Very Clinical: Bevels, Bonds, and Sleep Apnea Red Flags

Non-carious cervical lesions (NCCLs) aren't just about aggressive brushing—they're a red flag for a complex web of systemic issues, including sleep apnea, acid reflux, and airway dysfunction. Dr. Alan Mead and co-hosts Kevin and Zach dismantle the long-held myth that NCCLs are solely caused by toothbrush abrasion, revealing that acid erosion, bruxism, and poor airway function often work together in a vicious cycle. They argue that patients with multiple NCCLs, especially those with occlusal erosion, scalloped tongues, or cheek biting, should be screened for sleep apnea—not just told to switch to a soft-bristled toothbrush. The episode challenges dentists to stop oversimplifying multifactorial conditions and instead embrace diagnostic humility, even when the root cause remains elusive. One patient’s persistent pain despite multiple composites and a root canal underscores how some cases defy conventional treatment, reminding listeners that dentistry is as much about uncertainty as it is about certainty. The conversation also dives into clinical nuances: desensitizers like SDF and glutaraldehyde can help, but long-term success often requires resin restorations with strategic bevels and bonding prep. The hosts debate whether to crown teeth with large NCCLs versus relying on composites, with consensus leaning toward crowns for better longevity. They even question the wisdom of grafting over resin, admitting they don’t fully understand the long-term outcomes.