Methods of treatment of caries and the causes of its occurrence. How quickly the carious process develops. How to find out if I have cavities

This is only at first glance a simple disease known to everyone. For dentists, there is a distinction between its various types, and each of them requires its own special approach in treatment.

Caries is different

Caries is the most common disease of the oral cavity that develops in different parts of the teeth; the clinical picture of the process may also differ. For ease of treatment, right choice preparation of the tooth and the material used for filling, the types of caries are usually classified. Thus, classes are distinguished according to Black, according to the depth of the lesion, according to the degree of activity of the destruction process, according to the presence of complications, according to the clinical nature and localization of the lesion.

The classification proposed back in 1986 by the American dentist J. Black is especially popular. Its purpose was to systematize the principles of treatment for various types of carious lesions of the tooth.

Black classes

Black identified five classes by localization on the surface, that is, depending on where exactly the carious cavity is located:

Localization in fissures (depressions and cracks in the enamel of the chewing surface), pits of molars and premolars (large and small molars), canines and incisors.
Two or more surfaces are affected - the medial and distal (caries on the front teeth) or occlusal (cutting and chewing surface) of molars and premolars are captured.
The development of the disease on the medial and distal parts of the canines and incisors.
Localization is the same as in the third class, plus the angle of the coronal part or the cutting surface is captured.
The cavity occupies the cervical region of any group of teeth.

Black classes systematize all possible options for the development of caries, for each of them a separate treatment is provided, a method for preparing a diseased tooth and installing a filling.

Black first class

A carious cavity located in this way increases the risk of breaking the edge of the filling due to high pressure on it while chewing. When preparing a tooth, measures are taken to exclude this possibility. This happens by reducing the bevel of the enamel and applying a thicker layer of filling material. When using a chemical curing composite, it is applied parallel to the bottom carious cavity, since shrinkage will be directed towards the pulp. If a light-curing material is used, it is laid in oblique layers. Shrinkage in this case will be directed towards the source of polymerization. The layers should lie from the middle of the bottom to the edge of the cavity, the reflection occurs through the side walls, and then perpendicular to the chewing surface. As a result, a tight fit of the filling in the cavity is achieved.

Stages of filling cavities of the first class

Such actions must be taken by the dentist in order to cure class 1 according to Black:

anesthetize (use an anesthetic gel or,
prepare the tooth (preparation involves drilling the area affected by caries deep into the hard tissue),
if necessary, apply an insulating gasket (to prevent the impact of the composite on the pulp and its irritation),
pickle and wash off acids, dry the cavity,
isolate from saliva
if necessary, apply a primer (to prepare the dentin),
apply an adhesive (bonding element between the composite and dental tissue or primer),
apply the material layer by layer, cure it,
adjust to the desired shape, finish and polish,
make a reflection (final curing).

Black second class

Class 2 according to Black, which has its own difficulties, involves two main tasks in its treatment - to create a strong contact between the teeth and to ensure a snug fit of the composite to the edge of the main cavity. Often the filling process is complicated by the appearance of an overhanging edge of the filling, the lack of contact between the teeth or the material with the carious cavity. To prevent this, thin matrices are used, the tooth is displaced (within the possible limits) using wooden wedges. A matrix is introduced into the interdental space and fixed with a wedge, then moistened with water. The wedge swells and pushes the tooth back. This method during filling avoids overhanging the edge of the filling, which in turn can cause inflammation of the gums. The tight fit of the material to the cavity ensures the use of an adhesive - a binder, since the composite itself can only be firmly connected to the enamel, but not to the dentin.

Stages of filling cavities of the second class

Black's classes in treatment have similar points, but each of them requires special nuances of filling. Here are the steps for the second class:

anesthesia,
preparation,
if necessary, gum correction,
installation of a matrix with the introduction of a wooden wedge or holder,
if necessary, pushing the teeth,
applying an insulating gasket (if necessary),
carrying out the procedure of pickling, washing off the acid and drying
cavity,
isolation of the tooth from saliva,
application of primer and adhesive,
if necessary - restoration of the enamel edge (if there is none),
layering of the composite
extraction of the matrix and wedge,
interdental contact control,
correction, polishing,
final illumination.

Third and fourth grades

Here, the main role is played by the selection of color, because in this case caries is localized on the front teeth. Due to the different transparency coefficient of dentin and enamel, it is necessary to use a composite of two different colors during treatment. This is necessary so that the tooth appears homogeneous, and the filling does not look like a patch. To create the most natural effect, white shades of the material are used to imitate dentin, and almost transparent to recreate enamel. To make the transition invisible, the enamel bevel overlaps by 2-3 mm. It is important that such delicate work is done good dentist which can correctly determine the transparency of the tooth. There are three degrees of it: opaque (usually yellowish, even the cutting edge is opaque), transparent (yellow-gray shades, the cutting edge is transparent), very transparent (a grayish tint, the transparent edge occupies a third of the tooth.

Stages of filling cavities of 3 and 4 classes

To fill the third and fourth classes of cavities according to Black, the dentist must perform the following steps:

clean the surface from plaque,
determine the shade of the tooth,
anesthetize,
prepare the tooth, release from the affected tissues,
install or matrices, when necessary (the gingival margin is affected),
put on an insulating gasket
if necessary, restore the contours of the teeth,
wash off the acids and dry the cavity,
isolate saliva,
apply primer (optional) and adhesive,
apply layers of blocking material,
removal of the matrix and threads, if any,
correct the edges, give the desired shape to the tooth,
grinding and polishing,
final illumination.

Black Fifth Grade

In this case, the relationship between the gums and the carious cavity is of primary importance. With a deep lesion with the closure of the lower edge of the gum, its bleeding, a good dentist will immediately determine that a correction of the gingival margin is necessary. After carrying out the appropriate manipulations with the gums, they are imposed for several days to eliminate further difficulties in installing the permanent. The fifth class involves the use composite materials and compomers (composite-ionomer compositions). The second is used for superficial lesion with a significant area of localization. In cases where it is important aesthetic appearance(or the lesion affects only the enamel), light-curing composites of a specially selected shade are used.

Stages of filling cavities of the fifth class

Necessary actions for the fifth grade:

clean the surface of the tooth from plaque,
determine the shade
administer anesthesia,
perform preparation, removal of softened tissue,
adjust the gingival margin, if necessary,
insert retraction thread
apply a gasket for insulation if necessary,
wash off acids, dry,
isolate from saliva
apply primer and adhesive
material laying, reflection,
grinding and polishing,
final illumination.

Sixth grade

The famous American dentist, whose name is given to this classification, identified five classes of carious cavities. For a long time, his system was used in its original form. But later, at the initiative of the World Health Organization, the Black classes underwent minor changes - a sixth was added to them. He describes the localization of caries on the sharp edge of the incisors and on the mounds of the chewing teeth.

Tooth decay by caries pathological disease developing in hard tissues. Doctors say that the disease (on different stages) occupies a leading position among pathologies in dentistry. The development of dental caries occurs gradually, begins without pain with small spots ends with tooth loss. It is not difficult to detect the disease, the symptoms of dental caries are quite obvious. Why does disease occur? How many methods of dealing with the disease exist, what to do with the affected areas and is it painful to be treated? Let's consider further.

Caries - what is it?

The most common oral disease is caries. It affects more than half of the world's population. The emergence and development of the pathological process leads to damage to the enamel. Delayed treatment of caries destroys hard tissues finally. For greater clarity, pay attention to the photo of the affected teeth in comparison with healthy ones.

The signs of caries are as follows:

appearance dark spots on enamel;
discomfort in the destroyed centers;
formation of holes.

The etiology of the disease is quite complex. There are a number of other signs, including: pain in the gums and cheeks, discomfort when chewing, drinking hot or cold food. If you ignore the symptoms and start the process of developing spots, the following will happen:

the diameter of the resulting darkening will increase;
a superficial lesion will penetrate deep into the dentin;
further development of the pathological process will provoke the appearance of a "hole".

Caries on the front teeth causes particular discomfort (the incisor hurts, acutely “reacting” to temperature changes), and also creates significant aesthetic inconvenience (see photo of caries above). Thanks to modern methods of treatment, stop the disease and carious changes, returning healthy smile, can be done in one go.

Signs with photos and symptoms of the disease

This article talks about typical ways to solve your questions, but each case is unique! If you want to know from me how to solve exactly your problem - ask your question. It's fast and free!

How quickly caries develops is primarily due to the reasons that caused it - we will talk about the most typical of them below. Now let's deal with characteristic features diseases. Carious cavities manifest themselves in different ways, which directly depends on the degree of damage. The first stage of darkening of the enamel has a delayed latent reaction. Tooth sensitivity can be increased by eating the following foods:

very hot food;
cold snacks, drinks, etc.;
salty foods.

Hypersensitivity is observed periodically, especially aggravated after white spot on enamel gradually becomes brown. The initial stage of the lesion is characterized by the following symptoms:

chemical irritants lead to pain, but immediately after the pathogen has been eliminated, this factor disappears;
when the tooth neck is affected, there are sensations of pain in the place of pressure when eating solid food.

The following additional symptoms are inherent in the middle stage of caries:

Deep caries is characterized by aggravation of previously diagnosed signs:

any annoying factor causes pain;
carious cavities are large and dark.

When the first symptoms appear, you should consult a doctor so as not to harm or start the disease. It is important to recognize the development of caries in time and start treating already at the “white spot” stage, when medical remineralizing agents can still be used as the basis of therapy. If the process is started, caries treatment will already be invasive.

Types of carious lesions

Pathogenesis in dentistry is considered as a mechanism for the onset and course of a disease. Typical causes of caries in oral cavity are:

cariogenic microflora (including carbohydrates);
violation of hygiene rules;
reduced immunity.

Cariogenic factors, which are based on a violation of the acid-base (chemical) balance and the development of pathogenic flora, primarily contribute to the destruction of enamel and dentin. Scientists call genetic predisposition a separate cariogenic factor.

Types of caries are classified depending on the degree of damage to the tooth, the depth of carious cavities, their localization. Stages of the development of the disease with a photo illustration:

The initial stage is a superficial colorless enamel lesion, which is not diagnosed by the patient himself. The lateral part of the tooth surface is affected by fissure caries. The stage of manifestation of spots can be stopped if the spot is treated with medicines. local action and remineralizing agents.
The pathogenesis of medium-level caries is characterized by spread to upper layer dentin. Such caries is dangerous by the rapid destruction of the tooth. The doctor removes the affected area and seals the cavity.
Deep dental caries in the process of its development causes the destruction of the cavity to the level of dentin, which covers the pulp. Further infection and tissue softening occurs - it is necessary emergency treatment, since the consequence of untreated caries can be the removal of the pulp and even the tooth itself.
atypical form. The cutting edge, tubercle is destroyed. being treated invasive method with the installation of a seal. Complications from this caries are the destruction of the tooth from top to bottom to the deep stage.

A severe degree of neglected caries is difficult to cure. The progressive process inevitably leads to complications: pulpitis, periodontitis, etc.

Dentists also distinguish such types of caries as:

multiple or systemic;
root;
cervical (affects more often the front teeth near the gums) (we recommend reading:);
recurrent - occurs under a filling due to serious cariogenic factors.

Causes of caries in adults

What causes caries? Streptococci are a type of dental microbe found in organic acids destroying dentin and enamel.

The appearance and reproduction of bacteria begins during the development of pathological biochemical processes - with normal flora in the mouth pathogenic microbes no. The formation of a carious cavity is facilitated by:

violation of nutrition and hygiene (carbohydrates and acids are formed due to the remnants of rotting food);
somatic diseases associated with the gastrointestinal tract;
reduced levels of calcium, fluoride and vitamins in the body (pregnancy, chronic diseases, lack of good nutrition, radiation therapy, etc.);
tartar (hard plaque);
genetic predisposition.

Treatment - conservative and with the removal of carious cavities

Dentists identify two main ways to fix the problem:

Non-invasive - treatment superficial caries teeth occur conservatively, i.e. without drilling. This option is referred to as a modern type of treatment.
Invasive - treatment by cleaning out the lesions. Before drilling, a detailed examination, drug treatment of the carious cavity, removal of affected areas, and filling are carried out.

How to stop caries? In order to cure caries at the white spot stage, it is enough to saturate the teeth with fluorine and calcium, i.e. to remineralize the enamel.

cure the disease of the middle and deep degree possibly with the help of drug treatment of the carious cavity, followed by its filling. The standard stages of caries treatment are as follows:

removal of the affected part of the tooth;
restoration of the cavity by filling (the deep stage of the lesion is treated by installing two fillings - temporary and permanent).

Methods of therapy in dentistry

Caries treatment is almost painless. On the initial stage- stages of stain appearance - caries treatment in adults and children is carried out without touching the dentin and pulp. Only the top layer of enamel is removed, so the procedure is painless.

The disease at a more serious stage, especially advanced carious lesions of the dentin and its expansion inside the tooth, requires treatment of the oral cavity, removal of softened areas with a drill and subsequent installation of a filling.

Does it hurt to heal?

The question of whether it hurts to treat caries is of interest to most patients. Treatment in dentistry is carried out at all stages of caries quickly and painlessly. At the first stage, after the sanitation of the oral cavity, medical treatment is performed. Invasive removal of internal caries is performed under anesthesia and does not cause discomfort. It is recommended to deal with the problem already at the initial stage, then recovery will be quick and without pain.

Consequences and complications in case of untimely treatment of caries

Deep caries - advanced stage damage to the teeth, which is the last and requires urgent and quality treatment. In case of improper care, the carious cavity turns into pulpitis, characterized by severe pain. The consequences can be avoided timely handling to the clinic to remove the pulp

Recurrent formation can occur if carious cavities form between the filling and healthy teeth. Photos of this type of caries can be seen below.

Removing the seal drug treatment and its replacement - new therapeutic method treatment and management of complications.

Preventive measures - how to stop the carious process?

After treatment, patients are wondering how to prevent caries in the future. You can avoid the problem by following simple rules:

care for and monitor the cleanliness of the oral cavity (the main cause of the pathology is the formation of plaque due to food debris);
observe healthy diet nutrition (include foods high in trace elements and vitamins in the menu);
visiting a dentist every six months is a chance that will allow you to diagnose a pathology at an early stage and avoid a deep stage that is difficult to treat.

Vaccination against caries

Vaccines against carious teeth doesn't exist yet. However, some laboratories are conducting research and exchanging experience in this matter.

Human immunity is already “trained” with antibodies that destroy viruses and bacteria. So, for example, immunoglobulin, which is in saliva, does not allow pathogenic microorganisms get to the target. Therefore, we repeat, today a vaccination against a carious lesion is nothing more than an invention of science fiction writers.

Means for protection for every day

To effectively protect the oral cavity from caries, it is recommended to use pastes with calcium and fluorine. Such formulations are excluded when there are contraindications (for example, high content fluoride in water or fluorosis diagnosed in a patient). The purchase of expensive pastes is not necessary. The main thing is that active enzymes and the base filler contribute to the destruction of plaque and food debris.

Additional oral care products are rinses and flosses that clean the interdental spaces. Special scrapers and brushes are useful for processing the tongue. However, the listed funds are not able to stop the already existing destructive process.

Sometimes bacteria are transmitted through kissing, in which case chewing sugar-free gum is recommended. The main thing is not to overdo it - you will not achieve strengthening of enamel with chewing gum, but if you use it excessively, you can contribute to the wear and tear of tooth enamel.

The appearance of cavities in the teeth is associated with caries. Caries called the process of destruction of the structure of the tooth. Caries can affect both the enamel (the outer covering of the tooth) and the inner dentin layer.

Caries develops when particles of food containing carbohydrates (sugars and starches) linger on the teeth - for example, bread, cereals, milk, sugary soft drinks, fruits, pastries and sweets. Bacteria inhabiting the oral cavity feed on these particles, converting them into acids. These acids combine with bacteria that produce them, food debris, and saliva to form soft plaque that covers the surface of the tooth. The acids contained in the plaque dissolve the enamel of the tooth, and holes form in it, called carious cavities or simply caries.

Who gets caries?

Many people think that carious cavities are formed only in children, but age-related changes associated with the aging of the body make this problem relevant for adults as well. In particular, gum recession (separation from the roots of the teeth) is a phenomenon that accompanies the increasing incidence of gingivitis ( inflammatory disease gums) - leads to the fact that the roots of the teeth are also exposed to plaque. Cravings for sweets, which are sometimes observed in pregnant women, also increase the risk of dental cavities.

A common problem in adulthood is also caries around the edges of fillings in older people. Many of them in their youth could not take advantage of fluoride prophylaxis and other modern methods caries prevention, so they often have several dental fillings in their mouths. Over the years, fillings loosen, microcracks can form in them, which allows bacteria to accumulate in tiny voids where caries.

How can I find out if I have cavities?

The doctor will identify the existing carious cavities during a routine dental checkup. When touched with a special tool, softening of the affected areas of the tooth surface is felt. X-ray allows you to identify carious cavities even before they become visible to the eye.

With advanced caries, there may be toothache especially when eating sweet, hot or cold foods or drinks. Others clear signs caries are the visible depressions and holes in the tooth enamel.

How is caries treated?

Methods for the treatment of carious cavities may be different depending on the depth of the carious lesion. In case of non-spread caries, the affected part of the tooth is removed using a drill and replaced with a filling made of silver alloy, gold, ceramic or composite resin. These filling materials are considered safe for health. At one time there were concerns about some of them, in particular mercury-based silver amalgam fillings, but both the American Dental Association and the Federal Office of Dental Control medicines(FDA) still claims that these materials are safe. Cases of allergy to silver amalgam, as well as to other filling materials, are quite rare.

With widespread caries(when little is left of the original tooth structure) crowns are used. In such cases, the part of the tooth destroyed or eroded by caries is partially removed, partially treated, and then a crown is placed on the remaining part of the tooth. For the manufacture of crowns, gold, ceramics or cermets are used.

In cases where caries leads to the death of a nerve or tooth pulp, a filling is performed. root canal. In this procedure, the contents of the central part of the tooth (including the nerve, blood vessel and the tissues surrounding them) are removed together with the areas of the tooth affected by caries. The root canal is then filled with sealing material. If necessary, the sealed tooth is covered with a crown.

A number of new treatments are currently being developed. One of the experimental technologies is based on the use of fluorescent light to detect carious cavities much earlier than it can be done. traditional methods diagnostics. At early detection its carious process in many cases can be suspended or reversed.

In addition, scientists are working on the creation of a "smart filling" that prevents the development of caries due to the constant slow release of fluoride into the surrounding tissues of the filled tooth and into the tissue of neighboring teeth.

The review was prepared by doctors dental department Cleveland clinics.

What is dental caries? This is a pathological process that leads to the gradual destruction of dental tissues. The disease occupies a leading position among all dental diseases. According to statistics, 95% of total number patients who applied to the dentist have carious lesions on the teeth varying degrees gravity.

Modern methods of treating caries in adults allow you to deal with different forms disease, but it is better not to wait for extensive damage to the tooth, but to get rid of it for early stages nucleation, which will maximize the health of the tooth. Beginning caries can be cured without drilling the tooth.

Below we will consider all the stages of the disease, we will tell you how caries is treated, whether it is possible to get rid of it. And of course you will know main factor, causing such a popular problem of the dentition.

How is caries formed, why can it occur? The oral cavity is inhabited by cariogenic microorganisms, streptococci, which enter into chemical reaction with carbohydrates that come with food, processing their acid, which is detrimental to teeth.

Getting on the surface areas, it affects the enamel structure, and over time, a carious cavity can form there.

Thus, the primary cause of caries is bad care behind the mouth. It is the accumulated soft deposits, tartar, that are the result of poor hygiene, which lead to the formation of caries.

Row additional reasons and negative factors what causes caries:

the predominance in the diet of carbohydrate foods containing sucrose, fructose, lactose, glucose, starch. With such eating habits, a person should especially monitor the thoroughness of hygiene, rinse the mouth regularly after eating;
weakened immunity;
deficiency of vitamins and minerals that provide a strong structure to the teeth - common cause why caries appears;
drinking water that does not contain fluoride;
crowded teeth, malocclusion;
installed braces, prostheses that injure tooth enamel and impede proper hygiene;
saliva with a neutral acidity index or its secretion in insufficient quantities;
period of pregnancy and lactation;
impaired formation of dental tissues at the stage of embryonic development or eruption;
endocrine diseases, disturbed hormonal levels;

The causes of caries also include hereditary predisposition. Because of it, it can also form. Knowing the reasons, you can choose to decide how to deal with caries in your case.

Larisa Kopylova
Dentist-therapist
The fight against caries should begin in the form of prevention: it is necessary to monitor oral hygiene, remove food debris with a toothbrush, stopping the growth of bacteria.
Locations of caries
By location, carious cavities are divided into the following forms:
Cervical or lateral form of the lesion - the site of localization of the focus is the tooth neck, mainly the vestibular surface. It can be slightly covered by a slightly reddened area of the gums.
Removal can be quite painful due to the increased sensitivity of the affected area. But you should not be afraid of treatment, since the dentist removes it under anesthesia;
Contact type - when caries occurs in the interdental space. Remains of food constantly get stuck between the teeth, which causes dental caries and becomes the cause of halitosis.
Therefore, dentists emphasize the importance of using floss to cleanse the space. The development of a carious focus is asymptomatic and becomes noticeable to a person when the lesion reaches a significant size. It is quite difficult to treat this type of dental caries due to inaccessibility. To provide free access to the carious cavity, the doctor is forced to remove healthy tooth tissues;
Fissure form - caries begins on physiological irregularities and grooves that are present on the chewing surface of the molars;
Carious lesion of the circular type is considered the most dangerous, since the circumference of the tooth neck is destroyed, due to which the crown of the tooth may break and it will have to be restored.

You can see the differences between these types in the gallery below:
Cervical Contact Fissure Circular
Stages of carious lesions
The disease is characterized by slow development and gradual destruction of dental tissues. At the inception stage, the symptoms of caries have a very poor clinical picture, therefore, often a person does not notice the development of caries, since nothing hurts him.
As a rule, an appeal to the dentist occurs when the carious focus has spread deep into, or hit a large part of the crown of the tooth. At this time, signs of caries become apparent: complaints of severe pain, reactions to food and temperature stimuli begin to appear.
It is necessary to carefully examine your teeth in order to detect caries in the early stages of development and immediately eliminate it. Four stages of caries will be characterized below, the classification of which is focused on the depth of the lesion.
initial stage
The primary pathological focus is not a band defect, but only changes the color of the enamel. It affects its surface and is a rough flaw in the form of chalky spots. different size. Symptoms painful nature on the this stage are absent, only manifestations of a cosmetic defect are observed. Most often, patients find the initial form of caries if it is localized on the front teeth in the smile zone.
How to get rid of caries in teeth initial stage? To eliminate the white spot, drilling is not required; it is enough to use special external applications with therapeutic compounds. The therapy consists in restoring the structure using remineralizing solutions with fluorides, calcium compounds and other beneficial trace elements to strengthen the enamel.
To enhance the result, the patient is shown internal reception vitamin and mineral complex.
surface stage
Superficial carious lesion is a continuation of the initial stage in the absence of treatment. It likes to start as a well-defined shallow band defect of the oval or round shape. Caries of this form affects the limits of the enamel surface and practically does not differ from it in color. Symptoms still do not differ in variety, persist cosmetic defects. If the carious cavity has struck the vestibular side or chewing surface molars, then soft tissues may slightly scratch when in contact with the edges of the cavity. Some patients experience increased sensitivity and an unpleasant reaction to sweet, cold foods.
How to treat caries on the teeth with superficial destruction? AT this case it is necessary to resort to preparation. This is necessary to create favorable conditions to secure the seal. During the procedure, the dentist uses special dyes, thanks to which it is possible to accurately identify the affected areas on the enamel, and then eliminate them by drilling. Then the doctor selects the color of the filling material, close to natural teeth, and applies it in layers.
If installed, then the dentist acts on each layer with ultraviolet light to harden it. When filling with chemically curing materials, a special lamp is not required in the work, the seal hardens on its own. On the final stage, the filling is polished, adjusted according to the bite, physiological tubercles (fissures) are formed on the surface of the molars.
The table shows the stages of development of the disease. You can compare the degree of damage to the tooth and their x-rays.
Caries of medium depth
With medium caries, the destruction of all layers of enamel occurs, extending to the intersection of the enamel-dentin border and the surface layer of dentin.
Symptoms of moderate caries become more obvious due to the involvement of deep dental tissues. The cosmetic defect is much more obvious, and food residues begin to get stuck in a deep carious cavity. The patient complains of pain while eating.
How to cure caries middle stage? Its removal will not do without tooth preparation, since there has been a change in the color of enamel and dentin in the carious focus, and pigmented pathological tissues should be eliminated in without fail. It has long been established that a filling placed on a poorly cleaned cavity will lead to relapse caries and complications.
The method of treatment consists in the following actions:
the dentist carefully prepares the affected cavity;
the bottom and walls, together with the enamel-dentin border, are lined with lining insulating material so that the toxic substances of the filling do not penetrate the tooth. This action performed using appropriate materials, if installed modern views non-toxic filling materials, then an insulating gasket is not needed;
then the dentist fills the prepared area with a filling, finishes the cured tooth.

Deep stage of the lesion
When this type of caries occurs on the tooth, the symptoms cannot be confused with anything. As the name implies, such caries on the teeth is a neglected form of the disease and the result of ignored timely treatment by the dentist. At deep caries deep band defects are formed, penetrating completely all tissues (enamel and dentin). The defect is localized near the pulp, so the symptoms are pronounced.
Larisa Kopylova
Dentist-therapist
With a deep lesion, it is painful for a person to eat, to perform hygiene - the causative tooth makes itself felt when any irritant enters. There is a slow subsidence of the syndrome when the irritating factor is eliminated.
Is it possible to cure caries in this case? Certainly, but treatment is in progress deep defeat caries is more difficult and requires maximum accuracy, since the neurovascular bundle is located nearby. Manipulation is carried out by local anesthesia to exclude reflex movements of the patient on pain syndrome. In turn, the doctor works carefully, since one careless movement during preparation can result in a failure in dental cavity and the development of traumatic pulpitis.
The procedure includes three main steps:
laying of medical paste for partial restoration of dentin and removal of irritation from the pulp;
installation of an insulating lining;
filling.

The video below shows the complete process:
Thus, one can do without the preparation of one's own tooth only at the stage of a white spot, in all other cases of pathological destruction, the tooth must be turned, and the deeper the caries goes, the more tissues have to be affected to ensure effective treatment.
Treatment of dental caries
Capabilities dental techniques allow not only to get rid of caries, but also to introduce artificial teeth, in the absence of their own. But is it worth it to bring the oral cavity to such a state, because it is much cheaper and more practical to strive to preserve natural teeth, and for this it is enough to pass preventive examinations, perform regular hygiene with high-quality care products.
How to remove caries and restore teeth? Methods of treatment of this disease of the teeth directly depend on the current stage of the course, which we discussed above. The technological process of caries treatment consists of the following successive stages:
Performance professional cleaning– the dentist removes plaque, deposits, tartar with ultrasound, and then polishes special brushes and abrasive pastes on the tooth surface.
A filling material is selected that is as similar as possible to the shade of your own teeth, especially if you plan to treat the frontal group of teeth.
To provide comfortable treatment, the patient is given local anesthesia. A slight discomfort may be felt at the moment the needle is inserted into the soft tissues near the causative tooth.
One of milestones- the carious cavity undergoes a thorough preparation, the doctor eliminates all pathologically altered tissues in the form of carious dentin and enamel.
Then the cleaned cavity is isolated from saliva, treated with antiseptics and dried well.
In the course of treatment, the doctor is engaged in the restoration of the side wall of the tooth, setting special devices in the form of a matrix and wedges. Compared with the treatment of the average form of caries that affected the chewing surface of the molar, this type is more laborious.
To improve adhesiveness, the enamel is etched with a special gel with phosphoric acid, which is then washed off.
Applying adhesive to enamel and dentin, thanks to which it will be securely fixed.
Installation of an insulating gasket.
Filling the prepared cavity filling material, the formation of a dental crown, fissures.
Bringing the seal to the finish state. At the request of the patient, the restored tooth can be covered with a special protective material aimed at temporary isolation from saliva.

Here's how the dentist's treatment works general case. Many people are interested in how to stop caries, or stop its development, with the help of recipes. traditional medicine. As can be seen from the processes described above, such an undertaking is not advisable. It is possible to fight caries at home only when a chalky spot appears, that is, on early stage, but trying to extract black carious foci on your own is strictly prohibited.
On the way to this, therapeutic pastes with fluorine and calcium will help to professional hygiene, thorough brushing of teeth and tongue twice a day, balanced diet. Eliminating the causes of dental caries is much easier than the subsequent treatment of the disease. In addition, self-identify White spot rather difficult, it is more reasonable to entrust this activity to a dentist who knows exactly what to do with caries and how to cure it.

Under the term "internal caries" an ordinary patient dental clinic usually understands a disease that affects tissues deep under the enamel of the tooth. At the same time, doctors know that, by and large, any caries affects exactly internal tissues teeth, softer and more easily damaged than enamel. Therefore, the phrase "internal caries" can be applied to almost any case of the disease and by and large is a tautology.

In some cases, they talk about internal caries when they mean a pathological process under a crown or bad installed seal. Here, caries inside the tooth develops absolutely imperceptibly for both the doctor and the patient, and gives itself out only when the pathological process covers the enamel around the filling (crown) or when pain. But then again, this is still the same ordinary caries, just with non-standard localization.

In most cases, at the first examination of the teeth, their walls (surfaces) affected by caries are striking. These are often not carious cavities at all, but simply gray, tarnished enamel that has lost its healthy look due to demineralization.

Often the dentist sees a kind of "tunnel" in the gap between the teeth, but the probe may not pass into the hidden internal carious cavity due to the density of the interdental gap. Usually, the doctor shows the patient in the mirror grayish shades of enamel against the background of developed internal caries and begins the treatment of the tooth after anesthesia.

When a bur touches gray enamel, in almost 90% of cases it breaks off after a couple of seconds and the bur falls into internal cavity with an abundance of carious, pigmented, infected and softened dentin. If the anesthesia is performed correctly by the doctor, there is absolutely no pain.

The doctor carries out cleaning and filling of the tooth strictly according to the protocol for the treatment of caries. If the tooth already has a communication with the pulp chamber (the cavity where the nerve is located), then the doctor performs depulpation and filling of the canals, followed by setting permanent filling in one or two visits.

The photo below shows a tooth in which deep internal carious cavities are visible under bright light:

The following photo shows, that is, localized in the area of \u200b\u200bthe natural relief of the teeth. Under such darkening inside, significantly destroyed tissues are also often hidden, which are not immediately detected during a routine examination:

At home, such "internal caries" is almost impossible to detect. He will give himself away only with extensive damage to the dentin and the appearance of pain in the tooth when the pulp is included in the pathological process. That is why it is so important preventive visits to the dentist who special methods will be able to detect caries at any of its localization and cure the tooth before its depulpation (removal of the nerve) is required.

Reasons for the development of deep caries

The causes of caries in deeply located tissues of the tooth are similar to those for caries with any other types of its localization. The disease develops due to the following factors:

The constant presence in the oral cavity of acids, both got here with food (fruits, vegetables), and produced by bacteria that consume the remains of almost any carbohydrate food - flour, sweets, cereals.
Reduced secretion of saliva or its low bactericidal activity. It may be caused by other diseases or metabolic disorders.
Mechanical and thermal damage to tooth enamel.
hereditary factors.

Usually, caries develops under the influence of a complex of several such factors.

In any case, it is in the deep parts of the tooth that are under the enamel that caries develops most rapidly due to the greater susceptibility of the tissues here to the action of acids. Therefore, situations are not uncommon when under a barely noticeable (or even invisible to the naked eye) hole there is an extensive cavity destroyed by the carious process.

On a note:

That is why the enamel almost always breaks off (comes off in a piece) when a large carious cavity has already formed, affecting the layers of softened infected dentin. That is, the enamel can hold the load for a long time, hanging over the hidden carious cavity, often without giving it away.

Features of the diagnosis of caries inside the tooth

Caries inside the tooth is much more difficult to diagnose than the usual one, which has manifestations on the surface of the enamel. It can be clearly seen when using the following diagnostic methods:

In addition, neglected internal caries causes pain in the patient, at first mild and occurring mainly when chewing hard food and getting very cold foods on the tooth, and intensifying as the disease progresses. If the tooth is without visible damage begins to get sick regularly, you must definitely come to the dentist for a checkup.

The following methods can be used as auxiliary methods for diagnosing and confirming caries inside the tooth:

Rules for the treatment of the disease

In all cases of development of caries inside the tooth, its treatment requires opening the enamel, removing the affected dentin and filling the cleaned cavities. In advanced form, internal caries leads to the need to remove the nerve and fill the canals.

Even more difficult are the situations when a very significant amount of tissue is damaged by caries from the inside of the tooth, and either after their removal, or simply because of softening, it splits. In this situation, it is often necessary, according to indications, to remove a tooth with the subsequent installation of an implant at the request of the patient, or modern methods prosthetics.

On a note

A split is different for a split, therefore, tooth-preserving techniques may include, for example, the restoration of a tooth on a titanium (anchor, fiberglass) pin after its thorough intracanal treatment + the installation of a crown (metal ceramics, stamped, solid cast, etc.), may involve tooth preparation under the tab, installation of tabs + crowns. There may be many options.

Sometimes the damage is quite extensive, but with them it is possible to save the roots of the tooth by removing the pulp from them. In such cases, it is possible to dispense with the installation of a crown.

In any case, after detecting a carious cavity, the doctor cleans it with a bur. If such tissues come close to the pulp, their removal can be painful and is most often done using local anesthesia.

From dental practice

There are ambiguous situations when the area of the pulp is not yet opened during cleaning of the carious cavity, but the patient is already beginning to experience pain during the doctor's work. It is impossible to say unequivocally whether it is worth depulpation here or not. Without depulpation after the installation of the filling, it can begin to disturb when chewing nerve endings and cause pain. Some doctors tend to depulp such a tooth so that they do not have to carry out repeated work if, after installing the filling, the patient begins to experience pain. Other dentists explain the situation to the patient in detail and make a decision together with him. It should be borne in mind that many patients are very sensitive to the preservation of their teeth in a “live” form and are ready to take risks in order to walk with a tooth with preserved pulp for a few more years if there is no pain after a simple filling.

In general, even with deep caries, it is necessary to remove the nerve, according to statistics, in less than a third of cases, and the removal of the tooth itself due to deeply penetrated caries is generally a rather rare situation.

Prevention of deep caries

You can avoid the development of caries deep inside the tooth if you regularly undergo preventive examinations at the dentist and detect the appearance of the disease even at the stain stage. With this approach, with a high degree of probability, it will be possible to avoid depulpation, and in the absence of hidden caries, it will even be possible to do without opening the tooth and filling.

To prevent even the most early signs caries must be observed the following measures prevention:

brush your teeth thoroughly at least twice a day - after breakfast and before bed;
rinse your mouth after eating;
do not get carried away with sweets and sweets;
remove food debris stuck between teeth;
avoid getting too hot or too cold foods and drinks on your teeth.

With a predisposition to carious lesion teeth, you should consult a doctor and, on his recommendation, take calcium and fluoride preparations in the form of tablets or special solutions.

An additional preventive measure can be chewing gums containing xylitol instead of sugar. They should be chewed within 10-15 minutes after eating to increase saliva production and clean the gaps between the teeth.

In combination, with systematic use, such preventive measures will provide reliable protection from damage to the teeth, and even when the first signs of caries appear, the doctor will be able to manage to eliminate the pathology even before it spreads into deep tissues under the enamel.