- Classification of caries
- Causes of caries
- How does caries occur and develop?
- Caries in the spot or initial caries stage
- Superficial caries
- Medium caries
- Deep caries
- Caries of cement or root caries
- Errors and complications in the treatment of caries
- Prophylaxis of caries
Carious lesions of the teeth - or simply caries - appear after the tooth has already erupted. It is a process with a pathological form of the flow, in which hard tooth tissues (enamel, root cement and dentin) are demineralized (lose molecules of mineral substances) and soften. The destruction of the tooth tissue occurs with the formation of a cavity, which increases with time.
In our time, tooth decay is considered the most common disease that affects humanity. Numerous studies show that in developed European countries they suffer more than 98% of the population.
Not first glance, tooth decay is a harmless disease, but it is the biggest problem that dentistry faced. 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 tooth loss, causing diseases of the musculoskeletal system and all other organs.
Classification of caries
Despite the poor picture of the carious process, its classification is a rather long list.
1. Topographical classification (by the depth of the lesion) allows us to characterize the process depending on the degree of its development:
- Stain stage (pigmented or white);
- Caries of enamel;
- Dental caries;
- Caries of cement.
3. Classification by location:
- Fissure (deepening 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 field of hillocks and cutting edges;
- Circular (shingles).
4. By the nature of the current:
- Fast flowing;
- Slowly flowing;
- Stabilized (suspended).
5. By intensity:
There is a special classification, which is considered the main for dentists - the classification of carious cavities by Black :
- Caries in the field of natural grooves of the chewing teeth;
- Affection of contact (contacting) surfaces of chewing teeth;
- Defeat the contact surfaces of the front teeth without engaging 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 common fact is the destruction of enamel and dentin under the influence of organic acids, in the formation of which streptococci mutans (mutans), sanguis (sangvis), salivarius (salivarius) participate. Favorable conditions for their activity are created through a variety of etiological factors.
- Lack of fluoride in drinking water;
- Weakening of the body during the period of embedding and maturing of enamel and dentine;
- 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;
- Remains of food in the mouth;
- Violation of the biochemical composition of enamel, dentin and cement.
- Violation of the processes of bookmarking, development and teething.
- Defective structure of hard tooth tissues.
But why does not everyone get caries? There are people who perfectly observe the purity of the mouth and suffer multiple tooth lesions and those who brush their teeth through the time, and the caries bypasses them.
The answer lies in the degree of individual caries resistance of a person (resistance of the body to caries). The pathological process of tooth damage occurs when the destructive effect of streptococci overcomes the resistance of the body.
Caries resistance is manifested at different levels:
- At the molecular level, the resistance to organic acids depends on the composition of the enamel: the degree of mineralization and the interaction of constituent elements.
- At the tissue level, the enamel structure plays a decisive role. The more irregularities and defective enamel prisms (enamel cells) on its surface, the easier it is to retain bacteria and destroy it.
- At the tooth level, the shape and depth of the fissure (grooves on the tooth surface) and the structure of the pellicle (an organic film performing a protective function) are very important factors.
- At the level of the dentoalibular system, the resistance to tooth decay depends on the shape of the facial skeleton and jaws, the correct bite.
- The body fights the disease with the help of 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 are effective for both adults and children. But in children, tooth decay occurs more often, since after the eruption of the tooth enamel takes about two years to finally mature. It is during the maturation period that tooth decay occurs most often.
How does caries occur and develop?
Frequent consumption of carbohydrates for food and insufficient oral care create a favorable situation for the accumulation of plaque on the teeth. Remains of food are stuck in fissures, dents of teeth and between teeth; accumulate on prostheses and braces (if any in the mouth). Gradually, food begins to rot and wander; in it microorganisms develop 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, becomes mineralized and becomes firm. Mineralized dental deposits are called tartar.
Under the surface of the stone, acids act freely, dissolving the enamel prisms (enamel cells) due to their low acidity.
An interesting feature of our body is the fact that in parallel with demineralization (destruction) is the process of remineralization (recovery). In the place where microorganisms have breached the hard tissues of the tooth, mineral substances from the saliva are intensively ingested. With an equivalent flow of these two processes, the enamel remains intact. But if the balance is violated and the forces of bacteria prevail, caries are formed in the stage of the stain, which gradually grows 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 the timely taking of measures, caries can stop on its own, forming a dentin substitute (dentin-like substance that replaces the carious defect) in the depth of the carious cavity.
Caries in the spot or initial caries stage
Initial caries - a limited area of enamel matte, light brown, white or dark brown in color. The process begins with a loss of gloss enamel and progresses to a transition to superficial caries.
The patient may complain of a feeling of nausea. On the temperature (hot and cold) and chemical (sweet, sour and salty) stimuli the tooth does not react.
It is very difficult to detect caries in the stain stage, as with a standard examination the probe slides over its surface. In the identification of the initial caries helps a solution of methylene blue (special solution for dyeing the teeth), which stains the place of destruction (destruction of the enamel).
Differential diagnosis (differences between the initial caries and other identical diseases) is carried out with fluorosis and hypoplasia of the enamel.
Fluorosis manifests multiple, pearly-white spots on the incisors and canines (anterior teeth) and is located symmetrically on the teeth of the same name. Caries in the spot stage is a single manifestation that can be localized anywhere. The disease occurs in people prone to tooth decay, and in patients suffering from fluorosis, teeth, most often, whole.
At a hypoplasia the white maculae enclose a tooth in the form of a chain. They are formed before teething. And the initial caries can be found only on the already cut through tooth.
When staining with methylene blue, the spots of hypoplasia and fluorosis do not appear.
Treatment of the initial caries is reduced to remineralization, that is, saturation of the area with enamel destroyed by mineral substances. To do this, use:
- 10% calcium gluconate;
- 2% sodium fluoride;
- 3% remodent;
- Gels and varnishes with fluorine content.
First, professional cleaning and treatment of teeth with 0.5% hydrogen peroxide. The surface of the enamel is dried and a remineralizing substance is applied to the carious stain. The procedure is repeated until the stain disappears.
Periodically, during treatment, the affected area is stained with 2% methylene blue. As the enamel recovers, the intensity of staining becomes weaker until it disappears completely.
Unfortunately, complete cure of the initial caries can not always be achieved. The patient should be prepared for the fact that remineralizing therapy will be impotent and the initial caries will go to superficial.
The clinical picture of superficial caries is expressed by short-term pains from chemical (acidic, sweet, saline) and temperature (hot, cold) stimuli. There may be unpleasant sensations when brushing your teeth with a too stiff brush, if caries is localized at the neck of the tooth. Here the enamel layer is thinner than in other places and higher the degree of sensitivity.
When examining the oral cavity with a probe, one can grope a rough surface of a small diameter. The depth of the surface caries is within the enamel.
If the defect is on the contact surface of the tooth (the contacting surfaces of the teeth), food residues may become stuck in this place and cause inflammation of the gingival papilla. In addition, caries in such a hard-to-reach place can not be detected by a probe. If a carious process is suspected on the contact surface, an X-ray is taken, which will help to ensure the presence of the cavity.
Differential diagnosis of superficial caries is carried out with:
- Initial caries;
- Erosion of enamel;
- Endemic fluorosis.
From the initial caries surface differs in violation of the integrity of the enamel. When caries in the stain on the tooth can be seen only a spot, and with a surface there is a defect with a slight depth.
Erosion of the enamel is an oval formation with a depression and a smooth, shiny bottom, along which the probe slides. It is located on the more convex part of the tooth. Superficial caries has a rough bottom and is more often localized in places of natural deepening of the tooth (fissures, pits, cervical region).
With hypoplasia, the enamel remains undamaged and smooth. The spots are located on symmetrical teeth, which is not observed with caries.
The defeat of teeth by endemic fluorosis, in contrast to superficial caries, is characterized by the absence of pain from all kinds of stimuli and a symmetrical arrangement on the front surface of the teeth.
Treatment , in most cases, does not require preparation (grinding) and sealing. It is enough to polish the surface of the enamel in the affected area and perform remineralizing therapy as in the initial caries.
But with the localization of caries in the natural indentations, the imposition of a seal is recommended. To do this, composite materials are light (using a light bulb) and chemical (when mixing the two components of the seal) curing. The application of an insulating pad (a special material that prevents the interaction of tooth tissues and seals) is not necessary.
Patients with medium caries complain of pain from temperature, chemical and mechanical stimuli, when eliminating which discomfort passes instantly.
The average caries is characterized by cavity formation, but affects only the upper layers of the dentin. The defect is detected not only with the help of a probe, but also visually, with the naked eye.
The depth of the lesion is small. In the acute course of the process, the cavity is filled with pigmented, softened dentin, and in case of chronic - the bottom and walls are dense.
When examining the probe, soreness is revealed when the area where enamel and dentin are combined is affected.
The average caries is differentiated with:
- A wedge-shaped defect;
- Chronic course of apical periodontitis.
Unlike 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 react to stimuli and does not change its color.
With apical periodontitis, the process can be asymptomatic, as in caries. Difference - with periodontitis, sounding is painless, as is preparation. And with an average caries, the preparation requires analgesia with anesthetics. On X-rays, the apical periodontitis is determined by the widening of the periodontal gap (the space between the root of the tooth and the jawbone)
Treatment of medium caries requires compulsory dissection of the carious cavity. To carry out painless manipulations, the tooth is anaesthetized with anesthetics.
Tooling is reduced to removing pigmented (darkened) and infected tooth tissues. Then the bottom of the cavity is covered with an insulating spacer and a seal is placed on top.
When examining the oral cavity, a deep carious cavity is found that affects the lower layers of the dentin. When examining the cavity with a probe, the patient experiences severe pain. In the usual situation, pain can be caused by temperature, mechanical and chemical stimuli, after the removal of which the pain sensations disappear.
Differential diagnosis is carried out with those kinds of diseases of the oral cavity, which have similar symptoms with deep caries.
- Medium 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 painful only when the place where the enamel and dentin are joined. With deep caries, the depth of the lesion almost reaches the pulp (the dental nerve) and when probing (the probe with a carious cavity probe) the pain is felt by the patient all over the bottom of the cavity.
Acute focal pulpitis is prone to the occurrence of spontaneous pain, which is of a paroxysmal nature and occurs mainly at night. When probing, the pain is felt at one point - that is, in the place where the lesion of the pulp is located.
Chronic fibrous pulpitis differs from deep caries by the presence of a message with a 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 the help of 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 become bright and smooth.
- The cavity is thoroughly disinfected and dried.
- The bottom of the cavity is treated with fluorine-containing preparations to prevent the recurrence of caries.
- A medical pad (a drug with a curative effect for the restoration of dentin) and an insulating layer (a preparation for isolating the seal and preventing its harmful effect on the tooth) are applied.
- The next stage is the filling of the carious cavity. First, all the walls and the bottom are covered with a special glue for the seal, which is called the "adhesive". Then there is a process of filling the cavity with a seal.
- The finishing touches are correction (removal of excess material by burr), grinding and polishing of the seal.
Caries of cement or root caries
Caries of cement (solid substance covering the root of the tooth) is the most dangerous variant of all kinds of caries. It can appear on its own or be a continuation of the cervical caries.
The caries of the root is located under the gum, so it can be asymptomatic until complications develop.
The cause of dental caries is gum disease, in which subgingival tartar or caries is formed, located at the neck of the tooth.
Identify the caries of cement is quite difficult, since there are no visual signs or symptoms. Complaints can only be on pain when going caries to pulpitis.
During the examination, the doctor can detect under the gum softened, darkened tooth tissue.
The treatment of root caries is a little non-standard due to the location of the defect in an "unusual place."
If caries is located in the reach zone - the procedure takes on a classic character:
- Antiseptic treatment;
- Imposition of medical and insulating pads;
- Correction of the seal.
Errors and complications in the treatment of caries
Errors that a doctor can make in the process of caries treatment:
- Unintentional opening of the pulp chamber (the cavity in which the nerve is located) happens in the preparation of deep caries if the treated area is poorly visible or only a thin layer of dentine remains at the bottom.
The doctor should try to keep the pulp. To do this, drugs with a high calcium content are placed on the site of the dissection and the cavity is filled with a temporary filling. If no pain occurs after 2 days, a permanent seal can be applied.
- Accidental perforation of the carious cavity wall occurs most often at the cervix of the tooth. This leads to an incorrect visual assessment of the thickness of the tooth wall. The dentist should form the cavity so that it is possible to seal the damaged area without harming the pulp and the nearby teeth.
- Damage to adjacent teeth with boron.
This is facilitated by the location of caries on the contact surface and an incorrect bite. The difficulty of correcting an error depends on the degree of damage to the tooth.
With a small scratch, it is enough to perform remineralizing therapy, as with superficial caries. And with the formation of a significant defect, this tooth will also need to be sealed.
- The wound of the gum, cheek or tongue can be of varying degrees of depth. Shallow cuts can be disinfected and a disinfectant ointment applied, and deep seams may require suturing.
Complications that may occur after treatment:
- Inflammation of the pulp happens when boron burns and strong antiseptics, or when a seal is applied 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 hygiene rules.
- Papillitis - inflammation of the gingival papilla - manifests as redness, swelling and bleeding. Complication is a consequence of improper correction of the filling, when there is a sharp edge, traumatizing the tooth.
Repeated correction of the filling helps to eliminate the inflammatory process.
- Failure of a seal is the most common complication that can occur if the filling and preparation rules are not observed. You can correct the situation with a new, qualitatively delivered seal.
The patient should remember that not always mistakes and complications happen due to the doctor's fault. If the patient on the chair does not fulfill the request of the dentist and behaves inadequately - this too can cause perforations and cuts.
Prophylaxis of caries
Doctors-dentists identify three main risk factors that contribute to the development of caries:
- Mineralized and non-mineralized dental deposits (soft and hard plaque);
- Excessive consumption of sugar;
- Lack of fluoride in drinking water.
Accordingly, eliminating these causes helps to maintain healthy and strong teeth.
- To avoid accumulation of plaque on the teeth, it is necessary to clean teeth properly twice a day, use floss and conduct professional hygiene of 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.
- If there is a lack of fluoride in the water, it is recommended to take vitamin-mineral complexes additionally, brush teeth with fluorine paste, there are 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 disease of the teeth. Take care of your teeth from the very first time the first of them erupted and do not stop trying for the rest of your life.
- Deep caries: treatment
- Medium caries
- Superficial caries
- Cervical caries
- Caries of infant teeth in children