affected tooth appears radiographically in burrowing type of eruption?
Answer. The tooth exhibits radiolucency similar to that of dental caries.

Question 62. Describe the radiographic appearance of external resorption of tooth.
Answer.

• Early lesions: Produce raggedness or blunting of the root apex
• Larger old lesions: May even produce a moth-eaten appearance due to irregular or uneven destruction patterns of tooth.

Question 62a. Does the architecture of root canals alter in external resorption?
Answer. Generally, the architecture of root canal remains intact.

Question 63. What are the common consequences of external resorption of teeth?
Answer. External resorption is generally associated with the following consequences:

• Exposure of pulp
• Fracture of affected tooth
• An attempted repair of the resorbed area by apposition of cementum or bone with development of ankylosis.

Question 64. What is internal resorption of tooth?
Answer. Internal resorption of tooth refers to an uncommon condition in which the resorption process starts internally within the tooth itself and the dentin is gradually resorbed from
the pulpal side towards the periphery.

Question 65. What is the cause of internal resorption of tooth?
Answer. The exact cause is unknown, however it is believed that inflmmatory reaction in the pulp following injury causes activation of osteoclast or dentinoclast cells in the internal
surface of dentin, which causes resorption.

Question 66. How does the tooth appears in internal resorption?
Answer. The tooth often appears pink in color.

Question 67. Why the tooth appears pink in internal resorption?
Answer. The tooth appears pink because hyperplastic and highly vascular pulp tissue fils up the resorbed spaces in dentine and is visible through the transparent enamel. This typical
appearance is known as pink tooth of Mummery.

Question 68. Can the tooth appear pink in case of external resorption?
Answer. Sometimes pink appearance of tooth may occur in case of severe external resorption (especially in burrowing type), when the gingival tissue projects into the resorbed spaces
of dentin.

Question 69. In case of internal resorption the affected tooth is vital or non-vital?
Answer. The affected tooth remains vital unless there is pulp necrosis due to fracture of the tooth or due to its perforation.

Question 70. Describe the radiographic appearance of internal resorption?
Answer. The affected tooth in internal resorption exhibits a well-defined, spherical-shaped,radiolucent area in the dentine, which is usually continuous with the pulp chamber or
root canal. Occasionally there can be balloon type expansion of the root canal of the affected tooth; however the external outline of tooth remains intact.

Question 71. Name the types of internal resorption of tooth.
Answer.

• Internal inflmmatory resorption
• Internal replacement resorption.

Question 72. What is internal inflmmatory resorption?
Answer. When internal resorption of tooth occurs due to an intense inflmmatory reaction within the pulp tissue it is called internal inflmmatory resorption. In this case the pulp tissue
exhibits chronically inflmed pulp containing numerous inflmmatory cells along with few multinucleated dentin resorbing cells (dentinoclasts).

Question 73. What is internal replacement resorption of tooth?
Answer. This type of resorption occurs in the absence of any inflmmatory reaction within the pulp and here the pulp chamber of the tooth is often filed with a firous granulation
tissue containing ectopic, bone-like calcifid masses.

Question 74. What is the treatment of internal resorption of tooth?
Answer. Extirpation of pulp tissue and conventional endodontic therapy.

Question 75. What is pulp calcifiation?
Answer. Deposition or formation of calcified mass(s) within the dental pulp for no apparent reason is called pulp calcification.

Question 76.Name the causes of pulp calcifiation.
Answer.

• Idiopathic formation of pulp stones
• Formation of secondary dentin in response to caries
• Calcifi metamorphosis: Pulp obliteration due to ageing or trauma
• Dentinogenesis imperfecta: Excessive dentin formation causing pulp obliteration
• Dentin dysplasia Type-I: Chevron shaped pulp chambers
• Dentin dysplasia Type-II: Pulp obliteration in deciduous teeth and pulp stone
  formation in permanent teeth
• Ehler Danlos syndrome
• Regional odontodysplasia.

Question 77. What are the different types of pulp calcifiation?
Answer. Pulp calcification may be of several types, e.g. denticles, pulp stones and diffuse linear calcifiation of pulp, etc.

Question 78. What are denticles?
Answer. Denticles are small masses of tubular dentin formed within the pulp near the bifurcation area of tooth.

Question 79. What are pulp stones?
Answer. Pulp stones are nodular calcifid bodies having an organic matrix and they occur frequently in relation to the coronal pulp.

Question 80.What is diffuse linear calcifiation of pulp?
Answer. These are amorphous, unorganized, fie firilar strands of calcifid masses in the pulp.

Question 81. How pulp stones develop?
Answer. Pulp stones develop around a central nidus of pulp tissue (consisting of collagen firils,ground substance and necrotic cell debri).

Question 82. What are the different types pulp stones?
Answer. Pulp stones may be of various types:

• True pulp stones
• False pulp stones
• Free pulp stones
• Attached pulp stones
• Interstitial pulp stones.

Question 83. What are true pulp stones?
Answer. True pulp stones are composed predominantly of dentine and have dentinal tubules.

Question 84. What are false pulp stones?
Answer. False pulp stones are composed of concentric layers of calcified material in the pulp with no dentinal tubules in them.

Question 85. What are free pulp stones?
Answer. Free pulp stones are surrounded on all sides by pulpal tissue and are not attached to the dentinal wall.

Question 86. What are attached pulp stones?
Answer. Pulp stones, which are attached to the dentinal wall of the affected tooth are called attached pulp stones.

Question 87. What are interstitial pulp stones?
Answer. When the pulp stones become surrounded by reactionary or secondary dentine they are called interstitial pulp stones.

Question 88. In case of pulp stone development, the affected teeth are vital or non-vital?
Answer. The affected teeth are vital.

Question 89. What are the methods of detection of pulp stones?
Answer.

• Radiograph
• Ground section of tooth
• Microscopic examination.

Question 90. What is the clinical signifiance of pulp stone development in a tooth?
Answer. Both pulp stones may cause diffiulties during endodontic treatment of the affected tooth.

Question 91. What is hypercementosis of tooth?
Answer. Increase in the thickness of cementum (especially cellular cementum) on the root surfaces of tooth due to excessive cementogenesis is called hypercementosis.

Question 92. Why hypercementosis of tooth occurs?
Answer. The condition results from some local or systemic disorders.

Question 93. Name the local factors causing hypercementosis of tooth.
Answer.

• Periapical or peri-radicular inflmmation
• Occlusal trauma
• Mechanical stress
• Functionless tooth
• Unerupted tooth
• Tooth repair.

Question 94. Name the systemic factors causing hypercementosis of tooth.
Answer.

• Ageing
• Paget’s disease of bone
• Cementoblastoma
• Acromegaly
• Pituitary gigantism
• Arthritis
• Calcinosis
• Rheumatic fever
• Thyroid goiter.
• Vitamin A deficiency
• Idiopathic.

Question 95. What is the clinical characteristic of tooth with hypercementosis? Is the affected tooth non-vital?
Answer. Clinically the involved tooth is completely asymptomatic and the affected tooth is always vital.

Question 96. What is the radiographic appearance of tooth with hypercementosis?
Answer. Radiograph shows excessive cemental thickening with a typical bulbous appearance of the roots