- Caries classification
- Causes of caries
- How caries develops and develops
- Decay caries or initial caries
- Surface caries
- Average caries
- Deep caries
- Cement caries or root caries
- Errors and complications in the treatment of caries
- Prevention of caries
A carious tooth lesion - or just caries - appears after the tooth has already erupted. This is a process with a pathological form of flow in which hard tooth tissues (enamel, root cement and dentin) are demineralized (lose molecules of mineral substances) and soften. The destruction of tooth tissue occurs with the formation of a cavity, which increases with time.
In our time, caries is considered the most common disease that affects humanity. Numerous studies indicate that in developed European countries, they suffer more than 98% of the population.
Not at first glance, tooth decay is a harmless disease, but it is the biggest problem faced by dentistry. The progression of the carious process can lead to inflammation of the pulp (dental nerve) and periodontal tissues (hard and soft tissues surrounding the tooth), complicated by the loss of a tooth, cause diseases of the musculoskeletal system and all other organs.
Despite the rather poor picture of the carious process, its classification is a rather long list.
1. Topographic classification (by depth of damage) allows to characterize the process depending on the degree of its development:
- Stage spots (pigmented or white);
- Enamel caries;
- Dentine caries;
- Caries cement.
3. Classification by localization:
- Fissure (groove on the horizontal surface of the tooth);
- Approximal (the surface of the dental crown facing the adjacent tooth);
- Cervical (at the neck of the tooth);
- In the area of bumps and cutting edges;
- Circular (shingles).
4. By the nature of the flow:
- Fast flowing;
- Slow flowing;
- Stabilized (suspended).
5. By intensity:
There is a special classification, which is considered the main one for dentists - the Black carious cavities classification :
- Caries in the field of natural cavities of chewing teeth;
- The defeat of the contact (touching) surfaces of the chewing teeth;
- Affection of the contact surfaces of the front teeth without involving the cutting edge;
- Caries of the contact surfaces of the front teeth with a lesion of the cutting edge;
- Carious cavity at the neck of the tooth.
Causes of caries
The acknowledged fact is the destruction of enamel and dentin under the influence of organic acids, the formation of which involves streptococci mutans (mutans), sanguis (sanguis), salivarius (salivarius). Favorable conditions for their activity are created with the help of many etiological factors.
- Lack of fluoride in drinking water;
- The weakening of the body during the period of laying and maturation of enamel and dentin;
- Adverse effects on the body of environmental factors;
- Hereditary predisposition
- Soft plaque and tartar ;
- Violation of the properties and composition of saliva in certain diseases;
- Leftover food in the mouth;
- Violation of the biochemical composition of enamel, dentin and cement.
- Violation of the processes of bookmark, development and teething.
- Inadequate structure of hard tooth tissues.
But why caries does not occur at all? There are people who perfectly clean the oral cavity and suffer from multiple lesions of the teeth and those who brush their teeth through time, and caries bypasses them.
The answer lies in the degree of individual caries-resistance of the person (the body’s resistance to caries). The pathological process of tooth damage occurs when the destructive action of streptococci overpowers the body’s resistance.
Caries-resistance manifests itself at different levels:
- At the level of molecules, the ability of resistance to organic acids depends on the enamel composition: the degree of mineralization and the interaction of the constituent elements.
- At the tissue level, the structure of enamel plays a crucial role. The more irregularities and defective enamel prisms (enamel cells) on its surface, the easier bacteria linger on it and destroy it.
- At the level of the tooth, the shape and depth of the fissures (depressions on the tooth surface) and the structure of the pellicle (an organic film that performs a protective function) are very important factors.
- At the level of the dentition, resistance to caries depends on the shape of the facial skeleton and jaws, the correctness of the bite.
- The body fights disease with the help of the salivary glands. Saliva cleans the tooth surface from plaque, preventing the accumulation of bacteria. If the rate of salivation is reduced and its viscosity is increased, the rate of caries formation increases, and vice versa.
Etiological factors act on both adults and children. But in children, caries is more common, since after the eruption of the enamel it takes about two years to completely mature. It is during the ripening period caries occurs most often.
How caries develops and develops
Frequent consumption of carbohydrates in food and inadequate care for the oral cavity create a favorable situation for the accumulation of plaque on the teeth. Food remains stuck in the fissures, the dents of the teeth and between the teeth; accumulate on dentures and braces (if any in the mouth). Gradually, the food begins to rot and roam; microorganisms develop in it with enormous speed and produce organic acids (formic, pyruvic, propionic, butyric and lactic). Soft plaque, which is on the surface of the tooth for a long time, mineralizes and becomes hard. Mineralized dental plaque is called tartar.
Acids act freely under the surface of the stone, dissolving enamel prisms (enamel cells) due to their low acidity.
An interesting feature of our body is the fact that, in parallel with demineralization (destruction), there is a process of remineralization (recovery). In the place where microorganisms punched a gap in the hard tissues of the tooth, minerals from the saliva intensively flow. With an equivalent flow of these two processes, the enamel remains intact. But if the balance is disturbed and the forces of bacteria predominate, then caries forms in the sunspot stage, which gradually develops into a deep cavity.
Rational dental care, regular visits to the dentist and proper nutrition can stabilize the balance in the oral cavity. In some cases, with timely measures, the caries can stop on its own, forming a replacement dentin (dentine-like substance replenishing the carious defect) in the depth of the carious cavity.
Decay caries or initial caries
Initial caries - a limited area of enamel matte, light brown, white or dark brown. The process begins with the loss of luster enamel and progresses to the transition to surface caries.
The patient may complain of a sense of mouthwash. The tooth does not react to temperature (hot and cold) and chemical (sweet, sour and salty) stimuli.
It is very difficult to detect caries in the staining stage, since with a standard examination the probe slides along its surface. In identifying the initial caries helps solution of methylene blue (special solution for staining the teeth), which stains the place of destruction (destruction of enamel).
Differential diagnosis (differences between initial caries and other identical diseases) is carried out with fluorosis and enamel hypoplasia.
Fluorosis is manifested by multiple, pearl-white spots on incisors and canines (front teeth) and is located symmetrically on the teeth of the same name. Caries in the staining stage is a single manifestation that can be localized anywhere. The disease occurs in people prone to caries, and in patients with fluorosis, the teeth, most often, are whole.
In hypoplasia, white spots surround the tooth in a chain. They are formed before teething. And the initial caries can be found only on the already erupted tooth.
When staining with methylene blue, the spots of hypoplasia and fluorosis do not appear.
The treatment of the initial caries is reduced to remineralization, that is, the saturation of the area with enamel-destroyed minerals. To do this, use:
- 10% calcium gluconate;
- 2% sodium fluoride;
- 3% remodeling;
- Gels and varnishes with fluorine content.
First, professional cleaning and treatment of teeth with 0.5% hydrogen peroxide is performed. The enamel surface is dried and a remineralizing agent is applied to the carious stain. The procedure is repeated until the stain disappears.
Periodically, in the course of treatment, the affected area is stained with 2% methylene blue. As enamel recovers, the staining intensity becomes weaker until it disappears completely.
Unfortunately, it is not always possible to achieve complete cure of the initial caries. The patient must be prepared for the fact that the remineralizing therapy will be impotent and the initial caries will go to the surface.
The clinical picture of surface caries is expressed by short-term pain from chemical (sour, sweet, salty) and temperature (hot, cold) irritants. There may be discomfort when brushing your teeth too hard with a brush, if the caries is localized at the neck of the tooth. Here the enamel layer is thinner than in other places and the degree of sensitivity is higher.
When examining the oral cavity with a probe, you can grope the rough surface of small diameter. The depth of surface caries is within the enamel.
If the defect is on the contact surface of the tooth (the contacting surfaces of the teeth), food debris can get stuck in this place and cause inflammation of the gingival papilla. In addition, caries in such an inaccessible place with a probe cannot be identified. If a carious process is suspected, radiography is performed on the contact surface to help ensure that there is a cavity.
Differential diagnosis of surface caries is carried out with:
- Initial caries;
- Enamel erosion;
- Endemic fluorosis.
From the initial caries superficial differs violation of the integrity of the enamel. In case of caries in the stains stage, only a spot is visible on the tooth, and in case of surface caries there is a defect with a small depth.
Enamel erosion is an oval-shaped formation with a hollow and a smooth, shiny bottom along which the probe slides. It is located on the more convex part of the tooth. Surface caries has a rough bottom and is often localized in places of natural tooth deepening (fissures, pits, cervical area).
In hypoplasia, the enamel remains intact and smooth. The spots are located on symmetrical teeth, which is not observed with caries.
The damage of teeth to endemic fluorosis, unlike surface caries, is characterized by the absence of pain from all types of irritants and a symmetrical arrangement on the front surface of the teeth.
Treatment , in most cases, does not require preparation (grinding) and sealing. Enough to grind the surface of the enamel in the affected area and carry out remineralizing therapy as in the initial caries.
But with localization of caries in natural depressions, the imposition of fillings is recommended. Composite materials of light (using a light lamp) and chemical (when mixing two components of a seal) curing are suitable for this. The imposition of an insulating gasket (a special material that prevents the interaction of tooth tissues and fillings) is not necessary.
Patients with moderate caries complain of pain from temperature, chemical and mechanical stimuli, with the elimination of which the discomfort passes instantly.
The average caries is characterized by the formation of a cavity, but affects only the upper layers of the dentin. Defect is detected not only with the help of the probe, but also visually, with the naked eye.
The depth of the lesion is small. In the acute process, the cavity is filled with pigmented, softened dentine, and in chronic, the bottom and walls are dense.
When examining the probe pain is detected when the area where the enamel and dentin are connected is affected.
The average caries is differentiated from:
- Wedge-shaped defect;
- Chronic apical periodontitis.
Unlike the average caries, the wedge-shaped defect affects only the cervical part of the tooth and has the appearance of a wedge. The walls of the defect are smooth and shiny. The tooth does not respond to stimuli and does not change its color.
In apical periodontitis, the process may be asymptomatic, as in caries. The difference is that with periodontitis, the probing is painless, as is the preparation. And with an average caries dissection requires anesthesia with anesthetics. On X-rays, apical periodontitis is determined by the expansion of the periodontal gap (the space between the root of the tooth and the bone of the jaw)
Treatment of average caries requires mandatory preparation of the carious cavity. For painless manipulations, the tooth is anesthetized with anesthetics.
Instrumental processing is reduced to the removal of pigmented (darkened) and infected tooth tissues. Then the bottom of the cavity is covered with an insulating gasket and a seal is applied on top.
Examination of the oral cavity reveals a deep carious cavity that affects the lower layers of the dentin. When examining the cavity with a probe, the patient experiences a sharp pain. In a typical situation, the pain can be caused by temperature, mechanical and chemical irritants, after which the pain is eliminated.
Differential diagnosis is carried out with those types of oral diseases that have similar symptoms with deep caries.
- Average caries;
- Acute focal pulpitis (acute inflammatory disease of the dental nerve);
- Chronic fibrous pulpitis (chronic inflammatory disease of the dental nerve).
With an average caries, the cavity in the tooth is less deep and soreness is observed only when the place where the enamel and dentin join is affected. With deep caries, the depth of the lesion almost reaches the pulp (dental nerve) and when probing (examination with a carious cavity probe), the pain is felt by the patient throughout the bottom of the cavity.
Acute focal pulpitis is prone to the occurrence of spontaneous pain, which are paroxysmal in nature and occur mainly at night. When sensing pain is felt in one point - that is, in the place where the inflammation of the pulp is located.
Chronic fibrous pulpitis differs from deep caries by the presence of a message with the pulp chamber (the carious cavity and the cavity of the tooth in which the nerve is enclosed are connected by a small hole). When probing a small amount of blood appears from the cavity.
- Local anesthesia with anesthetics.
- The second stage is preparation with removal of all softened and pigmented tooth tissues. With the help of dental instruments, the carious cavity is cleaned until the bottom and walls are light and smooth.
- The cavity is thoroughly disinfected and dried.
- The bottom of the cavity is treated with fluoride-containing preparations to prevent the recurrence of caries.
- A medical pad is applied (a drug with a therapeutic effect to restore dentin) and an insulator (a drug to isolate the filling and prevent its harmful effects on the tooth).
- The next stage is the filling of the carious cavity. First, all the walls and the bottom are covered with a special adhesive for the filling, which is called “adhesive”. Then comes the process of filling the cavity with a filling.
- The final touches are correction (boron removal of excess material), grinding and polishing the fillings.
Cement caries or root caries
Cement caries (solid substance that covers the root of the tooth) - the most dangerous option of all types of caries. It may appear on its own or be a continuation of cervical caries.
Root caries is located under the gum, so it can be asymptomatic up to the development of complications.
The cause of caries of cement are gum disease, which produces subgingival dental calculus or caries, located at the neck of the tooth.
Identifying caries of cement is quite difficult, since there are no visual signs or symptoms. Complaints can only be pain when moving caries in pulpitis.
During the examination, the doctor may detect softened, darkened tooth tissues under the gum.
Treatment of root caries is a bit non-standard due to the location of the defect in the “unusual place”.
If caries is located within reach, the procedure takes on a classic character:
- Antiseptic treatment;
- The imposition of therapeutic and insulating pads;
- Correction seals.
Errors and complications in the treatment of caries
Errors that a doctor can make in the process of caries treatment:
- An accidental opening of the pulp chamber (the cavity in which the nerve is located) occurs during the preparation of deep caries, if the treated area is poorly visible or only a thin layer of dentin remains on the bottom.
The physician should try to preserve the pulp. To this end, preparations with a high calcium content are superimposed on the opening site and the cavity is filled with a temporary filling. If after 2 days the pain does not occur, you can impose a permanent seal.
- Accidental perforation of the wall of the carious cavity most often occurs at the neck of the tooth. This results in an incorrect visual assessment of the wall thickness of the tooth. The dentist must form a cavity so that the damaged area can be sealed without harm to the pulp and adjacent teeth.
- Damage to adjacent teeth boron.
This is facilitated by the location of caries on the contact surface and the wrong bite. The difficulty of correcting an error depends on the degree of damage to the tooth.
With a small scratch, it is enough to carry out a remineralizing therapy, as with superficial caries. And with the formation of a significant defect, you will need to fill this tooth too.
- A wound to a gum, cheek, or tongue can be of varying degrees of depth. Shallow cuts can be sanitized and a disinfecting ointment can be applied, and for deep cuts, stitching may be required.
Complications that may occur after treatment:
- Inflammation of the pulp occurs when burns with boron and potent antiseptics, or when applying a seal without an insulating pad. The complication is treated as acute pulpitis in the dental office.
- Secondary caries occurs when infected, softened tooth tissues are not completely removed. It is required to remove the seal and put a new one in compliance with all the rules of hygiene.
- Papillitis - inflammation of the gingival papilla - is manifested by redness, swelling and bleeding. A complication is a consequence of an incorrect correction of the filling, when a sharp edge remains, a traumatic tooth.
Repeated correction of a seal helps to eliminate the inflammatory process.
- The loss of a seal is the most common complication that can occur if the rules of filling and preparation are not followed. It is possible to rectify the situation with a new, high-quality seal.
The patient should remember that mistakes and complications do not always happen because of the doctor’s fault. If the patient on the chair does not fulfill the requests of the dentist and behaves inadequately - this can also be the cause of perforations and cuts.
Prevention of caries
Dentists identify three major risk factors that contribute to the occurrence of caries:
- Mineralized and non-mineralized dental plaque (soft and hard plaque);
- Excess sugar intake;
- Lack of fluoride in drinking water.
Accordingly, the elimination of these causes helps to maintain healthy and strong teeth.
- In order to avoid accumulation of plaque on the teeth, it is necessary to properly brush the teeth twice a day, use dental floss and carry out professional hygiene of the teeth and oral cavity twice a year.
- Excess sugar can be reduced by changing the diet and reducing the number of sweets and flour products in your menu.
- With a lack of fluoride in the water, it is recommended to take in addition vitamin-mineral complexes, brush your teeth with fluoride paste, eat more dairy products, fruits and vegetables.
Caries is always easier to prevent than to treat it and those complications that arise as a result of untreated carious teeth disease. It is necessary to take care of the teeth ever since the first one was cut through and not to stop efforts throughout life.