Superficial caries acute and chronic course. Chronic caries: characteristic signs, methods of therapy. Video - Treatment of chronic deep caries

Typical or chronic dental caries develops gradually. With this form of caries, one tooth is sporadically affected, less often two teeth. Such a lesion may go unnoticed by the patient for a long time. As a rule, the carious focus is localized on surfaces typical for caries - masticatory and approximal. Chronic caries can also develop in the area of blind pits (foramen coecum), on the buccal surfaces of the lower large molars and the palatine surfaces of the upper lateral incisors. Usually chronic caries affects molars, premolars and rarely upper incisors; other groups of teeth are not involved in the process.

Initial chronic caries, which manifests itself in the form of a brown or dark brown spot, is associated with the concept of "suspended caries". Such an element (pigmented spot) is especially common on the contact surfaces of the teeth and is easily detected in the absence of an adjacent tooth. In the region of the necks of the teeth, pigmentation of the spot indicates a favorable outcome of the initial caries. In the area of fissures, it is almost impossible to distinguish the focus of suspended caries from the alimentary pigmentation of the folds. Such spots usually do not cause concern to patients, their surface is smooth and shiny. When localizing a pigmented spot on the front teeth, patients pay attention only to their cosmetic inferiority. It is believed that with large spots, the enamel-dentin junction is involved in the pathological process. Under such conditions, the disintegration of the surface layer of enamel is inevitable (Pakhomov G. N., 1982).

In a patient with initial acute caries, the teeth have a normal appearance, sometimes covered with plaque, mainly at the neck of the tooth. The lesion has the appearance of a small spot, dirty gray or whitish, often not devoid of transparency.

An electron microscopic study of enamel with initial caries reveals a violation of intercrystalline bonds. In places, hydroxyapatite crystals lose the strict orientation characteristic of healthy enamel and occupy a disorderly position.

Initial violations of intercrystalline bonds in the initial stages of caries are found mainly along the boundaries of enamel prisms. Then the so-called interprism spaces expand. Changes are also found in the dentin. In some places, a granular sediment appears in the dentinal tubules, the integrity of their walls is violated. In caries at the stage of a pigmented spot, the dentinal tubules are filled with newly formed polygonal crystals, among which rhombohedral crystals predominate. Gradually, obliteration of the dentinal tubules occurs. The organic substance of dentin in the initial caries loses basophilicity and becomes picrinophilic. The pathological process is accompanied by increased accumulation of tyrosine, melanin, sulfhydryl groups and PAS-positive substances. Glycosaminoglycans almost completely disappear from the dentinal tubules, indicating their depolymerization.

With the spread of the focus of demineralization towards the enamel-dentine junction, the disintegration of the surface layer of enamel begins. The continuity (integrity) of the surface layer of enamel is also broken with an increase in the size of the carious spot. This stage of the lesion is already considered as superficial caries.

With the initial caries, the pulp of the tooth also changes. There is a disorganization of the layer of odontoblasts, a change in their processes and homogenization of the cytoplasm at the earliest stages of caries, as well as fatty degeneration of connective tissue cells and a change in the intercellular substance of the pulp.

The contours of the spot are uneven, but quite clear, especially visible after staining with a solution of methylene blue. As a rule, in this way, caries in the stain stage can only be detected on the labial and buccal surfaces of the teeth, closer to the neck of the tooth. There is almost no pigmentation of the spot. A sharp probe easily glides over the surface of such spots. Typically, such lesions are not associated with unpleasant or painful sensations.

DIAGNOSTICS:

In the diagnosis of initial caries, in addition to the main methods of examination (examination, probing), additional methods are also widely used: thermometry, vital staining, ultraviolet luminescence, transillumination, determination of the electrical conductivity of hard dental tissues, etc.

Thermometric study: in this study, the reaction of tooth tissues to the action of thermal stimuli is determined. An intact tooth with a healthy pulp reacts painfully to temperatures below 5-10°C and above 55-60°C.

With caries, the tooth reacts to temperatures below 18-20°C.

With deep caries, the tooth pulp can also be sensitive to temperatures above 45-50 C. During a thermometric study, the patient takes water of the appropriate temperature into his mouth.

If it is necessary to examine a certain tooth, it is irrigated with cold or hot water from a syringe. The water supplied from the syringe should not fall on adjacent teeth.

Vital staining is based on an increase in permeability, in particular, for large molecular compounds affected by caries of hard tissues of the tooth. Upon contact with dye solutions in areas of demineralized hard tissues, the dye is collected, while unchanged tissues are not stained.

The staining of enamel and dentin with a 2% solution of methylene blue is the most widespread. The surface of the teeth to be examined is thoroughly cleaned of plaque. The teeth are isolated from saliva with cotton rolls, dried, and the prepared enamel surface is treated with cotton swabs soaked in a 2% methylene blue solution. After 3 minutes, the dye is removed from the surface of the teeth with cotton swabs and rinsing.

E.V. Borovsky and P.A.Jleyc (1972) distinguish light, medium and high degree of coloration of carious spots, which corresponds to the degree of enamel demineralization. To determine the intensity of staining of carious spots, a standard ten-point blue scale is also used (A.P. Aksamit, 1974).

The luminescent study proposed by P.G. Sinitsin and L.I. Pilipenko (1968) is intended for the diagnosis of initial caries. It is based on the use of the effect of luminescence of hard tissues of teeth, which occurs under the influence of ultraviolet radiation.

The study is carried out in a darkened room. A beam of ultraviolet rays is directed to the dried surface of the teeth.

Under the influence of ultraviolet rays, luminescence of tooth tissues occurs, characterized by the appearance of a gentle light green glow. In the region of chalky and pigmented spots, a noticeable quenching of luminescence is observed. The degree of quenching of luminescence and its features depend on the nature of the pathological process.

Transillumination. This method is based on the assessment of shadow formations that appear when a cold beam of light passes through the tooth, which is harmless to the body. In the study in the rays of transmitted light, signs of caries damage to permanent and temporary teeth are found. In the initial stages of the lesion, they usually appear as specks of various sizes - from punctate to the size of a millet grain and more, with uneven edges from light to dark in color.

The lesions are clearly distinguished against the general background of the luminous crown of the tooth. On the posterior teeth, the transillumination patterns appear somewhat blurred compared to the lesions on the anterior teeth.

Determination of the electrical conductivity of hard tissues of the tooth is intended to identify those stages of caries that are not detected by other methods. In particular, this applies to the initial stages of fissure caries, as well as those cases of secondary recurrent caries, when the previously placed filling is preserved. The method is based on the fact that due to an increase in the content of organic substances, the electrical conductivity of pathologically altered areas of the hard tissues of the tooth increases.

Caries - one of the most common dental diseases that appear at any age, can occur in chronic forms.

Sluggish chronic caries eventually affects all tissues of the tooth. As a rule, the development of the disease occurs gradually, eventually affecting all layers of the dental tissue. The duration of such a process can be calculated for years and a person does not always suspect about it.

Features of the sluggish form

The chronic form of the disease is much more common than. In the course of the development of the disease, remission can last for several years or worsen after exposure to provoking factors.

Most often, it all starts with the defeat of one tooth, and if you do not resort to treatment in time, then the pathology will move to other teeth, gradually affecting the entire jaw.

The difficulty lies in the fact that chronic caries does not show itself for a long time, and the symptoms are completely absent.

For example, in an acute course, toothaches are observed, which cannot be said about the chronic form of the disease. In order to make a correct diagnosis, a comprehensive examination by a doctor is necessary.

As a rule, the transition from one stage to another occurs gradually and the patient does not notice it. This period lasts from several months to several years.

Initially, a whitish spot appears on the tooth, which later turns brown. If the stain remains white for a long time, then you need to consult a doctor, there is still the possibility of a complete cure without the use of drastic measures.

Provoking factors

Sluggish caries appears for the same reasons as rapidly progressing, so-called. To the factors provoking the appearance of the disease include the following:

absence, provoking the growth of bacteria on the teeth;
unbalanced diet, based on fast carbohydrates - when choosing food, you need to pay attention to those that contain vitamins and trace elements that strengthen tooth enamel;
due to common pathologies.

Most often, any dental disease develops precisely because of the lack of hygiene. In this regard, bacteria begin to multiply and process acids and carbohydrates. Over time, the enamel is gradually destroyed, and if in this case treatment is not started, then other parts of the tooth will also be affected.

Milk teeth are at risk

As practice shows, chronic is the most common dental disease among babies.

The main reason for this phenomenon can be called the fact that parents do not always start. In order to avoid the development of a lesion, you need to start brushing your teeth after the appearance of the first incisor.

If the doctor suspects the presence, in which the carious area, most often, is located, it is necessary.

From the practice of professionals

It is safe to say that sluggish and acute caries are two forms of the disease that flow from one to the other. For this reason, it is not always possible to distinguish them from each other even by an experienced dentist. To prevent the development of the disease, you need to visit the dentist twice a year.

Oleg Viktorovich, dentist of the highest category

Every second of my patients deals with the problem of carious lesions of varying degrees of complexity - all this is due to the fact that I do not think about my health in a timely manner. If the patient addresses in a timely manner, then I manage to bring the patient's teeth back to normal.

Chronic caries is a common disease that occurs not only in adults but also in children. In order to predict the disease in time and start treatment, it is necessary to visit the dentist regularly.

Anna Vasilievna, dentist-surgeon

Health care

Treatment of chronic caries practically does not differ from therapy. The difference is only in principles: therapeutic measures should be aimed not only at eliminating the carious area, but also at the causes that caused the disease. The doctor can offer his patient the following healing methods:

The first two techniques are used to treat the initial and. With the type of disease, a filling is indicated, and with -.

The choice of the method of therapy remains with the doctor and primarily depends on the depth of the lesion. If, then the treatment procedure will not be difficult, since it is not associated with the preparation of tissues. Also important is the age of the patient.

Preventive measures

Prevention of the disease is to prevent the causes that provoke it. These measures include the following:

If you follow all these rules, you will be able to maintain the health of your teeth and the entire oral cavity.

It has been proven that the hereditary factor, the developmental features of the fetus in the womb and the nutrition of the child in the first months of life affect how healthy a person’s teeth will be. But it is important to remember that deep caries can and should be prevented:

Spend enough time on oral hygiene, use all the necessary means for caring for your teeth.
Consuming enough calcium in food or in tablet form will help strengthen the tissues of your teeth and make them less susceptible to pathogens.
Do not abuse sugar - it is better to limit the consumption of soda, cakes, sweets and other sweets.
Visit the dentist on a regular basis and treat your teeth on time - do not wait until caries goes from mild / moderate to deep.

Varieties of deep caries

Experts distinguish between two main types of caries. Namely:

acute;
suspended (chronic).

Acute type of illness characterized by the fact that sweets, cold or hot food, salty strongly irritate the tooth, which causes pain. Even if these irritating factors are eliminated, the pain does not always go away. Signs of disease progression are very pronounced. The carious cavity has a narrow deep entrance, which greatly expands towards the base. Simply put, such a cavity looks like a regular bottle. The walls of the cavity consist of damaged dentin, which has to be peeled off during the treatment.

Chronic caries- a sluggish type of disease. In another way, this view is sometimes called "suspended." Symptoms of the disease may not manifest themselves in any way, since replacement tissues are deposited at the bottom of the carious cavity, which prevent irritants from penetrating into the cavity.

How does deep caries manifest?

This stage of the disease is the last stage of tooth damage with very characteristic signs; diagnosis and treatment are also specific here. But it should be understood that it is difficult for a non-specialist to distinguish between the stages of caries, since there are a lot of small differences between the middle and last (deep) stages of destruction. In general, the disease manifests itself with the following persistent symptoms:

The tooth begins to hurt from the fact that cold or hot food or liquid gets on it.
The tooth is irritated by food with a rich taste - salty, sweet, sour.
Food particles get into the cavity, which causes long aching pain.

Such symptoms are characteristic of the disease most often. As a rule, after any of the listed irritants gets on the affected tissues, sharp pains occur, which gradually stop after the meal is over.

However, since the pain is not permanent, many people simply endure it and put off going to the dentist indefinitely. This situation does not end well - sometimes it takes several months, six months or a year for caries to lead to inflammation of the nerve or tooth root. In this case, without strong medicines for toothache, a person cannot live in peace.

Complications of deep caries treatment

After caries is cured, a person may experience quite noticeable pain in the tooth. Sometimes they are sharp, sometimes they are aching and long. It should be understood that this is a consequence of medical errors, normally the patient should not experience pain after treatment.

As a rule, the pain completely disappears within a couple of weeks. Almost every patient is faced with tooth sensitivity after filling, which manifests itself:

pain from pressing on a new filling;
sensitivity to temperature changes, and the tooth is more responsive to cold;
uncomfortable feelings.

If you have cured caries, but the tooth has not stopped hurting, although the sensitivity period has long ended, a visit to the doctor cannot be avoided. In some cases, a new visit to the dentist is urgent. Namely:

acute pain attacks for no apparent reason;
the pain is very pronounced and does not go away even after taking painkillers;
the gum near the sealed tooth is swollen;
there are signs according to which the filling is overestimated and a reaction to the injury factor develops.

The last option is a consequence of the fact that the dentist did not completely polish the seal, and it does not fit your bite. This will not make it possible to fully close the teeth and chew, resulting in a reaction to a traumatic factor, which is fraught with inflammation of the tooth root or pulp of a traumatic nature.

It would be a wrong decision to take a wait-and-see attitude and hope that the seal will “grind” on its own, since such a problem will not disappear by itself. Among other things, such pains can also be the result of complications of deep caries - inflammation of the root, pulp, as well as periostitis, etc.

Self-diagnosis of deep caries

Self-diagnosis of the disease allows you to make sure that the tooth hurts precisely because of the development of deep caries, and not for other reasons. From the very beginning, you need to decide whether the condition of the tooth is aggravated by pulpitis. With caries, the pulp has not yet been affected, but if caries is complicated, pathogenic microorganisms will fully affect the dental nerve, gradually destroying it. Accordingly, if you only have caries, you will need to clean the cavity and put a filling, and if you also have pulpitis, remove the pulp, clean the channels, put fillings in them and much more. In the second case, the procedure will be much more complicated, and therefore significantly more expensive.

Consider the following when trying to determine what symptoms your toothache has:

The acute form is manifested by sharp sudden pains that can occur at night on their own, and deep caries is accompanied by pain only if there are irritants that act on the tooth.
After eating with deep caries, a person forgets about toothache, and with inflammation of the nerve of the tooth, it torments for a long time.
Chronic inflammation of the pulp can be accompanied by an opening of the nerve chamber, into which solid particles enter when eating - this causes prolonged severe pain.

However, one should not rely entirely on self-diagnosis, since the disease can manifest itself differently in each case. If you have found problems with your teeth and suspect caries, you should not delay treatment and wait until your teeth start to hurt. And even more so, you can’t endure temporary pains and wait for them to stop on their own, since tooth enamel and hard tooth tissues do not recover on their own. Delay in treatment only leads to the progression of the disease, more expensive treatment and pain.

Caries in dentistry is a common pathology. This disease has 2 forms - chronic and acute. In both types, extensive damage to the teeth develops. Without treatment, proper care and diet correction, chronic caries is incurable. The causes of the appearance of pathology and treatment are described in the article.

Peculiarities

Chronic caries is a sluggish form of the disease, in which there is a gradual defeat of all layers of the dentin. The disease progresses over several years with few and unexpressed symptoms. With this pathology, pain does not appear (with the exception of the last stage).

signs

In chronic caries, the following symptoms appear:

There are small lesions with dark enamel, but it has a dense, unchanged structure.
With the deterioration of the situation, the enamel becomes heterogeneous and rough.
Painful sensations are practically absent or manifest weakly and for a short time, only as a reaction to thermal or mechanical effects. There is a sharp reaction to sweets. The pain quickly disappears if the cause is eliminated.
The enamel in the compensated form is practically not affected, but with the development of the destructive process, the dentin is quickly damaged. Therefore, dentists are often faced with a situation where, with intact enamel, a cavity with dead tissues quickly appears.
The resulting cavity is characterized by steep, sloping edges and a wide entrance. On its bottom and sides there is a pigmented and dense dentin.

The course of chronic caries is characterized by incomplete remission, that is, it can persist throughout life and manifest itself as a relapse due to the influence of various factors.

The reasons

The causes of acute and chronic caries are the same. Pathology develops under the influence of various factors. Common reasons include:

An unbalanced diet, in which fast carbohydrates predominate, but there are no products that help saturate the enamel with vitamins and microelements.
Complex pathologies suffered during the appearance of hard dental tissues.
Lack of fluoride in water.
genetic factor.

Dentists have found that compensated caries usually appears in people with a history of chronic metabolic and endocrine pathologies, as well as weak immunity. Local causes include:

Lack or insufficient oral hygiene, due to which bacteria actively multiply.
enamel demineralization.
Pathologies that lead to a decrease in the formation of saliva and a change in its composition.
Congenital anomalies in the structure of the teeth and jaw.
Low resistance and changes in the structure of all dental tissues.

With the timely elimination of these factors, it will be possible to reduce the likelihood of developing the disease. And helps in this timely appeal to the dentist and careful care of the oral cavity.

In children

Chronic caries of milk teeth is more common. The main reason for the disease is that some parents are late in teaching their children about oral care. To avoid pathologies, brush your teeth immediately after the eruption of the first incisor. With a rare treatment of the oral cavity or its absence, saliva is not able to completely suppress the activity of bacteria and cope with the appearance of certain diseases.

Parents mistakenly believe that caries of milk teeth can be left untreated, since they still change with permanent ones, so they do not take their children to the dentist. But in fact, the health of milk teeth affects the condition of permanent ones. In the absence of caries treatment, their rudiments are affected, so new teeth erupt already sick.

stages

This disease has 4 stages. The transition of pathology from one to another is carried out slowly and almost imperceptibly:

Chalky spots. The disease is manifested by the appearance of an unnaturally white small spot on the enamel, which is similar in color to chalk. This period is called the “chalky spot stage” by dentists. It is completely reversible, that is, the development of caries can be stopped. The appearance of the stain is associated with the leaching of vitamin and mineral components from the enamel.
Superficial chronic caries. During this stage, destruction of the enamel is observed, when small holes and cavities with gentle edges appear on it. Whitish spots gradually darken. Their color can be from light brown to dark gray. There is no pain symptom, and during the examination of the affected area, it is revealed that the surface is heterogeneous and loose.
Chronic It penetrates the superficial layer of dentin. It can be identified by an increase in the size of the spot, the occurrence of causative pain, which disappears after the elimination of the irritating factor, and also by the formation of a narrow cavity.
Chronic deep caries. This stage is considered the most difficult. With it, large dark brown or black cavities appear. There is also an expansion of the interdental spaces. The edge is so that its edges are probed by the tongue. When caries destroys enamel and dentin, it moves to the pulp. There is no constant severe pain. This symptom is temporary and manifests itself only under the influence of irritating factors.

Diagnostics

To confirm the presence of a chronic degree of caries, several types of examinations are required:

visual inspection. The dentist examines the condition of the oral cavity, determines the degree of damage to the teeth.
Treatment of hard tissues with a special dye, which allows you to establish the pathological process at the beginning of its development. If darkened places are noticeable, then it will be possible to diagnose the beginning of the carious process in them.
Electroodontometry. The technique helps to establish the sensitivity of the pulp. If a short-term pain reaction appears when exposed to current, then this indicates that this fragment of the tooth is affected by caries.
Examination on the device "Diagnodent". By acting on the enamel with light waves, it analyzes the reflected light. If changes in the composition and structure of the enamel are noticeable, the device notifies about this.
Radiography. Invisible during visual inspection, caries is quite simply detected on an x-ray. In the image, healthy tissue will be light, and destructive areas will be black. An x-ray will help determine the depth of penetration of caries into the tissues.

Therapy

The treatment of chronic caries is similar to the treatment of acute. The difference is that in the chronic form of the disease, therapy is aimed at stopping the carious process, as well as at eliminating the cause that led to the disease. Based on the stage of the disease, the dentist chooses the method of therapy. Be sure to take into account the age of the person and the state of his health.

Remineralization

This procedure involves saturation of the enamel with calcium and phosphorus. With remineralization, the enamel density and its mineral composition are restored, sensitivity is reduced. For this purpose, 2 means are used:

Solution "Remodent" 3%.
"Calcium gluconate" 10%.

Each of these compositions is applied to cleaned teeth for 10-15 minutes. To improve the penetration of minerals, exposure to special light is required during this time.

All products are applied in several layers, then washed off with a special solution using a swab. Let the enamel dry. The number of sessions is set by the doctor, taking into account the level of tissue damage. The procedure is effective in primary lesions of the enamel.

Fluoridation

Treatment of chronic deep caries in this way is similar to remineralization. Only the teeth are covered with products containing fluoride. With their application, crystals are formed that fill microcracks in the enamel. To improve the penetration of the agent, the tooth is exposed to ultraviolet rays.

Fluoridation reduces the rate of spread of caries, prevents its occurrence in other teeth. The procedure improves the quality of all tissues in the oral cavity, increases the density of the enamel. Fluoridation is performed no more than once a year at the initial stage of the disease.

Fissure sealing

The procedure is performed with superficial caries, when sealing of the furrows on the molars is observed. First, the doctor performs the preparation of fissures to eliminate the affected tissues from them. Then the treated clean surface is covered with a heavy-duty mass, which contains remineralizing components. Sealing is carried out quickly, the furrows of one element are closed no more than 15 minutes.

filling

The technique is used if the destructive process has affected the deep layers of dentin. It involves the elimination of destroyed tissues and the creation of a cavity for the installation of a seal. If the inflammation affects the pulp, then the treatment is carried out with the extraction of the nerve.

When cleaning is done, the cavity is treated with an antiseptic solution, the root canals and the cavity are closed with a composite. The material for the filling is selected depending on the location of the diseased tooth and its functionality. The duration of filling lasts 40-50 minutes, and if you do not need to extract the nerve, then the time is reduced by almost half.

Prevention

To prevent the occurrence of chronic caries will allow the elimination of the main factor in its development. It is necessary to follow simple rules:

Timely treatment of dental diseases is required, which lead to the reproduction and spread of pathogenic microflora.
It is necessary to regularly and efficiently clean the oral cavity with the use of remineralizing anti-inflammatory pastes and rinses.
Daily processing of teeth should be supplemented by the use of floss, irrigator, dental brush.
The diet must be balanced. Avoid or reduce the amount of baked goods and simple carbohydrates consumed.
You should not gnaw nuts, click seeds, and also remove stuck food with sharp objects.
It is important not to damage the enamel.
It is necessary to go to the dentist every six months for the prevention and timely treatment of identified ailments.

Two types of the course of the carious process can be distinguished: acute and chronic caries. Moreover, according to a number of researchers, this division of caries according to the timing of formation and development is only of scientific interest - to study the processes occurring in the tissues of a carious tooth over a particular period of time. For us, this topic will be further interesting from the point of view of timely diagnosis of a carious focus, treatment and prevention.

By and large, chronic caries is a characteristic of the general condition of the patient's teeth. It can be described as the constant appearance of new lesions, their slow and imperceptible development. Only in the later stages of the carious process (with medium or deep caries) do characteristic symptoms appear, forcing a person to see a doctor.

Without a comprehensive fight, including proper dental care, diet and nutritional modifications, as well as without eliminating other possible cariogenic factors, chronic caries is incurable - it will appear on the teeth constantly until the causes of its occurrence are eliminated.

Chronic caries is much more common than acute. By and large, almost any caries that does not have signs of a generalized disease is chronic with one or another rate of development. Many patients do not even take this disease seriously, considering damage to the teeth as just some random misunderstanding, or as something taken for granted.

From the experience of a dentist:

It should be noted that the acute and chronic course of caries are mutually passing into each other processes. In other words, they are so unstable that with changes in the body, for a number of reasons, they can slow down, acquiring a chronic course, up to a temporary suspension. And vice versa, when the body is exposed to adverse factors, both external and internal (metabolic disorders, somatic diseases, stress, hypothermia, gross eating disorders, etc.), chronic caries can turn into acute at lightning speed.

That is why in practice it is almost impossible to accurately determine either the specific time of development of caries, or to distinguish one course from another according to the patient's complaints and external signs of the carious process. Often in the oral cavity, acute caries has no symptoms, since the destroyed part of the tooth is located in a place inaccessible to external irritating factors. That is, the tooth is destroyed quickly, and pain is not observed, which additionally causes difficulties in determining the activity of the carious process.

Chronic caries can also be observed in milk teeth. This is one of the most common diseases in children, as it can be difficult for parents to keep track of the condition of their teeth at an early age. Sometimes a dentist is faced with the problems of an acute course of caries, when in a matter of months in a child, caries in the stain stage turns into deep damage to the tissues of the tooth. In this case, it is required to immediately stop its development by conducting a comprehensive treatment of all foci.

There is evidence that chronic caries in children can be determined already on erupted permanent teeth. The principle of its development is the same as in the milk bite.

Clinical picture and symptoms of the disease

A typical appearance of teeth in chronic caries is shown in the photo below:

There are no extensive lesions of the teeth, and the dark areas that are present in some places are very small in size and often do not attract the patient's attention. Usually pain is absent.

In some cases, even deep caries, having a chronic course, passes with minor symptoms, not to mention those initial stages of the carious process, when the disease can be treated without filling. This is partly due to the formation of replacement dentin - an adaptive reaction of a living tooth to the appearance of an infectious irritating focus, when a secondary tissue is formed that protects the nerve from external agents and irritants.

Almost never chronic caries leads to noticeable destruction of the enamel, which is very typical for acute caries.

“I have been going to the dentist all my life for as long as I can remember. There is nothing particularly terrible, it's just that holes constantly appear in one tooth, then in another, they have to be filled. Two teeth don't even have nerves. Only now, after 30 years, I came across a good dentist who explained everything well. I have chronic caries, only slowly developing. The teeth themselves are strong, but I brush them incorrectly and irregularly, which is why caries develops.

In general, I began to solve this problem. I completely healed all my teeth (a little more than 20,000 everything cost me), bought a normal ROKS paste, a special rinse that the doctor prescribed. I have been using this for the third month now, I brush my teeth after every meal, I do not snack. Let's see if it works."

Ilya, Moscow

At different stages of development, the picture of chronic caries has its own characteristics:

Chronic caries at the stain stage practically does not manifest itself in any way. The tooth may react to cold foods or air, but this is not perceived by the patient as a pathology. The area of demineralized enamel looks like a whitish matte spot on the tooth.
Chronic superficial caries leads to the formation of a cavity in the tooth enamel, but without damage to the dentin. Such a cavity does not have overhanging edges, is wide, well-opened, the enamel itself usually darkens due to pigmentation, but retains a relatively high hardness.
Chronic medium caries is characterized by a wide cavity affecting the dentin. With this flow, the cavity does not have softened dentin, only pigmented dentin is present here. The bottom is dense with slight ledges and roughness, which indicates a sluggish process in the stage of compensation due to replacement dentin.
Chronic deep caries differs from the average only in the depth of the cavity. It also does not have overhanging enamel edges and is usually well polished.

At all stages of the development of caries, tapping on the affected area does not lead to pain. Percussion causes quickly passing pain only in case of complications in the form of pulpitis or periodontitis.

From the practice of a dentist

With all types of caries, percussion does not cause pain. Pain with light tapping on the tooth is associated only with complications of caries, and this is the main diagnostic sign that concerns official protocols.

In practice, sometimes with deep cavities located on the contact surfaces, the patient may have a kind of "food collector". Food gets stuck here and causes gum injury. If the patient comes with an abundance of stuck food and inflammation of the gingival papilla, then there will be sensitivity when tapping on the tooth (percussion). But we must understand that only the gum can hurt, not the tooth. Caries here is only an indirect cause of pain during percussion. Usually in these cases, additional methods of differential diagnosis are used. But this is a rare clinical situation; officially, with any caries, percussion is painless.

Causes of chronic caries

Generally speaking, chronic caries occurs for the same reasons that are characteristic of caries in general - due to the activity of bacteria that process carbohydrate residues in the mouth into organic acids. These acids regularly attack the enamel of the teeth and at one speed or another lead to its destruction. Then the dentin lying under the enamel is destroyed.

In most cases, the reason for the increased activity of cariogenic bacteria and contributing to the development of chronic caries is insufficient dental care. The slow course of the disease indicates that the tooth enamel of a healthy person is sufficiently resistant to the action of cariogenic factors, and saliva successfully suppresses the activity of bacteria and restores the structure of the enamel (saliva contains all the necessary chemical elements for this). Nature has already done everything possible to protect the teeth, and the development of the disease is usually only the fault of the patient.

Chronic caries of milk teeth develops for the same reasons (one example is the so-called bottle caries). Often, the parents' delay in teaching the child to oral hygiene leads to the appearance of foci of the disease, which could well have been avoided if elementary rules were observed - regular brushing of teeth and rinsing the mouth after eating.

In addition, chronic caries in children is often not perceived by parents as a disease at all. Separate carious lesions are attributed to the passion of children with sweets, and many parents do not pay attention to prevention and treatment, because they believe that if milk teeth fall out anyway, then it is not worth tormenting the child at the dentist and spending money on treatment. Accordingly, the necessary measures are not taken in time, and as a result, single lesions become chronic.

Diagnosis of chronic caries

Chronic caries is usually diagnosed with a simple visual inspection of the appearance of carious areas. Sometimes the conclusion that the patient has chronic caries is made by the doctor at regular examinations of the patient, when he can assess the frequency of the appearance of new lesions of the teeth and the rate of development of the disease.

X-ray, transillumination and luminescent diagnostics can be used to diagnose medium and deep chronic caries, but usually there is no need for their use due to the visibility of the state of the lesions.

On a note

Luminescent diagnostics is used to recognize initial caries. It can also be used as a diagnosis of caries complications, as an element of differential diagnosis. Transillumination will be redundant when the cavity is visible to the eye. X-ray will be good for identifying hidden medium and deep cavities.

Specificity of treatment

The treatment of chronic caries is practically the same as that of acute caries. In most cases, it is limited to the removal of identified foci of caries without the use of long-term treatment methods.

Superficial and initial caries are treated by the method of remineralizing therapy with the use of calcium and fluoride preparations (that is, without the use of a drill). However, in some cases, grinding of lesions is required, followed by mineralization, or even tooth preparation, followed by filling.

With medium and deep caries, necrotic dentin and pigmented enamel are removed. If the resulting cleaned cavity is relatively small, it is disinfected, after which it is filled with filling material. With a large size of the carious cavity or the destruction of one or more walls of the tooth, inlays or, in some cases, crowns are installed.

In general, with deep caries, crowns are rarely installed. Inlays are more common, since they were originally conceived in terms of repeating the relief of the anatomy of the tooth and improving functions, as opposed to conventional filling patches. Often tabs were placed and put on vital (living) teeth. With the modern development of aesthetic therapeutic dentistry, fillings and inlays are more important than crowns for vital teeth.

“I seem to have chronic caries. It constantly appears in different teeth, once every six months you regularly have to go to the doctor. But there hasn’t been anything especially terrible yet, all the time they only put fillings. The nerves have never been removed and crowns have not been placed, although the doctor says that soon there may be a reason, because caries may well develop under the oldest fillings.

Oksana, Kyiv

The choice of method of treatment depends not only on the stage of development of the disease, but also on the age of the patient, the localization of the cavity, the requirements for the aesthetics of the filling material. For example, practice has shown that children who know what colored fillings are and compete with each other in their brightness, very calmly and patiently endure manipulations with their teeth just to get such a bright filling.

On a note

With proper treatment of uncomplicated caries, a situation never arises when a tooth needs to be removed. With the blatant unprofessionalism of the doctor, when his direct actions (creating a hole in the bottom of the tooth, excessive preparation under the gum), or errors in diagnosis and treatment with the subsequent transfer of caries to pulpitis, can lead to the need to remove the tooth. A good doctor can always save a carious tooth without pulpitis and periodontitis.

Theoretically, in chronic caries, the doctor does not need to use filling materials that release fluoride into the tooth cavity for a long time, as well as engage in deep fluoridation and constant monitoring of the patient's teeth. Due to the low rate of development of the process, the removal of carious areas provides protection against caries for a sufficiently long period, and the patient's enamel already receives sufficient amounts of fluorine and calcium. However, given the ability of caries to rapidly change from chronic to acute, doctors sometimes prefer to play it safe and put insulating pads or fillings from glass ionomer cements that release fluoride into the surrounding tissues. It won't get any worse than that, but it could be useful.

Prevention of chronic caries

Prevention of chronic caries is aimed at eliminating the causes of its development - removing plaque on the teeth and dental plaques. For this you need:

Brush your teeth at least twice a day with pastes that remove plaque, preferably with a medium degree of abrasiveness. Well suited for this paste Elmex caries protection, R.O.C.S. Caribbean summer and some other tooth decay prevention pastes.
Limit the amount of sweets in the diet, eat coarse vegetables and fruits regularly.
Floss your teeth after eating, use sugar-free chewing gum.
Regularly undergo examinations at the dentist, in time to heal emerging foci of caries.

Sometimes a doctor may prescribe the use of remineralizing gels and mouth rinses. These recommendations cannot be ignored.

In children, chronic caries is prevented by the same methods. In children under 2 years of age, the rules of prevention also include the correction of the diet and the abolition of night feedings and meals before bedtime after brushing their teeth.

It is very important to teach children to brush their own teeth in time: the youngest patients are less likely to develop chronic caries, and usually the disease is acute with rapid and extensive damage to the teeth.

And most importantly - milk teeth in children should be treated as diligently as permanent ones. A complete set of healthy milk teeth is the main guarantee of the normal formation of the jaws in a child, and instilled dental care skills guarantee the child protection from chronic caries in adulthood.

Remember: dental health begins in childhood, and parents' attention to it will give much more than even the most professional and high-quality treatment.