The medical history of therapeutic dentistry is medium caries. Preparations for the prevention of dental caries. On examination, a small shallow carious cavity was found on the chewing surface.

Medium caries - carious damage to the enamel and dentin of the tooth. This is the second stage, which is preceded by superficial caries. If the disease is not treated, deep caries develops, in which the nerve is affected, the pulp becomes inflamed.

The density of enamel and dentin is different. Therefore, it happens when, when treating a small hole, the doctor is forced to drill out the floor of the tooth in order to leave only healthy areas. You need to know, for this we will consider the reasons for its occurrence.

Causes

Caries is caused by bacteria (streptococci). In the process of their vital activity, substances are released that cause the destruction of enamel, cement, and dentin.

In the history of the disease of medium caries, there are factors that stimulate its development:

1. The abundance of easily digestible carbohydrates (sweets, muffins) in food contributes to the formation of plaque;
2. With a decrease in immunity, enamel is weakened;
3. Chronic diseases in which mineral composition saliva;
4. Irregular or poor-quality brushing of teeth;
5. Hereditary tendency to disease;
6. Flaw minerals in food, consumption of contaminated drinking water;
7. The period of pregnancy and lactation.

Development

After a meal rich in carbohydrates, the pH of saliva drops to 4 in the acidic direction. The history of caries disease can last more than 4 years. But when the enamel is destroyed, it progresses 2.5 times faster. Most often it occurs on the chewing surface of the molar.

Symptoms

This is a slow disease. Most clear sign- Pain of moderate intensity. It occurs as a reaction to sour, sweet, cold, hot. Sometimes it is enough to go into a warm room from a frost to feel a short flash of pain.

In chronic caries, pain appears sporadically. A person may not even be aware of problems, attributing discomfort to hypersensitivity enamel.

The disease looks like a recess in which food debris accumulates. Perhaps the appearance of a dark rough. With the progression of the disease, bad smell from mouth.

Treatment

Caries treatment is performed only in dental office. At home, you can only reduce the symptoms with painkillers, but it is better to entrust your teeth to a specialist:

• First, the doctor removes deposits soft plaque and tartar. cleaning oral cavity performed with a brush with abrasive paste or ultrasound.
• After cleaning, the color of the filling material is selected. This is especially important if it is necessary to treat the anterior teeth.
• The doctor gives an injection of painkillers. In the treatment, topical preparations are used.
• When the anesthesia takes effect, the carious areas of the tooth are drilled out. It is very important to remove all damaged tissues. Otherwise, after filling, the disease will continue to progress and as soon as possible lead to pulpitis.
• To protect the area to be sealed from saliva, it is covered with balls of cotton wool and a bandage. But this method is not practical. It is much more effective to use a rubber dam - a latex scarf with cutouts for teeth. After application, it is fixed on the jaw with steel clamps.
• To destroy pathogenic microflora and prevent the development of inflammation, the reamed area is washed with antiseptic solutions.
• For better adhesion of the filling to the enamel, a gel with phosphoric acid is applied. After etching, the gel is washed off and dried. Mistakes in this procedure are fraught with serious complications.
• The drilled area is treated with an adhesive. After its complete absorption, for better shrinkage of the seal, a gasket is laid out at the bottom of the “hollow”.
• A filling is placed and the tooth is restored to its original shape.
• The final stage is grinding the filling, removing irregularities.

To a medical history of the middle chronic caries has not returned, you need to take care of your teeth. Brush your teeth daily, cut back on sweets and hard foods, and visit your dentist annually.

Complaints of the patient about the aesthetic defect of the hard tissues of the tooth (ten-year-old child). History of present illness, current state of the patient. The results of the examination of the oral cavity. Diagnosis of superficial caries. Defining a treatment plan.

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RUSSIAN UNIVERSITY OF FRIENDSHIP OF PEOPLES

DEPARTMENT OF PEDIATRIC DENTISTRY

DISEASE HISTORY

SUPERFICIAL CARIES (CHILD 10 YEARS)

WORK COMPLETED:

3rd YEAR STUDENT

MARTIROSYAN NARINE

MOSCOW 2011

Disease history

I. Generalintelligence.

Date of birth: 01/26/2002 (10 years old)

Address: Moscow

II. Complaints.

Complaint, according to the mother, about an aesthetic defect in hard tissues of 1.1 teeth.

III. Anamnesislife (Anamnesisvitae).

· Antenatalperiod:

The course of the mother's pregnancy (first): without complications, the presence of previous diseases, viral infections, toxicosis during pregnancy is denied.

During pregnancy, she took calcium and vitamin D3 supplements strictly in accordance with the prescription of a general practitioner.

· Postnatalperiod:

Childbirth occurred at 38 weeks and 4 days, the course of childbirth: lasted 6 hours, without complications. The child screamed immediately. Height at birth - 50 cm, body weight - 3100 g. Physiological jaundice newborn. The umbilical wound healed on the 5th day without complications. Discharged from the hospital on the 7th day. The age of the mother at the time of the birth of the child is 25 years.

The child was breastfed up to 11 months, complementary foods were introduced from 4 months, after 11 months - full nutrition, normal appetite,

From the pacifier weaned from 8 months.

· Transferredandrelateddiseases:

Chicken pox (1.8 years), rubella (2 years and 7 months), SARS (3 years).

HIV, hepatitis B, C, syphilis, tuberculosis, diabetes, cancer are denied.

· Allergologicalanamnesis:

According to the mother, there is no intolerance to drugs.

· teethingteeth:

Milk teeth erupted in a timely manner, symmetrically and consistently.

The first tooth erupted at 6 months, the process proceeded without pathological manifestations.

The change of milk teeth to permanent ones is carried out in a timely manner, sequentially, in pairs.

· Hygienecavitiesmouth:

From 6 to 12 months, oral hygiene was carried out by the mother, 2 times a day, using dental wipes (finger pads).

From 1 to 3 years of age, the mother brushed her teeth with a children's toothbrush, 2 times a day.

From 4 to 6 years of age, teeth cleaning was performed by a child, using a children's toothbrush and children's toothpaste, but under the supervision of a parent.

From the age of 7, oral hygiene is carried out by the child independently, 2 times a day, with the help of a children's toothbrush and children's toothpaste containing fluoride.

· Family and householdanamnesis:

Living conditions are satisfactory, they live in a 2-room apartment, the family consists of 4 people: a child, parents and grandmother.

· Familyanamnesis:

In the anamnesis of the family, the presence of such diseases as: HIV, hepatitis B, C, tuberculosis, oncological diseases, mental illness, alcoholism, drug addiction is denied.

IV. Storypresentdiseases (Anamnesismorbi)

According to the mother, about 2 days ago, a small defect was found on the front tooth.

The patient and her mother had not previously consulted a dentist about this.

V. Statesickinthe presenttime.

· Generalcondition the patient is satisfactory. Consciousness is clear

the reaction to others is adequate, the mood is good.

The development of subcutaneous fat is uniform, height - 142 cm, body weight - 33 kg, body type: normosthenic. Body temperature is normal (36.5C).

The color of the skin with a light yellow tint, the turgor is within the normal range, there are no integrity violations. Nasal breathing is not difficult. Pulse 108 beats / min.

According to the mother, no pathologies were found in the internal organs.

· Externalinspectionmaxillofacialareas:

The maxillofacial area is without visible pathology, the configuration of the face is not changed, the symmetry is not broken. Third parties are equal. The skin is normal, there are no violations of integrity, rashes, ulcers, swelling, hemorrhages, edema. Conjunctiva with a light yellow tint, moderate moisture. The size of the oral fissure is within the normal range. The condition of the red border of the lips is normal, there are no cracks or erosions. The state of the temporomandibular joints during opening, closing the oral cavity and at rest is normal. There is no crunch and pain, the movement of the joint is smooth. The degree of mouth opening is normal. Valle points are painless. Regional lymph nodes (parotid, submandibular, submental, buccal) are not enlarged, not soldered to the surrounding tissues, painless on palpation.

· Inspectioncavitiesmouth:

thresholdcavitiesmouth:

The mucous membrane of the lips pale pink, moderately moistened, without integrity violations. The mucous membrane of the cheeks is pale pink, moderately moistened, excretory ducts parotid salivary glands normal, no pathological changes. The secret is transparent, liquid. The depth of the vestibule is sufficient, the attachment of the frenulums of the upper and lower lips is normal. Gum condition: pink color, no swelling, no bleeding. The bite is orthognathic, diastema and trema are not revealed.

Actuallycavitymouth:

The mucous membrane of the soft and hard palate, tongue, floor of the mouth and gums of a pale pink color, moderately moistened, without pathological changes. The palatine arches, uvula, tonsils are normal, not enlarged, purulent plugs not found in lacunae. When massaging in the area of ​​the glands, a "salivary puddle" is formed at the bottom of the oral cavity for several seconds. Saliva is clear and liquid. The tongue is of normal size, clean, moist, no plaque, no teeth marks on the lateral surfaces of the tongue, which indicates the absence of edema. The tip of the tongue freely reaches the hard palate. The frenulum of the tongue is normal, without pathologies.

The color of milk teeth with a bluish tint, shape and size are within the normal range. The number of teeth corresponds age norm(20 teeth). The position of the teeth is not disturbed, non-carious lesions are not revealed. There is a filling on the 5.5 tooth, there is no violation of the marginal fit.

· dentalformula:

Bite - mixed

Anomalies in the shape, size and position of the teeth were not detected

· Indexhygiene

IndexFedorova-Volodkina: carried out to assess the quality of oral hygiene in children, the vestibular surfaces of the six frontal teeth in the lower jaw (8.3, 4.2, 4.1, 3.1, 3.2, 7.3.) are examined for the presence of soft plaque. Staining with Schiller-Pisarev solution, evaluation criteria: no staining - 1 point, 1/4 of the crown stained - 2 points, 1/2 of the crown stained - 3 points, 2/3 of the crown stained - 4 points, the entire crown - 5 points . Formula for calculating the index: ? / 6.

F. - V. \u003d (1 + 1 + 2 + 1 + 2 + 1) / 6 \u003d 1.3 (3) - hygiene is good.

· Statuslocalis:

Tooth1 .1

When viewed on the vestibular surface, in the cervical region, a defect was found within the enamel. The dentin-enamel connection is not broken, there are no changes in the dentin. When probing the surface of the tooth, the presence of roughness is painless. Percussion vertical and horizontal is painless.

VI. Additionalmethodssurveys.

vitalstaining: The surface of the teeth to be examined was thoroughly cleaned of soft dental deposits. The teeth are isolated from saliva, dried, and cotton swabs soaked in a 2% solution of methylene blue are applied to the prepared enamel surface. After 3 minutes, the dye was removed from the tooth surface by rinsing. Staining of tooth 1.1 was detected at the site of enamel demineralization.

Thermodiagnostics: -

Was led EDI - 3uA ( because tooth 1.1 is permanent, with a formed root).

VII. Preliminarydiagnosis.

· Diagnosis: Tooth 1.1 - K.02.0 superficial caries (caries superficialis).

· Diagnosisstagedon thebasis:

1) Complaints: according to the mother, about an aesthetic defect in hard tissues of 1.1 teeth.

2) Anamnesis data: According to the mother, about 2 days ago, a small defect was found on the front tooth.

3) Data of the main methods of examination: When viewed on the vestibular surface, in the cervical area, a defect was found, within the enamel. The dentin-enamel connection is not broken, there are no changes in the dentin. When probing the surface of the tooth, the presence of roughness is painless. Percussion vertical and horizontal is painless.

4) Data additional methods examinations:

vitalstaining: Staining of tooth 1.1 was detected at the site of enamel demineralization.

Thermodiagnostics: - reaction to cold, quickly passing after the removal of the stimulus.

EDI - 3uA

VIII. differentialdiagnostics.

Surfacecaries (cariessuperficialis) differentiateWith:

b Caries in the stain stage

b Average caries

b Enamel hypoplasia

b Fluorosis (erosive form)

b Erosion of hard tissues

b wedge-shaped defect

b Acid necrosis

differentialdiagnosticssuperficialcariesWithcariesinstagesspots.

1. There are no complaints about pain from irritants, there may be complaints about aesthetics.

2. Carious lesion is located within the enamel

3. Localization typical for caries

4. The pulp responds to a current of 2-6 μA

5. Carious lesion is stained with dyes

Difference:

1. With superficial caries, there may be complaints of short-term pain from chemical irritants

2. When probing caries in the stain stage, the probe slides over the surface, when probing superficial caries, a roughness or defect is found within the enamel.

3. With superficial caries, there may be pain when probing along the bottom. Probing a carious spot does not cause a pain reaction.

4. A temperature test with superficial caries can give short-term pain. With caries in the stain stage, the temperature test is painless.

differentialdiagnosticssuperficialcariescomediumcaries.

1. There may be no complaints or there may be complaints about the presence of a defect, and there may also be complaints of short-term pain from chemical irritants.

2. Localization typical for caries.

3. When probing, damage to the tissues of the tooth is determined

4. The tooth can give a short-term reaction to stimuli.

5. The pulp of the tooth reacts to a current of 2-6 μA

6. The affected areas of the tooth are stained with dyes.

Difference:

1. With superficial caries, the defect is located within the enamel, with medium caries, the enamel-dentin junction is disturbed, the carious process spreads within the mantle dentin.

2. When probing superficial caries, roughness is detected, when probing medium caries, shallow carious cavity filled with softened dentin.

3. When probing medium caries, pain is observed in the area of ​​​​enamel-dentine junction, with superficial caries, pain may be absent or be at the bottom of the carious cavity.

4. With superficial caries, the reaction to strong stimuli, with medium caries, the thermal test always gives short-term pain.

differentialdiagnosticssuperficialcariesWithhypoplasiaenamel.

1. There are no complaints about pain from irritants.

2. Complaint about aesthetics.

3. Defect within the enamel.

4. The tooth pulp responds to a current of 2-6 μA

Difference:

1. With hypoplasia, they are mainly affected permanent teeth before cutting. Superficial caries affects both milk teeth and permanent teeth, while the patient may indicate approximate time the appearance of a hearth.

2. With superficial caries, there may be complaints about irritants, with hypoplasia, only aesthetic insufficiency.

3. Defects in enamel hypoplasia, in contrast to superficial caries, are often multiple and localized at different levels of symmetrical teeth, and not on the surfaces of tooth crowns characteristic of caries.

4. When probing superficial caries, roughness is detected, when probing enamel hypoplasia, the surface is smooth.

5. Stain at local hypoplasia not stained with dyes. The carious lesion stains, the intensity of staining is directly proportional to the degree of demineralization of the enamel.

differentialdiagnosticssuperficialcariesWithfluorosis (erosivethe form).

1. There are no complaints about pain from irritants, there may be complaints about aesthetics.

2. Defect within the enamel

Differences:

1. With fluorosis, permanent teeth are mainly affected before eruption. Superficial caries affects both milk and permanent teeth, while the patient can indicate the approximate time of occurrence of the focus.

2. With superficial caries, there may be complaints about irritants, with fluorosis, only aesthetic insufficiency.

3. When probing superficial caries, roughness is detected, when probing the erosive form of fluorosis, the surface is smooth.

4. The stain with the erosive form of fluorosis is not stained with dyes. The carious lesion is stained.

differentialdiagnosticssuperficialcariesWitherosionsolidfabricsteeth.

1. Complaints about short-term pain from irritants.

2. Complaint about aesthetics.

3. Defect within the enamel.

4. Localization of lesions (vestibular surface, cervical region of the anterior teeth).

5. The tooth pulp responds to a current of 2-6 μA

Differences:

1. Erosion of hard tissues affects the necks of the teeth and is often accompanied by hyperesthesia.

2. Erosion of hard tissues is bowl-shaped, carious defect has an irregular shape.

3. With erosion of hard tissues, the bottom of the defect is smooth and shiny. When probing superficial caries, roughness is determined, the probe is delayed.

4. Hard tissue erosion is not stained with dye. With superficial caries, the focus is stained with dyes.

differentialdiagnosticssuperficialcariesWithwedge-shapeddefect.

1. Complaints of short-term pain from irritants or complaints about aesthetics.

2. Defect within the enamel.

4. The pulp responds to a current of 2-6 μA.

Differences:

1. A wedge-shaped defect is localized exclusively at the necks of the teeth.

2. The wedge-shaped defect has characteristic shape- wedge shape.

3. The bottom of the wedge-shaped defect has dense walls.

4. The wedge-shaped defect is not stained, superficial caries, when using a caries detector, gives persistent staining, the intensity of which is directly proportional to the degree of enamel demineralization.

differentialdiagnosticssuperficialcariesWithacidicnecrosis.

1. Complaint of short-term pain from irritants or complaints about aesthetics.

2. Defect within the enamel.

3. Localization of lesions (vestibular surface, cervical region of the anterior teeth).

4. Defect with a rough matte surface

5. The pulp responds to a current of 2-6 μA.

Difference:

1. Complaint at the beginning of the development of acid necrosis on the feeling of soreness on the teeth, a feeling of "sticking" of the upper teeth to the lower ones when they are closed.

2. Localization of lesions (vestibular surface, cutting edge of the anterior teeth) with acid necrosis.

3. History of acid necrosis, exposure to acids at work or ingestion of hydrochloric acid with anacid gastritis, as well as the use of a significant amount of citrus or sour juices.

4. With acid necrosis, a gray-matte defect.

IX. Finaldiagnosis.

Diagnosis: Superficial caries (caries superficialis) - K.02.0

Placed on the basis of:

b Anamnesis

b Basic examination methods

b Additional examination methods

b Differential diagnosis

X. Plantreatment.

Grinding of the rough surface of the defect and the use of remineralizing therapy. The course consists of 20 applications every day.

XI. A diaryvisits.

Under application anesthesia (Ultracaini DS 4% - 1.7 ml), professional oral hygiene and plaque removal were performed. Grinding the rough surface of the tooth and carrying out its treatment with agents that enhance remineralization. We wash the enamel surface with a 2% hydrogen peroxide solution, dry it, isolate the teeth from saliva with cotton rolls and apply cotton turundas soaked in 10% calcium gluconate solution for 15-20 minutes, replacing them with fresh ones every 4-5 minutes.

After application with a mineralizing solution, a cotton swab moistened with a 0.2% sodium fluoride solution is applied to the treated tooth surface for 2-3 minutes.

Do not eat for 2 hours.

The course of remineralizing therapy was carried out from 19.02.12 - 09.03.12

Conducted remineralizing therapy.

We carry out vital staining with mytilene blue for a control check of the result of remineralizing therapy.

Staining result: negative.

Thorough brushing of teeth 2 times a day. Rinse your mouth after every meal.

Repeated remineralizing therapy after 6 months.

XIII. Forecast.

The prognosis is favorable.

XIV. Etiologyandpathogenesis.

Demineralization of hard dental tissues under the action of organic acids formed by microorganisms is involved in the mechanism of caries occurrence. Factors predisposing to caries are:

1) microflora of the oral cavity;

3) quantity and quality of salivation;

4) general condition of the organism;

5) heredity, which determines the usefulness of the structure and chemical composition of tooth tissues;

6) condition dental system during the period of laying, development and teething;

7) nature of nutrition, high content of carbohydrates in food, etc.

ATresultinsufficienthygienecavitiesmouthcariogenicmicroorganisms (str. mutans, str. sanguis, etc.) tightlyfixedon thepellicle,formingdentalplaque. Accumulationinon the flyproductsthemvital activity (dairyacids) promoteslocaldowngradepHbefore5,5, going ondemineralizationsubsurfacelayerenamel.

XV. Pathologicalanatomy.

With superficial caries, an area of ​​enamel destruction is determined without violating the enamel-dentin junction and without changes in the dentin. With the progression of the process, the enamel-dentin junction is destroyed, and the next stage occurs carious process.

XVI. Recipes.

Rp.: Sol. UltracainiD.S.,4% - 1,7 ml

D.S. For infiltration anesthesia.

Rp.: Sol. Calcii gluconatis 10% 10 ml D. t. d. N. 20inampull.

S. For applications or electrophoresis on hard tissues of the tooth (inject from the anode for 20 minutes)

Rp.: Sol. Natrii fluoridi 0.2% 20 ml D.S. For applications or electrophoresis on hard dental tissues (introduce from the cathode for 2-3 minutes).

superficial caries tooth treatment

Bibliography

1. L.S. Persin, V.M. Elizarova, S.V. Dyakova "Stomatology of children's age", M., "Medicine", 2003

2. N.V. Kuryakina "Therapeutic pediatric dentistry", M., "Medical book", 2004

3. E.V. Borovsky "Therapeutic dentistry", M., "Medical book", 2001

4. Khomenko L.A. "Therapeutic dentistry of childhood", M., "Book plus", 2007

5. Kutsevlyak V.I. "Children's Therapeutic Dentistry", IIK "Balakleyshchyna", 2002

6. Vinogradova T.F., Maksimova O.P., Roginsky V.V. "Stomatology of children's age. A guide for doctors", M., "Medicine", 1987

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Federal Agency for Health and social development Russian Federation

State educational institution higher professional education

Far Eastern State medical University Roszdrav

Faculty of Dentistry

department therapeutic dentistry

Academic medical history

Clinical diagnosis: 2.1 tooth caries superficial K02.0.

Enamel caries white (chalky) spot stage, initial caries

Head department:

Teacher:

Khabarovsk 2012

Passport part

FULL NAME: ***************

Gender Female

Age: 69 years old, 03/04/1941

Education: Secondary

Profession: Group III disabled person

Family status: Married

Home address:

Date of contacting the clinic: 01/11/2012

Complaints

At the time of admission to the clinic:

The appearance of a white (chalky) spot

Slight sensitivity

Sensation of grin from chemical irritants

Anamnesis morbi

The patient considers herself ill for about a month, when she first noted the appearance of a white (chalky) spot on the distal-vestibular surface of the central upper incisor on the left, the tooth had not previously disturbed. Addressed on January 11, 2012 to Dental clinic"UNI-STOM" located at: st. **** for the purpose of sanitation of the oral cavity. was admitted for treatment with preliminary diagnosis superficial caries of 21 teeth.

1. General biographical information: Born in *** year. Born in a complete family, was the second child of three. The material security and nutritional conditions of the family were unsatisfactory. She grew and developed normally, did not lag behind her peers in physical and mental development.

2. Labor biography: she began her labor activity at the age of 16, she worked on a collective farm in agricultural work. Since 1972 she has worked as a tram driver. Occupational hazards: work associated with a long stay in a sitting position. Retired at 55.

3. Family and gender: Lives in the city of Khabarovsk in a comfortable two-room apartment in which three people live. Two daughters and a patient. The husband died 10 years ago. Meals are regular, the regime is observed. Gynecological history: Menstruation began at age 13, regular, painless. The beginning of a sexual life of 18 years. Pregnancies 3, childbirth 2. Menopause since 45 years.

4. Past illnesses: Viral hepatitis, Botkin's disease, tuberculosis, HIV, venereal diseases denies, contact with infectious patients and high fever denies. Trauma, blood transfusion denies. Surgery to remove a brain tumor in 2008. Polyarthritis.

5. Allergic history: allergic reactions on medicines and foodstuffs was not.

6. Chronic intoxications: smokes more than 20 years, rarely drinks alcohol, does not use drugs.

Visual inspection

The face is symmetrical, proportional,

skin integuments of physiological color, clean,

Nasolabial and chin folds are moderately expressed.

The corners of the mouth are lowered, the closing of the lips is free.

Opening of the mouth is complete, free, painless.

· When opening the mouth, the movement of the temporomandibular joints is free, painless, there is no crunching and clicking in the joint when opening the mouth. The nature of the movement: smooth, the amplitude is normal, synchronous in both joints.

· Palpation of masticatory muscles is painless.

Regional lymph nodes are not enlarged, the consistency is soft - elastic, mobile, not soldered to the skin and surrounding tissue.

Oral examination

Examination of the vestibule of the oral cavity

· During intraoral examination of the vestibule of the oral cavity - the mucous membrane of the cheeks is pale pink in color, well moistened. Puffiness, violation of the integrity is not revealed.

· Bridle top and lower lip, language are quite pronounced.

· The gums are pale pink, there are no puffiness, integrity violations, ulcerations and other pathological changes.

Gingival papillae are pale pink in color, normal in size, without breaking the integrity. When pressed with a tool, the imprint quickly disappears.

· Occlusion orthognathic.

Examination of the oral cavity itself

The mucous membrane of the lips, cheeks, hard and soft palate pale pink in color, normally moistened, without pathological changes, no puffiness is observed.

The tongue is of normal size, the mucous membrane of the tongue is pale pink, well moistened. The back of the tongue is clean, there are no desquamations, cracks, ulcers. Soreness, burning, swelling of the tongue is not detected.

The state of the follicular apparatus of the tongue without pathological changes.

· Pharynx pale pink, normally hydrated, without edema.

· Tonsils are not enlarged, purulent plugs in the lacunae are not revealed.

U P P K P U

8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

U P P P P P U

Clinical picture

On the vestibular-distal surface of the tooth 2.1 in the cervical region, a white spot, loss of enamel luster

When probing, the surface of the enamel is rough

· reaction to cold water painless

vertical and horizontal percussion is painless

The mucous membrane of the transitional fold in the region of the root apex is pink, moderately moist, painless on palpation

Additional examination methods

KPU caries intensity index

Conclusion: decompensated form

Hygienic index according to Fedorov-Volodkina

GI = 1+1+2+1+2+2 = 1.5/6

Conclusion: the hygienic condition of the oral cavity is normal.

Vital stain method

The lesion is stained with a 2% solution of methylene blue, 5% alcohol tincture of iodine.

Conclusion: the lesion is stained.

Remineralization Index

IR = 1.3 points

Conclusion: there are remineralization processes.

Caries markers

The presence of staining

Conclusion: the presence of staining indicates the presence of a carious process

Electroodontometry

The tooth pulp responds to a current of 3 μA.

Conclusion: the absence of an inflammatory process in the pulp

Luminescent diagnostics

When examining the causative tooth in the area of ​​the stain, the luminescence is extinguished against the background of a bluish glow of intact enamel.

Conclusion: area of ​​demineralized enamel

Clinical diagnosis

Based on the patient's complaints, anamnesis of life and disease, examination and additional methods of examination, a diagnosis was made.

2.1 Caries superficial

K 02.0 enamel caries "stage of white (chalky) spot" initial caries

Differential Diagnosis

Systemic enamel hypoplasia

The symmetry of the defeat of the teeth of the same name, due to the simultaneity of laying, development and mineralization

Localization on the vestibular surface of the frontal teeth, dental tubercles of molars and premolars

stain stability

whitish spots, clear border, shiny dense surface, painless

Local hypoplasia

violation of the formation of enamel of permanent teeth as a result of inflammation or mechanical injury rudiments of permanent teeth

The endemicity of the lesion

teeth are rarely affected by caries

stain stability

patches are dense, painless, shiny, smooth

do not stain with a caries marker

spotted form of fluorosis

pigmented spots

The endemicity of the lesion

Caries average

a cavity in the mantle layer of dentin

dentin-enamel junction destroyed

affected dentin

painless probing along the dentin-enamel border

Erosive form of fluorosis

pigmented spots

clear borders on matte enamel

Enamel wears off quickly

damage to dentin

enamel erosion

damage to the vestibular surface

The symmetry of the lesion

More often incisors upper jaw

damage to dentin

Dish-shaped defect

the bottom is smooth and shiny

Acid necrosis of enamel

The vestibular surface of the anterior teeth is affected

The symmetry of the lesion

often professional in nature

Sensitivity to chemical irritants

feeling of "sticking together" of teeth

dentin is soft on probing

Pigmented plaque

Removed when cleaning with specialized brushes and pastes

exposed enamel surface

Treatment

Treatment plan

1. Cleaning the tooth surface from plaque

2. Insulation against moisture

3. Treatment of the tooth surface with a 0.5-1% solution of H 2 O 2

4. Drying

5. Application of remineralizing preparations for 15-20 minutes (10% calcium gluconate solution, 3% Remodent solution)

6. Drying the tooth surface for 3-5 minutes

7. Application of fluoride preparations (2% sodium fluoride solution, Sol.Fluocali, Sol.Fluocal-gel)

8. Drying the tooth for 3-5 minutes

The course consists of 10-15 procedures

Implemented within 3-4 weeks

・Dispensary supervision

Preparations for the prevention of dental caries

Fluorine compounds

Rp.: Sol. Natrii fluoridi 0.05% - 50 ml

D.S. For rinsing the mouth.

D.S. For applications on the surface of tooth enamel or for electrophoresis, a course of 4-7 procedures.

Rp.: Phthorlacum 25 ml

D.S. Apply to the surface of the tooth.

Rep.: Tab. Natrii fluoridi 0.0011 № 50

D.S. 1 tablet per day.

Rep.: Tab. Natrii fluoridi 0.0022 No. 50

D.S. 1 tablet per day.

Rp.: Vitaftori 115 ml

D.S. 1 teaspoon 1 time per day with meals for 3 months.

Remineralizing agents

Rp.: Sol. Calcii gluconatis 10% - 10 ml

D.t.d. No. 20 in amp.

S. For applications on hard tissues of the tooth.

Rp.: Sol. Natrii fluoridi 0.2% - 50 ml

D.S. For applications on hard tissues of the tooth.

Rp.: Remodenti 3.0

D.t.d. No. 10 in pulv.

S. For rinsing the mouth (dissolve 1 powder in 100 ml of boiled water) for 1-2 minutes.

Rp.: Remodenti 3% - 100.0

D.S. For applications on hard tissues of the tooth, 20 minutes.

The course of treatment - 20 procedures.

Rp.: Sol. Calcii glycerophosphatis 0.5

D.t.d. No. 90 in tab.

S. 1 tablet 3 times a day.

Rp.: Sol. Calcii glycerophosphatis 2.5% - 100.0

D. S. For electrophoresis in hard tissues of the tooth, 20 procedures.

Rp.: Tab.Unicap-M No. 30

D.S. 1 tablet 1 time per day after meals for 20-30 days.

Rep.: Tab. “Ascorutini” 0.1 No. 180

D.S. 2 tablets 3 times a day for a month.

Rp.: Phytini 0.25

D.t.d. No. 50 in tab.

Rp.: Methionini 0.1

D.t.d. No. 90 in tab.

S. 1 tablet 3 times a day after meals.

Epicrisis

On January 11, 2012, the patient of *** *** year of birth applied for oral cavity sanitation to the Dental Polyclinic "UNI-STOM" located at the address: st. ***. On the basis of complaints, general and additional methods of examination, the diagnosis was made: 2.1 tooth superficial caries K02.0 Enamel caries stage of white (chalky spots) initial caries. It was decided to therapeutic treatment with the use of remineralizing therapy with the use of fluorine-containing preparations using the method of deep fluoridation. The patient was given recommendations on the rules of oral hygiene.

Complaints on admission

The patient does not complain, he came for the purpose of sanitation of the oral cavity.

Anamnesis of the patient's life (Anamnesis vitae)

1. Transferred and accompanying illnesses- SARS, measles, chickenpox. Tuberculosis, syphilis, alcoholism, mental illness in the family did not hurt.
2. Intolerance medicinal substances- Allergological anamnesis is not burdened.
3. Household history -

He lives with his parents in a separate 3-room apartment, the situation in the family is good, he eats regularly 3 times a day, he prefers a variety of foods of plant origin.

1. Labor history - studies at the institute (2 course).
2. Bad habits- Smoking, drinking alcohol, drugs denies.
3. Oral hygiene is good. He brushes his teeth 2 times a day, uses various means of caries prevention (floss, tooth elixir, chewing gum).

History of present illness (Anamnesis morbi)

The patient's tooth did not bother. He visits dentists once a year for the purpose of sanitation of the oral cavity.

The present state of the patient (Status praesens)

1. General condition of the patient -

The physique is correct, constitutional type according to the normosthenic type.

Height - 185 cm.

Weight - 67 kg.

Body temperature - 36.6 * C.

The skin is pale pink, normally hydrated, elastic. Rash, hemorrhage, scratching, peeling and ulcers were not detected.

The degree of development of subcutaneous fat is moderate.

The distribution is even. Edema was not found.

The condition of the organs according to the patient is good. No acute or chronic processes were identified.

2. External examination of the maxillofacial region.

The configuration of the face is not changed, the skin is pale pink, normally moisturized. There are no skin rashes or swelling. The red border of the lips is without pathological changes, the lips are normally moistened, there are no cracks, erosions, ulcerations.

Regional lymph nodes (submandibular, mental, parotid, cervical) are not enlarged, painless.

3. Examination of the oral cavity -

The smell from the mouth is normal. The mucous membrane of the lips, cheeks, hard and soft palate is pale pink in color, normally moistened, without pathological changes, no swelling is observed.

The gums are pale pink in color, there are no puffiness, integrity violations, ulcerations and other pathological changes. The gingival papillae are normal; when pressed with the instrument, the imprint quickly disappears. There is no increased bleeding. There are no pathological pockets.

The tongue is pink, clean, the papillae are without pathological changes, the tongue is normally moistened, the integrity is not broken, no desquamations, cracks, ulcers were found, no teeth marks were found on the surface of the tongue. The state of the follicular apparatus of the tongue without pathological changes.

The pharynx is pale pink in color, normally moistened, without edema.

The tonsils were not enlarged, no purulent plugs were found in the lacunae, and there was no plaque.

Dental formula:

Bite on orthognathic type.

The color of the teeth is white. Anomalies in the shape, position and size of the teeth were not found. Non-carious lesions of the teeth (hypoplasia, fluorosis, wedge-shaped defect, abrasion) are absent.

Soft plaque is colorless, localized in the cervical region of the teeth. Tartar is absent.

1. Description of the diseased tooth.

1. . For mechanical, chemical, temperature stimuli the tooth is not responding. When probing, it is determined that the carious cavity is filled with pigmented softened dentin, it does not communicate with the tooth cavity. Probing is painful along the enamel-dentine junction. Percussion is painless.

Additional research methods

X-ray diagnostics was not performed.

Diagnosis and its rationale

Diagnosis - caries media.

The diagnosis was made on the basis of basic and additional research methods.

On examination, a small shallow carious cavity was found on the chewing surface.

7. The tooth does not react to mechanical, chemical, temperature stimuli. When probing, it is determined that the carious cavity is filled with pigmented softened dentin, it does not communicate with the tooth cavity. Probing is painful along the enamel-dentine junction. Percussion is painless.

Additional research methods:

The tooth pulp responds to a current of 3 μA.

Differential Diagnosis

Average caries differentiate:

1. With a wedge-shaped defect, which is localized at the neck of the tooth, has dense walls and a characteristic wedge shape, is asymptomatic;

2. With deep caries, which is characterized by a deeper carious cavity with overhanging edges, located within the peripulpal dentin, probing the bottom is painful, mechanical, chemical and thermal stimuli cause pain, which quickly passes after the elimination of the stimulus. Percussion of the tooth is painless.

For medium caries is characteristic small cavity located within its own dentin. The bottom and walls of the cavity are dense, probing is painful along the enamel-dentin junction.

1. With chronic apical periodontitis, which can be as asymptomatic as median caries: no pain when probing along the enamel-dentin border, no response to temperature and chemical stimuli. The preparation of a carious cavity with an average caries is painful, but not with periodontitis, since the pulp is necrotic. The pulp of the tooth with an average caries reacts to a current of 2-6 μA, and with periodontitis - to a current of more than 100 μA. The radiograph in chronic apical periodontitis reveals a uniform expansion of the periodontal gap, destructive changes bone tissue in the projection area of ​​the root apex.

Therapy and prevention

In the treatment of secondary caries, the preparation of a carious cavity is mandatory. The preparation of the walls and bottom of the carious cavity is carried out before crepitus. If softened dentin is left at the bottom of the carious cavity, the process of demineralization under the filling will continue.

The treatment consists of instrumental processing of enamel and dentin, which form the walls and bottom of the carious cavity, and its subsequent filling with filling material. Surgical excision of necrotic and destroyed tooth tissues as a result of the carious process consists in removing functionally defective and infected tooth tissues that are not capable of regeneration. Like any intervention, surgical treatment should be painless.

The preparation is made with sharp carbide or diamond burs, without vibration, at the highest possible speed, with intermittent movements in the form of a "comma". The burs should correspond to the dimensions of the cavity, the work should be carried out within the limits of healthy tooth tissues in compliance with the principle of biological expediency.

During the preparation, cooling is necessary, and when working in a carious cavity, warm irrigation of the tooth tissues is necessary.

Stages of tooth preparation and filling:

1. Opening of the carious cavity

It comes down to the removal of overhanging edges of enamel that do not have support on dentin.

The goal is to create complete access to all necrotic and demineralized tissues.

The criterion is the absence of undermined enamel edges.

To excise the overhanging edges of the enamel, spherical or fissure burs are not used. large sizes.

A spherical bur is inserted into the carious cavity and the overhanging edge of the enamel is removed outward from the bottom of the cavity. When working with a fissure bur, overhanging edges are removed with its side faces until the walls become sheer.

2. Cavity expansion

The cavity is expanded with large-sized burs. This stage aims to remove softened and pigmented dentin, which is necessary to prevent further spread of the carious process. The expansion begins with the removal of tissue decay with an excavator. The denser dentin is removed ball bur or reverse cone, carefully at low speeds of the drill, so as not to open the tooth cavity. A properly treated cavity should be free of pigmented and softened dentin.

3. Necrectomy

• this is the final removal of the affected tissues of enamel and dentin. It is advisable to use fissure and spherical burs.

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

The criterion is the density when sounding the walls and bottom.

1. Formation of a carious cavity.

• this is the creation of the best conditions for fixing the filling material.

Principles of cavity formation:

• the walls of the carious cavity should be sheer and dense
• bottom - flat and creaking when probing
• the angle between the walls and the bottom of the formed cavity should be 90 *
• the formed cavity can have a wide variety of configurations: triangular, rectangular, dumbbell-shaped, cruciform, oval, etc.

In this patient, the cavity is formed of a rectangular shape.

• any formed carious cavity should have the optimal number of retention points that would provide the seal with the best fixation
• preparation should be carried out in compliance with the principle of biological expediency.

The cavity is formed according to class 1 (according to Black).

Class 1 Black cavities include cavities in the area of ​​fissures and natural recesses of molars, premolars, and incisors.

1. Finishing

• This is the smoothing of the edges of the enamel.

It is made with a diamond or fissure bur to the entire depth of the enamel at an angle of 45 * along the perimeter of the carious cavity. The resulting fold protects the seal from displacement under chewing pressure.

1. Medical treatment of the carious cavity.

After preparation, dentinal sawdust remains in the cavity, in order to remove them, the cavity is washed with a warm stream of water or warm physiological antiseptics: 0.02% furatsilina solution, 0.02% ethacridine lactate solution, 0.06% chlorhexidine solution, 5% dimexide solution.

Then the cavity is thoroughly dried, since traces of moisture significantly impair the adhesion of the filling material to the walls. Air drying is optimal. Care should be taken to ensure that the cavity is well isolated from saliva.

It is very important to have and maintain a thoroughly dried cavity during the entire filling process.

Means for antiseptic treatment of the carious cavity.

Rp.: Sol.Hydrogenii peroxydi dilutae 50 ml

Rp.: Sol.Chloramini 2% - 30 ml

D.S. For the treatment of carious cavity.

Rp.: Sol.Chlorhexidini 0.06% - 50 ml

D.S. For the treatment of carious cavity.

Rp.: Sol. Furacilini 0.02% - 20 ml

D.S. For the treatment of carious cavity.

Rp.: Sol. Aethacridini lactatis 0.02% - 20 ml

D.S. For the treatment of carious cavity.

Rp.: Sol. Kalii permanganatis 1% - 20 ml

D.S. For the treatment of carious cavity.

Rp.: Sol. Dimexidi 5% - 100.0

D.S. For the treatment of carious cavity.

Rp.: Sol. Aethonii 1% - 100.0

D.S. For the treatment of carious cavity.

Rp.: Sol. Spiritus aethylici 70% - 50 ml

D.S. For the treatment of carious cavity.

Rp.: Sol. Aetheris medicinalis 50ml

D.S. For the treatment of carious cavity.

1. Applying an insulating pad.

Filling begins with the imposition of an insulating gasket, which is most often used as glass ionomer cement.

The overlay has the following objectives:

• isolate the dentin and pulp from toxic substances contained in some filling materials;
• create a barrier for heat and cold conduction of seals;
• increase the adhesiveness of weakly adhesive filling materials;
• create additional fixation points on the bottom and walls of the cavity.

The insulating pad covers the bottom and walls of the cavity up to the enamel-dentin border with a thin layer, without changing the configuration of the cavity, without going beyond the prepared cavity, there should be no “bald patches”, as well as bumps and pits in the pad.

Fuji 2, Base Line, Chemfil Superior, Chelon Fil, etc. can be used as an insulating gasket.

For this patient, glass ionomer cement "Base Line" is used as an insulating lining.

1. Placement of a permanent filling.

Filling the carious cavity is an important step.

1. The cavity must be perfectly cleaned;
2. The filling material should fully imitate the color and transparency of the tooth enamel;
3. The filling should be round, fully restore anatomical shape tooth

Class 1 cavities are usually filled with amalgam, gallodent-M, or composite filling materials.

We fill the cavity for this patient composite material"Concise", chemically polymerized. It is a durable, aesthetic filling material. The material contains a quartz filler, which occupies 65% of the volume, with an average particle size of 9 microns.

The adhesive system is a complex of complex liquids that facilitate the attachment of composite materials to tooth tissues: a primer that connects to dentin, and an adhesive that provides bonding of the composite to the enamel and the primer film.

Primer - a complex volatile chemical compound, a component of an adhesive system based on alcohol or acetone; provides preparation of hydrophilic dentin for connection with the composite. Penetrating into the spaces between collagen fibers, the primer forms a hybrid zone, which completely eliminates the leakage of dentinal fluid. Adhesive (bond) - a chemical compound that provides the formation of a bond between the tissues of the tooth and the filling material.

Etching of enamel.

Due to the fact that enamel mainly consists of inorganic components, the question of its etching is beyond doubt. It has been established that when the enamel is treated for 15–20 s with 30–40% phosphoric acid, about 10 µm of enamel is removed and pores are formed to a depth of 5–50 µm. The acid must be washed off the surface of the enamel with water for 30 s from a pistol. The tooth is dried with air until a chalky surface appears on the enamel.

The next step is to mix the adhesive adhesive and fluid components and apply a single layer of adhesive material into the cavity to cover the dentin and etched enamel. Gently blow the surface with air to reduce the thickness of the material and evaporate the solvent. Then we dry it under special lighting for 10 seconds or apply a second adhesive layer and treat it with air.

Next, a filling material is introduced into the cavity and rubbed with a plugger to the walls and bottom of each portion. Then, the anatomical shape of the tooth, fissures, tubercles is restored with a trowel, and by biting, the height of the filling is determined by interaction with the antagonist. Next, the filling is polished.

1. Grinding and polishing of fillings.

Grinding is done with diamond burs, polishing is done with brushes with polyplastic, rubber circles and cups.

Grinding and polishing of the filling is prerequisite its long-term preservation. The seal is considered correctly processed if the border between the seal and the tooth is not determined by the probe. Lack of polishing and grinding of the seal leads to its accelerated destruction, corrosion, abrasive wear due to significant surface roughness.

Prevention

The incidence of dental caries is associated with the nature of the population's nutrition, the level of solar radiation, the content of fluorine in the environment, age, gender, various climatic and geographical conditions, etc.

Significant risk factors for caries were identified that create conditions for its development: pathological pregnancy, acute infectious and chronic systemic diseases, radioactive emissions and intensive X-ray therapy, hetero- and autosensitization of the body, anti-infective vaccinations and other effects that affect the immunological state of the body.

To a large extent, the incidence of caries in teeth depends on the care of the oral cavity and its hygienic condition.

For the prevention of dental caries, 3 risk factors for caries are of the greatest practical importance:

• Dental plaque and its microorganisms
• Excess sugar in food
• Fluoride deficiency in drinking water and food.

By influencing these factors in a certain way, it is possible to completely prevent the development of dental caries or reduce the intensity of the disease in children and adults.

The greatest effect of prevention is observed with simultaneous action on all 3 factors. In practice, this approach is called "integrated prevention".

All known methods for the prevention of dental caries are conditionally divided into 3 groups, respectively, 3 cariogenic factors to which they are directed.

This is the elimination of plaque microorganisms, the reduction of sugars in the diet, the replenishment of fluorine deficiency in the environment surrounding the teeth.

Schematically, all preventive measures can be divided into 4 groups:

1 - endogenous without drug prophylaxis dental caries. It implies the introduction into the body of food rich in proteins, amino acids, macro- and microelements, vitamins. Recommendations on diet, calcium and fluoride foods allow you to regulate the process of teething and maturation of tooth enamel;

2 - endogenous drug prevention. It implies options for drug prophylaxis for pregnant women, children of preschool and school age, adults. The most popular drugs are calcium and fluorine, videochol, vitamins B1, B6, D, fish oil, sodium nucleinate, phytin, methionine, etc., which should be taken orally, in courses, depending on the age and intensity of dental caries;

3 - exogenous drug-free prevention of dental caries. It involves, first of all, intensive chewing of hard food, careful personal oral hygiene with the use of therapeutic and prophylactic toothpastes, professional hygiene, balanced diet, restriction of carbohydrates, replacement of sugar with sweeteners, slow drinking of milk and tea, rational prosthetics (orthodontic and orthopedic);

4 - exogenous drug prevention of dental caries. Assumes topical application remineralizing agents (10% calcium gluconate solution, 2% sodium fluoride solution, 3% remodent solution, fluoride varnish and gels) in the form of applications on the hard tissues of the tooth, rinses, baths or electrophoresis, rubbing.

The presence of soft and calcified dental deposits in to a large extent depends on quality hygiene care behind the mouth and teeth.

Of course, other local factors (the presence of dento-jaw deformities, the intensity of salivation, the condition of the soft tissues of the oral cavity, etc.), as well as general factors, also affect the rate of formation of dental plaque, but it should be emphasized that the importance of regular oral care cannot be underestimate.

Oral hygiene consists of training, dental hygiene, monitoring the correctness of their implementation and includes brushing and rinsing teeth. To do this, use special tools and hygiene items that allow you to effectively clean the oral cavity from dental deposits and food debris.

There are certain requirements for oral hygiene products and items: they must be absolutely harmless to the tissues of the teeth and oral mucosa; have a good cleansing property, that is, remove plaque and thereby prevent the formation of tartar; have an anti-inflammatory effect on the gums and oral mucosa; have an anti-carious effect; should not violate the physiological balance of the microflora of the oral cavity and affect the activity of salivary enzymes, change the acid-base balance in the mouth.

Modern oral care products are divided into tooth powders, pastes, elixirs, gels.

Without these funds, it is impossible to carry out effective oral hygiene. All of them are different in their cleansing, deodorizing, taste and therapeutic and prophylactic properties.

The main items of oral care are toothbrushes, flosses, toothpicks, interdental stimulators and irrigators that allow you to clean all surfaces of the teeth, even hard-to-reach ones.

These items and oral hygiene products are used individually at home. In addition, there are other oral hygiene products and items that are used mainly in medical institutions.

These are various special brushes used with a drill, devices for irrigating the oral cavity. This also includes various tools for removing plaque, tartar, grinding and polishing.

Anti-caries toothpastes

Strengthen the mineral tissues of the tooth and prevent the formation of plaque. This is achieved by introducing compounds of fluorine, phosphorus and calcium into the composition of toothpastes.

Of the fluorine compounds in toothpastes, sodium monophosphate, sodium fluoride, tin fluoride, and organic fluorine-containing compounds are used.

When creating fluoride-containing toothpastes, much attention is paid to the concentration of fluoride in them. It is believed that in order to saturate the hard tissues of the tooth with fluorine ions, it is necessary to use weak concentrations of fluorine, not exceeding 2% in the tube. Toothpastes containing 1-3 mg of fluorine per 1 g of paste are effective.

The anti-caries effect of toothpastes is primarily due to the fact that fluorides applied topically increase the resistance of enamel to adverse effects.

The penetration of fluorine into the structure of the enamel creates a more durable system of fluorapatite, promotes the fixation of phosphorus-calcium compounds in the hard tissues of the tooth, in addition, fluoride preparations inhibit the growth of soft plaque microflora.

Anti-caries toothpastes: "Colgate", "Agua-fresh", "Signal", "Blend-a-med", "Pearl", "Arbat", "Crystal", "Remodent", "Cheburashka".

Remodent is widely used not only for treatment, but also for the prevention of dental caries in the form of applications. The drug is obtained from animal bones, contains a complex of macro- and microelements.

Upon contact with the enamel of the teeth, the inorganic elements of the remodent diffuse intensively into its surface layer, changing the biophysical properties of the enamel - permeability and solubility in acids.

Remodent is used in the form of applications after professional hygiene oral cavity.

All surfaces of the teeth of the upper and lower jaws are covered with tampons soaked in a 3% remodent solution for 15-20 minutes. With hypersalivation, tampons are changed every 5 minutes.

Preventive course - 10 procedures, 2 times a year. It is recommended to carry out applications every other day or 2-3 procedures per week. After the procedure, you can not eat or drink for 2 hours.

Remodent can also be used for prophylactic rinsing of the oral cavity in the form of a 1-3% solution, the course is 5 procedures 2 times a year. It is recommended to carry out 2-3 rinses per week, the duration of the procedure is 3 minutes.

After completion of mineralizing therapy with Remodent, it is advisable to cover the surface of the teeth with fluoride varnish.

Preparations for the prevention of dental caries.

Fluorine compounds

Rp.: Sol. Natrii fluoridi 0.05% - 50 ml

D.S. For rinsing the mouth.

D.S. For applications on the surface of tooth enamel or for electrophoresis, a course of 4-7 procedures.

Rp.: Phthorlacum 25 ml

D.S. Apply to the surface of the tooth.

Rep.: Tab. Natrii fluoridi 0.0011 № 50

D.S. 1 tablet per day.

Rep.: Tab. Natrii fluoridi 0.0022 No. 50

D.S. 1 tablet per day.

Rp.: Vitaftori 115 ml

D.S. 1 teaspoon 1 time per day with meals for 3 months.

Remineralizing agents

Rp.: Sol. Calcii gluconatis 10% - 10 ml

D.t.d. No. 20 in amp.

1. For applications on hard dental tissues.

Rp.: Sol. Natrii fluoridi 0.2% - 50 ml

D.S. For applications on hard tissues of the tooth.

Rp.: Remodenti 3.0

D.t.d. No. 10 in pulv.

1. For rinsing the mouth (dissolve 1 powder in 100 ml of boiled water) for 1-2 minutes.

Rp.: Remodenti 3% - 100.0

D.S. For applications on hard tissues of the tooth, 20 minutes. The course of treatment - 20 procedures.

Rp.: Sol. Calcii glycerophosphatis 0.5

D.t.d. No. 90 in tab.

S. 1 tablet 3 times a day.

Rp.: Sol. Calcii glycerophosphatis 2.5% - 100.0

D. S. For electrophoresis in hard tissues of the tooth, 20 procedures.

Rp.: Tab.Unicap-M No. 30

D.S. 1 tablet 1 time per day after meals for 20-30 days.

Rep.: Tab. "Ascorutini" 0.1 No. 180

D.S. 2 tablets 3 times a day for a month.

Rp.: Phytini 0.25

D.t.d. No. 50 in tab.

Rp.: Methionini 0.1

D.t.d. No. 90 in tab.

1. 1 tablet 3 times a day after meals.

02/21/2001 - No complaints, came for the purpose of sanitation of the oral cavity. On examination, a small shallow carious cavity was found on the chewing surface.

7. The tooth does not react to mechanical, chemical, temperature stimuli. When probing, it is determined that the carious cavity is filled with pigmented softened dentin, it does not communicate with the tooth cavity. Probing is painful along the enamel-dentine junction. Percussion is painless.

The tooth pulp responds to a current of 3 μA.

DS: caries media.

Treatment: the carious cavity is opened, softened dentin is removed from the walls and bottom of the carious cavity. The cavity is formed according to class 1. antiseptic treatment. "BaseLine" insulating gasket installed and then installed permanent filling"Concise", the seal has been finished.

Favorable.

Etiology and pathogenesis

About 400 theories have been proposed to explain the etiology and pathogenesis of dental caries, the most famous of which contributed to the accumulation of information that made it possible to express a certain complete judgment on this problem.

Etiology

Theories of the origin of dental caries.

According to this theory, carious destruction takes place in 2 stages:

1. There is demineralization of hard tissues of the tooth. The lactic acid formed in the cavity as a result of lactic acid fermentation of carbohydrate food residues dissolves the inorganic substances of enamel and dentin;
2. There is a destruction of the organic matter of dentin by proteolytic enzymes of microorganisms.

Miller recognized the existence of predisposing factors. He pointed to the role of the quantity and quality of saliva, nutrition factor, drinking water, emphasized the importance of the hereditary factor and the conditions for the formation of enamel.

Physico-chemical theory by D.A. Entin (1928)

Entin put forward the theory of caries based on the study of the physicochemical properties of saliva and teeth. He believed that tooth tissues are a semipermeable membrane through which osmotic currents pass due to the difference osmotic pressure two media in contact with the tooth: blood from the inside and saliva from the outside. According to the author of the theory, favorable conditions osmotic currents are centrifugal and provide normal conditions nutrition of dentin and enamel, as well as prevent external adverse factors from affecting the enamel. Under unfavorable conditions, the centrifugal direction of osmotic currents is weakened and acquires a centripetal direction, which disrupts the nutrition of the enamel and facilitates the impact of external harmful agents on it, causing caries.

Biological theory of caries by I.G. Lukomsky (1948)

The author of this theory believed that such exogenous factors, as a lack of vitamins D, B1, as well as a lack and an incorrect ratio of calcium, phosphorus, fluorine salts in food, the absence or lack of ultraviolet rays disrupt the mineral and protein metabolism. The consequence of these disorders is the disease of odontoblasts, which first weaken and then become defective. The size and number of odontoblasts decreases, which leads to metabolic disorders in enamel and dentin. Discalcination occurs first, followed by a change in the composition of organic matter. Then deeper changes appear: the content of calcium and phosphorus salts decreases, the amount of magnesium increases, and the composition of organic matter changes.

Theory of A.E.Sharpenak (1949)

A.E.Sharpenak explained the cause of dental caries by local impoverishment of enamel with proteins as a result of their accelerated decay and slowing down of resynthesis, which inevitably leads to caries in the white spot stage. The slowdown in resynthesis is due to the absence or low content amino acids such as lysine and arginine, and the cause of increased proteolysis is heat ambient air, hyperthyroidism, nervous excitement, pregnancy, tuberculosis, pneumonia, accumulation of acids in body tissues, which leads to increased protein breakdown. Sharpenak explained the cariogenic effect of carbohydrates by the fact that with their large assimilation, the body's need for vitamin B1 increases, which can cause beriberi and increased proteolysis in the solid substances of the tooth.

The modern concept of the etiology of caries.

The generally recognized mechanism for the occurrence of caries is the progressive demineralization of hard dental tissues under the action of organic acids, the formation of which is associated with the activity of microorganisms.

Many etiological factors are involved in the occurrence of the carious process, which makes it possible to consider caries as a polyetiological disease. The main etiological factors are:

• The microflora of the oral cavity
• The nature and diet, the content of fluorine in water
• Quantity and quality of salivation
• General condition of the body

All of the above factors were called cariogenic and divided into general and local, which play a role in the occurrence of caries.

General factors:

1. Inadequate diet and drinking water
2. Somatic diseases, changes in functional state organs and systems during the formation and maturation of tooth tissues
3. Extreme effects on the body
4. Heredity, which determines the usefulness of the structure and chemical composition of tooth tissues. Unfavorable genetic code.

Local factors:

1. Dental plaque and plaque teeming with microorganisms
2. Violation of the composition and properties of the oral fluid, which is an indicator of the state of the body as a whole
3. Carbohydrate sticky food residue in the mouth
4. The resistance of dental tissues, due to the full structure and chemical composition of the hard tissues of the tooth
5. Deviations in biochemical composition hard tissues of the tooth and defective structure of the tissues of the tooth
6. Dental pulp condition
7. The state of the dentoalveolar system during the period of laying, development and eruption of teeth

A cariogenic situation is created when any cariogenic factor or a group of them, acting on a tooth, makes it susceptible to acids. Of course, the trigger is the microflora of the oral cavity with the obligatory presence of carbohydrates and the contact of these two factors with the tissues of the tooth. In conditions of reduced resistance of dental tissues, the cariogenic situation develops easier and faster.

Clinically, in the oral cavity, the cariogenic situation is manifested by the following symptoms:

• Poor oral hygiene
• Abundant plaque and tartar
• The presence of multiple chalky carious spots
• Bleeding gums

Pathogenesis

As a result of the frequent consumption of carbohydrates and insufficient care of the oral cavity, cariogenic microorganisms are tightly fixed on the pellicle, forming plaque.

When eating sticky food, its remnants get stuck in the retention points of the teeth and undergo fermentation and decay. Plaque formation is influenced by:

1. The anatomical structure of the tooth and its relationship with the surrounding tissues
2. Tooth surface structure
3. Diet and intensity of chewing
4. Saliva and gum fluid
5. Oral hygiene
6. The presence of fillings and prostheses in the oral cavity
7. Dento-jaw anomalies

Soft plaque has a porous structure, which allows the penetration of saliva and liquid components of food. Accumulation in the plaque of the end products of vital activity of microorganisms and mineral salts slows down this diffusion, since porosity disappears. And this is already a new substance - dental plaque, which can only be removed by force and even then not completely. Under the dental plaque, organic acids accumulate - lactic, pyruvic, formic, butyric, propionic, etc. The latter are products of the fermentation of sugars by most bacteria during their growth. It is these acids that play the main role in the appearance of a demineralized area on a limited area of ​​​​enamel. Neutralization of these acids does not occur, since there is a limitation of diffusion both into and out of plaque.

Dental plaque contains streptococci, in particular Str.mutans, Str.sanguis, Str.salivarius, which are characterized by anaerobic fermentation. In this process, the substrate for bacteria is mainly carbohydrates, and for individual strains of bacteria, amino acids. The leading role in the occurrence of caries is given to sucrose.

The formation of plaque is affected by the composition of food, its consistency. It has been observed that soft food accelerates its formation as well as the content of large amounts of sugars.

Plaque microorganisms are able to fix, grow on hard tissues of the tooth, metal, plastic and produce heteropolysaccharides containing various carbohydrates - glycans, levans, dextrans, which play an equally important role.

Thus, both local and general factors play an important role in the occurrence of dental caries. The condition of the hard tissues of the teeth, their resistance is of great importance. The interaction of these factors in varying degrees or combinations leads to the appearance of a focus of demineralization.

pathological anatomy

Medium caries is characterized by 3 zones, which are revealed when examining a tooth section in a light microscope:

1. Decay and demineralization zone
2. Zone of transparent and intact dentin
3. Zone of replacement dentin and changes in the pulp of the tooth.

In the first zone, the remains of destroyed dentin and enamel are visible with large quantity microorganisms. Dentinal tubules are dilated and filled with bacteria. Dentinal processes of odontoblasts undergo fatty degeneration. Softening and destruction of dentin occurs more intensively along the enamel-dentin junction, which is clinically determined by the overhanging edges of the enamel, a small inlet into the carious cavity. Under the action of enzymes secreted by microorganisms, the organic matter of demineralized dentin is dissolved.

In the second zone, destruction of the dentinal processes of odontoblasts is observed, where a huge number of microorganisms and decay products are located. Under the action of enzymes secreted by microorganisms, the organic matter of demineralized dentin is dissolved. Along the periphery of the carious cavity, the dentinal tubules expand and deform. Deeper is a layer of compacted transparent dentin - a zone of hypermineralization, in which the dentinal tubules are significantly narrowed and gradually pass into a layer of intact (unchanged) dentin.

In the third zone, corresponding to the focus of the carious lesion, a layer of replacement dentin is formed, which differs from normal healthy dentin by a less oriented arrangement of dentinal tubules.

List of used literature

1. Therapeutic dentistry. E.V. Borovsky, V.S. Ivanov, Yu.M. Maksimovsky, L.N. Maksimovskaya.
2. Medicines in dentistry. L.N. Maksimovskaya, P.I. Roshchina.
3. Treatment and prevention of dental caries. L.M. Lukinykh.
4. Phantom course of therapeutic dentistry. E.A. Magid, N.A. Mukhin.
5. Guide to Dentistry. I.K. Lutskaya, A.S. Artyushkevich.
6. pathological physiology. Edited by A.I. Volozhin, G.V. Poryadin.

is an intermediate stage between superficial and deep caries. Medium caries occurs mainly in young and adulthood, but often affects milk teeth.

From point of view clinical course Distinguish acute and chronic average caries. By localization, the average caries can be cervical, fissure, contact.

it is characterized by three zones, which are revealed when examining a tooth section in a light microscope: 1st - decay and demineralization; 2nd - transparent and intact dentin; 3rd - replacement dentin and changes in the pulp of the tooth.

In the 1st zone– visible remains of destroyed dentin and enamel with a large number of microorganisms. Dentinal tubules are dilated and filled with bacteria.

Dentinal processes of odontoblasts undergo fatty degeneration.

softening and destruction of dentine more intensively occurs along the enamel-dentinal junction, which is clinically determined by the overhanging edges of the enamel, a small inlet into the carious cavity.

Under the action of enzymes secreted by microorganisms, the dissolution of organic matter occurs demineralized dentin.

In the 2nd zone there is a destruction of the dentinal processes of odontoblasts, where there is a huge number of microorganisms and their decay products. Under the action of enzymes secreted by microorganisms, the organic matter of demineralized dentin is dissolved.

Along the periphery of the carious cavity dentinal tubules expand and deform. Deeper is a layer of compacted transparent dentin - a zone of hypermineralization, in which the dentinal tubules are significantly narrowed and gradually pass into the layer of intact (unchanged) dentin.

In the 3rd zone According to the focus of the carious lesion, a layer of replacement dentin is formed, which differs from normal healthy dentin by a less oriented arrangement of dentinal tubules.

In the pulp of the tooth, some changes are also determined, the severity of which depends on the depth of the carious cavity. With caries in the white spot stage and superficial caries, no changes in the neurovascular bundle are detected.

But with an average caries, there are pronounced morphological changes in the nerve fibers and vessels of the pulp.

According to the hearth carious process a layer of replacement dentin is formed, which is characterized by a less oriented arrangement of dentinal tubules.

Causes of medium caries

According to modern ideas, enzymatic fermentation of carbohydrates, carried out with the direct participation of microorganisms, leads to the formation of organic acids that contribute to the demineralization of tooth enamel and the penetration of microbial flora deep into the tooth tissue.

In modern dentistry there is the concept of a “cariogenic situation”, i.e. conditions under which caries develops and progresses faster.

These conditions include poor oral hygiene (the presence of abundant soft plaque and tartar), dental anomalies (crowding, malocclusion, violation of the timing of eruption and change of teeth, etc.), increased bleeding of the gums.

Common factors contributing to the development of dental caries include medical conditions, poor diet, and drinking water(deficiency of calcium, phosphorus, fluorine), etc.

Medium caries develops with the progression of superficial caries and is accompanied by the destruction of the dentin-enamel junction, as a result of which the process passes directly to the dentin.

At the same time, microbial masses penetrate into the dilated dentinal tubules, under the influence of toxins of which the processes of odontoblasts undergo dystrophic and necrotic changes.

The waste products of microorganisms penetrate deep into the tubules, causing the processes of demineralization and softening of the dentin.

characteristic feature medium caries is the formation of a carious cavity (hollow), which has the shape of a cone with the top facing deep into the tooth, and the base - to its surface.

carious cavity made by three zones of dentin: softened dentin with a completely broken structure, transparent (calcified) dentin and replacement (secondary, irregular) dentin, reflecting a compensatory reaction aimed at stabilizing the carious process.

Main symptoms

There are times when the pain is completely absent. Dentists explain this phenomenon by the fact that during medium caries, dentin-enamel compounds, which are the most sensitive area, are destroyed. As well as the formation of replacement dentin, which, in turn, weakens the irritant effect on the tooth pulp.

Among aesthetic violations , we can note the presence of a medium-sized carious cavity, which is filled with softened dentin and food debris.

The bottom of the cavity is located within the middle and peripheral layers of dentin. Also, with an average of caries, an unpleasant odor from the oral cavity appears.

It occurs with abundant carious lesion teeth, because in the carious cavity it collects and rots a large number of leftover food. This symptom is quite rare in medium caries than, for example, in chronic gangrenous pulpitis.

This stage of the disease should not be confused with the superficial and deep caries . It should also be distinguished from chronic apical periodontitis, as median caries may resolve without symptoms. It is important to remember that only an experienced dentist can make a correct diagnosis.

Diagnosis of medium caries

Thermal test with average caries gives a positive result. Electroodontodiagnostics reveals the reaction of the pulp to the current strength of 2-6 μA. When performing radiography of the tooth (radiovisiographic examination), no changes in periodontal tissues are detected.

Differential Diagnosis should be carried out between medium caries and tooth erosion, wedge-shaped defect, deep caries, chronic periodontitis.

Treatment of medium caries

A diseased tooth needs to be reamed, although this causes unpleasant pain, the dentist must perform this procedure. If this is not done, then soon recurrent caries will form around the filling.

And if the tissues affected by caries remain at the bottom of the cavity, then the development of caries is inevitable. Worse yet, it can lead to pulpitis. The opening of the cavity is carried out with the help of a drill, while the boundaries of the enamel that do not have healthy dentin are removed.

There are times when patients complain that before visiting the dentist, they had a small hole, and it was drilled to a very large size.

This is influenced by the patient's state of health, his age, the mineralization of dental tissues, the selected filling material and other factors.

After the formation of the outer contours of the cavity for the filling, the cavity is washed, for this, water, air or an antiseptic is used. When all the preparatory stages are completed, the dentist will proceed directly to filling the teeth. Depending on the choice of filling material, the principles for setting seals will differ, but must strictly comply with the rules for filling teeth.

Forecast and prevention of medium caries

pledge prevention of secondary caries are systematic visits to the dentist, preventive measures(remineralizing therapy, professional hygiene), timely elimination of the initial forms of caries, nutrition correction.

It should be remembered that regular and proper oral hygiene reduces the need for dental treatment by 75-80%.