This is a carious cavity. According to the development of the process, forms are distinguished. How fast does the carious process develop?

Anesthesia. One of the main conditions contributing to the correct fulfillment of the requirements for each stage of treatment is the painlessness of manipulations. Therefore, along with the observance of a set of methodological techniques that reduce the impact of mechanical, thermal and chemical irritants, one of the methods of anesthesia should be used. dental practice has a fairly large selection medicines and methods for preventing and eliminating pain: sedation, electrical anesthesia, the use of application agents, local anesthesia, general anesthesia and etc.

Opening of the carious cavity. The size of the dentin lesion on the chewing surface of molars and premolars, as a rule, is larger than the enamel lesion, and therefore overhanging edges of the enamel are formed.

The stage of opening the carious cavity involves the removal of such overhanging edges of the enamel that do not have dentin support under them, which is accompanied by the expansion of a narrow inlet into the carious cavity. This allows further use of burs bigger size, which have the best cutting properties, have a good view of the cavity itself and more freely manipulate tools in it.

At this stage, it is advisable to use cylindrical (fissure) or ball burs small in size in accordance with the size of the inlet of the carious cavity or even somewhat smaller.

Expansion of the carious cavity. With the expansion of the carious cavity, the edges of the enamel are aligned, the affected fissures are excised, and the sharp corners. The cavity is expanded with medium and large fissure burs.

Stages of carious cavity preparation:

Necrectomy. At this stage, the affected enamel and dentin are finally removed from the carious cavity. The volume of necrectomy is determined clinical picture caries, localization of the carious cavity, its depth. The preparation of the bottom of the carious cavity should be carried out within the zone of hypercalcified (transparent) dentin. This is determined by the method of probing the bottom of the cavity with a tool (probe, excavator). At the bottom, it is permissible to leave only a dense pigmented layer of dentin. At acute course carious process in children, if there is a danger of opening the cavity of the tooth and injuring the pulp, in some cases it is permissible to preserve a small layer of softened dentin.

When performing necrectomy, it should be borne in mind that in the area of the dentin-enamel junction, in the areas of interglobular and near-pulp dentin, there are zones that are very sensitive to mechanical irritation.

Necrectomy is carried out using excavators or spherical burs. The use of an inverse cone or fissure bur during the treatment of the bottom of the cavity with deep caries is excluded, since this may open and infect the tooth pulp.

Formation of a carious cavity. Target this stage- create favorable conditions contributing secure fixation and long-term preservation permanent filling.

With superficial and medium caries, the most rational is a cavity with sheer walls, right angles, and a flat bottom. The shape of the cavity can be triangular, rectangular, cruciform, etc., i.e. correspond anatomical shape fissure. During the formation of the bottom of the cavity with deep caries, the topographic features of the tooth cavity should be taken into account. Due to the proximity of the pulp horns to the corners of the cavity, the bottom is formed in the form of a small depression in the safe zone.

For better fixation of the filling in the better preserved walls of the cavity, it is necessary to create strong points in the form of grooves, recesses, notches or form a cavity with gradual narrowing towards the inlet. When forming a cavity, inverse-conical, spherical, wheel-shaped burs are used.

Smoothing (finishing) the edges of the enamel. The duration of the preservation of a permanent filling is largely determined by correct execution stage of smoothing the edges of the enamel.

Enamel edges are smoothed with carborundum stones. This provides for the formation of a bevel (fold) along the edge of the cavity at an angle of 45 degrees. The resulting fold, like a nail head, protects the seal from axial displacement under the action of chewing pressure. The edge of the enamel after smoothing should be smooth and not have jagged edges.

It should be emphasized that when filling with amalgam, the fold is formed over the entire depth of the enamel, metal tab- in the surface layer of the enamel, and when using polymeric materials, the fold is not needed, the edges of the enamel are only smoothed. Smoothing the edges of the enamel at an angle is necessary for materials that do not have adhesion.

Enamel edge finishing:

Washing the formed cavity:

Cavity washing. After preparation and formation, the carious cavity is freed from dentinal sawdust with a stream of air, water, or washed with cotton balls soaked in a weak antiseptic solution. The substances used must not irritant on the pulp.

Medicamentous treatment of the cavity. At all stages of carious cavity preparation, instrumental treatment should be combined with medication to neutralize infected dentin. For this purpose, weak solutions of disinfectants are used (3% hydrogen peroxide solution, 1% chloramine solution, 0.1% furatsilina solution, etc.).

The use of potent and irritating substances is unacceptable.

Application of medical paste. In the treatment of deep caries in the formed cavity, it is necessary to create a depot of drugs to reduce the pathogenicity of bacteria in infected dentin, eliminate reactive manifestations from the pulp, calcify the bottom of the cavity and stimulate the deposition of replacement dentin. Pastas are cooked in water or oil based, are brought into the cavity with a small trowel and carefully compacted at the bottom.

Medicamentous treatment of the cavity:

Application of medical paste:

Applying insulating pads. In order to prevent the inactivation of drugs serving as a medical lining, a paste with medicinal substance covered with a layer of artificial dentin, which acts as an insulating lining. Phosphate cement is placed over the dentin lining. The lining material is brought into the cavity with the help of trowels and pluggers, it is distributed along the bottom and walls with the indicated tools or with an excavator.

Placement of a permanent filling. The prepared filling material is introduced into the treated cavity using a plugger or trowel, carefully rubbed against the bottom and walls of the cavity, turning Special attention for complete closure of the phosphate cement lining. To restore the functional ability of the tooth, it should be brought into contact with the antagonist. For this purpose, until the filling is completely hardened, the patient is offered to carefully and slightly close his teeth (in an orthognathic or habitual bite) and make lateral chewing movements. Excessively applied filling material is removed with a trowel, cotton swab(amalgam filling) or carborundum stone (cement and plastic fillings).

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 - serious illness. 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 contained in plaque convert them 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.
stick balanced diet With limited number starch and sugar. When including foods rich in starch and sugar in your diet, consume them during 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.

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 cavities are formed only in children, however age-related changes associated with the aging of the body, make this problem relevant for adults. 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 taking sweet, hot or cold food or drinks. Others clear signs caries are the visible depressions and holes in the tooth enamel.

How is caries treated?

Methods for treating carious cavities may be different depending on the depth. 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.

Formed carious cavities can be simple (cavities are located on one of the surfaces of the tooth) - cavities of classes I, V; and complex (several cavities per different surfaces teeth are connected into one) - cavities II, III, IV classes. In complex cavities, a main cavity and an additional one (support platform) are distinguished. The main cavity is formed at the site of localization of the carious lesion and its size is determined by the degree of spread of caries. Additional cavity is created involuntarily by excision of intact tissues of enamel and dentin and serves to improve the fixation of fillings.

Both in simple and in complex formed cavities, edges, walls and bottom are distinguished. The edge that outlines the inlet and separates the formed carious cavity from the surface of the tooth is called its edge. Depending on which surface of the tooth the walls of the cavity are directed to, they are called lingual (palatal), vestibular (buccal or labial), gingival and contact: distal and medial. The bottom of the carious cavity forms a surface that faces the tooth pulp. It can have the form of a single plane (as in cavities of classes I, V) or consist of two or more surfaces (cavities of classes II, III, IV). The walls and the bottom of the cavity form angles between themselves, which are called according to the names of the walls: lingual-medial, bucco-distal, etc.

Stages of carious cavity preparation

Pain relief is achieved by using local anesthesia techniques (infiltration or conduction).

Opening and expansion of the carious cavity(Fig. 9). The carious process in the hard tissues of the teeth is distributed unevenly. In dentin, it occurs much faster than in enamel, and therefore the size of the carious cavity is much larger than the size of the inlet, especially in acute caries. The opening of the carious cavity is aimed at removing, excising the overhanging edges of the enamel, providing good access and visual inspection of the cavity for the subsequent stages of preparation.

It must be remembered that with insufficient disclosure of the carious cavity, the overhanging edges remain devoid of nutrition from the pulp. In the future, with chewing load (pressure) on the tooth, they break off, which can cause the development of secondary caries, a violation of the anatomical shape of the tooth, or loss of a filling.

Rice. 9. Opening and expansion of the carious cavity

To open the carious cavity and excise the overhanging enamel, spherical and fissure burs are used. They are selected in such a way that the size of the working part is no larger than the inlet of this carious cavity.

When opening a carious cavity located on the chewing surface, a spherical bur is brought under the overhanging edges of the enamel. The drill is turned on and with careful comma-shaped (as if putting a comma) movements, the overhanging edges of the enamel are removed when the bur is removed from the carious cavity. When opening the cavity with a fissure bur, it is inserted perpendicular to its bottom and, moving along the perimeter of the cavity, the overhanging edges are cut off with the side cutting edges of the bur. With the correct execution of all actions at this stage, a cavity with sheer walls is formed. When "opening" the carious cavity, diamond or carbide burs are used with a rotation speed of up to 400,000 rpm. with water cooling.

To open carious cavities located on the contact surfaces of the teeth, they are first accessed through one of the surfaces of the tooth. It is most expedient to bring such a carious cavity to the chewing, lingual or palatine surfaces, only in some exceptional cases it is brought to the vestibular (labial, buccal) surface. To do this, small spherical or fissure burs are used, further opening of the cavity is performed as described above.

Expansion of the carious cavity carried out within the limits of practically healthy, not affected by caries of hard tissues of the tooth. In addition, during expansion, excision of the affected fissures, alignment of the enamel edge, rounding of sharp corners along the perimeter of the cavity is provided. This manipulation is carried out in order to prevent the occurrence of secondary caries. It is most expedient to expand the cavity with fissure burs.

The volume of opening and expansion of the carious cavity in clinical conditions depends on the nature of the course and the depth of the carious process. In the traditional preparation of the carious cavity, its expansion is carried out completely within the projection of the carious cavity on the surface of the tooth crown, for example, chewing. If the preparation takes place in accordance with the principle of "biological expediency", then a minimal expansion of the carious cavity is possible. In such cases, the cavity is filled with filling materials that have a caries-prophylactic effect, such as glass ionomer cements. Therefore, the inlet may be narrower than the cavity, and the cavity itself, after formation, acquires a round shape. If the risk of caries is high, then an extended opening of the carious cavity is carried out with excision of the so-called caries-susceptible areas to caries-immune zones. The fissures of the chewing surface are excised to the slopes of the tubercles of the chewing surface.

Rice. 10. Necrectomy of non-viable hard tissues of the tooth

necrectomy- this is the final removal from the carious cavity of all non-viable hard tissues (mainly dentin) and their decay products. The volume of necrectomy is determined by the nature of the clinical course of caries, localization and depth of the carious cavity (Fig. 10). It is carried out with the help of various sizes of excavators, spherical, fissure or reverse cone burs with a rotation speed of up to 4500 rpm.

Manipulation begins with a sharp excavator, selected according to the size of the carious cavity. Working with an excavator is less painful, since significant layers of softened dentin can be removed relatively quickly. It is important that the working edge of the tool is sharp. Further features of the manipulations depend on the depth of the carious cavity. In shallow and medium-depth cavities, excavation of dentin can be carried out, starting in turn from each of the walls of the carious cavity. With the sharp edge of the working part of the excavator, they go deep into the softened dentin and remove the dentin layer with lever-like movements. In this case, it is necessary to take into account the structural features of the various layers of dentin. In mantle dentin, the fibers of its main substance are located radially, so the excavator should be directed vertically in the direction of the tooth axis; in the peripulpal dentin, the fibers are located tangentially, so the excavator should be directed in the transverse direction (it is desirable to remove the dentin layer parallel to the bottom of the carious cavity). necrectomy, especially in deep cavity should be carried out carefully so as not to open the cavity of the tooth and not injure the pulp. Removal of infected, but more dense dentin is continued with a drill using spherical, fissure and reverse cone burs.

A properly prepared cavity should not have softened and pigmented dentine. Sometimes, after the preparation of the carious cavity, invisible demineralized areas of hard tissues remain. In such cases, chemical and physical methods are used to detect them. To determine the boundaries of carious and clinically healthy dentin, a caries detector "Caries detector" should be used, which is a 0.5% solution of basic fuchsin, or a 1% solution of red acid in propylene glycol, which stains carious tissues into red. A swab with a dye is introduced into the cavity for 15 seconds, while the non-viable dentin layer is stained, but the healthy one is not. The stained areas are removed with boron. The method allows economical excision of tooth tissues due to the partial preservation of the demineralization layer. The hardness of the remaining dentin is checked with a pointed probe. This should be done especially carefully when preparing the teeth of the anterior group in order to achieve a good cosmetic effect.

There are several preparations with the effect of a caries detector: Caries Detector (H&M), Caries Marker (Voco), SEEK and Sable (Ultradent), Canal Blue (VDW), Radsi-Dent (Raduga-R). ").

At deep chronic caries when the bottom of the carious cavity is very thin and there is real danger opening the pulp, necrectomy should be carried out mainly with spherical burs of a rather large size. In these cases, it is permissible to leave dense pigmented dentin at the bottom, and in case of acute deep caries, even a small layer of softened dentin, subject to further drug (remineralizing) action on it.

Formation of a carious cavity- very milestone preparations. Its goal is to create such a form of a carious cavity that would be able to hold the filling material for a long time and preserve the filling. To do this, it must meet a number of requirements.

General rules for a classically formed carious cavity:

the walls and bottom of the carious cavity should be located (one plane relative to the other) at a right angle and have a smooth surface.

the bottom of the cavity, as a rule, is flat or, to a certain extent, repeats the shape of the chewing surface of the tooth.

it is necessary to ensure that the angles between the walls and the bottom are straight and well-defined (with the exception of class V cavities), since additional fixation occurs in these places filling material, which does not have a pronounced adhesion to hard tissues tooth (Fig. 11).

When preparing teeth, cavities with sheer walls and a flat bottom, that is, in the form of a box, are considered typical. The optimal is the rectangular shape of the cavity, in which the walls are located at a right angle relative to the bottom plane. A rectangle is the most convenient form for holding a filling, but depending on the spread of the carious process, oval, triangular, cruciform, cylindrical cavities are possible. For better fixation of the filling, it is sometimes recommended to create retention points on the walls of the cavity in the form of grooves, recesses, cuts. Somewhat less often, with a shallow and wide cavity, its walls can be tilted at an angle of 80-85 ° relative to the bottom plane, as a result of which the dimensions of the inlet of the formed cavity will be somewhat smaller than the dimensions of its bottom.

When forming a carious cavity with deep caries, it is necessary to take into account the topography of the pulp (tooth cavity). In these cases, the bottom of the carious cavity does not always have the shape of a flat plane, but somewhat repeats the configuration of the pulp and its horns. When caries is localized on the contact surfaces, for better fixation of the filling, it is necessary to create additional cavities on other surfaces of the tooth. Often they are formed on the chewing, vestibular, lingual surfaces in the form of a triangle, dovetail, cruciform, etc.

Rice. 11. Formation of a carious cavity (A) and additional elements for fixing a filling (B): 1 - wedge-shaped recess; 2 - recess for the parapulpal pin; 3 - furrow

To form a carious cavity, fissure, reverse-conical, cone-shaped and wheel-shaped burs are used.

AT clinical setting when forming a cavity, it is necessary to take into account the nature of the course and the depth of the carious lesion. With a small risk of a carious process and its chronic course, a small cavity can be formed with rounded edges: filling is carried out with glass ionomer cements or composites (can be fluid) - using the adhesive filling technique. small cavities pear-shaped (with an inlet smaller than the bottom) can be formed. In this case, overhanging, but not affected by the carious process, the enamel edges of the cavity can be left. If it is intended to use filling materials that do not have adhesive properties (amalgam, silicate cements), then right angles and retention points should be clearly formed in the cavity. For better retention of such a filling material in the cavity, it is desirable to give it a rather complex configuration according to the course of the fissure of the masticatory surface. When using composite materials, this is undesirable due to the effect of the C-factor: a more complex cavity configuration creates additional polymerization stresses in the filling material. The internal contours and corners of the cavity should be smoothed and rounded to avoid tearing the composite from these areas of the carious cavity.

In the presence of two cavities on the chewing surface, with a low risk of caries, two separate cavities are formed, with a high risk, they are combined into one with the expansion of the cavity to caries-immune zones. In premolars, it is desirable to preserve the zone of resistance - the enamel ridge connecting the lingual (palatal) and buccal tubercles of the chewing surface.

Processing (finishing) of the edges of the carious cavity - final stage cavity formation. Care must be taken to ensure that the outer portions of the enamel prisms are well supported by the underlying dentine. Otherwise, the overhanging edges of the enamel will be deprived of nutrition and support from the pulp, will not be able to withstand the chewing pressure and break off. All this can lead to a violation of the marginal fit of the filling material and hard tissues of the tooth, the occurrence of a retention point, recurrence of caries, destruction or loss of the filling. Therefore, with finishers and carborundum heads, carefully (because the enamel is rather fragile and can easily break off), the enamel edge is processed, excising (cutting off) the overhanging areas of the enamel. The enamel edge should be formed according to the direction of the enamel prisms. Depending on the application of one or another filling material, it may be necessary to bevel the enamel edge at an angle of 45 ° or round it (Fig. 12).

It is generally recommended to bevel the enamel edge when filling with amalgams. This is due to the fact that in amalgam with a small layer thickness, a high risk of marginal breakage is possible. When using amalgam latest generations(third generation, non-gamma-2 amalgams) enamel bevel can be omitted. This is due to their higher strength and less fluidity. Enamel bevel is not created when filling the cavity with cements - they are less durable and easily break off along the bevel line.

Rice. 12. Treatment of the edges of the carious cavity and options for their formation

The use of adhesive technologies of composite materials provides for the creation of a strong bond between the material and the tissues of the tooth: enamel and dentin. For a strong attachment of the composite to the enamel, a sufficient thickness of the enamel layer is required - at least 1 mm. Therefore, it is recommended to bevel the edge of the enamel at an angle of 45° or even more to achieve the optimum thickness of the enamel. It is also recommended to adhere to this rule when forming the vestibular wall of carious cavities of III and IV classes. This creates a smooth color transition between the composite filling material and the enamel, which makes the filling less visible on the vestibular surface of the anterior teeth. The same goal is achieved by creating a bevel with a concave surface on the vestibular wall - a concave or gutter-like bevel. Microhybrid, micromatrix and viscous composite materials have significant strength (up to 420 MPa in compression), so when using them, the enamel edge can not be beveled. In general, it should be noted that when using composite materials, the bevel angle can be in the range from 10° to 45°, depending on the class of the carious cavity (more on the vestibular wall of class III and IV cavities) and the strength of the composite material.

At the end of the formation of the edge of the cavity, the created edge of the enamel is finished. At the same time, small cracks, irregularities, areas with fragmented enamel prisms that have no connection with the underlying tissues (dentin) that have arisen during the preparation are removed with finishers. This improves the marginal fit of the composite filling material and improves the filling efficiency.

When preparing a carious cavity, it is necessary to take into account a number of provisions that will help achieve the greatest efficiency of its filling and, consequently, the treatment of caries:

It is necessary to remove all the hard tissues of the tooth affected by the carious process, forming a prepared cavity within the healthy tissues of the teeth. In the clinic, certain exceptions to this rule are allowed, depending on the nature of the course and the depth of the carious process.

The formation of a carious cavity should be carried out taking into account the characteristics of the filling material. If materials are used that do not have adhesion to the hard tissues of the teeth (amalgam), then the prepared cavity is given a more complex shape and retention points are formed to mechanically hold the filling. When using composite materials, the cavity configuration should be simpler to compensate for the C-factor.

Under clinical conditions, the prepared carious cavity should be dry and not contaminated with saliva or other biological fluids (blood). If necessary, it is treated with antiseptic solutions and dried thoroughly before filling.

When preparing carious cavities, it is necessary to adhere to certain rules for the purpose of high-quality, less painful (atraumatic) and safe preparation. According to modern requirements, the preparation of teeth with living pulp must be carried out with the use of anesthesia. The manipulation of the preparation itself should be carried out with sufficient lighting and constant visual control of the doctor over the position of the instruments in the carious cavity. To do this, it is necessary to comfortably position the patient in the chair so as to provide the doctor with the best access to the prepared tooth. So, for example, when manipulating the teeth mandible the head of the patient sitting in the chair should be fixed almost in upright position, and when manipulating the teeth of the upper jaw, it is thrown back. When treating a patient in the supine position, his head, as a rule, is placed in the most reclined position. When using modern dental units and filling techniques, the patient is often placed in a prone position, which provides more convenient working conditions for the doctor and comfortable for the patient.

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, 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 a 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, as well as a side effect of certain medications, 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. After inflammation (also known as "pulpitis") occurs, treatment is possible only through depulpation and other surgical procedures, or by removing the 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 occurs, the best way to diagnose and treat caries is to visit your dentist regularly for periodic check-ups, which will help prevent caries from progressing 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 during 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.