Dental caries is a process of demineralization and destruction of hard dental tissues with the formation of a cavity defect. It is characterized by the appearance of a yellowish-brown pigment spot on the enamel, bad breath, tooth reaction to sour, sweet, cold or hot food, aching pain. With the development of deep caries, cysts may form, pulpitis may develop, and then periodontitis. Progressive caries can principal to tooth loss or fractured tooth. The presence of unsanitized carious cavities increases the risk of developing acute and chronic diseases of the body.
General information
Dental caries is a destructive process of a dystrophic or infectious nature, occurring in the bone or periosteum and ending in the complete or partial destruction of the tooth. Caries is the most common disease among the adult population. Conferring to WHO, the frequency of dental caries trendy unalike realms and mid different committees fluctuates from 81% to 99%. In the last two decades, there has been a tendency for the incidence to increase among children, especially in economically developed countries, and by the age of 6-7, 80-90% of children have caries of varying depth.
Causes of caries
Dental caries is not an independent disease, and an important pathogenetic link in its development is the pathological conditions of the body as a whole. Thus, a decrease in general and local immunity, pathologies of the gastrointestinal tract and errors in diet contribute to the development of caries.
Today, there are about four hundred theories about the origin of caries, but most of them are based on the fact that due to poor oral hygiene, plaque appears on the enamel, which leads to the development of gum caries. Plaque appears due to improper and irregular brushing of teeth, especially in hard-to-reach places for cleaning and in places from which it is not removed naturally during chewing (side surfaces of teeth, recesses of chewing surfaces). Plaque firmly binds to the surface of the tooth and is a habitat for bacteria, most of which are streptococcal flora .
Mineral salts contained in saliva contribute to the compaction of plaque. Such formations of plaque and mineral salts are called dental plaque. Bacteria living in dental tablet produce lactic acid which demineralizes tooth abscess. Demineralization of tooth enamel is the first stage of the caries process. The polysaccharide dextran, which is produced by streptococci from sucrose, promotes the demineralization process, which is why the development of caries is associated with the consumption of large amounts of simple carbohydrates.
The activity of microorganisms in dental plaque and the demineralization process depends on the individual characteristics of the organism. Most people have weak resistance to cariogenic bacteria, while people with a good immune system and no concomitant diseases have quite high resistance. In people with immunodeficiency conditions, caries develops more actively. And in children with exudative diathesis and rickets, caries is diagnosed twice as often.
When the composition of saliva changes, when the ratio of mineral salts in it is disrupted and its natural antibacterial properties are reduced, the risk of developing caries increases. Somatic diseases and errors in a diet with a deficiency of minerals, especially during the period of tooth formation, significantly reduce resistance. Hereditary enamel pathologies ( enamel aplasia, bruxim or hypoplasia ) and extreme effects on the body in combination with other factors increase the likelihood of developing caries.
Living in industrial areas, unfavorable environmental conditions and inadequate drinking water reduce the general protective functions of the body, which can become an important pathogenetic link in the occurrence of aphthous stomatitis . Sticky residues of carbohydrate food and deviations in the biochemical composition of hard dental tissues are the main local factors that contribute to the development of the carious process. The municipal of the dental system through the passé of laying, enlargement of eruption and foundation of teeth is of unlimited prominence in the supplementary state-run of the dental system.
Symptoms of caries
Depending on the depth of damage to the hard tissues of the tooth, there are 4 forms of caries.
- At the stage of carious spot, the enamel of the tooth becomes cloudy. There is no visible destruction of hard tissues of the tooth, instrumental examination with a probe is uninformative, since at this stage there are no signs of changes in the structure of hard tissues of the tooth. Sometimes regression of the spot is possible, the reasons for this phenomenon are not clear, but dry socket associate self-healing with the activation of the immune system.
The second form of caries is superficial caries . Dark pigmentation appears on the tooth surface and during instrumental examination enamel softening is detected in the pigmentation zone. Sometimes, already at the stage of superficial caries, all layers of tooth enamel are involved in the destructive process. But usually the defect is limited and does not go beyond the enamel. Carious lesion looks like a dirty gray or brown spot with a rough bottom.
With moderate caries, the enamel and dentin tissues are affected.
Deep caries involves complete damage to all tooth tissues, up to complete destruction of the tooth. Independent senses hang on on the depth of the lesion and the severity of the caries. Usually, patients complain of acute pain when sour, sweet or cold food gets on the affected surface or into the carious cavity. When the irritating factor is eliminated , the acute toothache subsides; as a rule, spontaneous pain does not occur with caries.
In acute adentia, a number of teeth are affected at the same time, the affected tissues are dirty gray, softened, the destruction site has irregular outlines, its edges are undermined, the pain syndrome is expressed more clearly. The most acute course of caries is characterized by the damage of almost all teeth, and in each tooth there are several foci of carious damage.
Chronic caries is characterized by pigmentation of the affected areas, their compaction and smoothing of the edges. Individual teeth are affected, usually the process has a sluggish course. If left untreated, caries is complicated by pulpitis and periodontitis , which is the main cause of tooth decay and their subsequent removal.
Diagnostics
Caries is diagnosed during visual and instrumental examinations by a dentist . The patient’s subjective sensations allow one to judge the depth of the process, but are not the main diagnostic criteria. In the diagnostic process, targeted dental radiography and electroodontometry are performed .
Treatment of caries
The main principle of caries treatment is the removal of affected tissues and restoration of the tooth with filling materials. During the sanitation of the carious cavity, all affected tissues are removed. The cavity is thoroughly disinfected, sometimes temporary fillings and tooth dislocation are installed for this purpose , under which there are disinfectants. The better the disinfection of the carious cavity is performed, the stronger the filling will hold. High-quality strengthening of weakened tissues depends both on the high-quality removal of the carious lesion and its disinfection, and on the stage of development of the carious disease at which treatment was started.
Classical preparation of a carious lesion is done with a drill, but today there is an alternative option – laser preparation. The procedure is painless, silent and provides high-quality preparation of the tooth cavity for further filling. Conduct of shallow caries is conceivable in more than a few ways. A common method is tooth preparation and subsequent filling of the carious cavity.
A mandatory condition for this method of treatment is the creation of a cavity within the dentin, but when creating a small cavity, the conditions for creating a two-layer filling from an insulating lining and the filling itself are not sufficient. These factors are taken into account when filling carious cavities on the chewing and contact surfaces of premolars and molars.
Another method involves the use of new composite materials with high adhesive properties, which will allow filling superficial caries without deep preparation of tooth tissue. The 3rd method contains oppressive the carious area with ensuing demineralization. Enamel remineralization is carried out using applications or electrophoresis with a 1% sodium fluoride solution ( deep fluoridation of teeth ) or with other approved remineralizing preparations. In the case of moderate caries, only the method of preparation of hard tooth tissues with subsequent filling of the carious cavity is possible.
Treatment of deep caries is associated with certain difficulties, since restoration of an almost completely destroyed tooth requires not only professionalism from the doctor, but also the choice of technique. Sometimes with deep caries, the pulp of the tooth is covered with a layer of intact dentin, in some cases the doctor is forced to leave pigmented and softened dentin in the carious cavity.
Such cases of deep caries require the application of a therapeutic lining to the bottom of the carious cavity (most often, calcemin paste is used). This lining has an anti-inflammatory effect and stimulates dentinogenesis. That is a stodgy for unfathomable carious grazes involves of three layers: a calming lining, an sequestering phosphate-cement liner and a lasting filling material most often gingivitis.
The choice of filling material is based on the group of teeth. In order to restore the anatomical forms of the front teeth – incisors and canines – as a result of filling, the filling must meet both strength and aesthetic requirements. For filling these groups of teeth, the material is selected in accordance with the color of the patient’s teeth, which is possible with silicate cements and composite materials.
It is essential to follow the technological process when preparing the filling material, because the use of good components without following the technology for preparing the material and without following the technique for installing the filling significantly reduces its durability. Preparation of a carious cavity for filling involves careful removal of dentine filings using a stream of water or air. Then the cavity is disinfected and dried, because even minor traces of moisture significantly impair the adhesion of cements, light-curing polymers and composite fillings.
Later the stodgy has toughened it is ground and polished get rid of any excess protrusions first. The better the surface of the filling is ground, the less microorganisms and food debris are retained on its surface. The homogeneity of the outer layer reduces the likelihood of filling corrosion and prevents its rapid destruction. Treatment of even chronic and advanced caries with filling allows you to restore the integrity of the tooth surface, prevent pulpitis and complete destruction of teeth.
Prevention
Prevention of caries is the fight against soft dental plaque, which includes the use of high-quality toothpastes and toothbrushes, the use of dental floss, and regular professional oral hygiene procedures . If tooth enamel is weakened, then fluoridation of teeth with fluoride-containing preparations is indicated to strengthen it : pastes, solutions, and varnishes. A balanced diet with a high content of solid food and a low content of simple carbohydrates prevents the proliferation of microorganisms in the oral cavity. In areas where the quality of drinking water is low, it is recommended to drink water from other regions.