What is important to know if caries has destroyed deep-lying internal tooth tissues .... Locations of caries. Preventive measures - how to stop the carious process

Classification

According to the international classification of diseases ICD-10, dental caries is placed in a separate section. Deep caries (dentine caries) is assigned code/code K02.1. Depending on the degree of compensation (because caries can worsen, acquire different activity), the dentist can use codes K. 02.0-02.9 to encrypt the diagnosis.

acute form

Patient complaints:

• The occurrence of acute pain under the influence of mechanical, thermal and chemical irritants, while the pain disappears immediately after the disappearance of the cause of irritation.
• Tooth discoloration.
• Carious cavity, constantly increasing in size.
• Food stuck in carious cavity.

On examination at the dentist:

• Deep carious cavity, and the inlet is often less than the width of the cavity.
• Chalky coloration of dentin/enamel.

Chronic form

Patient complaints:

• Mild pain.
• The presence of a cavity in which food enters.
• Change in tooth color.

On examination at the dentist:

• A wide inlet into a deep carious cavity.
• The bottom and walls of the cavity are filled with pigmented plaque.
• Damage to the peripulpal dentin.

Deep caries under filling

Dentists distinguish two types of carious lesions under the filling.

1. Secondary caries (when a carious lesion develops due to the formation of micro-slits between the filling and hard tissue and the penetration of microbes into them).
2. Recurrence of caries (if during the previous treatment the affected tissues were not completely removed).

• Sensitivity to thermal stimuli.
• Darkening of the tissues of the tooth (gray dentin tissue is visible through the enamel).
• Mobility of the filling

In the photo: 3 teeth destroyed by deep caries

The reasons

There are many theories of the occurrence of carious processes. Their graphic symbol was the "Case's shamrock" (overlapping in the center of the circle). According to him, caries develops when three conditions coincide: low enamel resistance, cariogenic flora and easily digestible carbohydrates. Dentists of our time supplement the "shamrock" with another circle and, accordingly, the condition - the duration of exposure.

Besides, deep caries can develop in a previously treated tooth - with defects in treatment, under a filling, when a filling is chipped.

Reasons for development:

1. General (insufficient fluoridation of water for drinking and eating foods with insufficient content of minerals and vitamins; predisposition to caries at the gene level and malfunctions of the mother's body during the period intrauterine formation dental germs; ecology).
2. Local (food debris remaining on the teeth after eating - dental plaque begins to form as early as 2 hours after brushing; reduced saliva secretion in certain diseases and conditions; dental deposits).

Diagnostic methods in dentistry

1. Clinical examination. Using a probe and a special dental mirror, the doctor examines the appearance, assesses the condition of the teeth and gums. When examining with a light microscope with deep caries, 3 zones are clearly visible: decay and demineralization, transparent and intact dentin, replacement dentin and changes in the pulp.
2. Thermometry. Study of tissue response to temperature. With deep caries, the tooth reacts to temperatures below 18-20 and above 45 degrees. To determine the reaction, dentists use irrigation with cold water, chloroethyl and pieces of heated gutta-percha.
3. X-ray examination. A picture of one, two or more neighboring teeth can be taken, a panoramic picture, which will capture two dentitions. The picture allows you to evaluate the quality of the seals and identify the carious cavity. Significant disadvantages of the method: radiation exposure and the possibility of detecting occlusal caries in a large cavity.
4. Transillumination. Illumination of dental tissue with a photopolymerization lamp. Carious cavities and cracks appear as dark spots. This method is uninformative in the presence of a filling on the tooth.
5. luminescent method. Fluorescent stomatoscopy is performed in a darkened room. A beam of ultraviolet rays is directed to the enamel. When hit on healthy parts of the tooth, a blue glow is observed. With caries, the glow is extinguished, and dark spots become clearly visible.
6. caries markers. With the help of caries markers, the boundaries of the carious cavity are determined. For staining demineralized tissues dental practice preparations based on fuchsin or 2% methylene blue are used. Their principle of action is simple: healthy dentin has small pores, and the dye does not penetrate into them, while infected tissues with large pores acquire a certain color.
7. Laser diagnostics. A highly accurate diagnostic method that can be used even in childhood. Diagnostics is based on fluorescent radiation. The radiation spectrum of healthy tissues differs from the spectrum of infected tissues. The laser beam, falling on the infected area, is reflected from the carious cavity, and the diagnostic device emits a special sound signal.
8. Electroodontometry (EOD). healthy tooth responds to a current strength of 2-6 μA. Caries reduces the insulating properties, and the electrical resistance is reduced to 15-20 μA. A decrease in excitability to 60 µA indicates an inflammatory process of the coronal pulp, to 100 µA - to the root pulp, more than 100 µA - to the death of the pulp.

Symptoms and self-diagnosis

1. The presence of a carious cavity (dark spot on the enamel).
2. Pain (from hot / cold, sweet / sour, when pieces of food enter the cavity).
3. Bad breath (especially noticeable with multiple lesions of the teeth).
4. Violation of the seal (its loss, mobility, spalling).

In the photo: advanced deep caries on the left tooth

In chronic deep caries, the asymptomatic period can last several years. Only when the destruction of the dentin reaches the bottom of the tooth, there is pain on pressure.

Treatment

General stages of treatment:

1. Anesthesia (local anesthesia with lidocaine drugs)
2. Disclosure of the carious cavity (the dentist removes the overhanging edges of the enamel with a bur).
3. Necrectomy (removal of softened dentin).
4. Formation of a cavity using air-water cooling (the walls should pass into the bottom of the cavity at a right angle; in deep carious cavities, the bottom becomes stepped or roller-shaped).
5. Cavity finishing (smoothing the edges of the enamel and removing its damaged areas; it is necessary for a snug fit of the filling and for preventing the development of secondary caries).
6. Antiseptic treatment and drying of prepared hard tissues (warm solutions of furacilin, chlorhexidine, dimexide, ethonium are used; drying is carried out with sterile cotton swabs).
7. Etching of enamel.
8. Washing and drying the surface.
9. Application of primer and adhesive (necessary for better fixation of the filling to the dentin).
10. Application filling material(glass ionomer cement or composite material).
11. Filling polymerization (treatment with a polymerization halogen lamp).
12. Polishing.
13. Post-bonding (grinding of roughness).
14. Application of fluorine preparations.

The duration of one procedure can be from 40 minutes to one and a half hours.

Tools and materials

Medical pad

Even sparing preparation of tissues injures the processes of odontoblasts and negatively affects the condition of the pulp. The therapeutic pad has a healing effect on the pulp, stops the inflammatory process, stimulates reparative processes, anesthetizes, withstands pressure after hardening.

With deep caries, a dentist usually applies a medical pad with antiseptic and odontotropic effects. These can be pads based on calcium hydroxide ("Calme-cin", "Dycal", "Alkaliner", "Reocap-E", etc.), zinc-eugenol cement (the main component is eugenol - an antiseptic plant origin), combined medicinal pastes.

A warm medical pad is applied with a thickness of not more than 0.5 mm only to the bottom of the prepared carious cavity.

With deep caries, the layer of healthy dentin is so thin that cariogenic microbes penetrate into the pulp. If during a visual examination the dentist has this kind of suspicion, then a medicinal tab is installed and a temporary filling is placed.

The following one-component materials are often used: dentin paste, water or artificial dentin, cements, polymeric materials. A temporary filling can also be diagnostic. It is installed in order to see how the pulp behaves after preparation. If replacement dentin begins to be produced, then the patient's soreness no longer bothers. A tooth with an infected pulp requires endodontic treatment.

Insulating pads

The purpose of the insulating lining is to protect the dentin, pulp from chemical and thermal influences. In addition, it is placed between the bottom of the carious cavity and a permanent filling to prevent hypersensitivity after drilling.

Insulating pad functions:

• Improving the fixation of a permanent filling.
• Dentin sealing to prevent microbial invasion.
• Remineralizing effect on the underlying dentin.

Depending on the condition of the carious cavity, the dentist may use a base or thin layer pad. If the thin layer only protects the pulp from chemical exposure, then the base one creates the optimal geometry of the carious cavity, protects the pulp from thermal irritants and allows the use of a smaller amount of filling material.

Materials for creating insulating gaskets: insulating varnishes, glass ionomer cements, polycarboxylate and zinc phosphate cements (the last two are practically not used).

Healing paste

Therapeutic pastes are prepared immediately before being introduced into the carious cavity. Medicinal substances included in their composition may be different. Their choice depends on the clinical situation and individual preferences of the dentist. Their main disadvantage is fast loss activity and insufficient mechanical strength, therefore, pastes are used during the period of “active” treatment under a temporary filling, followed by replacement with some kind of cement.

Scroll medicinal substances used for the preparation of combined pastes:

1. Anti-inflammatory agents (prednisolone, salicylates, hydrocortisone, indomethacin).
2. Odontotropic substances (Algipor, calcium hydroxide, dentine sawdust, fluorides, calcium glycerophosphate, collagen).
3. Antimicrobial agents (ethonia paste, chlorhexidine, lysozyme, metronidazole).
4. Proteolytic enzymes (imozimaza, profezim).
5. Other means (natural oils - sea buckthorn, clove), dimexide.

Preparations:

• Pulpomixine;
• Pulpanest;
• Pulperyl;
• Contrasil;
• Calcipulpe;
• Septomixine forte.

Treatment of deep caries under the gum

The pathological process that develops under the gum often does not capture visible to the eye plots, so it is found already in a deep form. Often in such cases, pulpitis develops and treatment is impossible without removal of the nerve.

Peculiarities:

1. Subgingival carious processes require gum correction (coagulation, excision). It is necessary for quality treatment tooth and isolation of the working area from saliva and blood.
2. With a significant destruction of the walls, it is necessary to install an inlay (or an inlay with a pin).
3. If the crown of the tooth is completely infected and the root is intact, a crown is placed on a living tooth.

Tooth extraction is performed if the deep parts of the roots become infected.

Features of treatment in children

Treatment of deep carious lesions in children is associated with a number of difficulties. Children quickly get tired, often close their mouths. The treatment of the carious cavity is hampered by abundant salivation, mobility of the head and tongue.

Preschool children

Carious cavities at this age have wide inlets, they are flat and small. Dentin is easily removed. During treatment, the pulp horn may be opened, so the dentist must be very careful.

Machining starts at 2-3 visits. It is preceded by coating the teeth with fluorine varnish. The doctor gently treats the carious surface with a spherical burr, removing softened dentin, treats the cavity with non-irritating antiseptics and fills the tooth with polycarboxylate or glass ionomer cements.

In childhood, treatment with a delayed method is possible (without anesthesia and a drill). The purpose of the method is to prevent tooth decay and wait until the child gets used to the dental environment.

Stages of treatment:

• Treatment of the carious cavity with hand instruments.
• Temporary restoration of a tooth with glass ionomer cement.

This material is temporary, it tends to stain with dyes, chip, sag, so the minimum service life of such a filling is 6-12 months. After this time, the tooth must be restored with permanent material.

Pupils

To restore carious defects in fillings at this age, dentists use silver amalgam, chemically and light-curing composite materials. When treating teeth with deep caries with immature roots, silver amalgam is also preferred. An invasive fissure sealing technique can also be applied.

How is it treated during pregnancy

A carious focus can cause intrauterine infection of the fetus, delay its development, provoke miscarriage and premature birth. In addition, acute pain during caries causes the release of specific hormones that adversely affect the embryo (they disrupt the nutrition and breathing of the fetus). Therefore, at the first symptoms of deep caries, it is necessary to contact a dentist who, taking into account the duration of pregnancy, will select a safe treatment regimen. Best time for treatment - from 13 to 32 weeks of pregnancy.

1. Anesthesia. Modern drugs used for anesthesia penetrate the systemic circulation, but do not cross the placental barrier. Therefore, if the dentist offers local anesthesia, you should not refuse.
2. Radiography. Pictures during pregnancy are taken with a radiovisiograph - a device of local action (on an area of ​​​​2-3 cm) with an extremely low level of radiation. The abdomen is protected by a special apron with lead plates that do not transmit x-rays.
3. Sealing. After treatment of the carious cavity, hypoallergenic light-curing fillings are installed. Photopolymer lamps are used to illuminate them. Their blue glow is not an ultraviolet cure, but a stream of light passing through a filter.

Anesthetics are used: articaine (considered the least toxic, but not used in case of anemia in a pregnant woman), ultracaine, brilocaine, primacaine.

Photo - before and after treatment

Before After

Folk remedies

Treatment of deep caries folk remedies impossible, because requires the intervention of a qualified dentist. At home, resorting to recipes traditional medicine, it is possible only for a while to remove the sharpness of painful sensations and signs of inflammation.

Relieve Pain:

• Alcohol tincture of propolis, vodka, Japanese Sophora, onion peel tincture, fir oil.

Relieve inflammation:

• Rinsing with decoctions of the bark of thought, chamomile, sage.

What not to do:

1. Apply honey or powdered milk. The carbohydrates contained in them activate the growth of bacteria and promote intensive growth. carious lesion.
2. Use hydrogen peroxide (may burn oral cavity).

The reason for the development of deep caries of wisdom teeth is the rapid accumulation of plaque and an inconvenient location that prevents hygiene procedures. It happens that the "eight" erupts from the gums already with deep caries, and the person is unaware of its development until the pain begins to bother. Another variant of the imperceptible course of the disease is interdental caries, which, in addition to the wisdom tooth, also affects the adjacent molar. It is almost impossible to notice such caries at the stain stage.

Most dentists are in favor of removing a carious wisdom tooth, because. it is sometimes simply impossible to completely remove infected tissues. Even in the case of high-quality filling, there is a high risk of developing secondary caries due to the inaccessibility of a toothbrush.

However, the G8 may be required in the future. For example, as a support for a prosthesis.

Considering all of the above, the question of the treatment or extraction of a caries tooth remains open.

Consequences and complications

Post-filling sensitivity, which is manifested by pain with pressure on the filling, a feeling of discomfort, normally disappears within 1-2 weeks. If tangible pain persists longer, this is one or another complication that has arisen due to a dentist’s mistake.

1. Change in the color of the filling (due to eating food containing dyes on the first day).
2. Depressurization of the space between the tooth and the filling (due to a violation of the filling technique; it is fraught with the development of secondary caries and tissue infection).
3. Postoperative sensitivity (with overdrying of the dentin).
4. Fracture of the filling (during processing, setting or thinning).
5. Loss of a seal (violation of the technology for introducing a seal and forming a cavity).
6. Papillitis (after irrational filling; manifested by swelling and redness of the gingival papilla).
7. Inflammation and necrosis of the pulp (due to overheating of the dentin, traumatic treatment of the day of the cavity; endocanal treatment is required).

Sealed deep caries - the tooth hurts and aches

Slight aching pain is the norm after treatment of deep caries. The fact is that the bottom of the carious cavity is located close to the nerve, and the filling material transfers pressure to the pulp. Within a month, a protective layer of dentin will develop, and the tooth will stop hurting. If acute pain worries, there is fever then you need to see a dentist. After the x-ray, he will determine a plan for further treatment.

Painful to chew after filling

Pain when biting and chewing food after filling can occur with a high surface tension of the filling on the tooth surface. In most cases, it is enough to refill the tooth. It is not necessary to treat channels and remove the nerve.

Pulpitis after treatment of deep caries

If, after treatment, increasing pain is disturbing, then pulpitis has probably developed. You should immediately contact your dentist to remove the infected pulp and seal the root canals. At timely handling there is a chance to leave the pulp alive, i.e. do not remove the nerve. The doctor will remove only the coronal part of the pulp, using the so-called biological method of treatment (after removing the tissues affected by caries, a therapeutic calcium-containing pad is placed in the cavity and a temporary filling is installed).

Sore gums after treatment

A slight inflammation of the gums after treatment is possible. It usually goes away on its own. If the gums become inflamed after treatment, then after eating, the mouth should be rinsed with solutions medicines(furatsilin, chlorhexidine), decoctions of chamomile, sage, calendula tincture, etc. If the inflammation does not subside after 2-3 days, you should see a doctor (to exclude chronic gingivitis and other complications).

Tooth sensitivity after deep caries treatment

The cause of sensitivity may be a violation of the tightness of the filling material to the surface of the tooth due to overdrying / underdrying of the tooth cavity. Overdrying causes damage to nerve endings and even their death. In case of underdrying, water drops remain on the walls of the cavity, which prevent the penetration of the adhesive into the dentinal layers. Only a doctor can clarify the origin of sensitivity, therefore, with negative dynamics, be sure to contact him for advice. Refilling the tooth may solve the problem.

After treatment, the tooth reacts to cold, hot or sweet

Increase sensitivity - normal reaction pulp for intervention, but if the tooth reacts to stimuli hypersensitivity more than 5-7 days, you should consult a dentist. Perhaps the tooth was not completely cured, and infection of the dental canal occurred.

Can there be throbbing pain after treatment?

If deep caries with the penetration of infection into the tissues of the tooth has not been completely treated, then aching or paroxysmal pain may occur. They can occur both during meals and at rest (particularly at night). These are symptoms of developing pulpitis. A characteristic sign of such a toothache is irradiation to the temple or ear. At home, you can only stop the pain syndrome (take Ibuprofen, Analgin). Then you need to contact the dentist to clarify the diagnosis.

Prevention

1. Regular sanitation of the oral cavity (includes brushing teeth with fluoride-containing pastes, rinsing after each meal, professional cleaning every 6 months).
2. Restriction of sugar-containing foods in the diet.
3. Timely treatment of secondary caries.
4. Fissure sealing (application of a thin film on the chewing surface to protect against bacteria).
5. Vitamin therapy (prevention of enamel demineralization by taking vitamins C, D and fluorine).

Prices

The price for the treatment of deep caries depends on the degree of destruction of the crown part of the tooth, the cost of materials (medical and insulating pads), and the chosen treatment method.

The average cost of treatment is from 4000 to 8000 rubles. Diagnostic measures, professional cleaning, removal of the pulp and restoration of the shape of teeth severely damaged by caries are not included in the total cost.

Frequently asked Questions

Is there a difference in the treatment of medium and deep caries?

The treatment of deep caries differs only in that before the filling material is applied, a medical pad is applied to the bottom of the cavity.

Is it possible to treat without removing the nerve?

Timely treatment of deep caries allows you to stop infection at the level of dentin and enamel and preserve the viability of the pulp. If the crown of the tooth is severely destroyed, and the carious cavity has reached the pulp chamber and the latter is opened during cleaning, then the removal of the nerve is the only possibility save the tooth (and subsequently restore it).

When is tooth extraction required?

Indication for removal is a pathological process that is a consequence of deep caries (destruction of the tooth crown, which cannot be restored either by filling or artificial crown; inflammatory process in the pulp and periodontium, not cured by medical and surgical methods).

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What is deep caries

When a person is irresponsible about the health of his teeth and ignores the first manifestations of caries in the phase white spot, does not apply for the treatment of medium caries, then rather quickly the process of tooth destruction passes into the next stage, the most difficult - deep dental caries, in which the deep layers of the hard tissues of the tooth - dentin are involved in the pathological process. In this case, the tooth is already severely destroyed, and only a very thin layer of healthy dentinal tissues remains between the bottom of the cavity and the pulp.

Photo of deep caries

deep caries is last stage before the development of such pathological complications as pulpitis (inflammation of the pulp) and periodontitis (inflammation of the periodontal tissues). There are two types of deep carious destruction:

• primary, which develops from untreated secondary caries;
• secondary- develops under fillings, after poor quality treatment tooth.

A particularly severe course is characterized by deep caries of the anterior teeth, which is often found in children due to the irresponsible attitude of parents to the baby's temporary milk teeth. Firstly, carious front teeth look very unpresentable. Secondly, pain is difficult to eliminate even with the most modern pharmacological preparations. And, thirdly, the regime is violated good nutrition because it is impossible to bite with sick teeth.

Acute and chronic form of deep caries

Two forms of the disease are distinguished along the course:

• chronic deep caries, characterized by sluggish development, with the periodic occurrence of short-term pain when the tooth is disturbed. chronic course has some peculiarity in the appearance of the diseased tooth - the cavity, as a rule, is very large, deep, hollow, softened dentin is located only at the bottom. The walls of the cavity are strongly pigmented. This form most often sharply develops into acute pulpitis.
• acute deep caries- characterized by very strong, but short-term pain from thermal and mechanical stimuli, but the reaction to salty and sweet is weak. This is due to the shape of the carious cavity - it is narrow on top, but deep and wide inside the tooth. Often it looks like a small hole from the outside, and the tooth is almost already destroyed. When the tooth is opened, a large amount of soft light dentin is visible, which can be easily removed.

Symptoms and Diagnosis

It is not difficult to diagnose this stage of tooth disease - most often it begins with the appearance of soreness in the tooth when chewing or hot drinking. But, since the pain passes quickly, people pay little attention to it - and the pathological process continues further, quickly developing into an acute and very painful pulpitis. If you immediately contact a dentist, he can easily diagnose deep caries, the symptoms of which are typical - this is the occurrence of short-term pain:

• with mechanical irritation - pressure, food entering the cavity;
• from thermal stimuli - from cold or hot food and drink;
• from the ingress of chemicals - sweet, sour, salty, etc.

As a rule, such pain is quite sharp, but quickly passes if the irritant is eliminated. Remarkably, when tapping on the tooth, pain does not occur. But, if the pain does not subside within 15-20 minutes, most likely the process has already spread to the pulp, and the development of pulpitis has begun.

Only a qualified dentist can make a differential diagnosis of deep caries in relation to a number of other diseases of the tooth and periodontal tissues with a similar clinical picture, in particular:

• with focal pulpitis, in which pain is observed long time after impact on the tooth. Pain chronic pulpitis it can occur spontaneously, paroxysmal, even without tooth disturbance, and in acute it does not stop and is very strong. In this case, the cavity will not necessarily be large in appearance, but very deep. Probing is painful, but only in one place - in the focus of pulpitis, when, during caries, there is uniform pain throughout the tooth;
• with moderate caries. Although in both cases the cavity can be large, but with an average form of caries, probing the cavity is practically painless, since a rather thick layer of hard dentin has been preserved between the pulp and the destroyed tissues. With deep caries, probing always and unequivocally gives a strong pain reaction;
• differentiation is also necessary with chronic fibrous pulpitis. In this case, the tooth is filled with soft dentin, severe pain is constantly observed, the pulp can bleed. In such cases, the reaction of the pulp to weak currents (electroodontodiagnostics) is included in the diagnosis. This method helps to differentiate specifically - this is deep tooth decay or pulpitis, since during pulpitis the necrotic pulp does not respond to weak currents up to 10 μA, but only to exposure to currents above 100 μA.

Also, the presence of deep caries is indicated by the patient's complaints about the soreness of the tooth under the filling. Most often, the secondary process develops for a long time asymptomatically, and only when the destruction of the dentin has reached the bottom of the tooth, a painful reaction to mechanical pressure appears, and the filling becomes mobile or falls out altogether. In any case, in addition to an external examination, the doctor will definitely prescribe an x-ray, in the picture of which the darkening from the destroyed dental tissues will be clearly visible. The thinner the layer of healthy dense dentin between the pulp and the destroyed dentin, the deeper the caries and the more severe its course. There is no need to be afraid of an X-ray, even if 2 pictures are prescribed, one of which is a control one, after the treatment. Modern x-ray machines are practically safe, especially the radiovisiograph, and are approved for use even for children and pregnant women.

Stages of deep caries treatment

When the diagnosis is made, almost every patient in the dental chair is primarily interested in only one question: does it hurt to treat deep caries? We want to calm down immediately - it does not hurt.

Anesthesia in the treatment of deep caries

The first thing the doctor will do is local anesthesia. As a rule, this is an injection into the gum with one of the modern effective painkillers: novocaine, lidocaine, dicaine, articaine. In this case, the doctor must initially perform a test sample for individual patient tolerance of the chosen drug for anesthesia. If no reactions are observed (which must be entered on the card), then a small amount of anesthetic is applied to the gum, then it is injected under the gum mucosa. And only when it starts to act (after 1-2 minutes) - under the periosteum. With this algorithm of manipulations, the patient does not feel not only pain from the injection, but even discomfort.

• preserve healthy tooth tissues as much as possible;
• prevent the occurrence of relapses of the disease;
• to remineralize the preserved dentin;
• ensure the formation of replacement dentin.

It is difficult for an uninitiated person to understand what is at stake, so we will better tell you what and in what order the doctor will do. Initially, the dentist will determine whether the treatment of deep caries will be performed in 1 visit, or the patient will have to visit his office twice.

Treatment in 1 or 2 visits: which is better?

Let's say right away that the second option is preferable, no matter how much the patient would like to quickly get rid of the problem and not come back to dental clinic. If a permanent filling in the treatment of deep caries is delivered immediately, then situations are not excluded that the tooth will hurt and it will have to be opened. Moreover, this may not even depend on the qualifications of the dentist and the quality of the treatment performed, but on the fact that carious microbes have already penetrated into healthy-looking dentin tissues. It is even worse when the tooth does not hurt, and under the seal, the pathological process continues further. Which sooner or later will lead to its complete destruction. That is why the treatment of deep caries in 2 visits avoids these complications. During the first visit, the doctor will perform the treatment and place a temporary filling. It will be replaced with a permanent one only when there is confidence that caries is 100% removed from the cavity and there will be no further troubles (usually after 3-4 days).

In the process of treating deep caries, the doctor himself can offer to immediately put a permanent filling if he sees that the layer of healthy dentin is thick enough, that the pulp chamber was not opened as a result of drilling the tooth, and before the treatment, the pain in the patient's tooth was not strong and frequent. These parameters are enough to make a decision to perform filling in one stage.

The next steps in how deep caries is treated are:

1. After the onset of anesthesia, the doctor removes all damaged tooth tissue using a drill and a special tool. At the same time, in order not to open the pulp chamber, only spherical burs are used, and the bottom of the cavity is not leveled. But in the treatment of acute deep caries, healthy tissues hanging over the cavity are necessarily removed, and the cavity itself is made wide and deep, with excision of all affected dentinal tissues. This is necessary for high-quality cleaning of the tooth, carrying out full treatment and a good fit of the filling. Here is the answer to pretty frequently asked question patients: why the hole was small, but the doctor made it so big.
2. Further, after a thorough cleaning of the cavity, it is disinfected, and a special gasket is placed there to protect the dentin and pulp from microorganisms. Therapeutic pad to prevent pulpitis in deep caries is made from concentrated calcium preparations with a strong bactericidal effect (calcium hydroxide, Calcemin, Calcipulpe, Calcimol, etc.). That is, this layer simultaneously performs two functions: remineralizes healthy tooth tissues and protects them from infection.
3. The next step in the treatment of deep caries is the application of an insulating pad, the task of which is to tightly fix the therapeutic layer, as well as to protect it from the external photopolymer filling.
4. At the next stage, the dentist either puts a temporary filling, which will be replaced with a permanent one in a few days if there are no complications. Most often this happens if the patient had a very deep caries or there is a risk of developing complications. Or a permanent photopolymer filling will be placed immediately. At the same time, the price for the treatment of deep caries does not depend on the number of visits to the dentist. The cost is calculated for the final result.

Complications and consequences of deep caries treatment

For some reason, people who did not worry much about their teeth and allowed the development of the most extreme stages of caries, when visiting a dentist, are very interested in the question: what are the consequences for a tooth that are likely to have deep caries. We don’t want to upset, but there may be sad ones - the tooth will have to be removed. But, nevertheless, in most situations and with the appropriate qualifications of a dentist, the tooth can be saved, and it will serve its intended purpose for a long time to come.

Sometimes, in no more than 7-8% of cases, complications occur after treatment. The most common nuisance is pain after deep caries treatment. Occurs in almost a quarter of cases. This is due to the rather complex nature of operational manipulations. The pain usually goes away on its own within 24-48 hours. For the first time, the dentist will recommend the most suitable pharmacy remedy for pain relief.

If the pain does not subside within a day or two, but, on the contrary, it becomes tearing, impulsive, accompanied by swelling (swelling in the area of ​​the treated tooth), hyperemia (reddening of the gums), fever, vomiting, dizziness and other unpleasant phenomena - immediately contact for medical help. Up to calling an ambulance, if there is no way to find your doctor. This development of events may indicate infection and have very dire consequences.

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Classification

Deep caries is classified depending on the localization of the carious cavity, on the nature of the course of the pathological process, and also on the degree of intensity of its progression.

The location of the cavity is determined in accordance with existing classification Black:

• Grade 1 - the pathological process struck only anatomical depressions, called fissures;
• Class 2 - cavities are localized on the contact (approximal) surfaces of the chewing group of teeth;
• Grade 3 - deep caries struck the contact surfaces of the canines and incisors;
• Grade 4 - the destruction affects both the contact surfaces and the tubercles of the teeth;
• Grade 5 - the cavity is localized in the neck of the tooth;
• Grade 6 - cutting edges and tubercles of teeth are destroyed.

By the nature of the course, this type of caries happens:

• fast;
• slow;
• in the stabilization phase.

According to the degree of activity, caries is divided into:

• active;
• inactive;
• suspended.

Causes

Factors affecting the progression of the disease in children and adults are divided into two large groups- general and local.

Common reasons:

• adverse effects on the body of adults and children of the environment;
• the use of foods containing an insufficient amount of minerals, as well as vitamins;
• predisposition to the progression of carious processes at the genetic level;
• insufficient amount of fluoride in the water used;
• decrease in the immune forces of the body during the formation of dental structures.

local reasons:

• deposits on the surface of the teeth;
• pieces of food that remain in the mouth after each meal;
• change biochemical composition saliva. This condition may develop due to the progression of some chronic ailments in the human body;
• inadequate oral hygiene. It is this reason that is called the main one in the development of caries in adults and children.

Development mechanism

Deep caries is a process that does not develop in one day. The mechanism of its development is very complex. The cavity is formed gradually. This process can be conditionally divided into several main stages:

• poor oral hygiene (root cause);
• leftover food begins to rot and ferment;
• a lot of soft plaque accumulates on the surface of the teeth;
• dental deposits from soft are reborn into hard ones, and tartar is formed;
• under the formed tartar, pathogenic microorganisms actively multiply, releasing a lot of organic acids, which destroy the structure of the tooth;
• formation of a carious cavity. If it is not eliminated at the first stage of development, then it will gradually increase and affect more and more tooth tissues.

Forms

Deep caries has two main forms:

• acute form. It is characterized by the occurrence of severe pain when exposed to various irritants on the tooth. Most often it is hot, cold or sweet. It is worth noting that the pain may not go away even after the elimination of the cause that provoked its manifestation. Symptoms of the progression of the pathological process are very pronounced. The carious cavity has a narrow and rather deep entrance, as well as an expanded base. The shape resembles an ordinary bottle - a narrow "neck" and a wide "base". The walls of the cavity consist of the affected dentin, which can be peeled off;
• chronic form. A symptom like short term pain, is also characteristic of chronic deep caries. It occurs under the influence of certain stimuli (sour, hot, etc.). In this case, the carious cavity is deep and wide. Its walls have a dense structure and are usually pigmented. Softened dentin can only be seen at its bottom. Chronic deep caries is the most dangerous form of this pathology, since in most clinical situations it leads to the development of pulpitis.

Symptoms

With deep caries in children and adults, the hard tissues of the crown of the tooth, as well as the deep layers of dentin, are destroyed. This is the basis for further patient complaints. As a rule, they are concerned about short-lived, but very intense pain that occurs after mechanical, thermal or chemical stimuli. For example, pain often occurs after eating hot or cold food, as well as from picking a toothpick in the teeth. After eliminating the immediate cause that provoked the pain, all discomfort disappear.

Visual inspection can easily detect the presence of deep cavity filled with the remains of the affected dentin, as well as pieces of food. Probing can cause pain, which will immediately go away after the probe is removed.

If there is still a thin layer of healthy tissues between the pulp and the formed cavity, then symptoms of pulpitis may appear:

• spontaneous aching pain;
• inability to chew food properly.

The main complaints of the patient may also be accompanied by severe headaches, as well as a feeling that the pain radiates to the neck, to the eye, or to another area.

Deep caries in children

Deep caries in children can affect both milk and permanent teeth. Symptoms are the same as during development this process in adults. The main reason for the progression of this pathological process in children is inadequate oral hygiene. Also, caries affects the teeth of children due to the fact that they eat too much sweets. Namely, carbohydrates are the main "food" for pathogenic microorganisms that are in the mouth.

If deep caries in children was found in milk teeth, then most often they are not treated, but simply removed to make room for normal eruption of permanent teeth. They also resort to setting a medical pad. But before that, it is necessary to completely clean the cavity from the affected tissues. But in the process, the pulp chamber may open. In this case, the only right decision is to remove the tooth. If, after the preparation, there are still healthy tissues, then a medical pad is applied to them and first a temporary and then a permanent filling is placed.

Diagnostics

Diagnosis of deep caries includes several stages:

• inspection. As a rule, at this stage, the doctor clarifies the patient's symptoms of the disease (when the pain appeared, how intense it is, etc.). A visual examination of the oral cavity is also carried out, in which it is possible to identify the presence of a carious cavity and its depth. When probing, the pain may increase somewhat;
• radiography. The most informative technique, as it makes it possible to clarify the localization of the cavity, its proximity to the pulp chamber. On the panoramic shot you can see all the teeth that are located in the jaw. If necessary, also take an aiming picture. This technique is used to diagnose caries in both adults and children.

simptomer.ru

What it is

Deep caries is an extensive lesion of the hard tissues of the tooth, covering in depth not only the enamel, but also most of the dentin.

An insignificant dentinal bridge separating the carious cavity and the pulp is defective, infected, demineralized and has a high permeability for microflora.

At the same time, there are changes inflammatory nature and in the pulp of the tooth, they are local and are reversible during qualified treatment.

Video: caries

Varieties

By clinical course it is divided into acute and chronic. This division is justified by differences in the structure of the affected tooth tissues, and in the methods of treatment used.

Spicy

Acute caries develops rapidly and decompensated. The process of destruction significantly exceeds compensatory mechanisms trying to preserve hard tissues and protect the nerve from inflammation.

The cavity is deep, with a large amount of enamel and dentin hanging over it. The walls and bottom of the cavity are made of loose and light decay. Probing the bottom of the cavity is painful, especially in the projection zones of the pulp horns.

Chronic

Chronic caries progresses more slowly because the tooth was initially more mineralized and had the ability to resist decay.

In chronic caries, obstruction of the dentinal tubules occurs, which increases the density of the dentin and reduces its permeability and reduces pulp irritation.

In addition, on inner surface the pulp chamber is rapidly forming secondary (replacement) dentin, which also delays inflammation of the nerve.

The carious cavity is filled with a thick layer of relatively dense and highly pigmented decay. Probing the bottom of the cavity is slightly painful, when irrigated with cold or hot water pain is not severe.

Symptoms

In any course of deep caries, there are complaints about a significant defect in the crown part of the tooth. This can cause discomfort to the patient from disturbing the appearance of the tooth and from inconvenience while eating.

A significant amount of decay in the carious cavity can cause bad breath (halitosis), especially pronounced in multiple caries.

The intensity of the remaining symptoms largely depends on the severity of caries. In an acute course, there will be severe pain from cold or hot, as well as when a dense particle of food enters the cavity. But this pain is short-lived, it disappears within seconds after the cessation of exposure to the stimulus.

With slow destruction, the reaction to temperature changes is not so pronounced.

Diagnostics

Diagnosis does not cause problems, the appearance of the tooth and the patient's complaints are very eloquent. However, differential diagnosis can often be very difficult.

It must be distinguished from some other diseases.

• Medium caries. The bottom of the cavity is denser and less sensitive, on the x-ray the defect is fenced off from the pulp by a significant layer of dentin, it is better to mistakenly treat with medium caries as with deep caries, rather than vice versa.
• Acute focal pulpitis. Characterized by sharp, throbbing, spontaneous pain, worse at night. Probing the bottom of the cavity is sharply painful at one point.
• Chronic fibrous pulpitis. When probing the cavity, an open part of the pulp is detected, the pain is from sluggish to significant, a drop of blood appears.
• Chronic hypertrophic pulpitis. A soft pink tissue resembling a gum is found in the cavity of the tooth. It should be clarified - is the gum area grown into a defect with deep caries, or has the pulp grown with chronic pulpitis?
• Chronic periodontitis. The anamnesis data and, most importantly, the radiograph help, with caries there are no periodontal changes.

How are they treated

Treatment of deep caries is possible only with reliable injection anesthesia. The task of the doctor is the complete removal of all necrotic tooth tissues, as well as the edges of the cavity hanging over the defect.

The need to excise externally unchanged edges of the enamel is explained by the fact that these areas are already deprived of a direct supply connection with the pulp, and, therefore, will become brittle and crack over time. A recurrent carious defect will appear.

Stages

After anesthesia and preparation, the cavity should be treated with an antiseptic solution and an assessment of the condition of the tooth. The density of the walls is analyzed, underprepared areas are identified. Then the cavity is pre-prepared in order to create an optimal shape for filling.

There are several reasons for this. The lining material protects the pulp both from chemical irritation by the filling and from temperature exposure when hot or cold food is taken.

One or two visits?

Tooth filling in one visit is performed with a compensated course of caries, in the presence of dense walls of the cavity and sufficient thickness of the bottom.

The absence of pronounced complaints of the patient before the start of treatment is also taken into account.

In the case when there are doubts about the diagnosis (caries or already pulpitis?), It is not possible to make X-ray diagnostics, etc., it makes sense to apply a temporary filling with medical pad. After 3–10 days, in the absence of complaints, temporary materials are removed and a filling is performed.

But it also happens like this: acute course caries, the bottom of the cavity is not dense enough for a “calm” filling. In order to avoid inflammation of the nerve, it is necessary to activate the production of replacement dentin.

At this stage, the doctor can either apply a therapeutic pad under a temporary filling for a period of 1 to 6 months, or use a therapeutic layer as a permanent pad under the main filling.

Decision, in one or two visits to treat this species caries, depends not only on the condition of the tooth, but also on the favorite methods worked out by the doctor and the equipment of the office.

Preparations

In the treatment of deep caries, the choice of a doctor occurs mainly between two groups of drugs - based on eugenol and calcium. An example of the first is the classic zinc-eugenol paste.

Ease of use, many decades of use, that's not all. Preparations of this group are reliable, practically do not irritate the pulp, i. work softly. But - slowly.

Calcium-containing preparations are divided into two groups, with low and high alkalinity.

Slightly alkaline are well combined with modern composite materials, they make excellent medical-insulating pads. Materials with high alkalinity work much more actively, but there is some risk of getting alkaline pulp necrosis.

Complications after therapy

Deep dental caries is an extreme degree of the carious process, bordering on pulpitis.

In the event that the treatment was never started, or it was carried out without taking into account the real extent of the existing pathology, an acute and irreversible inflammation of the pulp begins.

In this case, there are strong, spontaneous pain. Treatment in this case should include, in addition to excision of necrotic tissues in the carious cavity, a full-fledged endodontic intervention.

Second, no less formidable complication- recurrent, or repeated caries. Occurs on the border between the tooth and the filling, usually due to non-compliance with medical technologies.

In addition, with a significant coverage of the crown of the tooth by destruction, with a strong thinning of the walls of the tooth during treatment, it is possible to break off part of the crown of the tooth. In this case, a decision is made either to re-fill or to additionally strengthen the tooth with a crown.

In addition to the above, an iatrogenic complication is possible, i.e. caused by the physician. In an effort to carefully remove necrotic tissue, the doctor can open the tooth cavity.

Whether this is a forced measure or the result of negligence, the situation should be objectively assessed to decide on the possibility of preserving the nerve. If the perforation is sealed unnoticed, pulpitis is guaranteed.

Video: caries, pulpitis, periodontitis

Prices

Treatment depends on the number of visits and materials used.

The cost of treatment in Moscow clinics

zubzone.ru

What is deep caries

In this article, we will consider the causes of the onset of the disease, possible complications, and methods of treatment.

The clinical picture is characterized by the appearance of a deep cavity inside the tooth, which is accompanied by the destruction of the crown, discomfort, increased sensitivity of the enamel to tactile, thermal and chemical factors, acute or aching pain.

The treatment of deep caries begins with a diagnosis in the clinic. Diagnosis involves a visual examination of the patient by a dentist, taking an anamnesis, probing a hole and necrotic tissues, electrical and thermal diagnostics, and x-rays.

Visual diagnostics is practiced in every dentistry and involves the use of a special probe, a dental mirror. During probing, the key parameter is the depth of the tooth lesion, the degree of decomposition, the structure and hardness of the affected tissues, as well as the areas of dentin. Visual examination with this disease is quite unpleasant, since the cavity reaches the area of ​​​​the pulp (nerve), which causes pain or even bleeding.

X-ray allows you to detect areas of damage that are invisible to the dentist's eye. AT modern dentistry Increasingly, a contact x-ray is taken to provide information about a particular tooth (or several). Such precise data allows to reproduce visiographers. After obtaining a picture, the affected cavity on it can be enlarged, which will allow you to accurately determine the depth of the spread of the disease. X-ray beams effectively pass through the damaged areas, displaying them in the image as a darkened area.

Causes of the disease

deep caries ( With Latin " cariesprofunda") can develop instantly or be the result of an untreated cavity, the progression of the disease. Often the lesion occurs under earlier installed seal or in case of damage (chipping, crumbling, normal wear and tear).

The disease appears and develops according to the principle and pathogenesis of ordinary carious disease. Irregular or poor-quality oral hygiene leads to the fact that the remnants of carbohydrates and other food begin to ferment and decompose in the oral cavity. As a result of this process, organic acids (for example, lactic acid) are released, which corrode the surface of the enamel. It enters the formed microcracks and through them into the dentin channels pathogenic microflora(carious bacteria), which begin to multiply actively. The products of bacterial activity are calcium salts, which protrude from the bowels of the dentin, which leads to its softening, violation of the integrity and strength of the crown, the occurrence of deep caries (photo below).

Also, bacteria are present in sufficient quantities in a soft whitish plaque, a dark stone, which often forms between the teeth, in the gum pockets, on the surface of the enamel, fissures.

Another reason is natural structure saliva, its balance, volume of excretion, remineralizing properties, buffering and protective abilities. Change in the nature of the secret due to illness, hormonal adjustment, metabolic disorders or hereditary factors often leads to aggravation of carious processes on enamel.

Genetic predisposition, failure of mineral, protein or carbohydrate metabolism, damage to hard tissues due to impact, fall or bruise can also cause progression of the disease.

There are also household factors that contribute to the development of carious disease: poor water quality, an illiterate diet, a lack of microelements in the body (phosphorus, fluorine, calcium).

Sometimes the quality of the teeth can deteriorate greatly during the period of eruption or change. Enamel during this period is especially thin, fragile, therefore it is easily exposed to pathogenic microflora.

How the disease manifests itself

To diagnose deep caries, consider the symptoms.

Typically, a patient is admitted with a complaint of acute, blunt, or aching pain, localized in the area of ​​\u200b\u200bone tooth and extending to various parts of the jaw. Enamel sensitivity also appears, which causes discomfort and pain when using acidic and spicy foods, cold or warm dishes, as well as during regular hygiene in the affected area. Also, discomfort is felt during chewing, biting food, food residues getting into the carious hole, as well as during tactile impact on the area (palpation, tapping, rubbing with the tongue, etc.).

As a rule, all these sensations last only when exposed to a stimulus, that is, no more than 5-20 minutes. If the soreness lasts during the day, then we can talk about the development of the disease in pulpitis. Deep dental caries differs from acute pulpitis in that these diseases damage various tissues of the tooth. Caries corrodes the hard tissue of the crown and soft tissues dentin (less often), and with pulpitis, the lesion reaches the nerve, which leads to acute and prolonged pain, bleeding and loosening of the tooth. Complex forms of carious disease often lead to pulpitis.

Interestingly, the lesion can spread for years under a normal-looking filling. All this time, the disease can be asymptomatic, gradually undermining the dentin up to the dental one and the pulp. Then the filling can fall out abruptly or break off.

If a tooth hurts after treatment of deep caries, then we can talk about re-development diseases under a fresh filling. This indicates the incompetence of the chosen dentist, who is obliged to cure the disease for free and put in a new, more reliable filling.

During a visual inspection of the damaged area, we can see a deep hole covered with necrotic black and dark tissues, decomposition residues and traces of microbes. Often, dark tartar and dense yellow plaque form on such teeth.

Effective treatment

As a rule, the treatment of deep caries in children (video below) and in adults is not much different and is carried out in several visits.

With this disease, a small part of healthy dentin remains in the tooth. Bacteria and microbes can penetrate into the very depths of this part, therefore, if the tooth is saved and a conventional filling is installed, the lesion may continue at the level of the pulp. It is recommended to carry out treatment in 2 visits, during which depulpation and canal filling are performed, and then the formation of a crown with filling material.

It looks simple - the doctor prepares the tooth, cleaning out all the putrefactive formations and decomposed tissues, puts a special medicine into the cavity and applies a temporary filling. If the tooth does not hurt after the procedure, then you can replace the seal with a permanent one.

In dental practice, several types of drugs are used that effectively eliminate these ailments.

The most effective and common are drugs based on calcium hydroxide. They come in the form of dental pastes, composite material, suspension, powder, gel, varnish, etc. The medicine is placed deep into the carious hole, and the active components get through the thinned dentin directly to the pulp. If there is no dentin layer, then the medicine is put into the opened pulp chamber, which bleeds a little and aches (an unpleasant process).

This drug has a disinfectant and anti-inflammatory effect, promotes the development of a new replacement dentin, its compaction. Also, calcium hydroxide does not allow the penetration of bacteria into the cavity.

In addition to this drug, medical pads of domestic and foreign manufacturers are also used.

Consider the stages of treatment of deep caries.

1. Nurse or doctor conducts local anesthesia with an injection of Ultracaine (the most common option). Next, you should wait 5-10 minutes until the anesthetic spreads and there is sufficient freezing of the dentition and soft tissues for the procedure.
2. Using a probe and a mirror, the doctor determines the depth of caries damage, coordinates with the patient further treatment(the ability to split into several stages, the type of tooth restoration, etc.).
3. Next is the removal of necrotic, carious soft and hard tissues of the tooth. The cavity is completely protected and sanitized with the help of dental procedures.
4. Then the dentist puts a medical pad on the very bottom of the cavity, which will prevent possible complications (pulpitis). The gasket is made from calcium concentrate and has a disinfecting effect.
5. Following the medical lining, an insulating one is laid, which allows you to securely fix the first one in the depth of the tooth. Also, the insulating gasket protects the treatment from the ingress of the filling composite, which dries under a UV lamp.
6. At the last stage, the doctor chooses whether a permanent or temporary filling should be installed in a particular case. If the treatment takes place in 2 stages (the pulp chamber was opened, the dentin layer is absent or thinned, the patient complains of severe and acute pain, the disease began to turn into pulpitis, etc.), then the doctor will apply a temporary filling.

Caries requires timely and prompt treatment, otherwise there is a risk of serious complications that are treated much more difficult, more painful and will cost you much more.

www.vashyzuby.ru Broken wisdom tooth what to do

carious cavity

V - cervical caries.

How to treat a carious cavity

Oral diseases

06/03/2018 admin Comments No comments

carious cavity- a cavity in the tissues of the tooth, which occurs during caries.

Depending on the course of the pathological process, caries is distinguished in the spot stage (pigmented or chalky), superficial caries, medium caries, deep caries. So what is a carious cavity and its types.

According to the location of the carious cavity, five classes of caries are distinguished:

I - caries in the area of ​​natural furrows (fissures);

II - caries of the contact surfaces of small and large molars;

III - caries of the contact surfaces of the canines and incisors with the preservation of the cutting edges;

IV - caries of the contact surfaces of the canines and incisors with broken cutting edges;

V - cervical caries.

Causes of caries can be

• the use of carbohydrates (sucrose, glucose, fructose) in between meals, and leading role it is not the number of sweets consumed that plays, but the frequency of their intake and the time spent in the oral cavity;
• at present, food is overcooked, becomes soft, and the necessary self-cleaning of the teeth does not occur. Plaque forms on the contact and buccal surfaces of the teeth, and then caries;
• microorganisms, of which there are a huge number in the human mouth. Some of them in the human mouth are fixed on the surface of the teeth with the help of an adhesive substance, which then forms plaque or plaque, which begins to dissolve the enamel and provokes the onset of caries;
• past diseases change the conditions for the maturation and formation of hard tissues of the tooth, enamel in the first place, becoming less resistant to cariogenic factors;
• in addition, caries is affected external influences- ionizing radiation and long-term x-rays.

How to treat a carious cavity

Treatment of caries with a chalky spot is carried out using remineralizing therapy by applying applications of 2% sodium fluoride solution and 10% calcium gluconate solution. After the procedure is completed, eating and rinsing your mouth is not recommended for 2 hours. The duration of remineralizing therapy is 15-20 applications, which are carried out daily or every other day. In this case, the stain may disappear completely or decrease in size.

A pigmented spot indicates the stabilization of the process. For the treatment of caries at this stage, the preparation of altered tooth tissues with a drill and the installation of a filling are shown.

Treatment of deep, medium and superficial caries is carried out by removing the pathological tissues of the tooth with a drill and then filling the carious cavity.

The carious cavity is the leading clinical symptom of a chronic pathological process.

Topic #7

Caries of temporary teeth and permanent teeth

with incomplete root formation. Classification.

patterns clinical manifestation and currents.

Differential diagnosis.

Dental caries is a pathological process that manifests itself after teething, which is a focal demineralization of the hard tissues of the tooth, followed by destruction and the formation of a defect in the form of a cavity.

Dental caries is a chronic pathological process of the body, characterized by focal demineralization of tooth tissues with the formation of a carious cavity in the tooth; capable of aggravating, stabilizing, acquiring various activities and be in varying degrees compensation of a chronic pathological process.

The carious cavity is the leading clinical symptom of a chronic pathological process.

For diagnosis and treatment, the dentist is important :

Localization of the carious cavity;

activity, intensity of carious lesions;

the rate of degradation that is taking place.

In the history of dentistry, many classifications of caries have been developed, the main of which are the following.

AT 1986 Black singled out V classes according to the localization of caries:

I class - localization of the carious cavity in the area of ​​fissures, grooves, pits, molars and premolars;

II class - localization of the carious cavity on the proximal surfaces of the molars and premolars;

III class - localization of the carious cavity on the proximal surfaces of the incisors and canines without involving the cutting edge;

IV class – localization of the carious cavity on the proximal surface involving the corner of the crown;

V class - localization of the carious cavity in the cervical region of any tooth on the vestibular or lingual surface.

T.D.Ovrutsky, H.M.Saifulina propose to distinguish caries:

E.V. Borovsky distinguishes during caries:

P.A. Leus (1980) developed a classification according to the level of intensity of caries in 12-year-olds:

· low level intensity (0-2.6);

average intensity level (2.7-4.4);

a high level of intensity (4.5-6.5);

very high intensity level (from 6.6 and above).

According to the ICD, caries belongs to class 11 - diseases of the digestive system. Code 02.

K02.0 - enamel caries (initial, superficial)

K02.1 - dentine caries (medium, deep)

K02.2 - cement caries

K02.3 - suspended caries

T.F. Vinogradova proposed for practical application the following classification of caries in children:

I. According to the degree of activity of the carious process, there are 3 forms of caries:

· compensated (I degree): - 1,2,3 cells. up to 5;

· subcompensated (II degree): - 1,2,3 cells. from 5 to 8;

- 8-10 cells. - from 6 to 9;

· decompensated ( III degree): - 1,2,3 cells. from 8 or more;

- 4-7 cells. – 8 or more;

- 8-10 cells. from 9 or more.

We take the intensity of caries as a basis — index KPU+KP, KP, KPU.

II. According to the localization of the carious lesion, caries is distinguished:

III. According to the clinical course, caries is distinguished:

initial (in the spot stage);

IV. According to the sequence of occurrence, caries is distinguished:

primary (first discovered);

secondary (caries around the filling).

The diagnosis is made on the basis of complaints, anamnesis, examination, probing, percussion, thermal tests, vital staining, EOD data, radiographs, etc. additional methods research available in the doctor's arsenal.

studopedia.org - Studopedia.Org - 2014-2018. Studiopedia is not the author of the materials that are posted. But it provides the possibility of free use (0.002 s) .

In other words, a "carious cavity" is the destruction of teeth by caries. The occurrence of caries largely depends on lifestyle - diet, oral hygiene, the presence of fluoride in water and toothpaste. The predisposition of teeth to caries also depends on heredity.

Caries is most common in children, but adults are also affected. There are the following forms of caries:

• Superficial caries- most common in both children and adults, it affects the chewing or interdental surfaces of the teeth.
• Deep caries - with age, the gums sink, exposing the roots of the teeth. Since the roots of the teeth are not protected by enamel, cavities easily form in the affected areas.
• Secondary caries - carious cavities affect previously sealed teeth. This is because plaque often accumulates in such areas, which can eventually turn into carious process.

Adults who suffer from dry mouth syndrome, a disease associated with a lack of salivation, are most susceptible to caries. Dry mouth syndrome can be caused by an illness and also be side effect certain drugs, radiation and chemotherapy. It can be temporary and last from several days to several months, or permanent, depending on the causes of the disease.

The formation of carious cavities is a serious disease. Without timely proper treatment, a carious cavity can destroy a tooth and damage the neurovascular bundle in the center of the tooth, which in turn can lead to inflammation of the root canals. Once inflammation occurs (also known as "pulpitis"), treatment is possible only by depulpation and other surgical procedures or by removing a tooth.

How do I know if I have cavities?
Only a dentist can accurately diagnose caries. This is due to the fact that the carious process begins below the surface layer of enamel, where it is invisible at first glance. When eating foods rich in carbohydrates (sugar and starch), the bacteria in plaque converts it into acids that destroy tooth enamel. Over time, the enamel layer is destroyed from the inside, while the surface remains intact. With a progressive tissue defect, the surface layer also collapses over time, forming a carious cavity.

The deepening of the chewing surfaces of the molars, interdental surfaces, and surfaces in contact with the gingival margin are most often subject to the formation of caries. Regardless of where it originates, The best way Diagnosis and treatment of caries is a regular visit to the dentist for periodic examinations, which will help prevent the transition of the carious process to more severe stages.

How to prevent the development of caries?

• Brush your teeth at least twice a day, and also use dental floss daily to remove plaque from the interdental spaces and cervical part of the gums.
• Visit your dentist regularly. Preventive measures allow you to avoid the occurrence of diseases, or to stop their development at an early stage.
• Eat a balanced diet with limited starch and sugar. When including foods rich in starch and sugar in your diet, consume them at main meals, not between them - this will limit the time during which the teeth are exposed to acids.
• Use fluoride-containing oral care products, including toothpaste.
• Make sure children drink water enriched with fluoride. If the water in your area is not fluoridated, your child's dentist and pediatrician may prescribe fluoride supplements for your child.

Healthy teeth are a relative concept, absolutely every person faces caries. Any external damage to the tooth is colloquially referred to as a hole in the tooth, and there is some truth in this. Dentists use their own term - a cavity, which means that a hole in the tooth has formed as a result of caries.

Prices for the treatment of carious cavities

Reception (examination, consultation) of a dentist-therapist 1500 P

Grinding of hard tissues of the tooth in the treatment of caries and its complications by classes: I and V 529 P

Grinding of hard tissues of the tooth in the treatment of caries and its complications by class: II 1061 P

Grinding of hard tissues of the tooth in the treatment of caries and its complications in classes: III and IV 1588 P

Specialists in carious cavities

Litvin Irina Borisovna

1991 - graduated from the Moscow State University of Medicine and Dentistry. Semashko specializing in dentistry.

1991-1992 - passed a clinical internship on the basis of the Zelenograd city polyclinic, specializing in therapeutic dentistry.

1995 - completed advanced training courses at the faculty of advanced training of dentists of the Ministry of Health of the Russian Federation.

Classification of carious cavities

All carious cavities have distinctive features, which are recognized by Black - the degree of localization, the WHO system and other classifications, depending on the degree, depth of the lesion, the duration of the course, and the severity of the disease. The Black classification was named after the American doctor and luminary of dentistry Green Black. The scientist differentiated 5 classes of tooth damage, and later the 6th class of the newly identified type of caries was added to the spectrum. In dental practice, the following carious cavities according to Black are distinguished:

• small lesions located in fissures: anatomical depressions on the surface of any tooth;
• carious cavities of molars and premolars: molars;
• formation of cavities in incisors, canines;
• carious cavities of incisors, canines, combined with damage to the crown;
• carious cavities in the necks of any tooth - cervical;
• atypical carious cavities of mounds of chewing teeth and edges of frontal teeth.

Several videos about cavities

Classification according to the depth of the lesion

Obviously, the formation of a carious cavity occurs gradually, because not everyone goes to the clinic when it is detected. When examining a patient, the doctor sets the degree of caries depth and plans to solve the problem: how to treat this form of the disease:

• carious stain, the easiest form of enamel damage, which nevertheless should be immediately restored;
• superficial caries. The stain gets deeper, but the dentin of the tooth (the underlying tissue of the tooth underneath the enamel) is not affected. Tooth damage is usually manifested by sensitivity to hot, icy food or drink;
• average caries. The damage affects the enamel and enamel-dentine junction. There is a periodic pain syndrome;
• deep. The damage is fundamental - carious cavities reach the peripulpal dentin, the pain is permanent.

If you do not contact the dentist in a timely manner, the patient is waiting for more serious problems- complications in the form pulpitis and periodontitis. In the presented photos you can see the common types of caries.

Photo with examples of carious cavities

Professional help

All types of dental damage are subject to emergency treatment. Affected teeth are not only an unsightly smile, a violation of normal communication in society. Carious cavities lead to infection of the whole organism as a whole, diseases of the gastrointestinal tract. Qualified specialists Groups of the clinic "Center aesthetic dentistry» offer to carry out a filling carious cavities using the latest medical techniques. Black tooth preparation is carried out in several preparatory stages:

• Stage 1.

  disclosure of the affected channel with the help of modern equipment;

• Stage 2.

  expansion of the cavity;

• Stage 3.

Caries is one of the most famous diseases in all countries, affecting hard tissues tooth with the formation of foci of thinning of the enamel, softening of the underlying dentin and the formation of a carious cavity. The degree of activity of the process and its duration depend on various factors, are largely determined by the conditions in which the tooth was formed or that it was affected after eruption. Do than adults. This is due to the structural features of the tissues of temporary teeth, their strength and density. Among the main reasons for the development of caries are heredity, the effect on the body of the fetus of adverse factors during prenatal development, quality and regularity of oral hygiene, availability chronic diseases organs and systems, bad habits, features of metabolism and nutrition.

Caries classifications

In terms of damage intensity:

• Caries of an individual tooth (single foci of different localization).
• Multiple caries (or carious disease in which defects appear on several teeth at once). An important role in this form of caries is played by the general state of immunity and the presence of chronic diseases.

Clinical classification of caries

• Initial caries (caries in the stain stage).

G. M. Pakhomov singled out 5 forms initial caries(spot stages): white, gray, light brown, brown, black.

• Superficial caries (foci of damage to the enamel).
• Medium caries (formation of a cavity within not only enamel, but also dentin).
• Deep caries (deep cavity, the bottom of which is close to the nerve).

Children according to this classification (for milk teeth) do not have a diagnosis of "deep caries". This is due to the anatomy of temporary teeth, their size and the proximity of the nerve. With a very deep cavity, caries is considered medium-deep or considered and treated already as chronic pulpitis.

Classification of caries by flow:

1. spicy (very rapid appearance defects on several teeth at once).
2. Chronic (prolonged destruction, the cavity and tissues of the tooth have time to darken).
3. Acute or blooming caries (the appearance of multiple foci on most teeth and in different places that are not typical for caries).
4. recurrent ( secondary caries around fillings or under them).

International classification of the disease according to WHO:

• Enamel caries.
• Dental caries.
• Cement caries.
• Suspended.
• Odontoclasia (a condition of resorption of the roots of milk teeth).
• Another.
• Not specified.

Classes of carious cavities according to Black:

1 class. Caries in natural depressions, pits, fissures on the chewing, buccal or palatal surfaces of molars and premolars.

Grade 2 Caries of contact surfaces of molars and premolars.

Grade 3 Caries of the contact surfaces of the incisors and canines without disturbing the cutting edge of the teeth.

4th grade. Carious cavities on the contact surfaces of incisors and canines with a violation of the integrity of the cutting edge.

Grade 5 Cervical carious cavities.

In order of occurrence:

1. Primary caries (develops on the tooth for the first time).
2. Secondary caries (new caries occurs on previously treated teeth, next to or around fillings).
3. Relapse (caries under filling).

According to the development of the process, forms are distinguished

1. Simple caries (uncomplicated).
2. Complicated caries (as a result of the process, inflammation of the pulp (nerve) or tissues around the tooth develops - pulpitis or periodontitis).

Separately allocated "bottle" caries develops in children who are accustomed to night feeding, drinking sweet drinks, juices from a bottle. In this case, the anterior incisors are first affected from the inside, defects for a long time are not visible. The process then spreads further. Before going to bed or at night, carbohydrates of sweets settle on the surfaces of the teeth in contact with the nipple or horn, the viscosity of saliva increases markedly during sleep, which contributes to the rapid development of caries on the teeth.

Classification of caries in children according to T. F. Vinogradova

1. Compensated caries (pigmented carious cavities are found in a child, more often single, tissues of the walls and bottom of the cavity are dense);
2. subcompensated caries;
3. decompensated caries (carious cavities in in large numbers; the tissues of the tooth are destroyed quickly, therefore they do not have time to be strongly stained with pigments - light, the walls of the cavities are soft, pliable).

This classification is based on the calculation of the caries intensity index, which is defined as the sum of carious, filled and extracted teeth (KPU) in one child. If there are both milk teeth and permanent teeth in the oral cavity, then the amount is calculated for them separately (KPU + KP). Removed milk teeth are not taken into account.

MMSI classification

Clinical forms:

• Spot stage

1. progressive (white, yellow spots);
2. intermittent (brown spots);
3. suspended (dark brown spots).

• carious defect

1. superficial caries (enamels);
2. caries of a dentin: average depth and deep;
3. cement caries (damage to the tissues covering the root of the tooth. For example, when the necks of the teeth and roots are exposed).

By localization:

• fissure (caries chewing surface, on which natural depressions are located - fissures);
• caries of contact surfaces (between teeth);
• cervical caries (the area between the crown and the root is closer to the gingival margin).

Along the process:

• fast flowing
• slow-flowing
• stabilized

In terms of damage intensity:

• Single.
• Multiple.
• Systemic.

There are quite a few classifications of caries and all of them are largely repeated. It is important for the doctor to correctly determine the main parameters: the depth of the lesion, the nature of the course of the process, and to identify the main cause of the appearance of defects. In some cases, it will be, in others - bad habits, in others - crowding of teeth or congenital disorders in the structure of enamel and dentin. A correct diagnosis largely determines the success of further treatment.