Caries definition as the types of diagnosis and treatment develop. Dental caries: symptoms, stages, methods of treatment. Stages of caries with their characteristic symptoms

A hole in a tooth is what is called caries in the professional language of dentists.

Caries begins with softening of the tooth enamel and penetration into the tooth bacterial infection. The waste products of bacteria contain acids that corrode the surface of the enamel and, as a result, microscopic cavities form in it.

If pathogenic microorganisms are not removed from such cavities in a timely manner and carefully, then a carious process develops.

In our article, you will learn what caries appears from, as well as methods for its treatment.

Why does caries occur?

Millions of bacteria naturally live in the human mouth, which, in the course of their life, process carbohydrates into lactic, formic, butyric, propionic and other organic acids. Remains of food, colonies of microorganisms and acids produced by them mix and form a porous plaque on the surface of the teeth.

Tooth decay is usually the result of poor diet and poor oral hygiene.

The absence of the habit of brushing your teeth regularly provides acids with prolonged contact with the enamel and leads to the appearance of primary carious foci of shallow depth on it.

Inflammation of the pulp is accompanied by severe pain due to the presence of a large number of nerve endings in it. In general, the process of development of caries can be long and take up to 2 years.

Caries usually affects molars with a large chewing surface. Due to the specific shape and position in the dentition, it is quite difficult to remove plaque and food fibers from them, so acids have a long-term destructive effect on the enamel.

Factors that increase the risk of caries

Diet and diet

In the diet of a modern person, there is an excess of fast carbohydrates. By eating a large amount of foods containing starch and sugar, we supply bacteria with material for processing it into acids that destroy tooth enamel.

The risk of developing caries increases if there is a habit of constantly snacking between main meals.

Chocolate, bread, dried fruits, chips, sugary sodas and other typical snack foods contribute to an intense buildup of plaque that stays on the teeth for at least a few hours until the next brushing.

Then the first microscopic damage occurs on the surface of the enamel.

Poor oral hygiene

Irregular and inefficient mechanical brushing of teeth, inner surfaces not treated with a toothbrush, perigingival, interdental spaces and tongue create a favorable environment for the reproduction of pathogenic microorganisms.

Dry mouth

Since saliva helps to keep the surface of the teeth clean from plaque, neutralizes some acids and promotes remineralization of the enamel, any violation of salivation increases the risk of caries.

A decrease in the amount of saliva produced may be due to smoking, taking a number of medicines(antihistamines, beta blockers, tricyclic antidepressants, antiepileptic drugs) or radiation therapy to the head and throat.

Gum pathology

One of the common problems with gums is their natural settling and exposure of the necks of teeth that do not have an enamel coating. In places where there is no enamel, the teeth are even more susceptible to the aggressive effects of acids and the occurrence of the so-called cervical caries.

bottled water

Ordinary tap water contains essential minerals and fluoride that protect teeth from decay. Purchased drinking water does not contain fluorine, depriving us of this protective factor.

Unsatisfactory condition of seals

Over time, fillings can wear out, sag, crack, their fixation weakens. Such defects create ideal conditions for the accumulation of microorganisms and often lead to the recurrence of caries.

Symptoms

At the initial stage, signs of the presence of caries may be mild, but with the development of the pathological process, the following symptoms are often observed:

• pain when eating sweet, sour or salty foods;
• increased sensitivity to the temperature factor: pain reaction to cold air, very hot or cold food;
• discoloration of the enamel, the presence of black, brown or gray spots on it;
• holes and other visible violations of the integrity of the tooth enamel;
• bad breath;
• an unpleasant or tart taste in the mouth;
• pain when biting;
• inflammation of the gums;
• throbbing or aching pain;

Treatment Methods

Treatment methodis chosen by the doctor based on the stage and nature of the course of the carious process:

Before and after caries filling

1. remineralizing therapy. It is carried out to treat the disease in the initial stage. The affected areas of enamel are treated with fluorine, calcium and phosphorus preparations to saturate it with minerals lost under the influence of organic acids.
2. Sealing. If the carious process has reached the deeper layers of the tooth lying under the enamel, then the destroyed areas are removed with a drill and replaced with strong ones.
3. . With significant carious destruction, the doctor may recommend the installation of a crown instead of a conventional filling. This is done in cases where the filling is not able to sufficiently restore the strength of the tooth. To install a crown, the destroyed part of the tooth is removed, the remaining part is cleaned and slightly reduced in size. A specially made individual crown covers the entire tooth, restoring its original shape.
4. . The method is optimal for the treatment of caries in the inner part of the tooth - the pulp, where blood vessels and nerve endings are concentrated. After removing the inflamed pulp, the root canals are treated and sealed.
5. Removal. This method of treatment is used if the carious destruction of the tooth is so great that it cannot be cured and restored based on its own root. Since the extraction can change the configuration of the dentition and affect chewing function, in the future, the patient is recommended to resort to implantation and prosthetics.

Prevention

There are professional caries protection measures offered by dental clinics: professional teeth cleaning procedure, mineralization and fluoridation procedures to strengthen enamel, sealing of depressions (fissures) on the chewing surface of teeth, correction of malocclusion.

The simplest and most accessible measures will also help reduce the risk of developing the disease and its complications:

1. Visit the dentist twice a year to check possible problems at an early stage.
2. Brush your teeth at least twice a day for 2-3 minutes, and preferably after each meal.
3. Do not forget to brush your teeth to also remove plaque from the tongue.
4. Use not only a regular toothbrush, but also other aids: dental floss, toothpicks, interdental brushes.
5. Use a fluoride rinse after brushing your teeth.
6. Change your toothbrush at least once every three months.
7. Drink clean water (or rinse your mouth) after meals and sugary drinks to remove excess sugar from your mouth.
8. Include solid foods (such as raw vegetables and nuts) in your diet for natural mechanical cleaning of your teeth.
9. Avoid food that is contrasting in temperature, this leads to cracking of the enamel and infection.

Almost everyone suffers from dental problems from time to time. The most common dental disease is caries. It is a process of destruction of hard tissues of the tooth. First, caries affects the tooth enamel and if left untreated, the process begins to affect the deeper layers of the tooth and can lead to its complete destruction. If the disease is started, a hole appears in the tooth enamel, it gradually increases, opening access to pathogenic bacteria inside the tooth. This leads to the fact that other diseases join caries, exacerbating the situation. What are the causes of caries and can you protect yourself from it?

This disease does not occur on its own. It is caused by special cariogenic bacteria Streptococcus mutans, Streptococcus sanguis and actinomycetes living in the oral cavity. But why does caries rarely occur in some people, while others are forced to go to the dentist every year, or even more often? The fact is that each organism has a different resistance to these microorganisms. It has been noted that people with weak immunity are more susceptible to the effects of cariogenic bacteria.

Attention! Bacteria live and multiply in dental plaque. Brushing your teeth can get rid of plaque, but only soft deposits can be removed with a toothbrush. In a few days, plaque turns into hard tartar that cannot be removed on its own. To get rid of it, you need to see a doctor.

With the help of special tools, the doctor will break up and remove hard deposits. If you do not get rid of tartar in time, cariogenic bacteria will continuously attack the tooth, and this will sooner or later lead to caries.

There are many causes of tooth decay, but some of which we encounter every day: improper oral care, poor water quality, lack of vitamins and minerals in the body - it is necessary to pay attention to these factors, because. we can control them.

For active reproduction, bacteria require certain conditions. These conditions are:

• poor oral care;
• poor cleaning;
• predominance in the diet, rich in carbohydrates(flour, sweet), as well as the lack of fresh vegetables and fruits;
• poor-quality drinking water with a low content of calcium, fluorine, phosphorus;
• lack of vitamins;
• reduced immunity;
• diseases of the digestive system;
• violation of the formation of teeth, which can be provoked by transferred to childhood diseases (tuberculosis, rickets).

Under the influence of these factors, plaque begins to accumulate on the teeth - a favorable environment for bacteria. The enamel becomes thinner, becomes brittle and is affected by caries. To avoid this, it is necessary to eliminate or reduce the influence of harmful factors.

Why else does caries occur?

As mentioned above, the main causes of the disease are cariogenic bacteria that actively multiply in food debris and plaque. But, in addition to this, there are several additional factors that increase the risk of caries. What is it?

Diagnosis of caries

If the carious process has already developed, it becomes visible to the naked eye, but at the initial stage it is impossible to independently determine the presence of the disease. This can only be done by a dentist with special equipment. Three main types of examination are used: vital staining of tooth enamel, ultraviolet irradiation, and x-rays.

Stages of the disease

Like any disease, caries develops gradually and has several stages. Dentists distinguish three stages in the development of the disease.

• early caries. At this stage, the tooth retains its integrity, but a small white spot appears on its surface. Gradually, the enamel becomes pigmented, acquiring a grayish tint, and its surface becomes rough.
• Medium caries. At this stage, the carious process affects not only the enamel, but also the next layer of the tooth - the dentin, as a result of which a cavity appears in it, which gradually increases in size.
• deep caries. If the patient does not go to the doctor, the carious process continues its destructive effect and affects the deep layers of the tooth. At this stage, others can join the main disease.

This figure shows caries in three stages: early, medium and deep caries.

Each person develops caries at a different speed - for someone quickly, for someone slowly. Usually in adults, the disease is chronic, sluggish. In children, this process proceeds much faster, since milk teeth are not as strong as permanent ones. The rapid course of the disease is called acute caries.

Patients who neglect their dental health and do not treat caries are at risk of complications. Untreated caries destroys the hard tissues of the tooth and goes beyond them. What complications can arise?

Pulpitis

Inside the tooth is a neurovascular bundle - the pulp. When the inflammatory process affects it, pulpitis develops. The disease is characterized severe pain. If no action is taken, the pulp tissue dies and the tooth loses its source of nutrition.

Periodontitis

Periodontitis is an inflammation of the periodontium. Periodontium is the tissue around the tooth. The inflammatory process extends to the canals located inside the tooth and covers nearby tissues. If pus accumulates in the root area, this indicates the development of a periodontal abscess.

Tooth cyst

Dental tissues are destroyed, leading to the growth of granulations and the formation of a cavity, which is filled with pus. To treat a cyst, the dentist makes a puncture and removes the formation.

Flux

It is not uncommon for patients to visit the dentist with swollen cheeks. This condition indicates the development of flux. Flux occurs when the periosteum, the tissue that covers the bone, becomes inflamed. The periosteum exfoliates, and the resulting cavity is filled with pus. In this case, the patient needs urgent treatment. The doctor makes a small incision, drains the pus, cleans the cavity, and then prescribes a course of antibiotics to the patient. If the tooth can still be saved, treatment of pulpitis and periodontitis will be required. In this case, the flux will not develop again.

Many people believe that caries is not a serious disease of the teeth and turn to the dentist after the onset of pain. But pain indicates that caries has already passed into a difficult stage and dangerous consequences may appear in the form of pulpitis, periodontitis, cysts or flux.

Prevention of caries

In order not to suffer from caries and its consequences, you need to try to prevent the disease. Caries prevention methods:

• Regular brushing of teeth. To keep your teeth healthy, you need to brush them twice a day - in the morning, after waking up and in the evening, before going to bed. In terms of time, the procedure should take at least two minutes and should not be limited to brushing the surface of the teeth. It is also necessary to clean the interdental, near-gingival spaces and the tongue, since microbes also accumulate there. To make cleaning as effective as possible, you need to choose the right toothpaste and brush.
• Mouth rinse. In addition to brushing your teeth regularly, dentists recommend rinsing your mouth with water after every meal. This helps to wash away the acids left by acidic foods from the surface of the teeth, as well as get rid of food particles stuck in the interdental spaces. In the morning and evening, after brushing your teeth, you should use special mouthwashes. They freshen breath, slow down the process of plaque formation, and also strengthen the enamel, saturating it with minerals.
• Replenishment of the lack of fluorine.

  Attention! Fluorine is an important trace element that affects the strength of tooth tissues. It is found in drinking water, but not in all regions, water has a sufficient amount of this substance. A lack of fluoride leads to thinning of tooth enamel.

  This problem can be solved by fluoridation of drinking water. But the easiest way to use oral rinses, which include fluoride. Another way to make up for the lack of fluoride is to eat foods rich in this element, such as fish and other seafood.

• Food temperature. Sudden changes in temperature are harmful to tooth enamel, since such exposure leads to the appearance of microcracks, into which microbes then penetrate. To avoid this, you should not eat too hot, cold or contrasting food.
• Regular visits to the dentist. Often, patients go to the doctor only when the teeth start to hurt. It is not right. To prevent caries, it is recommended to undergo periodic medical examinations at the dentist in order to timely identify the first signs of the disease. Adults need to see a doctor at least every six months, and children every three months, as their teeth decay much faster.

Do not neglect preventive examinations. This will help to detect problems with the teeth in time and avoid possible complications.

Recent archaeological research confirms that even our ancestors, who lived more than five thousand years ago, suffered from caries. Information about the destruction of teeth similar to carious ones can be found in the writings of ancient and ancient Eastern healers, in the Middle Ages, bad teeth were a general problem, and street tooth pullers became characters of folklore and even got into many literary works of those times.

The very word "caries" came to us from Latin and means literally "rotting", in fairness it is worth noting that initially this name was poliomyelitis, but after that a disease that we all know was established under this name - an infectious process that destroys, and sometimes even simply "devouring" the teeth of a person. The causes of caries and, as a result, ways to get rid of it occupied the minds of many pundits of antiquity and the Middle Ages. Whatever assumptions were not expressed - from an excess of "bad juices" that enter the body, which antiquity operated on (it must be said, there is some truth in this, if all kinds of food acids are understood as bad juices), to "toothworms" in the Middle Ages.

Causes of dental caries

Today, disputes about what caries is and why it happens are long in the past. The cause of caries is known to everyone - these are carious bacteria that feed on carbohydrate residues from food and live in plaque. By the way, we are not born with these bacteria, they are not part of the original composition of our microflora, but once they enter the body, they settle in it forever. As a rule, "infection with caries" occurs in childhood, and we perceive this disease from our own parents - most often through common dishes. However, caries bacteria can long time how to doze off in our body, not showing itself in any way until the first opportunity.

And although caries this moment- perhaps the most studied dental disease, the question still remains how to stop caries - discoveries in this field are made almost every year.

Risk factors for dental caries

One of the most interesting questions is why some people are more likely to get caries, while others are less common, and whether there are those who do not suffer from it at all. So, modern theorists and practitioners of dental science distinguish several risk factors for caries. As you might guess, among these factors there are also very “selective”, that is, it is known for certain that some people are initially more predisposed to carious lesions of the teeth. Here are some signs that you should be wary of cavities.

Caries Risks

• Bulb-shaped fissures. If there are many places on the surface of your teeth that seem to be created for the accumulation of plaque and the formation of cavities, then the bacteria will not take long to wait. So, teeth with flask-shaped fissures (grooves on the chewing surface) are more susceptible to carious lesions.
• Crowded teeth and bite problems. Even among the individual characteristics that make a person more vulnerable to caries, one can distinguish bite problems, as well as teeth that are crowded - a close arrangement relative to each other. On such teeth, which are very difficult, and sometimes impossible to clean properly, contact caries often occurs.
• Geography of residence. People are less likely to get cavities in areas with fluoridated tap water.
• Professional activity. Citizens working with alkalis, acids and other harmful substances, on the contrary, are more susceptible to caries.
• Age. milk teeth in young children are very often victims of carious bacteria, the greatest activity of which, however, occurs between the ages of 11 and 40 years.
• Gender identity. Women are more likely than men to suffer from this disease, which is associated primarily with the destruction of teeth during pregnancy.

The risk of caries is affected by the quality of tooth enamel and pellicle - a thin organic film covering it, the work of the salivary glands and chemical composition saliva, diet and even sleep patterns.

caries symptoms

Caries will not keep you waiting long in the following cases: if you pay little attention to daily dental hygiene; with reduced immunity, for example, due to a long cold; if you eat a lot of fast carbohydrates.

Carious bacteria and the acid they secrete are very insidious - in the initial stages, caries is almost asymptomatic. That is why it is so important to regularly attend preventive examinations, during which the dentist has the opportunity to diagnose caries in the initial stages.

The first signs of caries

1. Stains on teeth. The first signs of caries are spots on the enamel - they can be either white or brown or even black. However, even such spots can be difficult to see on your own.
2. Pain in caries. If you feel that a tooth has begun to react to sweet food, for cold and hot, then you should consult a dentist.
3. Hole for caries. If you can feel the hole in the tooth with your tongue, then caries has already flowed into a more severe form and requires immediate treatment.
4. Odor from the mouth with caries. When a person is not in a hurry to dentistry, experimenting with the treatment of caries at home, the teeth begin to rot and decay. The result is bad breath.

Stages of caries - types and intensity

The most popular among modern dentists is the Black classification of caries. According to this system, caries is divided into six classes depending on the localization of carious cavities and the extent of carious lesions of the teeth.

Tooth enamel caries

Class I caries, or superficial caries, affects, as a rule, the already mentioned fissures - grooves on chewing teeth. Sometimes such caries is called caries in the stain stage, if you notice it in time and take action, you can even do without drilling with a drill and stop the carious process at the root, preventing it from spreading deeper. If you miss the first signs, then the deterioration will not take long.

Contact type of caries

Next stage - class II caries - often affects the contacts of chewing teeth, which is why it is sometimes called contact caries . At this stage, as well as at the previous one, caries does not bother its carrier and can go unnoticed for a long time.

front teeth

Class III caries, or medium caries, affects the contact surfaces of the anterior teeth. Many experts consider the use of floss the best prevention against it. Also, average caries is a disease of the sweet tooth.

Dentin caries

When the caries of the anterior teeth of the middle stage is not treated, it flows into next class - IV and affects the dentin.

Radical

Class V caries, it is also radical, or cervical, caries, spreads along the gingival line both on the front and chewing teeth. Manifested by increased sensitivity of the teeth in the neck of the tooth. Cervical caries usually results from poor oral hygiene.

Atypical

Caries of the last class according to Black - VI - is also called atypical caries. This type of caries destroys the cutting edge and tubercles of the teeth, scoop-shaped teeth are most susceptible to it.

It is also necessary to note three special categories of caries: multiple, recurrent and root caries. Their distinctive features are already clear from the names, but we will consider them in more detail.

Multiple dental caries

Multiple caries, it is also generalized, or systemic, a large number of teeth are affected at once - from six to twenty, but even this is not enough for him - in each tooth affected by him, the dentist can detect not one, but two or even as many as three carious cavities. As you might guess, such caries develops quickly and can lead to the loss of several teeth or even the entire dentition. The causes of such a carious catastrophe are often immune, infectious and other severe general somatic diseases. Sometimes this happens to teenagers during puberty, when the body goes through the strongest hormonal storm, because of which the immune system can also experience stress.

Secondary caries

Recurrent caries, it is also secondary, as the name implies, it occurs in a previously affected, cured and sealed tooth. The reasons for his return may be poor-quality treatment, as well as untimely replacement of fillings or other orthopedic structures - after all, fillings and crowns, although they serve for a long time, alas, do not last forever. Over time, they begin to fit worse to the tissues of the tooth, saliva, bacteria, plaque, food debris get into the gaps - true friends of caries. You can distinguish secondary caries by the brown contour at the junction of the orthopedic structure and dental tissues.

Root caries

Root caries affects the roots of the teeth exposed during the recession of the gums. This type of caries is directly related to periodontal disease, malocclusion and age-related changes.

As the name implies, root caries affects the exposed tooth root. This form usually seen in the elderly and usually affects the posterior teeth. This is explained by the fact that with age, the risk of periodontitis increases, bone atrophy occurs, gums recede, and salivation decreases. First, the visible surface of the tooth root is affected, which becomes dark in color. Then, progressing, the carious focus expands and completely captures the root of the tooth. This often leads to a fracture with complete separation of the crown from the root (amputation caries). The disease often recurs if the root surface is left exposed and toothbrushing is irregular or incorrect.

So, as we have already found out, practically no one is insured against caries, and some people from birth or due to their lifestyle are included in special risk groups. However, regardless of whether you have “aggravating circumstances”, the most important thing you need to remember is that high-quality hygiene, regular preventive examinations, coupled with professional cleaning and timely treatment of caries in the initial stages are the key to a beautiful and healthy smile for many years. .

The concept of "caries" corresponds to the semantic meaning of the word "decay" and in practice is a slowly developing pathological process, accompanied by the decomposition of hard dental tissues. Statistics show a high prevalence of caries, reaching a ratio of 93-95%.

Scientifically substantiating what caries is, the scientist identified the main stages in the development of the pathological process:

• demineralization of the inorganic part of the segment under the influence of lactic acid;
• destruction of the organic part of the segment due to the activity of microorganisms.

Such a theory explaining the mechanisms of the development of the disease, of course, is very conditional and schematic, since in ancient times the knowledge of biology was at an extremely primitive level, but Miller and his followers were the first to express their point of view about the presence of carbohydrates in the oral cavity and the participation of microorganisms in the pathological process.

Of the other theories of the localistic type, the more modern theory of Banting is of interest, explaining dental caries by the activity and number of acidophilus rods in the oral cavity. Numerous supporters of Banting in the USA believe that due to the activity of an acid-forming strain of acidophils, initial caries occurs. Genetic predisposition and the level of sensitivity of the body, of course, are important for the development of the disease, but Banting points out the need for careful oral hygiene, which can block the growth of acidophilic flora.

Of the theories of modern times, the theories of Eggers-Lur and Schatz-Martin deserve attention, taking into account the importance of factors affecting the strength of enamel (the role of soil, water, nutrition, etc.). The theory also takes into account the influence of an alkaline environment and the ability of sugars accumulated in plaque to form compounds that affect dental tissues.

A variety of theories of the onset of the disease agree that dental caries is influenced by the content of the microflora of dental plaque, which has been repeatedly proven in practice. Cariogenic microorganisms (lactobacilli, streptococci, etc.) contribute to the destruction of hard dental tissues.

The pathological process of the development of the disease is usually classified at the stage of caries, depending on the degree of damage to the tissues of the tooth.

Caries is considered a scourge modern society, the causes of which depend on a number of general and local factors:

• the destructive effect of microorganisms on hard dental tissues due to improper and irregular oral hygiene (accumulation of soft and hard dental deposits);
• irrational and unbalanced diet with an excess of carbohydrate soft foods and insufficient consumption of raw vegetables;
• the presence of hypovitaminosis;
• insufficient content of minerals (calcium, phosphorus, fluorine) in drinking water;
• decrease in the immune forces of the body;
• pathological disorders in the formation of teeth, which may be associated with diseases suffered in childhood (tuberculosis or rickets);
• the presence of diseases of the gastrointestinal tract;
• stress and various extreme factors that negatively affect the body;
• genetic predisposition;
• violation of the structure of hard dental tissues due to a low level of enamel mineralization (laid during the intrauterine development of the child);
• violations of the state of the dentoalveolar system (malocclusion, incorrectly installed prostheses and braces);
• changes in the composition and properties of saliva and a decrease in its secretion.

Factors that influence the development of the disease or one way or another provoke it are called cariogenic. The intensity of the occurrence of pathology depends on a significant amount of carbohydrates in the diet (especially sucrose) and the saturation of the enamel with fluorides, and therefore fluoridation of drinking water is recommended.

Predisposition to caries is established depending on the following aspects:

• climatic conditions (presence of minerals in water and soil);
• professional characteristics (work associated with constant stress or the production of acids and alkalis);
• features of age groups (disease activity decreases only after 40 years);
• gender factor (dental caries attacks women more often than men, which is associated with the use of sweets and the loss of trace elements during breastfeeding and pregnancy).

In countries where caries is widespread, it is possible to identify groups of individuals with a high body resistance to the development of pathology. Such people are called caries resistant due to the special structure of their tooth enamel with a low degree of permeability to various substances and the stability of local oral immunity.

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Classification of the disease: types of caries

Depending on the depth of the pathological process, experts have adopted the following classification:

Simple (uncomplicated) type of disease:

• caries in the stain stage; at this stage, the tooth enamel changes color due to the formed chalk stain, while the surface of the enamel remains smooth.

The initial stage of caries is most susceptible to the use of medical procedures:

• superficial caries, during the development of which the chalky spot becomes rough due to demineralization of the enamel; there is a painful reaction to temperature stimuli and increased sensitivity to sour and sweet;
• medium caries, in which inflammation penetrates into the deeper layers, affecting the enamel-dentin junction; pain increases and becomes longer;
• deep caries, in the presence of which the inflammatory process penetrates into the peripulpal dentin, as a result of which the removal of the damaged area of ​​the tooth is required;

Complicated type of disease:

• complicated caries (pulpitis, periodontitis), which takes into account the depth of penetration of the inflammatory process and attaches great importance to diagnostics in order to differentiate caries from non-carious lesions such as fluorosis and hypoplasia.

The classification of the disease according to the prevalence and severity of the inflammatory process involves the following forms:

• compensated form (the process is moving slowly);
• subcompensated form (the intensity of the process is equal to the average);
• decompensated form (acute type of the disease with the formation of many carious cavities, at the extreme stage of its development being a systemic lesion of the teeth, in other words, generalized caries).

Depending on the location of the inflammation, there are:

• cervical caries;
• caries between the teeth (in the interdental spaces);
• caries on the contact surfaces of the teeth;
• caries of the neck of the tooth;
• caries of the anterior teeth (damage to the cutting edges of the frontal segments);
• dental caries around dentures, crowns, braces and various foreign objects in the oral cavity.

There are also primary and recurrent (secondary) caries that occurs in previously sealed teeth (caries under the filling).

The main symptoms and signs of caries

What does caries look like if it is necessary to highlight the main signs of caries:

• a rather rare manifestation of a pain attack under the influence of temperature stimuli (cold air flow or cold food) or chemical stimuli (sour, sweet, salty taste);
• spontaneous painful sensations are not fixed;
• deep caries is characterized by pain during the chewing process (pressing hard food on the bottom of the carious cavity);
• the presence of an unpleasant odor from the oral cavity;
• sensation of sharp irregularities of the carious cavity (tactile perception of them by the surface of the tongue);
• visual darkening of the surface layer of enamel.

Signs of caries during professional diagnostics:

• results of an X-ray examination (the ability to detect a disease in hard-to-reach areas, for example, caries between teeth or caries under a filling);
• examination with the help of stomatoscopy, i.e. by irradiation with a halogen or ultraviolet lamp, in which the affected areas look darkened;
• the use of a caries marker, which is a dye-based preparation that stains foci of inflammation;
• the use of the Diagnodent apparatus, which determines the areas of carious lesions using laser fluorescence.

Stages of caries with their characteristic symptoms

Caries in the stain stage is characterized by the formation of a demineralization zone due to a lack of minerals in the tissues, the main of which are calcium salts, which ultimately leads to structural disorders of the tooth enamel.

Initial caries is reversible, i.e. the broken structure of the enamel can be restored using remineralizing therapeutic methods. The initial stage of caries can develop in two main ways:

• a carious spot violates the integrity of the surface layer and transforms into superficial caries;
• the pathological process is suspended and temporarily stabilized.

For the purpose of unmistakable diagnosis, caries in the stain stage is determined by staining the area with methylene blue.

Medium caries / superficial caries usually occur and develop in the area white spot due to deformity of tooth enamel. For this stage of caries, the occurrence of short-term pain sensations under the influence of chemical and temperature stimuli is characteristic, and during a visual examination, a carious cavity is detected. Superficial caries is characterized by the presence of a defect within the boundaries of the enamel, and medium caries involves the dentin in the pathological process, and the speed of the destructive mechanisms increases due to the soft structure of the dentin. Patients complain of increased pain and darkening of the tooth from the inside.

Medium caries

Deep caries is characterized significant changes structures of the dentin surrounding the pulp and a further increase in prolonged pain. If the necessary treatment is not carried out at this stage of caries, then a serious damage to the pulp chamber is ensured, and further removal of the nerve will be required. Diagnostic measures, in addition to visual examination and other procedures, include probing the day of the cavity, which is very painful for the patient. With an advanced form of the disease, signs of pulpitis may appear, namely, aching prolonged pain even after the removal of the irritant.

deep caries

Types of caries, taking into account the location and their complications

Types of caries, depending on the location, have characteristics development.

Root caries is often observed in elderly patients and mainly develops on the posterior teeth. Due to the fact that age-related changes increase the risk of periodontal disease, there is a decrease in bone tissue, atrophic processes in the gums and a decrease in salivation. After the defeat of the outer surface of the tooth root, the carious focus progresses, expands and captures the root system of the tooth. A complication of the process threatens with a fracture and total separation from the root of the crown, i.e. amputation caries. In addition, caries of the tooth root is dangerous with relapses.

Radical caries (cervical caries) develops rapidly in the border area with the gums, since in this zone the enamel has a minimum thickness, and there is no transition zone to the tooth root at all. This part of the tooth is not involved in the chewing process, therefore, self-cleaning with solid particles of food does not occur, moreover, often during brushing the teeth, the gingival zone remains uncovered, resulting in favorable conditions for the accumulation of plaque and the development of pathogens. Radical caries is distinguished already in the early stages by increased sensitivity to a variety of stimuli and high permeability of demineralized tissues. If left untreated, the destructive process can lead to chipping of the crown portion of the tooth.

Cervical caries

Caries under the filling occurs due to insufficient removal of the affected tissues or due to the unscrupulous installation of the filling after the initial treatment of the disease. Such a recurrent pathological process can develop as a result of existing cariogenic factors. This caries at an early stage has a rich Brown color and develops near the edge of the filling.

Caries under filling

Caries of the anterior teeth is not only dental, but also psychological problem, since everyone's attention is riveted to the state of the frontal segments. The front teeth have the thinnest and fastest decaying layer of dentin, so pain is perceived more acutely in this area. In order to prevent the occurrence of a carious cavity, methods of conservative therapy should be used already at an early stage of the disease. Otherwise, caries of the front teeth threatens with the development of complications such as periodontitis and pulpitis.

Caries between the teeth is initially manifested by the appearance of a dark spot, which, if left untreated, spreads to the dentin. At the same time, the appearance of bad breath is recorded, and with the further spread of the inflammatory disease, the situation is aggravated by the darkening of the enamel in the area of ​​the chewing surface. Cold air, hot tea can provoke a painful reaction to temperature stimuli. About the occurrence of such symptoms, one should not postpone a visit to the dentist, since the further development of the pathology can lead to sad consequences in the form of pulpitis. Timely diagnosis of interdental caries with the help of X-ray examination will indicate the presence of a problem in time.

caries between teeth

Generalized caries is a consequence of active enamel demineralization, as a result of which the pathology spreads to a significant number of teeth, and several carious foci can be located on individual segments at once. The acute form of the disease is manifested by extensive lesions of the dentin, the rapid accumulation of plaque and increased salivation with increased viscosity. This multiple form of the disease is diagnosed as generalized caries in the presence of more than 5-6 diseased teeth. A particular danger lies in the fact that the process of development of pathology is proceeding at a rapid pace and, spreading, captures an increasing number of teeth, destroying the external attractiveness of a person. Preventing the advanced development of caries, it is necessary to seek help from a dentist as soon as possible.

In order to prevent complications in the development of carious processes and not bring the clinical situation to the occurrence of pulpitis, periodontitis, cyst and flux formation, it is enough to conduct regular dental examinations and strictly follow the medical recommendations of specialists.

Where to turn if you are worried about caries?

Caries treatment is a process that every person faces sooner or later. After all, statistics show that almost 100% of the population suffers from caries. Therefore, any person will benefit from information about the features of the course of caries and about modern methods of its treatment.

What is caries

Translated from the Greek word "caries" means "rotting". Therefore, caries is the process of tooth decay. Putrefactive processes on the teeth are caused by cariogenic bacteria and, above all, Streptococcus mutans. These bacteria, which settle on our teeth, produce organic acids and destroy tooth enamel, by the way, the hardest tissue in the body. Usually the disease proceeds in the form of the formation of a carious cavity.

There are 4 stages in the development of caries:

• carious spot,
• superficial caries,
• average caries,
• deep caries.

A carious spot is a small area of ​​enamel on which there is a slight degradation of the surface layer. With superficial caries, the enamel is already so severely damaged that a depression appears - a carious cavity. With medium caries, the carious cavity reaches the border of dentin and enamel. At deep caries between the bottom of the carious cavity and the central part of the tooth - the pulp chamber, only a small layer of dentin remains. Dentin is softer than enamel, so the carious cavity, penetrating into dentin, makes a much larger depression in it than in enamel. Consequently, the carious cavity can often be a kind of spacious cave with a narrow entrance.

There is another classification of dental caries - according to the location of caries.

One of the main features of caries is that it can affect all hard tissues of the tooth - both enamel and dentin, and even dental cement - the material that covers the roots of the tooth.

Caries can be primary, that is, formed on an initially healthy tooth, and secondary, which appeared in a sealed place.

The main symptoms of caries are pain and discoloration of the enamel. However, a visually carious lesion is not always easy to detect during self-examination of the oral cavity. After all, often a carious cavity can develop on the back of the tooth.

Pain during caries becomes noticeable, starting with a superficial form. As caries progresses, they become more and more distinct. With caries, the tooth usually reacts with pain to thermal or chemical stimuli - too sweet, cold or hot food, or to mechanical pressure. Typically, pain disappears after the stimulus ceases to act. Sometimes the carious cavity can even be felt by touch with the tongue.

Diagnosis of caries

Diagnosing caries in the presence of obvious symptoms, such as pain, and a carious cavity, is not difficult. Instruments such as a dental mirror and probe are used to detect carious cavities. Difficulties arise only in a situation where caries is located at the point of contact between two teeth. In order to determine the diseased tooth, in this case, thermodiagnostics, electroodontodiagnostics and x-rays are used.

The disease in the stain stage can be diagnosed with the help of dyes that stain the affected surface.

When diagnosing caries, it is necessary to differentiate the disease from hypoplasia, erosion, fluorosis, wedge-shaped tooth defect.

Should caries be treated?

Of course it's worth it. The carious cavity increases over time, and the affected tooth begins to ache in a person. Becomes impossible good nutrition. And when the cavity becomes large enough, it will pass through the outer hard shells of the tooth - enamel and dentin, and reach the pulp chamber containing the nerve plexus. Here the pain becomes simply unbearable and the patient willy-nilly goes to the doctor. However, pulpitis is already a more difficult disease to treat. And the next stage in the development of inflammation, periodontitis, threatens to lose a tooth. Other complications of caries are possible - cyst, flux, phlegmon. Therefore, it is necessary to treat caries at an early stage of the disease in order to avoid complications and keep the teeth intact.

Sometimes there is also an opinion that milk teeth are not worth treating. After all, they will fall out anyway - many parents think so. But this is a delusion, since the premature loss of milk teeth can disrupt the process of eruption of permanent ones. Therefore, caries on milk teeth is also subject to timely treatment.

Treatment of caries in adults

There are many methods of caries treatment. One of the most modern ways is the remineralization of the enamel surface. This method of treatment is used only for caries in the form of a spot, when a carious cavity has not yet formed.

Remineralization therapy of caries

The doctor applies special compresses to the tooth, including fluorine and calcium compounds. Due to this, the enamel tissues are saturated with these substances and strengthened.

Before remineralization, the tooth is cleaned of plaque and washed with weak acid solutions (for example, 40% citric acid).

The course of caries treatment lasts 10 days. In this case, the following compositions are applied:

• calcium gluconate (10%),
• Remodent preparation (1-3% solution),
• sodium fluoride (2-4%).

Each procedure takes about a quarter of an hour.

Treatment of carious cavities

If a hole has appeared in the tooth, that is, as doctors say, a carious cavity has formed, then the remineralization technique for the treatment of caries is no longer suitable. It is necessary to install a filling that would eliminate the defect of the tooth and prevent further penetration of bacteria into hard tissues.

In modern dentistry, an important stage in the treatment of caries, which precedes all manipulations, is the isolation of the tooth from saliva. For this purpose, both cotton rolls can be used, which cover the tooth from all sides, and more modern methods such as the application of a rubber dam. The rubber dam is a latex fabric with holes for the teeth. The disadvantage of this method is its complexity for the doctor.

The treatment of caries on the interdental surface is a certain difficulty, since in this case it is necessary not only to heal the carious cavity, but also to restore the damaged contact surface. To restore it, special devices are used - wedges and matrices.

To fix the filling in the carious cavity, its inner surface is pre-coated with an adhesive composition. Some adhesive formulations require pre-etching of the cavity surface with phosphoric acid. However, there are self-etching adhesive compositions.

Also often, before filling, an insulating gasket is placed in the bottom of the carious cavity. The insulating lining both isolates the pulp from the filling material, which can be toxic to it, and serves to compensate for the shrinkage of the polymeric filling material. Typically, the gasket is made from glass ionomer cement. There are also medical pads. They are impregnated with medicinal compounds and prevent inflammation of the pulp.

Preparation for treatment

If a dense yellow plaque has formed on the teeth or they are covered with deposits of tartar, then these deposits sometimes need to be removed first. For this, ultrasonic devices, special brushes and abrasive pastes are used.

Treatment of caries with a drill

There are several technologies for installing seals. Usually the cavity is treated with a drill. This removes pieces of enamel and dead dentin, in which bacteria have settled. Only healthy tissue remains. The cavity is disinfected and a filling is inserted into it.

Modern fillings do not initially represent a solid piece of some material. The material that makes up the filling is in a pasty form and is applied in layers. Each layer is cured with a lamp. After completion of the filling, excess material is removed by grinding. This is necessary so that the filling does not cause injuries to the oral mucosa. Also, a seal that protrudes too much can be unreliable and fall out due to constant mechanical stress.

If the disease is secondary, that is, the occurrence of caries occurred near a previously installed filling, then first the old filling is removed, and then the doctor proceeds to treat the carious cavity itself.

The dental drill is a complex and perfect apparatus. When treating a carious cavity, burs and nozzles of various shapes and types are used. Also, an experienced doctor should have a good command of the drill, be able to firmly hold it in his hands, since any wrong movement can lead to the removal of an unnecessary area of ​​​​enamel or dentin.

Treatment of a carious cavity with a drill is a rather complicated operation. The doctor must remove, first of all, the areas of dentin and enamel affected by bacteria. In addition, if healthy enamel prevents access to such areas, then it must also be removed.

Disadvantages of treatment with a drill

The treatment of the cavity with a drill is quite long and unpleasant for the patient, especially if it is performed without anesthesia. Therefore, in many patients there is a panic fear of a drill as an “instrument of torture”. And from this follows the fear of treating dental diseases as such. The grinder also has other disadvantages. When treated with boron, tissue overheating often occurs, microcracks may appear, and soft tissue damage is likely, especially if the carious cavity is located close to the gum.

Treatment without a drill

In some cases, the use of a drill can be avoided in the treatment of caries. For example, there are special dental tools - excavators that help scrape off the affected areas of enamel and dentin. The resulting cavity is filled with cement. However, this method of treating caries has not received wide distribution, despite its relative low cost. Treatment with this method is usually used in areas where there are no full-fledged dental offices equipped with drills. True, an excavator, as an auxiliary tool, can also be used with a standard treatment method, including the use of a drill.

laser method

There is also a caries treatment technology that allows you to treat a carious cavity using laser radiation. The advantages of this method are a guarantee of the absence of microcracks, the absence of vibration, less pain compared to a drill, sterilization of the surface of the cavity. The risk of soft tissue injury, however, remains. Contrary to popular belief, complete painlessness is not achieved with this method. In addition, this treatment technology is expensive and has not yet been widely adopted.

Air abrasive method

Another method of treating caries that allows you to get rid of the drill is air-abrasive. Here, an air jet is used to treat the carious cavity under high pressure containing particles of aluminum oxide. Processing is carried out by pulses of 10-15 s.

Ozone therapy

Ozone therapy is another treatment technology that allows you to do without a drill. It can be used for caries at the stain stage, and for some types of superficial caries. The treatment technology is based on the properties of ozone as a powerful oxidizing agent that easily kills cariogenic bacteria.

Filling materials

Caries therapy usually ends with the installation of a filling or inlay. Fillings can be made from materials that differ in reliability, durability, aesthetic qualities and, of course, in price. There are two main types of fillings: temporary and permanent.

The main classes of substances used for filling:

• zinc phosphate and phosphate cements,
• silicate cements,
• acryloxide,
• amalgams,
• ceramics,
• light-curing polymeric materials,
• self-curing composite materials.

There are also combined fillings made from several materials.

The following seal designs are available:

• monolithic,
• reinforced,
• Sandwich fillings.

Inlays are prostheses that replace part of the tooth tissue. They are installed in the event that, as a result of the treatment of a carious cavity, the patient has lost a significant part of the dental crown. Inserts can be metal cast, composite reinforced, ceramic.

Before filling, the doctor determines the color of the tooth on a special scale. This is necessary so that the installed seal does not stand out in color. This is especially important for those surfaces of the teeth that are visible when smiling.

Caries complicated by pulpitis

Often, in addition to caries, inflammation of the pulp (pulpitis) is also found on the teeth. In this case, pulpitis is preliminarily treated, most often consisting in the removal of the pulp and the processing of the channels. And only then the doctor is engaged in sealing the carious cavity. With pulpitis, treatment can take several visits to the doctor.

Anesthesia

If the tooth contains a living nerve (pulp), then the doctor may offer the patient to cure the disease under the condition of anesthesia. In fact, such treatment is more pleasant not only for the patient himself, but also for the dentist, as it eliminates involuntary movements on the part of the patient caused by painful sensations. The probability of a doctor's mistake is reduced, his work becomes more comfortable.

The time of anesthesia lasts from 40 minutes to several hours - it all depends on the type of anesthetic drug and its dose. Usually this time is enough to treat any caries, even complex ones. However, if the effect of the drug weakens, then a second injection is possible.

A contraindication to anesthesia in the treatment of caries can only be an allergy to painkillers. Anesthesia is used with caution in diseases of the cardiovascular system, diabetes, and blood clotting disorders. It is worth bearing in mind that local anesthetic formulations contain adrenaline, a powerful vasoconstrictor. And although its action is usually limited only to the area of ​​​​the tooth, it is possible that some part of the drug enters the systemic circulation.

Treatment of caries can be carried out under general anesthesia. This technique is preferred for patients suffering from multiple caries, for those who are afraid of dentists. However, it should be remembered that general anesthesia has even more side effects than local anesthesia. And the cost of such a procedure is also quite high.

Treatment of caries during pregnancy

Pregnancy is not a contraindication for caries treatment. Local anesthesia can also be used in treatment, since it does not affect the development of the fetus in any way. This is evidenced by the results of scientific studies carried out in various countries. Also, there was no negative impact on the development of the fetus and X-rays during diagnostic procedures used in dentistry.

What you need to know before treating caries in dentistry

Before going to the doctor for the treatment of caries, it is necessary to prepare the oral cavity - thoroughly clean the teeth and rinse them with an antiseptic composition. If you have any systemic diseases such as diabetes or bleeding disorders, then this should be reported to the doctor. The fact is that with vascular disorders, an injection of a standard dose of an analgesic may be ineffective. It is also necessary to report any allergic reactions to painkillers.

How is caries treated at the dentist

The method of treating caries largely depends on its stage - a carious spot, superficial, medium or deep.

Treatment of the disease at the stage of a carious spot is not very difficult. Usually it is enough to carry out the procedure of remineralization of the tooth. At other stages of caries, much more manipulations are required to close the damage in the tooth.

After the patient comes to the dentist, the doctor invites him to sit in the dental chair. Then the dentist examines the oral cavity, notes the condition of the teeth. If some teeth are affected by caries, the doctor suggests the patient to treat them. If there are several such teeth, then treatment usually begins with those where caries is most dangerous and has passed into the most severe stage.

Now almost all dental clinics treat caries with anesthesia. An exception is made only for depulped teeth (those where the nerve bundle responsible for tooth sensitivity has been removed). Also, some patients may be allergic to painkillers. For anesthesia, before starting treatment, the doctor makes an injection with an anesthetic drug into the gum.

After the tooth loses sensitivity, the doctor gets to work. Before starting all procedures, it is necessary to isolate the diseased tooth from the rest and from the ingress of moisture into it. For this, special techniques are used, for example, an overlay of an insulating rubber dam.

Only after that the doctor takes up the drill - the main tool in the treatment. With its help, parts of the tooth affected by the carious process are removed. Also, the purpose of processing with a bur is to create a cavity into which a filling could be inserted.

After the cavity is created, it is disinfected. Usually, a 2% chlorhexidine solution is used for this purpose. Then the inner surfaces are covered with an adhesive material. If the carious cavity is close to the pulp chamber, then an insulating gasket is installed. Then the seal is installed. The last step is grinding the filling. The doctor may ask the patient to bite on a special piece of paper to check if there is any discomfort felt when biting. If this is the case, then the excess pieces of the filling are removed.

What to do after the end of treatment

After completing the treatment of caries, the patient is not recommended to eat for some time. The duration of this period depends on how quickly the tooth regains its sensitivity after an analgesic injection. However, even if such an injection was not made, it is still necessary to wait at least an hour.