Tooth decay is the definition of how types of diagnosis and treatment develop. Dental caries: symptoms, stages, methods of treatment. Stages of caries with 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 the penetration of a bacterial infection into the tooth. The waste products of bacteria contain acids that corrode the surface of the enamel and, as a result, microscopic cavities are formed in it.

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

In our article, you will find out what causes tooth decay, as well as the methods of 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. Food debris, colonies of microorganisms and the acids produced by them mix and form a porous plaque on the surface of the teeth.

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

Lack of the habit of regularly brushing your teeth provides acids with long-term contact with enamel and leads to the appearance of primary carious foci of small depth on it.

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

Caries usually affects the 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, therefore 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 to convert it into acids that destroy tooth enamel.

The risk of developing tooth decay increases if you have a habit of constantly snacking between meals.

Chocolate, bread, dried fruit, chips, sodas and other typical snack foods all contribute to the intense plaque buildup that lays on your teeth for at least several hours before the next brushing.

Then the first microscopic damage occurs on the enamel surface.

Poor oral hygiene

Irregular and ineffective mechanical cleaning of teeth, internal surfaces not treated with a toothbrush, peri-gingival, interdental spaces and the tongue create a favorable environment for the reproduction of pathogenic microorganisms.

Dry mouth

Since saliva helps keep the surface of the teeth free of plaque, neutralizes some acids and promotes the remineralization of enamel, any disturbances in salivation increase the risk of caries.

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

Gum pathology

One of the common problems with gums is their natural subsidence and exposure of the necks of teeth that do not have an enamel coating. In places where enamel is absent, 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, which protect teeth from decay. Purchased drinking water does not contain fluoride, depriving us of this protective factor.

Unsatisfactory condition of fillings

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

Symptoms

At the initial stage, signs 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;
• hypersensitivity to the temperature factor: painful 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;
• biting pain;
• inflammation of the gums;
• throbbing or aching pain;

Treatment methods

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

Before and after filling caries

1. Remineralizing therapy. It is carried out to treat the disease in its initial stage. The affected areas of the enamel are treated with fluoride, calcium and phosphorus preparations to saturate it with minerals lost under the influence of organic acids.
2. Filling. 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. . In case of significant caries damage, the doctor may recommend installing 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 the crown, the destroyed part of the tooth is removed, the rest 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 the vessels and nerve endings are concentrated. After removing the inflamed pulp, root canals are treated and filled.
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 removal can change the configuration of the dentition and affect the chewing function, in the future, the patient is recommended to resort to implantation and prosthetics.

Prevention

There are professional measures of protection against caries offered by dental clinics: a procedure for professional cleaning of teeth, procedures for mineralization and fluoridation to strengthen the 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 your dentist twice a year to identify 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. Remember to also remove plaque from your tongue when brushing your teeth.
4. Use not only a regular toothbrush, but also other auxiliary means: dental floss, toothpicks, interdental brushes.
5. Use a fluoride mouthwash 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 with a contrasting temperature, this leads to cracking of the enamel and the penetration of infection.

Almost everyone suffers from dental diseases from time to time. The most common dental disease is tooth decay. It is a process of destruction of hard tooth tissues. 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 enlarges, opening access to pathogenic bacteria inside the tooth. This leads to the fact that other diseases join caries, aggravating the situation. What are the causes of caries and can you protect yourself from it?

This disease does not occur by itself. It is caused by special cariogenic bacteria Streptococcus mutans, Streptococcus sanguis and actinomycetes living in the oral cavity. But why do some people rarely have caries, while others have 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 noticed that people with weak immunity are more susceptible to the effects of cariogenic bacteria.

Attention! Bacteria live and multiply in plaque. Brushing your teeth removes plaque, but only soft deposits can be removed with a toothbrush. Within a few days, plaque turns into hard tartar, which cannot be removed on your 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 the hard deposits. If the tartar is not removed in time, cariogenic bacteria will continuously attack the tooth, and this will sooner or later lead to caries.

There are many reasons for the occurrence of caries, but we encounter some every day: improper care of mouthwashing, poor water quality, lack of vitamins and minerals in the body - you need to pay attention to these factors, because we can control them.

For active reproduction of bacteria, certain conditions are required. These conditions are:

• poor oral care;
• poor quality cleaning;
• predominance in the diet of food, rich in carbohydrates (flour, sweet), as well as a lack of fresh vegetables and fruits;
• poor-quality drinking water with a low content of calcium, fluorine, phosphorus;
• lack of vitamins;
• decreased immunity;
• diseases of the digestive system;
• violation of the formation of teeth, which can be triggered by diseases transferred in childhood (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 fragile 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 onset of the disease are cariogenic bacteria, which actively multiply in food debris and plaque. But, in addition to this, there are several additional factors that increase the risk of caries. What does this refer to?

Caries diagnostics

If the carious process has already developed, it becomes visible with 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 using special equipment. Three main types of examination are used: vital staining of tooth enamel, ultraviolet irradiation, and X-ray.

Disease stages

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 - dentin, as a result of which a cavity appears in it, which gradually increases in size.
• Deep caries. If the patient does not see a doctor, the carious process continues its destructive effect and affects the deep layers of the tooth. At this stage, others can join the underlying disease.

This picture shows caries in three stages: early, middle and deep caries.

Each person develops caries at a different rate - someone quickly, someone slowly. Usually in adults, the disease is chronic, sluggish in nature. 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 dental health and do not treat cavities 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 by severe pain... If you do not take action, the pulp tissue dies and the tooth is deprived of a source of nutrition.

Periodontitis

Periodontitis is an inflammation of the periodontium. Periodontal tissue is the tissue around the tooth. The inflammatory process spreads 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 that fills with pus. To treat the cyst, the dentist makes a puncture and removes the formation.

Flux

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

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

Caries prevention

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

• Regular teeth cleaning. To keep your teeth healthy, you need to brush them twice a day - in the morning, upon waking up and in the evening, before bed. In time, the procedure should take at least two minutes and not be limited to cleaning the surface of the teeth. It is also necessary to clean the interdental, peri-gingival spaces and the tongue, as germs accumulate there too. To make cleaning as effective as possible, you need to choose the right toothpaste and brush.
• Rinsing the mouth. In addition to brushing your teeth regularly, dentists recommend rinsing your mouth with water after every meal. This helps to wash away 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 need to use special mouth rinses. They freshen breath, slow down the formation of plaque, and also strengthen the enamel, saturating it with minerals.
• Replenishment of the lack of fluoride.

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

  This problem can be solved by fluoridation of drinking water. But the easiest way is to use mouthwashes that contain fluoride to care for your oral cavity. Another way to make up for a 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 an effect leads to the appearance of microcracks, into which microbes then penetrate. To avoid this, you should not eat food that is too hot, cold, or contrasting.
• Regular visits to the dentist. Often, patients visit a doctor only when their teeth start to hurt. It is not right. To prevent caries, it is recommended to undergo periodic medical examinations with a 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, since their teeth decay much faster.

Do not neglect preventive examinations. This will help detect dental problems in time and avoid possible complications.

The latest archaeological research confirms that even our ancestors who lived more than five thousand years ago were sick with caries. Information about the destruction of teeth, similar to carious ones, can be found in the works of ancient and ancient Eastern healers, in the Middle Ages, sick teeth were a common problem, and street cheaters became characters of folklore and even got into many literary works of those times.

The word "caries" itself came to us from Latin and literally means "decay", in fairness it is worth noting that initially this name was given to poliomyelitis, but after that a disease that we all know was established under this name - an infectious process that destroys, and sometimes simply "devouring" human teeth. The causes of caries and, as a result, the ways to get rid of it occupied the minds of many learned men of antiquity and the Middle Ages. Many assumptions were not expressed - from an excess of "bad juices" that enter the body, which was what antiquity operated on (I must say, there is some truth in this, if we mean all kinds of food acids by bad juices), to "tooth worms" in the Middle Ages.

Causes of dental caries

Today, the debate about what caries is and why it happens is long gone. The cause of caries is known to everyone - it is 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 for a long time as if to doze off in our body, not showing itself in any way until the first opportunity.

And although caries at the moment is 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: why some people more often get caries, while others less often, and are there those who do not suffer from it at all. Thus, modern theorists and practitioners of dental science identify several risk factors for caries. As you might guess, some of these factors are very “selective”, that is, it is known for certain that some people are initially more prone to carious lesions of the teeth. Here are some signs that you should be concerned about tooth decay.

Caries risks

• Flask-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 carious cavities, then bacteria will not take long to appear. So, teeth with bulbous fissures (grooves on the chewing surface) are more susceptible to carious lesions.
• Crowded teeth and bite problems.Among the individual characteristics that make a person more vulnerable to caries, one can distinguish problems with bite, as well as teeth that are crowded - close to each other. On such teeth, which are very difficult and sometimes impossible to clean with high quality, contact caries often occurs.
• Geography of residence.People are less likely to suffer from tooth decay in areas with fluoridated tap water.
• Professional activity. Citizens who work with alkalis, acids and other harmful substances, on the contrary, are more prone 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.Women more often than men suffer from this disease, which is associated primarily with tooth decay during pregnancy.

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

Caries symptoms

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

Carious bacteria and the acid secreted by them 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. Teeth stains. The first signs of caries are stains on the enamel - they can be white, brown or even black. However, even such spots can be difficult to see on your own.
2. Pain with caries. If you feel that a tooth has begun to react to sweet food, for cold and hot, then it is worth contacting the dentist.
3. Hole with caries.If you can feel a hole in a tooth with your tongue, then the caries has already spilled over into a more severe form and requires immediate treatment.
4. Bad breath with caries.When a person is in no hurry to get to dentistry, experimenting with caries treatment at home, teeth start to rot and decay. The result is bad breath.

Caries stages - 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 spot 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 keep you waiting.

Contact type of caries

The next stage is caries class II - often affects the contacts of the chewing teeth, which is why it is sometimes called contact caries ... At this stage, as at the previous one, caries does not bother its carrier in any way 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 to be the best prevention against it. Also, average caries is a sweet tooth disease.

Dentin caries

When the treatment of caries of the anterior teeth of the middle stage flows into next class - IV and already affects dentin.

Basal

Caries of the V class, aka radical, or cervical, caries, spreads along the gingival line on both the anterior and chewing teeth. It is manifested by increased sensitivity of the teeth in the area of \u200b\u200bthe necks of the tooth. Cervical caries usually results from poor oral hygiene.

Atypical

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

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 generalized, or systemic, immediately affects a large number of teeth - from six to twenty, but this is not enough for him - in each affected tooth, the dentist can detect not one, but two or even three carious cavities. As you might guess, such caries develops quickly and can lead to the loss of several teeth or even a whole dentition. The causes of such a carious catastrophe are often immune, infectious and other serious general somatic diseases. Sometimes this happens to adolescents during puberty, when the body goes through a strong 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, healed and filled tooth. The reasons for its 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, are not eternal. Over time, they begin to adhere worse to the tooth tissues, saliva, bacteria, plaque, and food debris get into the gaps - true friends of caries. You can distinguish secondary caries by the brown outline at the junction of the orthopedic structure and dental tissues.

Root caries

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

As the name suggests, root caries affects the exposed root of the tooth. This form is usually observed in the elderly and usually affects the posterior teeth. This is due to the fact that with age, the risk of periodontitis increases, bone atrophy occurs, gums decrease 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 remains exposed and the teeth are brushed irregularly or incorrectly.

So, as we have already found out, almost no one is insured against caries, and some people from birth or due to the peculiarities of 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: high-quality hygiene, regular preventive examinations, coupled with professional cleaning and timely treatment of caries in the initial stages - 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 indicate 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 is, of course, very conditional and schematic, since in ancient times knowledge of biology was at an extremely primitive level, but Miller and his followers for the first time expressed the point of view about the presence of carbohydrates in the oral cavity and the participation of microorganisms in the pathological process.

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

Of the theories of modern times, the theories of Eggers-Lure and Schatz-Martin deserve attention, taking into account the importance of factors affecting the strength of the 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.

Various 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 tooth tissues.

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 body's immune forces;
• pathological disorders in the formation of teeth, which may be associated with diseases carried over in childhood (tuberculosis or rickets);
• the presence of gastrointestinal diseases;
• 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 (it is laid during the intrauterine development of the child);
• violations of the condition of the dentition (malocclusion, incorrectly installed prostheses and braces);
• changes in the composition and properties of saliva and a decrease in its secretion.

The factors influencing the development of the disease or one way or another provoking it are called cariogenic. The intensity of the onset of pathology depends on the significant amount of carbohydrates in the diet (especially sucrose) and the saturation of the enamel with fluorides, in connection with which fluoridation of drinking water is recommended.

The predisposition to caries is established depending on the following aspects:

• climatic conditions (the 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 people 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 the local immunity of the oral cavity.

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Classification of the disease: types of caries

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

Simple (uncomplicated) type of disease:

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

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

• superficial caries, with the development of which the chalk stain becomes rough due to the demineralization of the enamel; there is a painful reaction to temperature irritants and an increased sensitivity to sour and sweet;
• middle caries, in which inflammation penetrates into deeper layers, affecting the enamel-dentin junction; pain sensations intensify and become more prolonged;
• deep caries, in the presence of which the inflammatory process penetrates the peri-pulpal dentin, as a result of which the removal of the damaged area of \u200b\u200bthe tooth is required;

Complicated type of disease:

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

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

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

Depending on the location of the inflammation, there are:

• cervical caries;
• caries between teeth (in the interdental spaces);
• caries on the contact surfaces of the teeth;
• tooth decay;
• 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 filled 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 irritants (cold air flow or cold food) or chemical irritants (sour, sweet, salty taste);
• spontaneous painful sensations were not recorded;
• 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;
• a feeling of sharp irregularities in 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:

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

Stages of caries with characteristic symptoms

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

Initial caries is reversible, i.e. the damaged 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 error-free diagnosis, caries in the spot stage is determined by staining the area with methylene blue.

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

Medium caries

Deep caries is characterized by significant changes in the structure of dentin surrounding the pulp and further intensification of prolonged pain. If at this stage of caries the necessary treatment is not carried out, then a serious damage to the pulp chamber is ensured and in the future it will be necessary to remove the nerve. Diagnostic measures, in addition to visual examination and other procedures, include probing of the cavity day, 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 elimination of the irritant.

Deep caries

Types of caries, taking into account the site of localization and their complications

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

Root caries is often seen 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 damage to the outer surface of the tooth root, the carious focus progresses, expands and captures the root system of the tooth. Complication of the process threatens with fracture and total separation of the crown from the root, i.e. amputation caries. In addition, tooth root caries is dangerous to relapse.

Basal caries (cervical caries) develops rapidly in the area bordering on the gum, since in this area the enamel has a minimum thickness, and the zone of transition to the dental root is completely absent. In the chewing process, this part of the tooth is not involved, therefore, self-cleaning with solid food particles does not occur, moreover, often during brushing the teeth, the gingival zone remains not covered, as a result of which favorable conditions arise for the accumulation of plaque and the development of pathogens. Basal caries is distinguished already in the early stages by increased sensitivity to various stimuli and high permeability of demineralized tissues. If untreated, the destructive process can lead to the chipping off of the crown area of \u200b\u200bthe tooth.

Cervical caries

Caries under the filling occurs due to insufficient removal of the affected tissue or when the filling is not properly installed after the initial treatment of the disease. A similar recurrent pathological process can develop as a result of the existing cariogenic factors. This caries at an early stage has a rich brown color and develops near the edge of the filling.

Caries under the filling

Caries of 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 most rapidly disintegrating dentin layer, so pain is perceived more sharply in this area. In order to prevent the occurrence of a carious cavity, it is necessary to apply the methods of conservative therapy at an early stage of the disease. Otherwise, caries of the front teeth threatens the development of complications such as periodontitis and pulpitis.

Caries between teeth is initially manifested by the appearance of a dark speck, which, if untreated, spreads to the dentin. In parallel, the appearance of an unpleasant odor from the mouth is recorded and with the further spread of the inflammatory disease, the situation is aggravated by darkening of the enamel in the chewing surface. Cold air, hot tea can provoke a painful reaction to temperature stimuli. If such symptoms occur, you should not postpone a visit to the dentist, since the further development of pathology can lead to sad consequences in the form of pulpitis. Timely diagnosis of interdental caries using X-ray examination will indicate the presence of a problem in time.

Caries between teeth

Generalized caries is a consequence of the active demineralization of the enamel, as a result of which the pathology spreads to a significant number of teeth, and several carious foci can be located on separate segments at once. The acute form of the disease is manifested by extensive dentin lesions, 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 to bring the clinical situation to the onset of pulpitis, periodontitis, the formation of cysts and flux, it is enough to conduct regular dental examinations and strictly follow the medical recommendations of specialists.

Where to go if you are worried about caries?

Caries treatment is a process that sooner or later any person faces. 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 Greek, the word "caries" means "decay". Therefore, tooth decay is the process of tooth decay. Putrefactive processes on the teeth are caused by cariogenic bacteria and, above all, Streptococcus mutans. These bacteria that settle on our teeth produce organic acids and destroy tooth enamel, by the way, the hardest tissue in the body. Usually, the disease occurs in the form of the formation of a carious cavity.

There are 4 stages in the development of caries:

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

A carious spot is a small area of \u200b\u200benamel where there is a slight degradation of the surface layer. With superficial caries, the enamel is already damaged so much that a depression appears - a carious cavity. With medium caries, the carious cavity reaches the border of dentin and enamel. With 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, therefore, a carious cavity, penetrating into dentin, makes a much larger depression in it than in enamel. Consequently, a 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 appears in a filled place.

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

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

Caries diagnostics

It is not difficult to diagnose caries in the presence of obvious symptoms such as pain and cavities. Instruments such as a dental mirror and probe are used to detect cavities. Difficulties arise only in a situation when caries is located at the point of contact between two teeth. In order to identify a bad tooth, in this case, thermodiagnostics, electrodontodiagnostics and X-rays are used.

Spotting disease can be diagnosed with 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 hurt. Nutrition will become impossible. 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. At this point, the pain becomes simply unbearable and the patient willy-nilly goes to the doctor. However, pulpitis is a more difficult disease to treat. And the next stage in the development of inflammation, periodontitis, already threatens with the loss of a tooth. Other complications of caries are possible - cyst, flux, phlegmon. Therefore, it is necessary to be treated for caries at an early stage of the disease in order to avoid complications and keep the teeth intact.

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

Caries treatment in adults

There are many methods of caries treatment. One of the most modern methods 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 for caries

The doctor applies special compresses to the tooth, including compounds of fluoride and calcium. Thanks 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 drug (1-3% solution),
• sodium fluoride (2-4%).

Each procedure takes about a quarter of an hour.

Treatment of carious cavities

If a hole appears in the tooth, that is, as the 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 tooth defect and prevent further penetration of bacteria into the hard tissue.

In modern dentistry, an important stage in the treatment of caries, which precedes all manipulations, is the isolation of the tooth from the ingress of saliva. For this purpose, both cotton rolls can be used, with which the tooth is covered from all sides, or more modern methods, such as the placement of a rubber dam. Rubber dam is a latex fabric with holes for teeth. The disadvantage of this method is its laboriousness 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 preliminarily covered with an adhesive compound. Some adhesives require pre-etching of the cavity surface with phosphoric acid. However, there are also self-etching adhesives.

Also, an insulating pad is often placed at the bottom of the carious cavity before filling. The insulating gasket both isolates the pulp from the filling material, which may be toxic to it, and serves to compensate for the shrinkage of the polymer material of the filling. Usually the gasket is made of glass ionomer cement. There are also medicated pads. They are impregnated with medicinal compounds and prevent pulp inflammation.

Preparing for treatment

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

Caries treatment with a drill

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

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

If the disease is secondary, that is, the occurrence of caries occurred near the 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 processing 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 hold it firmly in his hands, since any wrong movement can lead to the removal of an unnecessary area of \u200b\u200benamel or dentin.

The treatment of a carious cavity with a drill is a rather complicated operation. The physician must remove primarily the bacteria-affected areas of dentin and enamel. In addition, if healthy enamel prevents access to such areas, then it is necessary to remove it.

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 carried out without anesthesia. Therefore, many patients have a panic fear of the drill as a "instrument of torture." And from this follows the fear of treating dental diseases as such. The drill has other disadvantages as well. When processing with boron, tissue overheating often occurs, microcracks may appear, there is a high probability of damage to soft tissues, especially if the carious cavity is located close to the gum.

Treatment without a drill

In some cases, when treating caries, the use of a drill can be avoided. For example, there are special dental instruments - excavators that help to scrape off the affected areas of enamel and dentin. The resulting cavity is filled with cement. However, this method of caries treatment has not become widespread, despite its relatively low cost. Treatment by this method is usually used in those 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 technology for the treatment of caries, which allows you to treat a carious cavity using laser radiation. The advantages of this method are the guarantee of the absence of microcracks, the absence of vibration, less pain in comparison with a drill, and sterilization of the cavity surface. The risk of soft tissue injury, however, remains. Contrary to the existing opinion, complete painlessness is not achieved with this method. In addition, this treatment technology is expensive and has not yet become widespread.

Air abrasive method

Another method of caries treatment 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 pressurecontaining particles of aluminum oxide. Processing is carried out in 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 stage of staining, 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 a filling or inlay. Seals 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 polymer materials,
• self-curing composite materials.

There are also combined fillings made of several materials.

There are the following options for the design of seals:

• Monolithic,
• Reinforced,
• Sandwich fillings.

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

Before filling, the doctor determines the color of the tooth using 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, pulp inflammation (pulpitis) is also found on the teeth. In this case, pulpitis is preliminarily treated, most often consisting in removing the pulp and processing the canals. 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 suggest that the patient cure the disease, subject to pain relief. In fact, such treatment is more pleasant not only for the patient himself, but also for the dentist, since it excludes 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 for the treatment of 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 pain medications. Pain relief is used with caution in diseases of the cardiovascular system, diabetes, and blood clotting disorders. It should be borne in mind that the formulations for local anesthesia contain adrenaline, a powerful vasoconstrictor. And although its action is usually limited only to the area of \u200b\u200bthe tooth, it is possible that some part of the drug will enter the systemic circulation.

Caries treatment can also be carried out under general anesthesia. This technique is preferable for patients with multiple caries, for those who are afraid of dentists. However, it should be remembered that general anesthesia has even more side effectsthan local anesthesia. And the cost of such a procedure is also quite high.

Caries treatment 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. This is evidenced by the results of scientific studies conducted in various countries. Also, no negative effects on fetal development and X-ray radiation were found during diagnostic procedures used in dentistry.

What you need to know before treating dental caries in dentistry

Before going to the doctor for the treatment of caries, it is necessary to prepare the oral cavity - thoroughly brush the teeth and rinse them with an antiseptic composition. If you have any systemic diseases such as diabetes or a blood clotting disorder, you must inform your doctor. The fact is that in case of vascular disorders, an injection of a standard dose of an analgesic may be ineffective. It is also necessary to report any allergic reactions to pain medications.

How is dental caries treated at the dentist

The method of caries treatment largely depends on its stage - 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 a tooth remineralization procedure. In other stages of caries, much more manipulations are required to repair 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, then the doctor suggests the patient to take care of them. If there are several such teeth, then treatment is usually started from those where caries is most dangerous and has passed into the most severe stage.

Now, in almost all dental clinics, caries treatment is carried out with anesthesia. An exception is made only for pulped teeth (those where the nerve bundle responsible for tooth sensitivity has been removed). Also, some patients may be allergic to pain relievers. For anesthesia, before starting treatment, the doctor injects an anesthetic into the gum.

After the tooth loses its sensitivity, the doctor starts to work. Before starting all procedures, it is necessary to isolate the diseased tooth from the rest and from moisture entering it. For this, special techniques are used, for example, applying 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 solution of chlorhexidine 2% 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 pad is installed. Then a seal is placed. The last stage is filling the filling. The doctor may ask the patient to bite a special paper to check if there is any discomfort in any place when biting. If so, the extra 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 the injection with an analgesic. However, even if such an injection was not given, you still need to wait at least an hour.