Caries: types, treatment, prevention
Caries is a relatively slow developing pathology of hard tooth tissues, which is characterized by the formation of an enamel defect, and later - dentin and cement.Caries is the most widespread human disease.According to the World Health Organization, the incidence rate is 93%.80-90% of children have tooth decay temporary bite.Table of contents: Causes of caries development Complications of caries Classification of the disease and symptoms of various types of caries Diagnosis of caries How to treat tooth decay?Prophylaxis of tooth decay
Causes of caries development
Caries is considered as a polyethological disease, i.e., a number of reasons immediately influence its development.There is a hereditary( genetically determined) predisposition to this disease.Often it can be observed that among members of the whole family strong healthy teeth are preserved until old age.But more often the situation is reversed: if the mother has repeatedly suffered from tooth decay, the baby has lesions of even baby teeth.The main cause of the formation of defects in hard tissues is the demineralization of the tooth in combination with the damage to the organic matrix.
Complications of caries
As the structure of dentin changes and its infection, inflammation of the pulp( pulpitis) develops, which is manifested by acute pain.Pains are possible not only in pulpitis, but also in deep caries, since the pulp chamber in this phase is covered only by a thin layer of affected tissue, through which the pressure on the vascular-neural bundle appears when eating.Painful sensations are possible with medium caries, since nerve endings are present in the zone of the enamel-dentine border. Deep penetration of infection often causes complications from periodontal disease, threatening loss of a dental unit.It is also possible that abscesses and phlegmon develop, which poses a serious threat to the health and even the life of the patient.Pay attention to : experts note that the incidence of caries is slightly lower among people living in the equatorial zones of the Asian and African continents. The rate of development of the pathological process depends on a number of endogenous and exogenous factors, the leading of which is the intake of calcium and fluoride compounds into the body.As a rule, in permanent teeth, the cavity is formed within 3-4 years.With a low level of hygiene, a high presence of carbohydrates in foods and a small level of fluoride in drinking water, caries develops rapidly - literally for several months.
Classification of the disease and the symptoms of various types of caries
Now dentists use several classifications of the disease. It is common among specialists to distinguish between two stages of caries - early( caries in the stage of white or pigmented spot) and late - with the formation of a defect( superficial, medium and deep caries). General classification according to WHO:
- caries of enamel;
- dentin lesion;
- cement damage;
- Odontoclase( resorption of the roots of temporary bite teeth);
- suspended caries;
- , unspecified.
Localization( classes according to Black)
- I - fissure caries( cavities in the region of furrows between chewing tubercles);
- II- cavities are available on the contact sides of premolars and molars;
- III - defects are localized on the contact areas of the incisors and canines( the cutting edge is unaffected);
- IV - the contact surfaces of the anterior group of teeth with a cutting edge defect are involved in the process;Incisors and canines with a defect in the cutting edge and corners;
- V - Cervical caries
According to the refined classification, the VI class is also distinguished.For this type of disease is characterized by an atypical location of the cavities.In particular - on chewing molars and premolars.
In the depth of the process, an uncomplicated and complicated form is distinguished.
- The initial stage is caries in the stain stage.The surface of the enamel remains smooth, and the demineralization process is just beginning.At this stage, it is possible to eliminate the stain without resorting to the preparation of hard tissues.An indispensable condition for successful treatment is remineralization therapy, which involves local application of solutions of calcium and fluoride salts, as well as coating all surfaces of teeth with fluoride varnish.
- At the stage of superficial caries, the stain becomes rough, and the tooth reacts to temperature stimuli, as well as to sweet and sour food.Treatment involves a gentle grinding of the damaged enamel fragment and remineralization therapy.If the lesion is localized in the region of the furrows, then a complete preparation with the filling is required.
- With medium caries, the process affects the enamel-dentine border.Most patients complain of pain sensations of varying intensity.Therapy requires careful removal of affected enamel and dentin, drug treatment of the cavity and the placement of the seal.
- Deep caries penetrates into the area of the dentin, directly covering the pulp chamber.Treatment of deep caries requires complete removal of softened and infected tissues, tooth treatment and restoration of tissues with filling material.In some situations, depilation may be required, i.e., removal of the neurovascular bundle of the tooth.Untreated deep caries leads to complications in the form of inflammation of the pulp and periodontal ligaments.
Complicated caries Under complicated caries is meant pulpitis, periodontitis and other complications from the periodontal tissues. There are also:
- primary caries( develops on the intact tooth);
- secondary( the process appears on previously filled teeth).
Classification according to the severity of the process
In terms of developmental acuity, the following forms are distinguished:
- compensated, characterized by a slow formation of the pathological cavity.
- is subcompensated - the process develops at a speed corresponding to the average performance;
- decompensated( sharp) - characterized by extremely high intensity of the process.In some cases, with acute caries develops a cervical caries of most dental units.
Diagnosis of caries
Diagnosis is made by the dentist on the basis of patient complaints, external examination data, and instrumental examination.Probing is used to examine the cavities.With significant cavities, a very informative method of instrumental research is radiography.Identify caries in the stage of the chalk spot is possible by applying to the enamel solution of fuchsin or methylene blue.The demineralized sections are intensively colored. Surface caries should be distinguished from the following non-carious lesions of the enamel:
- fluorosis( due to excess fluoride);
- congenital hypoplasia;
- wedge-shaped defect;
- erosive lesions( occur against the background of contact with aggressive substances).
How to treat tooth decay?
Treatment of caries involves the removal of the affected tissue, the creation of a cavity for optimal fixation of the replacement( filling) composition, setting the seal and its processing.Before the beginning of manipulation, points of occlusion( closing of teeth) are determined.Then local( or general) anesthesia is carried out.On the gums are applied insulating devices - cofferdams.Then boron remove the overhanging edges of the enamel and carry out a complete removal of the affected tissue.After the preparation of the cavity, it is antiseptically treated with chlorhexidine solutions( 2%) and thoroughly dried.Note: when treating a deep caries and saving the pulp to the bottom is applied a medical pad, which prevents the development of pulpitis. Then a seal of cement, composite or photopolymer is put.The prepared seal is ground and polished.
Important: is an alternative to tooth preparation with the help of a drill to introduce melanocyte-stimulating hormones into the carious cavity.There is evidence that in this way it is possible to stimulate the growth of cells of dental tissues.Enzymes can also be used to remove soft tissues, but the risk of relapse with this method of treatment is high enough. Principles of caries treatment of baby teeth in children in general do not differ from the therapy of permanent teeth damage.The difference is that when resorption of the roots has already begun( ie, preparation for the change of teeth is under way), it is not advisable to keep the temporary tooth.In this regard, often resorted to extraction( removal).The so-called "bottle caries" most often affects the incisors and fangs in the cervical region.The disease is typical for children under 3 years.In literature, you can find another name - "milk caries."The reason for the development of this pathology is an incorrect diet, combined with insufficiently high level of oral hygiene.To this variety of caries often sucking sweet( including milk) drinks from the bottle at night.At night, the salivary glands of the baby produce relatively little secret, resulting in the creation of the most favorable conditions for the reproduction of streptococci and lactobacilli.Bottle caries is dangerous because it causes early loss of teeth, as a result of which the formation of a permanent bite is broken.
Prevention of tooth decay
Prevention of hard tissue damage to the teeth implies the elimination of a cariogenic situation in the oral cavity and an increase in enamel resistance to cariogenic factors. The most important directions in the prevention of tooth decay are:
- a high level of oral hygiene( which includes the correct selection of the toothbrush);
- application of toothpastes with the addition of fluoride compounds;
- application of flosses;
- use of rinsers with antiseptic components;
- reduced consumption of "fast carbohydrates";
- Prophylactic examination at the dentist at least once every six months.
Of no small importance is also the general improvement of the body, in particular - the strengthening of general immunity. Plisov Vladimir, dentist