Average Depth of NCCL Causing Pulpal Irritation/Pathology
Based on clinical investigations, the vast majority (91%) of non-carious cervical lesions have axial depths of 1-2 mm, and these lesions typically exhibit mild to moderate sclerotic dentin (76%) with minimal sensitivity (73% showing no or mild sensitivity), indicating that pulpal irritation is uncommon at these depths. 1
Depth Characteristics and Pulpal Response
Typical NCCL Dimensions
- 91% of NCCLs have axial depths between 1-2 mm 1
- 49% have occlusogingival widths of 1-2 mm 1
- These dimensions represent the most common presentation in clinical practice 1
Protective Pulpal Responses at Common Depths
The tooth responds to NCCL formation through several protective mechanisms that prevent pulpal pathology:
- Dead tracts are present in 88% of teeth with NCCLs, with 62% located directly adjacent to the defect 2
- Sclerotic dentin forms in 48% of cases immediately next to the lesion, providing a protective barrier 2
- Tertiary dentin deposition occurs in 60% of teeth with NCCLs 2
- 76% of lesions demonstrate mild to moderate sclerosis 1
Clinical Sensitivity Profile
The sensitivity profile suggests that pulpal irritation is not a primary concern at typical NCCL depths:
- 73% of NCCLs present with no or mild sensitivity 1
- Only a minority of lesions cause significant discomfort despite their presence 1
Clinical Decision Algorithm for Treatment
When to Intervene Based on Depth and Symptoms
Conservative management through prevention is recommended, with restorative treatment delayed until necessary based on specific clinical indicators rather than depth alone 3
Indications for restoration include:
- Lesion progression documented over time 3
- Impact on patient's quality of life 3
- Persistent sensitivity despite conservative measures 3
- Poor esthetics affecting patient satisfaction 3
- Food collection causing discomfort or hygiene issues 3
Important Clinical Considerations
The sclerotic dentin present in most NCCLs (76%) acts as a natural barrier, explaining why pulpal pathology is rare even at 1-2 mm depths 1, 2. This sclerotic layer requires special consideration during restoration, as it does not etch like normal dentin and may require surface texturing with a fine diamond instrument to improve restoration retention 3.
The multifactorial etiology (excessive horizontal toothbrushing, acidic diet, potential occlusal factors) means that addressing causative factors is more important than immediate restoration based solely on depth 3, 4.
Common Pitfalls to Avoid
- Do not assume depth alone indicates need for treatment - the presence of protective sclerotic dentin and tertiary dentin formation means most lesions at 1-2 mm depth do not cause pulpal pathology 1, 2
- Avoid premature restoration - conservative management through prevention should be the first approach unless specific clinical indicators are present 3
- Do not overlook the protective responses - dead tracts, sclerotic dentin, and tertiary dentin formation are present in the majority of NCCLs and protect the pulp 2