If under the seal caries treatment. Causes and symptoms of caries under filling, treatment of secondary tooth damage. Prices for treatment

Secondary or recurrent caries is called caries that has developed under a filling as a result of poor quality dental treatment or shrinkage of poor quality filling materials. The cause of secondary caries can be the patient himself, neglecting hygiene, suffering from bruxism.

Expert opinion

Biryukov Andrey Anatolievich

doctor implantologist orthopedic surgeon Graduated from the Crimean Medical Institute. institute in 1991. Specialization in therapeutic, surgical and orthopedic dentistry including implantology and prosthetics on implants.

I think that you can still save a lot on visits to the dentist. Of course I'm talking about dental care. After all, if you carefully look after them, then the treatment really may not reach the point - it will not be required. Microcracks and small caries on the teeth can be removed with ordinary toothpaste. How? The so-called filling paste. For myself, I single out Denta Seal. Try it too.

The pathological process can proceed for a long time and imperceptibly, which is visually manifested by the darkening of part or all of the sealed molar. Often, for secondary caries, patients turn to the dentist after 2-4 years, when its too advanced stage is manifested by vivid pain symptoms.

If after dental intervention they do not go away unpleasant symptoms in a filled tooth, you should revisit the dentist who performed the treatment. In clinics, a warranty card is usually issued for the manipulations performed, then in the event of a filling falling out or pain, the doctor must carry out the necessary therapy and re-filling for free.

In the absence of a guarantee, it is advisable to turn to a more conscientious and qualified specialist to solve the problem.

Why does caries appear under a filling?

Repeated caries can develop under the filling as a result of errors or dishonesty of the doctor:

• Poor primary care.

In the process of treating a primary carious lesion, the doctor's task is to carefully remove the destroyed and damaged tissues in the crown part by drilling. Then spends antiseptic treatment, to kill pathogenic microbes. For some time, he can put medicine into the drilled cavity, closing it with a temporary seal for safety.

On the next visit (after 2-3 days), the medicine is removed and re-treated. After making sure that the patient has no complaints, the hole is disinfected, the doctor carefully dries it and seals it. If a piece of the affected tissue remains under the filling, then the pathology will begin to develop under the filling, destroying the molar from the inside.

• Inadequate filling.

The filling material must be tightly connected with the tissues of the tooth; for this, the doctor must carefully prepare the surface of the hole and outer part molar. With a loose fit of the material, bacteria will rush into the remaining microcracks, which are numerous in the mouth, causing a relapse.

• Seal shrinkage.

Fillings, especially from light-polymer materials, shrink under the influence of ultraviolet rays. It is important for the doctor to guess required amount material for such a filling. Low-quality filling materials are also prone to shrinkage.

Saliva and microorganisms entering the microcracks can provoke re-development caries.

Development secondary pathology Other factors also contribute:

• poor quality hygiene care for hard and soft tissues mouth;
• the use of solid food (nuts, crackers);
• passion for viscous sweets and chewing gum;
• mechanical trauma to the teeth;
• sudden changes in temperature (alternating hot / cold dishes and drinks);
• bad habits
• bruxism (teeth grinding).

Symptoms of the disease

Patients for a long time may not notice the development of secondary caries, which is asymptomatic until advanced stage. The pathology is evidenced by the darkening of the enamel in the area of ​​​​filling.

Later there are:

• pain in the tooth and in the jaw itself;
• swelling in the area of ​​the sealed molar;
• redness of the mucous membrane;
• bleeding gums;
• putrid smell;
• spots and black dots on the enamel;
• excessive sensitivity of teeth to chemical irritants;

The appearance of acute pain indicates damage to the pulp in the depths of the tooth.

Diagnostic methods

An experienced doctor and with a standard examination can determine the causes of uncomfortable symptoms in a sealed molar. For an accurate assessment of the condition of the teeth and gums, a visiograph is used, especially if complicated caries, pulpitis, periodontitis are suspected.

The method (visiography) is used for examination and diagnosis of sealed molars and for monitoring the results of treatment of carious foci, the quality of filling.

A high-quality image on the monitor allows you to see the canals and cavities of the tooth, existing voids and foci of inflammation. Digital X-ray equipment allows you to instantly get a picture, repeatedly increase it, while maintaining quality. The visiograph uses smaller doses of radiation than with conventional panoramic shot, the picture is saved digitally on the computer, no development is required. Can be used to diagnose dental diseases in children.

With the help of a dental visiograph, you can take a targeted picture of any number of teeth (1-2-3) in order to diagnose dental diseases(caries, pulpitis, etc.). Applying various filters in the picture, you can consider each type of tissue.

They have their own shade: pins, prostheses - white, granulomas, cysts - dark, bone- grey. The doctor uses a method to evaluate clinical picture before and after dental procedures. The cost of a picture of 1 tooth is 600-1000 rubles. CT is used for 3D imaging.

Treatment

The method of treatment is selected depending on the degree of secondary caries. After the examination, the doctor directs the patient to a picture of the problematic molar. If the destructive process has not gone too far, a second filling is performed:

• the old filling is removed with a drill, the layer of destroyed tissues is removed and removed from the molar cavity;
• the treated surface of the hole is ground and treated with disinfecting solutions;
• a special gasket is laid at the bottom to protect the pulp chamber, and a second sealing is carried out;
• ground and polished, the surface of the seal is covered with a protective layer of varnish to prevent the formation of microcracks in which bacteria can accumulate.

With too much destruction of the crown, it may be necessary to build up a tooth on a pin or install custom-made impressions. ceramic inlays for restoration anatomically shaped tooth. The doctor will advise to cover it with a crown.

Adhesive restoration

If the hole in the tooth is large, an adhesive material is applied to restore the integrity of the dental unit. The method is based on the effect of adhesion (sticking) composite materials to the tissues of the tooth. Polymer materials durable for chewing function, practically do not differ in transparency and color from natural enamel.

The polymer is firmly bonded to the enamel, the treatment is carried out in one stage and does not require laborious preparatory procedures of the traditional one. This technique is used to fix crowns, veneers and bridges, in the treatment of caries. For the implementation of high-tech adhesive restoration requires a trained dentist, the availability of equipment.

If the carious cavity is too large, then the adhesive material may fall out of it, then a crown must be placed to save the dental unit. If the deep layers of the tooth and root are affected, it will have to be removed.

Microprosthetics

With the help of ceramic inlays, it is possible to restore the crown part of the tooth if it is thoroughly destroyed. AT dental laboratory Based on the impression taken, an individual inlay is made, which is selected according to color, and in shape fits exactly to the tooth, and is fixed with special cement.

The tabs look aesthetically pleasing, more durable and more reliable than a filling.

Crown installation

If it is impossible to carry out the restoration of the tooth with the above in modern ways apply a proven and long-used method of prosthetics - the installation of a crown. Now many new materials are being used, from which it is possible to choose the option that is suitable for a particular patient. Crowns made of metal alloys (durable and inexpensive), but much inferior to expensive ceramic ones in terms of aesthetic qualities.

Before installing the crown, the dentist-therapist depulps the tooth (removes the nerve), seals the canals and the crown part. To avoid the risk of developing pulpitis under the crown, depulpation is almost always performed.

Then the orthopedist proceeds to prosthetics:

• together with the patient, it is determined with the type and price of the crown material;
• grinds the crown part of the molar;
• removes the cast;
• trying on a product made in a dental laboratory;
• installs the crown on the cement.

For secure fixation crowns (in case of severe destruction of the molar), pins screwed into the root canal or metal root tabs are used.

Possible Complications

The development of secondary caries under the filling is dangerous, since the lesion extends deep into the tooth, where the pulp chamber is located, in which the bundle of nerve and blood vessels. In the event of a violation of the tightness of this chamber (which can occur 2-3 months after filling), acute unbearable pains appear in the affected molar. The pain intensifies when moving the jaw, the temperature may rise, swelling on the face. Pulpitis requires immediate medical attention.

Complications threaten if recurrent caries is not detected:

• destruction of the canals, and then the root of the tooth;
• damage to deep layers
• damage by caries to neighboring (next to standing) healthy molars;
• complete destruction and removal of the dental unit.

Severe inflammation of the pulp in the closed space of the tooth can lead to its necrosis (putrefaction), which is chemically promoted by silicate cement fillings.

Do you get nervous before visiting the dentist?

YesNot

Preventive measures

To filling material did not crack and served for a long time, the patient must follow the doctor's recommendations for care. Secondary caries can occur not only through the fault (low qualification) of the doctor, but also with the patient's careless attitude to dental health.

• to choose quality materials for filling (do not save) and a qualified dentist;
• follow the recommendations of the doctor after filling (do not eat, do not drink for at least 2 hours);
• in the presence of fillings in the mouth, do not eat sticky, hard foods;
• carry out qualitatively hygienic cleaning using floss, quality pastes, conditioners, removing food residues;
• rinse your mouth thoroughly after eating;
• monitor the condition of sealed teeth by regularly visiting a doctor;
• To prolong the service life of seals, polish their surface once a year.

visiting for preventive examination twice a year dentist, will be able to avoid serious injuries dental tissues, the doctor will detect in time initial signs recurrent caries. In addition, by polishing existing fillings, the dentist will extend its service for several years. In the rough edges of the filling, microcracks accumulate bacteria that destroy the enamel.

Your dentist may suggest fissure sealants to help prevent recurrence of caries. Manipulation involves cutting tubercles chewing molars and filling with hardening sealant. This prevents the accumulation of bacterial plaque in the grooves between the tubercles. Sealants contain additives that mineralize enamel and prevent caries. A procedure is recommended for molars immediately after their appearance.

At the slightest suspicion of secondary caries ( gray shade enamel, black spots, darkening of the dentin) you need to visit a dentist who will help you save the old filling or refill to save the tooth.

Filling is the most common method of caries treatment. But, despite all the advantages, it does not guarantee complete elimination of the disease. There are times when carious lesion observed after some time, i.e. again. Usually, we are talking about 2-4 years after the intervention of a dentist-therapist. However, if the doctor made a mistake during the treatment, then caries under the filling can occur much earlier - already a couple of weeks after the procedure.

A feature of the course of such a process is the difficulty of determining - due to the fact that caries under the filling is invisible on early stages, many patients turn to the doctor already with severe symptoms and deepening pathological process.

Secondary and recurrent caries: what are the differences

Secondary caries under the filling is the appearance of new foci of destruction under the previously installed filling material. It is provoked by pathogens that have penetrated through microscopic cracks between the enamel and the filling. However, secondary caries can affect not only those tissues that are under the seal, but also affect previously healthy enamel near it.

Important! If for the first time caries arose as a result of inadequate hygiene and after filling the patient did not begin to pay enough attention to it, the likelihood of developing a secondary process of destruction is very high. In addition, not only this tooth, but also the rest can suffer.

Recurrent caries is the recurrence of a carious lesion in the area that has been treated. In this case, most often we are talking about a violation of the filling technology: excessive shrinkage of the material, insufficiently careful use antiseptics or poor drying of the tooth cavity before filling, etc. It is important to understand the causes of the disease.

Causes and mechanism of formation of secondary inflammation

The mechanism of damage is as follows: at the first stage, micro-slits are formed between the filling and one's own tissues, at the second stage pathogenic microorganisms enter them, at the third stage their active reproduction takes place, the result of which is a large number of acids that destroy enamel.

Recurrent caries occurs according to the same principle, only in this case, the appearance of microcracks may not be - the pathological process takes place under the filling as a result of the fact that the bacteria remained there after unsuccessful treatment.

Common reasons for the return of caries can be represented as follows:

• violation of treatment technology - removal of not the entire volume of softened tissues, ignoring the rules of asepsis and antisepsis, insufficient preparation of the tooth cavity, poor-quality materials or their incorrect use,
• shrinkage features - sagging of the filling material, the formation of cracks between the tissues and the filling,

On a note! Light polymers are most susceptible to shrinkage - the size of the seal changes significantly under the influence of light. In order to avoid negative impact polymerization shrinkage, good dentist carefully observes the requirements for the implementation of the main stages of work: completely removes softened and exposes undamaged tissues, removes overhanging edges of the enamel, smoothes the corners between the walls and the bottom of the cavity - thus, the stress associated with shrinkage is reduced. Smooth transitions significantly reduce the likelihood of cracking, in addition, these composites have fluidity, and rounding of the shape cavity will go to the benefit. You can also reduce the likelihood of complications with the help of a base layer or an insulating gasket.

• decrease in the wear resistance of the filling as a result of temperature contrast, solid food intake, bite problems or violation of the tone of the masticatory muscles, poor hygiene.

It is difficult to determine why caries forms under the filling in each specific case - several reasons can be predisposing factors at once.

Symptoms of caries under filling

The main signs of caries under the filling are as follows:

• moderate pain in the causative tooth, aggravated by mechanical action - chewing, closing the jaws, touching,
• black dots on enamel and filling,
• violation of the integrity, color of the seal, mobility,
• increased sensitivity of the enamel and the tooth itself.

Acute pain is a symptom that joins later, with advanced disease. It is worth noting that it can also occur for other reasons, but if a secondary process or relapse occurs discomfort do not occur immediately after the procedure of therapy and filling.

Diagnosis of secondary caries

How to determine caries under a filling, the doctor decides. In some cases, the darkening of the enamel around the material is noticeable when visual inspection. However, in the absence of such a sign, he can use other methods. Radiovisiography is one of the most accurate ways to make a diagnosis.

It can be used to assess the condition of teeth and gums in short time. A clear image is displayed on the computer screen, on which the doctor detects the localization and size of the foci of tooth destruction. You can detect the disease on a simple x-ray- it will show the depth and location of the pathological process. Often hidden caries looks like a dark border around a white spot.

Treatment Methods

Treatment of secondary caries is carried out using several methods: the choice is determined by the doctor, taking into account the depth of the lesion, the condition of the tooth.

1. Refilling

This method is carried out in several stages: the dentist removes the old filling, as well as part of the tissues softened carious process, cleans the cavity and treats it antiseptic solutions, if necessary - preparations containing calcium. After laying an insulating gasket on the bottom of the cavity and installing a new seal.

“A year after filling the “six”, the tooth ached again. I went to the clinic, according to the results of the x-ray, it turned out that caries had re-developed inside. I must say that for the first time the tooth was filled with a simple “cement”, for the second time I chose a light-cured filling, I have been walking with it for 3 years, nothing bothers me. I don’t know if it depends on the material, maybe a more qualified doctor got caught the second time ... "

Nik, from a review from a dental forum

2. Installing a dental inlay

This is an alternative to a crown and a large filling. The main advantage of the method is that it implies minimal impact on hard tissues and helps to preserve the integrity of the tooth. The method is as follows: the filling and affected tissues are removed, the tooth is treated with an adhesive polymer, an inlay is fixed in the cavity, which is created individually.

It can be simply designed for the top of the tooth, or it can also fill the root, if necessary. In the second case, we are talking about stump tabs.

3. Installation of the crown

The crown is set if the previous methods cannot be implemented. In the event that only the root remains safe and healthy, this is the most optimal solution. As a rule, it is resorted to deep caries and damage to the pulp, severe destruction of the coronal part.

Crowns are made from steel alloys, cermets, ceramics or zirconium dioxide. Preparation for prosthetics consists in removing the remnants of the crown or turning and grinding it, depending on which part of it remains intact. After that, the doctor makes a plaster cast and sends it to the laboratory. Based on it, the dental technician will make a future crown according to individual parameters.

After manufacturing, the crown is fixed on temporary dental cement - this allows you to track the "behavior" of the diseased tooth. If the crown fits and there is no discomfort, the structure is fixed with permanent cement.

Consequences and complications of re-inflammation

Failure to take action in the case when caries has developed under the filling is fraught with complications: inflammation of the pulp and periodontal tissues, complete destruction of the tooth, development of cysts and root granulomas. In this case, saving your own tooth is likely to fail.

Preventive measures

In assessing whether there may be caries in a filled tooth, regular visits to the doctor help a lot. It is important to carry out professional cleaning teeth twice a year, ensure proper hygiene on your own - use dental floss, brush your teeth twice a day, use mouthwash after meals. An early visit to the dentist will allow timely detection of the onset of the disease and take action - the doctor will promptly replace the old filling, preserving maximum amount living tissues of the tooth.

1 I.K. Lutsk. Ways to minimize the effects of polymerization shrinkage of composite materials, 2012.

Within 2-4 years after filling a tooth affected by caries, its secondary manifestation is possible. The problem is back again. The difficulty of timely detection of new lesions is that the processes of their formation develop under the filling. In this case, you have to contact the dentist with acute or aching pain with already advanced caries.

Important! When there are microcracks between the filling and the tooth tissue, bacteria can easily get there, provoking the development of secondary caries. It is also customary to call the further spread of caries to the healthy part of the tooth next to the filling.

• the damaged dentin was not completely removed;
• the rules of antiseptics were violated, an infection develops due to the bacteria remaining in the lesion.

It is almost impossible to accurately determine the cause of secondary or recurrent caries. It can be associated both with the negligence of the dentist during the filling, and with the shrinkage of the filling itself. Both factors appear very often, and two types of caries can develop in combination.

Secondary caries is a carious lesion of a sealed tooth, it develops and proceeds completely unnoticed, and the first signs appear already on last stage when the disease goes into a deep form.

How does this happen

Secondary caries affects healthy tooth tissues near the filling gradually:

• microcracks appear between the filling material and the tooth tissue;
• pathogenic environment in the form of microbes, bacteria penetrates into the formed cracks;
• bacteria in the process of intensive reproduction in favorable conditions emit acids that destroy tooth enamel and break the strength of the filling material. As a result, its rejection begins until it falls out.

Bacteria multiply and destroy

Cause further development damage to the tooth installed seal initially in poorly performed treatment:

1. Cleaning process carious cavity was carried out carelessly, incompletely, the affected tissues remained.
2. Before the installation of the seal was unsatisfactory prepared outside surface tooth. This leads to the appearance of cracks, the tissues around the filling crumble.
3. If the filling material is capable of shrinking during the curing process, like photopolymers under the influence of light, then such a filling sags over time. Microbes enter through the cracks.

Caries does not always return due to negligence or non-compliance with the treatment protocol by the doctor. Sometimes it's all about the seals installed long ago. Their “service life” has expired, they sagged and worn out, became mobile, which contributed to the penetration and development pathogenic microorganisms below them.

Usually, secondary caries develops due to poor-quality filling material or its natural aging. The filling decreases in size and shrinks. Between it and the wall of the tooth, a microcrack is formed, into which carious bacteria enter, causing this disease.

The wear resistance of the filling material and the quality of treatment are constantly subjected to serious tests:

• sharp fluctuations in temperature when eating - hot and cold, such as hot soup and drinks with ice, ice cream and coffee;
• love for solid foods - nuts, seeds, hard meat, caramel, crackers;
• structure problems dental system, incorrect closure of teeth, malocclusion;
• a tendency to unconscious (in a dream) grinding, knocking, clenching of the jaws - bruxism, leading to abrasion of the enamel layer as a result of frequent friction;
• not proper care behind the teeth and oral cavity, poor-quality cleaning of the teeth, when food particles remain between them, provoking the appearance of plaque containing bacteria.

Diagnostics

If a regular, regular check-up at the dentist did not reveal a problem, but there is a suspicion of secondary caries, then accurate diagnosis will help to install a visiograph.

In cases of deep carious lesions of the hard tissue of the tooth, progressive periodontitis or pulpitis, rather new method diagnostics - visiography. With its help, a complete study of the condition of the teeth, gums is carried out, according to the results, they select necessary treatment. Teeth with installed fillings are also subject to inspection by this method.

The advantages of this technique are:

• speed of image execution and its display on the computer screen;
• 10-15 times lower, which means safer dose irradiation compared to obtaining an x-ray;
• the image on the computer monitor is clear, it can be enlarged and the details of the localization of foci of inflammation in the mouth can be seen.

The same method is used when examining restored teeth after secondary caries. With the help of a visiograph, you can see, evaluate the effectiveness and quality of treatment.

A visiograph is a device that allows you to take pictures of your teeth on a special sensor, with which the image is transmitted to a computer.

Clinical picture of secondary caries

1. Toothache, aggravated by touch.
2. The gums bleed and hurt.
3. The smell of putrefaction from the mouth.
4. Inflamed mucous membrane oral cavity, redness in the mouth.
5. Change in color and mobility of the existing filling.
6. Black dots on the enamel of healthy teeth.
7. Increased, painful sensitivity of tooth enamel, swelling near the sealed tooth.
8. Developing inflammatory process, in advanced cases increase in body temperature is possible.

At first, secondary or recurrent caries does not reveal itself in any way. Symptoms along with severe acute pain appear at an advanced stage of development. Often this requires the adoption of radical measures of dental treatment up to the removal of the affected tooth.

dental care

Attention! In the case of a deep carious lesion of the tooth, up to the root, it is removed. The decision is made by the doctor after a thorough examination and diagnosis.

If the tooth can still be saved, then apply:

Re-filling

Treatment is carried out in the following sequence:

• reaming of the affected part of the tooth;
• removal of old fillings, damaged, dead particles of dental tissue;
• dentin and enamel are carefully, cleanly treated with a drill;
• carry out antiseptic treatment of the cavity of the damaged tooth with special preparations;
• an insulating insert-laying is installed, which is mandatory and helps to preserve dentin for a long time;
• a seal is installed to replace the old one.

Are the tissues damaged by caries completely removed after the re-treatment, can be seen by staining them with a special dye.
During re-filling, the main thing is to ensure a snug fit of the new filling to the tooth tissue. It depends both on the doctor's scrupulousness and the patient's behavior. He should try to fulfill all the requests of the doctor and not interfere with him:

• keep your mouth wide open
• don't move your tongue
• do not swallow saliva
• do not try to talk or move during the procedure.

When treating secondary caries, teeth are refilled: removing old fillings - cleaning the cavity from carious lesions - treating tooth canals - filling canals - installing a filling - aesthetic design of the filling.

Microprosthetics

Microprosthetics in some cases is indicated even for children.

Attention! The meaning of microprosthetics is to make and install a special tab in the affected tooth. It is simultaneously a prosthesis, securely fastened and completely invisible to others.

The damaged tooth is processed, the affected parts are removed, then an impression is made. Based on the impression, a ceramic inlay is made in the laboratory, it can also be made of another material. The tab is firmly fixed, ideally suited in color and size. How foreign body she is not felt. If such a procedure is not possible for certain reasons, a crown is placed.

Adhesive restoration

Instead of installing a crown, an adhesive polymer is applied, which is applied to the tooth, restoring and protecting the enamel from the effects of temperature extremes, making it less sensitive to irritants (sour, sweet, salty). This is due to the high degree of adhesion (from the Latin - sticking) in relation to the tooth enamel of the material used for this procedure. Such restoration restores the tooth, making it stronger and more durable. With this dental manipulation, the impact on it is minimal, especially on tooth enamel.

Crown installation

If a re-installation filling is impossible, it is impossible to build up, any other method of treating caries recurrence is not applicable, then the affected tooth is closed with a crown. It can be made of medical steel (used mainly on distant teeth due to unaesthetic, rough appearance), metal-ceramic (strong, aesthetically attractive) or ceramic (poorly withstands the load, fragile, but indistinguishable from real teeth). To do this, the damaged tooth is removed or, before installing the crown, they are prepared in a special way: the canals are sealed, the tooth is grinded and polished. Then measurements are taken, a plaster cast, and before the crown or bridge is made, the turned tooth or teeth are closed with a temporary plastic crown or a bridge.

If during the treatment of secondary caries, it is not possible to re-fill the teeth, then you can install a crown or bridge, having previously prepared the teeth (cleansing from caries, turning treatment and fitting under an artificial crown).

The crown, made according to the cast, after careful fitting is installed on a special cement. There is an option when the crown is placed on a non-permanent cement in order to trace the behavior of a diseased tooth under it, its influence on neighboring, healthy ones. If a negative consequences no, the cement is replaced with a permanent one.

Consequences of secondary caries

If secondary caries was not diagnosed on time, and treatment was not carried out, then serious complications are possible:

• the root and canals of the tooth are destroyed;
• caries spreads to adjacent, healthy teeth;
• deep layers of bone tissue are affected;
• extraction of a tooth due to its complete destruction.

Important! Secondary caries leads in some cases to pulp necrosis due to its severe inflammation. It's called annoying toxic influence chemical substances used in the treatment, or filling material.

Traumatic impact during the treatment and processing of the tooth can also cause an inflammatory process.

In the case when secondary caries has led to the destruction of the canals and roots of the tooth, treatment is meaningless. It is more rational to remove a diseased tooth in order to prevent caries from affecting neighboring teeth.

Prevention measures

Careful, proper care of the teeth and oral cavity is the main preventive measure for the development of caries recurrence. This requires the use of high-quality toothpastes, brushes, dental floss, rinses. Recommended twice a year obligatory visit dentist for the rehabilitation of the oral cavity.

These simple measures and efforts will help stop the development of caries on early stage or warn him. It is especially necessary to take care of this for those who already have fillings and crowns installed in order to prevent secondary caries.

Many people think that a cured tooth will no longer bother them, but this is not true. After a few months, and sometimes after 2-3 years, the pain may return. This is due to a new carious focus that destroys the tooth. A big problem that it is under a seal. If it was extensive, then healthy tissues may not be enough for new canal cementation, more complex treatment methods will have to be applied.

Causes of relapse

Secondary caries can occur due to various factors:

1. Poor quality filling. In this case, the disease makes itself felt within a few months, the exact period depends on the person's immunity. He considers poor-quality treatment in which the carious cavity is not completely cleared of infections. If even a small area is left, then the disease can begin to progress again. It will destroy the tooth from the inside. Caries may reappear if the drilled cavity has not been treated with an antiseptic.
2. Photocomposite materials are capable of shrinking, in which gaps appear. Bacteria get into them, which begin to destroy healthy tissues. As a rule, this cause is only valid when the photocomposite is used incorrectly. It is necessary to lay the material carefully, highlighting each area, and not in a single monolithic piece. Even if the technology is followed, shrinkage can occur after 5 or more years.
3. A gap is also formed with a poorly sealed joint between the laid material and healthy tissue. The gaps can be so large that pieces of food can get stuck in them. In such a situation, caries will return very soon.
4. Incorrect bite, poor fit of the filling material and its prolonged use lead to abrasion of the used material.

Approximately one third of cases of secondary caries are due to patient negligence. It occurs against the background of a lack of oral hygiene, the simultaneous use of hot and cold, the habit of chewing hard objects or food (especially when it appears on the front teeth).

Can the disease go unnoticed?

The big problem is that it is really only possible to detect caries under a filling late stage. On the early stages op proceeds almost imperceptibly, sometimes it is found by chance during an X-ray examination of the dentition. In the pictures, this type of caries is easy to detect. When the infection has already occurred, and the bacteria began to destroy healthy tissues, symptoms appear:

• pain that occurs when eating hot or cold food;
• inflammation of the gums, their bleeding, swelling;
• change in the color of the sealed material;
• the appearance of cracks, chips on the enamel;
• the seal is loose;
• accompanies the patient bad smell from mouth.

If the symptoms are not recognized in time, then the next stage of the disease will develop - pulpitis. With it, the tooth begins to react not only to irritating food, but also to hard pieces. Very soon they will be unable to chew even relatively soft foods, such as bread. When you try, it will start to hurt.

Secondary caries often gives itself out as darkening of the dentin. When this symptom appears, you should not postpone a visit to the doctor, so as not to allow pulpitis and deterioration. When microorganisms penetrate inside, the enamel under the filling most often acquires a gray tint, almost black spots may appear.

The loosening of the filling is also one of the most frequent and dangerous symptoms. Over time, the filling material will fall out, and the tooth will collapse in a matter of days. It will not be easy to restore it, since in the process of infection of the carious cavity, bacteria can penetrate deep into the root, disrupt its integrity.

Treatment methods for relapse

To get rid of secondary caries, it is necessary urgent appeal to the doctor. Treatment will be carried out according to the instructions:

1. Inspection and carrying out the necessary diagnostic procedures including x-rays.
2. Reaming of materials, removal of old fillings. When working, the doctor must cover the entire cavity, clean the filling base so that it cannot affect the treatment.
3. Next, clean healthy tissues from necrosing dentin.
4. The results are evaluated and in most cases a new filling is placed.

Fissure sealants can be used to prevent recurrence. For this, the bumps on chewing surface cut off, and then pour the solution inside, which hardens over time. This allows you to rid the fissures of food debris and bacteria.

If there is very little living enamel left, then the doctor may recommend making a tooth extension on a pin or installing ceramic inlays. The latter are made according to individual casts of teeth. Inlays are most suitable for restoring the anatomical surface of the dentition; they can be used to correct the bite, if it was previously not ideal. The cost of such restoration of teeth is extremely expensive, since you need to pay extra for the labor of a dental technician, but this is one of the most durable methods of treatment.

How annoying it is sometimes! Fear is defeated, willpower is taken into a fist, with deep breath we sit in a chair to the dentist and go through the entire procedure of filling from beginning to end. And after a couple of years, the brave man notes that a carious lesion develops again under the old filling. What to do to heal a tooth once and for all?

Causes of secondary caries

Seal shrinkage

A common cause of repeated caries is filling shrinkage.

Shrinkage is the reduction in size of a filling as it cures. Accordingly, such a filling ceases to adhere tightly to the walls of the tooth, and a microgap is formed, where carious microorganisms can perfectly exist and multiply.

Why does shrinkage occur? Firstly, this phenomenon occurs if the doctor uses low-quality cement to place a filling.

But, alas, even the most advanced and expensive material can shrink for one simple reason - if you work with it not according to the protocol. Putting a filling in a wet cavity, exposing the light-curing material “in one piece”, and not in small portions - all this leads to the fact that the likelihood of secondary caries increases significantly.

Dentin affected by caries

Most milestone fillings - removal of affected tissues

Everyone knows that before placing a filling, the doctor prepares the tooth tissue using a burr machine - the most unpleasant action in the entire treatment procedure, but also the most important. All that blackness that gapes at the site of caries in the tooth is softened dentin, dotted with bacteria and their metabolic products. To permanently stop the destruction of tooth decay by drilling, all these affected tissues should be carefully removed to dense hard dentin by drilling. The bottom and walls of the carious cavity should literally“creak” when the doctor runs his instrument over them - it means you can start filling.

If some part of the necrotic, microbially impregnated dentin was left and buried under the filling, the development of secondary caries is simply inevitable.

open little secret: If you want to help your dentist with the perfect cleaning of the carious cavity, try to behave decently in the chair. Patients who suddenly start jumping and screaming at any new sensation, or refuse anesthesia, and then suddenly grab the doctor's hand, cause an involuntary desire to finish the job as soon as possible. The doctor begins to feel like a kind of Gestapo, and in the hustle and bustle, trying to calm you down, he can miss a piece of soft dentin in a secluded corner of the carious cavity. Only interaction with the dentist and joint efforts is the key to an ideal tooth filling.

Symptoms of a secondary manifestation of the problem

Watch closely for changes in tooth color - darkening may indicate secondary caries

Consider a few basic symptoms by which it is easy to determine the appearance of caries under a filling.

• Sensitivity to temperature stimuli of the tooth under the filling. At a minimum, this means that the filling does not fit snugly against the dentin, and these same temperature stimuli penetrate into the microspace of the filling-tooth, causing sensitivity in the delicate dentin. That is, if secondary caries has not yet begun in such a tooth, it has every chance of occurring.

• Darkening of the tooth tissue around the filling- also a very likely sign of the onset of secondary caries. If you notice in the mirror that the shade of the tooth has changed and gray dentin tissues show through the enamel, you should consult a doctor.

• Mobility of the seal, felt by the tongue. Here, in general, there is nothing special to talk about - caries takes place, and such a filling will soon fall out. She needs to be replaced immediately. Food can get stuck between the filling and the tooth, causing an unpleasant odor. This situation in the mouth requires an urgent visit to the dentist.

Treatment of the disease

There is only one way out of the situation - re-staging a new seal after complete removal old

Treatment this disease passes according to the standard pattern, in all cases without exception:

• Complete removal of the old filling.

• Removal of necrotic carious dentin under the filling.

• Antiseptic treatment of the formed cavity.

• Placement of a new filling.

If you neglect the first point, and leave part of the filling in place, secondary caries may reappear. In a situation where the filling takes most tooth, the doctor may suggest orthopedic treatment- placing a crown. And this will be quite competent and justified, since after the removal of the filling and tissues affected by caries, almost nothing will remain of the tooth, and sculpting a “patchwork quilt” from old and new fillings is very short-lived, and can lead to further destruction.

Prevention of caries under filling

Prevention of secondary caries is very conditional. Basically, it all depends on your attending physician and how and with what he will fill the tooth. But even that small part that depends on the patient should be done responsibly - open your mouth well, sit quietly in a chair, try not to move your tongue excessively and follow all the doctor's instructions. During the filling process, try to resist the urge to cough, spit, or talk about the weather - these desires are quite natural, but can seriously damage the fit of the filling to the tooth tissues and cause secondary caries.

And of course, one of the aspects of the prevention of secondary caries is to prevent the primary one. It's worth thinking about.

Hello. My name is Inna. I am an obstetrician-gynecologist, head of the center women's health. After graduating from the university in the specialty "Medicine", there was a subordination in the profile "Obstetrics and Gynecology" and after it an internship at a clinical maternity hospital.