Etiology and pathogenesis of dental caries: predisposition, stages

The attention of the public has always been affected by the fact that the teeth, which every person has since birth, deteriorate during life only in some.The known disease "caries" is fairly selective and develops only in predisposed people with low tooth tissue stability.

Origin of the disease

In order to understand the mechanism of the pathology impact on an organism, the etiology and pathogenesis of caries, its classification and clinical picture should be considered.

From the introduction to the article it became clear that caries can be attributed to individual diseases, which completely depends on the human body, anatomical and genetic predisposition.

Also, lesion more often covers the chewing zone of the enamel - in noticeable cavities created by the fungal fissures, the cariogenic microflora accumulates and a so-called "microbial plaque" appears.

Caries is formed exclusively in places where the nature of the accumulation of microbial deposit and hard stone is laid.

The anatomical structure of the tooth row( narrow spaces between the teeth) promotes the accumulation of food, which is known to be the direct source of carious bacteria.

As for the anatomical predisposition, it is impossible not to note the density, quality and health of the enamel itself, the possibility of forming an organic coating( pellicula) on it.The stronger and more enduring the enamel to the mechanical, temperature and flavor stimuli that cause microcracks, the lower the chance of appearance of putrefactive processes in it.

It is interesting that even the salivary glands and the qualitative composition of the secret, as well as the peculiarities of food intake( chewing on one side, biting by a certain side of the teeth, uneven distribution of load due to installed prostheses or implants) directly affect the chance of caries.

In addition to anatomical predisposition, there are other individual factors that increase the chance of developing the disease.

1. Geographical indication. Scientists have determined that in each state the chance of caries disease will be very different.For example, the most risky residents of North America and Bulgaria, but Nigerians have nothing to worry about( only 2% of the risk of the disease).The CIS countries mainly occupy an average position( 50-99% of the risk).What in the geography of the country can influence the development of dental diseases?First of all, these are the climatic conditions that form the mineral composition of the soil( respectively, plant and animal food) and, most importantly, water.
   It is known that the fluorine content in running water directly affects the possibility of occurrence of so called "holes" - the higher the content of the microelement, the lower the risk.
   

   Geographic feature is one of the increasing chances of caries development

2. Choice of profession. Many people, when choosing a place of work, do not think about possible specific health consequences.Working in the conditions of enterprises, factories and factories where various alkaline and acidic compounds are regularly used, there are chemical waste, etc., the patient risks not only the health of the teeth, but the whole organism as a whole.By the way, even the profession of a confectioner increases the chance of appearance of putrefactive processes on the teeth.
3. Age of the .The etiology of caries can not ignore the fact that up to 2-3 years of life the child is practically not at risk of caries, while in adolescence the chance is more than 60%.Interestingly, after 40 years, this indicator again decreases.

It should be noted that in childhood and adolescence, the development of pathology is affected by additional factors:

• changes in the endocrine system and hormonal background, which is associated with puberty;
• possible violations of the liver and GIT;
• low index of fluoride and calcium in the body;
• concomitant diseases of the oral cavity, as well as systemic;
• change in the qualitative composition of saliva and enamel;
• dental pathology( violation of bite, installation of bracket systems, etc.).

1. Sexual trait. The academic community has recognized that women suffer from dental diseases more often than men, which is quite logical.Pregnancy, lactation and other serious changes in the female body( climax) primarily "hit" on the condition of teeth, hair, nails and other aesthetic indicators.
   Also it is impossible to hide the fact that women use confectionery products much more often, which sharply increase the chance of putrefactive processes on enamel.

Among the other causes of the disease, the following can be noted:

• unbalanced diet( predominance of destroying enamel of sweet, acidic and solid products);
• illiterate and irregular oral hygiene;
• is a metabolic disorder;
• lack of orgasm of certain micro- and macroelements, minerals, vitamins;
• genetic predisposition to tooth decay;
• features of forming the dentition in the period of bookmarking, cutting, changing, etc.

Pathogenesis of caries

Spotted spots

So, the very beginning of the disease is laid long before the appearance of processes of decay and tissue death.First of all, there is a gradual washing out of the upper layers of the enamel of the minerals necessary for its structure and strengthening( fluoride, calcium and others).This is facilitated by natural and organic acids produced by bacteria.Thus, a so-called "petrous spot" appears on the surface.

If at this stage insufficient hygiene of the oral cavity is attached, the cariesogenic microbes settle on the pellicle with colonies, causing a dense whitish or yellow coating of .Breeding in this environment, microorganisms more and more secrete organic acids that erode enamel.This is also promoted by mineral salts and the use of carbohydrates, especially sweets.The initial caries at this stage is characterized by the appearance of a plaque.

When the acid level of the tooth surface is reduced to the critical values ​​of , the enamel begins to actively degrade.Hydrogen ions enter the formed pores together with acids and bacteria, which provokes demineralization of deeper layers, widening the spaces between molecules.The protective functions of enamel are reduced and cariogenic microorganisms enter solid tissues, causing their gradual decomposition, decay.

Classification of the disease and clinical picture

Deep caries

We examined the etiology and pathogenesis of dental caries.The above factors and processes apply to each type and stage of the disease.But the tactics of treatment will differ, but depending on the type of illness and the characteristics of the symptoms. Consider the standard classification of caries.

1. The disease can differ in the place of penetration and development.So, caries happens in a stage of a stain and superficial( initial stages), and also average and deep( can give complication - a gingivitis, a pulpitis).
2. Depending on the area of ​​the lesions, caries of enamel( superficial), dentine( medium and deep), and tooth root are isolated.
3. Caries can affect various surface areas of the tooth: fissure, proximal, cervical, basal, etc.
4. Depending on the speed and intensity of development, tooth decay is slow, stable or fast flowing.
5. The disease can also be in different stages of activity: decompensated, subcompensated, compensated.

The initial caries of ( as well as the spot stage) are mostly asymptomatic.In some cases, the patient himself sees a small spot, but most of the time the dentist sees it at the reception.With a detailed examination of the tooth, the patient may notice a change in the structure of the tooth, the appearance of enamel haze.Also, this may be accompanied by an increase in its sensitivity to temperatures and taste stimuli.

Surface caries ( second stage of the disease) can be accompanied by painful sensations during meals.The sensitivity of the enamel increases even more, it begins to react and to mechanical stimuli( toothbrush, solid products, etc.).The dentist at this stage marks a defect in the tooth surface and the formation of a spot.In some cases, the disease is accompanied by inflammatory processes of soft tissues - gums, dentogingival papilla.Possible swelling of the area, increased bleeding gums.

Surface caries

The average tooth decay is accompanied by severe paroxysmal pains associated with various internal or external factors.The patient feels for his tongue an uneven indentation - a carious cavity, which is associated with the destruction of the integrity of the enamel and dentin.

Deep caries ( last stage) is also characterized by increased discomfort during meals, acute pains that do not go away immediately after eliminating the stimulus.Pain also appears when the tooth is clicked and probed.Visually, there is a deep cavity with a colored soft dentin, necrotic tissues.

Remember that caries in the initial stages is a cosmetic problem, and in later stages - a serious disease with complications.