13 October 2021

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Non-carious cervical lesions and associated factors

Edoardo Mancuso

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Non-carious cervical lesions (NCCLs) are a type of tooth wear, with loss of dental hard tissue near the cement-enamel junction. May lead to sensitivity and aesthetic problems and tooth weakening. Different factors have been suggested in the literature for the etiology of NCCLs. These factors are generally considered to be multifactorial, including demographic, behavioral, and clinical. Moreover, Toothbrushing has been often suggested as an etiological or aggravating factor for NCCLs development, especially in the presence of an acidic environment. 

However, which might be the prevalence and their association with individual and tooth-related factors is still uncertain. With the purpose of better understand NCCLs and their characteristics, an interesting cohort study has been written, by Dr. Demarco and his team, and recently published in the Journal of Clinical Periodontology. 

Materials and Methods

In the study, 539 participants were interviewed and clinically examined at the age of 31. 

Oral health and general health data were collected from previous follow-ups. 

Variables from Individual and tooth were analyzed. The individual variables included gender and family income, acidic beverages and fruits consumption, smoking, toothbrushing frequency, bruxism, and tooth wear. Tooth variables were gingival recession and probing depth. 

Results

In the study of Dr. Demarco, among all the participants, the prevalence of NCCLs at age 31 was 26%. Of these, 56.5% were in the maxilla and 43.5% in the mandible. More than 70% of NCCLs occurred in premolars, followed by 19.2% in molars, 7.1% in canines, and 0.7% in incisors. Women presented a lower prevalence of NCCLs compared with men. Individuals who reported smoking at both 22 and 30 years (always smoked) showed a higher prevalence of NCCLs, compared to those individuals who never smoked. In the research, those participants who reported a higher frequency of toothbrushing also presented a higher prevalence of NCCLs. Moreover, data analysis on gingival recession showed that this pathology is directly associated with the presence of NCCLs in the same tooth. The presence of probing depth ≥4mm was instead,  inversely associated with the presence of NCCLs. 

Discussion

In the discussions section of the article is noted that the most frequently affected teeth by NCCLs were the first premolars, followed by the second premolars and the first molars. The authors speculate that the greater susceptibility of this dental group to the development of NCCL may be due to factors related to anatomy, presenting a smaller volume of dental crown, thinner vestibular bone plate, where during excursions of the mandible there may be flexion of the tooth to the vestibular, amplifying the lesions in the cervical region. 

The results presented in the articles showed that men have more susceptibility to NCCLs. Such finding, following the authors of the article, could be explained by men being exerting a greater masticatory force, which leads to greater occlusal pressure, generating a higher concentration of tensions, making the dental structure more susceptible to the development of cervical lesions isolated or associated with others risks factors. Also, smokers presented a higher prevalence of NCCLs when compared to non-smokers. 

The discussion concludes by focusing on the periodontal pockets and their inverse association with NCCLs presence. Their results showed that teeth with periodontal pockets ≥ of 4mm presented a lower prevalence of NCCLs compared with those without periodontal pockets. The article explains that NCCLs are not related to the presence of plaque. Thus, in sites with the presence of periodontal pockets, caused by an accumulation of biofilm, causal factors of NCCLs may not be present. 

Conclusion 

The article concludes by assessing that NCCLs were detected in one-quarter of the examined individuals and that they were more prevalent in men, in smokers, and in those with a high frequency of toothbrushing. While the presence of periodontal pockets was associated with a lower prevalence of NCCLs, gingival recession was a strong clinical indicator for the presence of non-carious cervical lesions.

For additional information: Non-carious Cervical Lesions (NCCLs) and associated factors: a multilevel analysis in a cohort study in Southern Brazil