Treatment of demineralization of teeth. Features of remineralization of teeth at the dentist and at home: gels, pastes and caps for enamel. Low risk

Tooth enamel is a protective shell that covers the anatomical crown of the teeth. Her most takes inorganic matter- hydroxyapatite. In addition to it, the composition includes water and organic substances (in total less than 3-4%). Under influence various factors the structure and composition of the enamel can change - it is demineralized. Enamel demineralization is one of the most common ailments in dental practice. It is accompanied by the appearance dark spots loss of natural shine. Restoration requires enamel remineralization with preliminary sanitation of the oral cavity and brushing of teeth.

Enamel demineralization is a loss mineral components and salt. Most often, it occurs in the absence of proper care for the teeth and oral cavity, as well as, with malnutrition. All important elements- calcium, fluorine, phosphorus and magnesium should be present in food, but in certain moderate doses. Their lack or vice versa, excess content can lead to enamel demineralization.

Consider the process of demineralization from a chemical point of view. The main constituent of enamel and dentin is the mineral hydroxylapatite. It is in equilibrium with the oral fluid (mixed saliva) in a neutral environment. In this case, the oral fluid has an excess of calcium and phosphate ions. Hydroxyapatite is characterized by sensitivity to hydrogen ions under conditions acid environment(at pH<5,5). Когда ионы водорода вступают в связь с фосфатами, происходит нарушение равновесия связей в кристаллах минерала. В результате возникает потеря минералов – деминерализация.

Signs of the disease

The process of loss of mineral components develops gradually. At first, patients may not visually notice problems with the appearance of their teeth. But after a few months, the loss of natural shine becomes clearly visible. The main signs of enamel demineralization include:

• deformation (roughness and porosity) of enamel;
• the appearance of white spots or stripes;
• darkening of spots to a brownish tint.

The main causes of the disease

Demineralization of tooth enamel occurs as a result of a violation (decrease) of the acid-base balance. This is facilitated by the remains of carbohydrate products and carious bacteria, which lead to the destruction of enamel. The reproduction of pathogenic bacteria induces a decrease in acidity in the oral cavity, which leads to the loss of hydroxyapatite crystals. At the same time, there are a number of other factors that provoke the appearance of such an ailment. These include:

• lack of compliance with due;
• serious pathologies of the thyroid gland;
• unbalanced diet (abuse of fast carbohydrates);
• bite pathologies (for example, crowded localization of teeth, which complicates their cleaning);
• abuse of tobacco and alcohol products;
• the presence of chronic diseases;
• deviations from the endocrine system (hormonal failure, diabetes mellitus);
• incorrectly installed structures (bracket systems);
• inflammation of the gums ();
• violation of the secretion of the salivary glands (insufficient salivation).

Anna Losyakova

Dentist-orthodontist

Important! The risk group includes young children, as well as people who abuse confectionery and carbonated drinks.

Methods to detect the disease

As a rule, it is not difficult for a dentist to diagnose a disease. To do this, he uses different diagnostic methods. Below is a table with the most common and reliable ways to detect pathology.

Method name	Description of the technique
visual inspection	The specialist conducts a thorough examination using a dental mirror and probe. According to the characteristic features (white spots, loss of gloss, surface roughness, strong pigmentation), he can make a diagnosis at an advanced stage of the disease.
Vital staining	This is one of the simplest and most popular methods for determining enamel demineralization. The tooth surface is cleaned with cotton wool soaked in 3% hydrogen peroxide, dried and a new cotton wool soaked in 2% methylene blue solution is applied. If, after a few minutes of removing the indicator, the area turns out to be colored, a diagnosis of demineralization is made. The color may be pale blue or deep blue (depending on the degree of damage).
Laser research	This method is rarely used due to the high cost of the apparatus used. Under the influence of a laser, damaged enamel reflects waves of a certain length, while the device signals with a sound.
Examination with ultraviolet light	With the help of a special apparatus, the doctor exposes the teeth to an ultraviolet beam. At the same time, the damaged area glows with a dark light, while healthy enamel has a blue tint.

Focal damage

The initial degree of development (demineralization) is a focal lesion. A lesion of this nature is characterized by the appearance of spots, both on the chewing surface and in the cervical zone. In most cases, 1 or 2 teeth are affected at the same time. The defeat of a focal nature is especially characteristic of children at an early age (8-12 years). This is due to poor oral hygiene and excessive consumption of unhealthy foods.

How is professional help provided?

When the first symptoms of the disease appear (disappearance of shine, formation of spots), it is recommended to immediately seek help from a dentist. Coping with the disease in the early stages is not difficult.

When enamel is destroyed, doctors often prescribe a procedure such as mineralization. With its help, the enamel is enriched with useful substances - fluorine, magnesium, phosphorus and calcium. The ions of these substances enter the deep layers of the tooth, against which the enamel becomes a powerful barrier to various pathogens. Mineralization of tooth enamel is carried out not only to restore the enamel, but also to prevent its further weakening. At the same time, it provides a number of other useful properties:

• significantly improves the aesthetic appearance of the teeth;
• brightens the enamel, restoring shine to the teeth;
• eliminates hypersensitivity to temperature changes;
• normalizes the state of microflora;
• helps to prevent and get rid of caries in the initial stages.

Before the implementation of mineralization, preparation is required: for this, the dentist conducts professional sanitation of the oral cavity and brushes the teeth. After these procedures, they proceed directly to the mineralization itself. Among the drugs used for enamel remineralization, there are two main groups - fluorine-containing agents and fluorine-free agents. The first group consists of varnishes, gels and toothpastes, which are characterized by a high fluorine content. The second group includes gels and toothpastes, which are characterized by a high content of active calcium compounds. Among the most popular and effective remedies, dentists single out Elmex and ApaCare.

How to reduce demineralization?

Insufficient enamel mineralization is one of the main factors contributing to the occurrence of caries. To restore enamel without the help of specialists, it is important to follow a diet, eat fast carbohydrates correctly and do not forget about the rules of hygiene. Since calcium and fluorine are in short supply, you should add to the diet those foods in which they are in excess. These include: meat, dairy products, eggs, fresh vegetables and legumes.

Before the main meals, it is recommended to avoid sweet snacks, do not eat confectionery before bedtime, completely eliminate sticky sweets (for example, toffee) from the diet. After each meal, you should use a rinse and, and brush your teeth strictly 2 times a day - in the morning and in the evening. As practice shows, in most patients, with proper oral hygiene and proper nutrition, the destruction of enamel stops in a short time, the enamel is restored naturally.

Prevention

Mineral deficiency leads to the formation of caries and subsequent complications (up to tooth loss). To avoid this, it is important to cope with the disease in a timely manner, stopping the appearance of a carious cavity. As a prophylaxis, it is recommended to use preparations for remineralization of teeth at home (for example, R.O.C.S. gel). Also, it is necessary to adhere to proper nutrition and daily oral hygiene (using not only toothpaste, but also floss). At least once a year, you should drink multivitamin complexes and undergo an examination by a dentist (even if nothing bothers you).

Conclusion

The loss of mineral components and enamel salts is a common problem that can occur in people of all ages. It leads to the development of carious disease. To diagnose the disease, it is recommended to seek advice at the first sign. Restoration requires remineralization of tooth enamel, which will avoid negative consequences. To avoid recurrence, it is important to maintain oral hygiene and eat right.

(white carious spot, the initial stage of caries) is one of the earliest clinically diagnosed stages of dental caries. In the clinic, it manifests itself in the form of dull grayish-white spots with fuzzy borders, a dull shade, usually located in the area of ​​​​the neck of the tooth, the chewing surface of fissures. The size of the stain can vary from barely visible to occupying half the area of ​​the tooth surface.

The pathomorphological picture of focal demineralization consists in a partial loss of the enamel mineral phase in the center of the stain, mainly in its surface layer. First of all, calcium salts are lost, which leads to a change in the color of the enamel, an increase in permeability and electrical conductivity in the lesion. The protein matrix of enamel at this stage of the disease is not changed, and this is the key to the reversibility of the process. The surrounding enamel is not broken. Changes in permeability are manifested in the ability of the demineralization focus to be stained with dyes. This property is used as a diagnostic and differential diagnostic sign of focal enamel demineralization with hypoplasia and fluorosis. For diagnosis, a cotton swab with a 3% solution of methylene blue is applied to the surface of the enamel. After 5 minutes, the swab is removed and the dye is washed off. If the stain retains its color, this indicates focal demineralization of the enamel. The higher the degree of coloration of the stain, the more active the violation of permeability is observed in the tooth (Borovsky-Aksamit test). Focal demineralization can also be diagnosed by an increase in electrical conductivity.

Clinical observations show that the larger the spot size, the higher its permeability, the more actively focal enamel demineralization flows. With a far advanced process, there is a violation of the pattern of perikymatia on the surface of the enamel, indicating a superficial focal demineralization.

There are 3 clinical outcomes of focal demineralization. In about 20-40% of cases, an increase in focal demineralization is observed and superficial caries develops in its place. In 20-30% there is a spontaneous reverse development of demineralization and the disappearance of the spot. In other cases, the development of focal demineralization is suspended indefinitely.

The accumulated experience has shown that focal enamel demineralization is most common in children. In various regions of the country, it is observed in 15-40% of children, the largest at the age of 9-11 years, when a child has an average of 1 to 20 foci. The presence of focal enamel demineralization is an accurate criterion for the active course of caries and requires active preventive and therapeutic measures. In this case, the leading method is remineralizing therapy.

Since focal enamel demineralization is the only reversible stage of caries, the doctor must do everything possible to preserve an intact tooth and reverse the development of the disease. Applications of fluorides, remodent, calcium gluconate, etc. are used for treatment. The positive dynamics of focal enamel demineralization is an early and significant sign of the success of preventive measures, therefore, during their implementation, control over the dynamics of focal enamel demineralization is of great importance.

Focal enamel demineralization - a white spot - is the first visible manifestation of the initial carious lesion and can serve as a prognostic test (Borovsky E.V., 2002). Thus, the presence of a large number of chalk spots in one examined person can serve as a marker of the active course of dental caries and indicate a pronounced cariogenic situation in the oral cavity (Saifullina Kh. M., 2000).

Therefore, for the prevention of caries, determining its activity, to characterize the effectiveness of the impact of preventive measures, it is important to take into account the number of carious (chalky) spots, it can be done according to the same principle as determining the KPU index. At the same time, its peculiarity is the possibility of dynamics in two directions, in contrast to the KPU index. Accounting for the amount of focal demineralization, and especially the dynamics, is extremely important and useful in any study to determine the effectiveness of prophylactic agents, to determine the negative effects on enamel, to determine the effect of hygiene products, etc. The main advantage of this test is the ability to obtain the necessary information in an extremely short time - 1-3-6 months, especially if a number of stain indicators are determined - the absorption of dyes, the degree of de- and subsequent remineralization, size, shape, etc.

The purpose of the study was to determine the effectiveness of the use of course remineralizing therapy with calcium phosphate adhesive gel "RoxMedical" in the complex prevention and treatment of focal demineralization in adolescent children.

Materials and methods of research

Under our supervision there were 115 children aged 12-13 years (of which 67 girls and 48 boys), 62% of whom had signs of initial caries during the initial examination, which indicated a pronounced cariogenic situation in the oral cavity of adolescents of puberty.

Preventive and hygienic measures taken by schoolchildren included the following methods: conversations with adolescents and their parents about rational nutrition, the rules of hygienic oral care, controlled brushing of teeth with individual recommendations for the selection of hygiene products, as well as the appointment of course remineralizing therapy with calcium phosphate adhesive gel " Rox Medical” with 25 sessions. Applications were carried out by schoolchildren at home using disposable caps and gel unidose (Fig. 1).

Rice. 1. Disposable mouthguard.

To diagnose caries in the stain stage, we used the following methods.

The method of vital staining was carried out by us using "Color-test No. 2" (manufacturer: CJSC "VladMiVa", Belgorod) - a solution for detecting caries in the initial stage during a preventive examination of the oral cavity. The technique is based on the ability of a diagnostic solution, which includes fuchsin and a base, to stain the site of damage to tooth enamel in red-violet color. The evaluation of the results was carried out by us visually, since the places of damage to the enamel, painted in red-violet color, were clearly distinguished. The vital staining method is an affordable and economical way to diagnose initial caries, although it is not without drawbacks. So, the technique does not allow to objectively assess the degree of demineralization of the initial forms of caries: large dye molecules cannot penetrate the entire depth of the lesion (K. A. Ashirov, 1999).

The accuracy of this method is limited: it is based on the subjective assessment of the color range by the researcher, in addition, it is difficult to use it in the area of ​​fissures and contact surfaces, especially on permanent teeth with incomplete enamel mineralization. Therefore, for a detailed and objective diagnosis of initial caries in the area of ​​fissures and contact surfaces, we used the method of laser fluorescence.

Laser fluorescence is one of the most sensitive modern methods for detecting areas of carious lesions and assessing the volume of tissue demineralization. Laser fluorescence is an objective non-invasive method that consists in transilluminating the tooth surface with an argon laser. The laser diode creates pulsed light waves of a certain length, which fall on the surface of the tooth and are reflected, since the tissues of the tooth have optical properties. This reflection of light is perceived by special photocells.

Demineralization causes a change in the optical properties of tooth tissues, and they fluoresce with light waves of a different wavelength. The length of the reflected waves is analyzed by the corresponding instrument electronics and converted into digital values ​​and an acoustic signal. The method of working with the Diagnodent device (KaVo, Germany) is very simple and consists in the following: the tooth surface is cleaned of dental deposits, dried, then the examined area of ​​the tooth tissues is illuminated with the help of a sensor, and after a few seconds, the research data appears on the digital display in the form digital indicators. The shape of the sensor is made in the form of a dental probe, which allows you to explore the entire relief of the tooth surface. The degree of focal demineralization is reflected by the numerical values ​​of the Diagnodent apparatus, which vary depending on the depth of damage to the hard tissues of the tooth. According to A. Lussi (1995), the numerical values ​​of the scale from 0 to 14 correspond to the normal structure of the enamel (including hypomineralized areas), from 15 to 25 - caries within the enamel, and indicators 21-90 - caries within the dentin.

According to prof. Reich (Univ. Hamburg), figures from 5 to 25 correspond to carious lesions of the enamel, 25-35 - half the thickness of the dentin, from 35 - deeper damage to the dentin. According to Russian authors O. A. Krasnoslobodtseva and L. Yu. Orekhova (2000), the indicators for caries in the spot stage corresponded to 9.0 + 2.0; superficial caries - 15.0+3.0; average caries - 50.0+30.0. The difference in digital indicators characterizing the state of the tissues of the tooth, according to different authors, is explained by the different degree of initial mineral maturity of the diagnosed teeth (Kidd E.A., Beighton D., Zoitopoulos L., 2001).

Research results

According to the results of our study, the typical localizations of focal demineralization in all adolescents examined by us were the following: cervical areas, blind pits and approximate surfaces of the upper incisors (34.5%); cervical areas, blind pits of the molars of the lower jaw (20.5%); approximal surfaces of the mandibular incisors (15.7%); fissures and approximal surfaces of the upper premolars (11.8%), as well as other localizations (17.5%). We associate such characteristic areas of the appearance of chalk spots with insufficient hygienic cleaning of these areas against the background of a lower level of their initial physiological mineral maturity in comparison with other surfaces of the same teeth. At the time of the initial examination, according to the "Diagnodent" apparatus, the average index of focal demineralization of the initial carious lesion in adolescents was 11.82+0.08 on average.

Initially, the state of areas of focal demineralization depended on the degree of activity of the carious process. Thus, the general trend characteristic of adolescents was the presence of the greatest number of chalk spots in children with sub- and decompensated forms of the carious process (2.2 and 4.03 per one examined, respectively), they also observed a more pronounced degree of demineralization of chalk spots (12.9 + 0.07 and 14.9 + 0.08, respectively) in comparison with the same indicators in children with compensated caries (0.48 per one examined, the degree of demineralization - 7.56 + 0.04) (Table No. 1).

Table number 1.

During the observation period, in the adolescents studied by us, against the background of applications of the remineralizing gel, only 5 cases of progression of initial caries were observed and 2 chalk spots that appeared for the first time were identified. The results of our observation of the dynamics of changes in foci of demineralization demonstrate the high efficiency of calcium phosphate gel applications on the tooth enamel of adolescents, since 77% of chalk spots underwent remineralization and/or reverse development.

conclusions

1. A large number of foci of demineralization, identified by us during the initial examination of schoolchildren aged 12-13, indicates a cariogenic situation in the oral cavity in adolescents, which is associated both with a low level of hygienic care for "hypomineralized" teeth, and with the influence of physiological hormonal changes, observed during the period of intensive growth and puberty.
2. Typical localizations of chalk spots are typical for areas of accumulation of plaque and hypomineralized areas of teeth in the early stages after their eruption.
3. In children with sub- and decompensated course of dental caries, the number and degree of focal demineralization per one examined is significant (p<0,05) выше, чем в группе с единичными кариозными поражениями.
4. The absence of reverse development and / or remineralization of chalk spots, as well as the appearance of new foci of demineralization, is most characteristic of adolescents with a decompensated course of the carious process.
5. The use of adhesive calcium-phosphate remineralizing gel "Rocks Medical" for 25 sessions contributed to a decrease in the number of chalky spots by 2.8 times, and the degree of enamel remineralization increased by 53.3% compared to baseline.

Literature

1. Bulanova E. A. The mechanism and effectiveness of the treatment of initial dental caries in children: Abstract. dis. …cand. honey. sciences: 14.00.21 / Omsk state. honey. acad. - Omsk, 1992. - 21 p.
2. Kobiyasova I. V. An integrated approach to the prevention and treatment of dental caries in adolescents during puberty: Abstract. dis. …cand. honey. Sciences: 14.00.21. / St. Petersburg State Medical University im. acad. I. P. Pavlova. - St. Petersburg, 2004. - 18 p.
3. Krasnoslobodtseva O. A., Orekhova L. Yu. "Diagnodent" experience of clinical application // New in dentistry. - 2000. - No. 1. - S. 23-25.
4. Kuzmina I. N. Prevention of early forms of caries during the eruption of permanent teeth in children: Abstract. dis. … cand. honey. Sciences: 14.00.21 / Moscow. honey. stomatol. in-t im. N. A. Semashko. - M., 1996. - 28 p.

A complete bibliography is in the editorial.

Conversations about rational nutrition, the rules of hygienic care of the oral cavity, controlled brushing of teeth with individual recommendations for the selection of hygiene products, as well as the appointment of course remineralizing therapy with calcium phosphate adhesive gel "Rocks Medical" in the amount of 25 sessions. Applications are carried out at home using disposable caps and unidose gel.

The method of vital staining using the "Color-test No. 2 - a solution for detecting caries in the initial stage during a preventive examination of the oral cavity.

Laser fluorescence is one of the most sensitive modern methods for detecting areas of carious lesions and assessing the volume of tissue demineralization. Laser fluorescence is an objective non-invasive method, which consists in transilluminating the tooth surface with an argon laser. The degree of focal demineralization is reflected by the digital values ​​of the Diagnodent apparatus, which vary depending on the depth of damage to the hard tissues of the tooth.

Remineralizing therapy This is one of the promising areas for the prevention of dental caries. It is aimed at creating conditions for the full formation and mineralization of hard tissues of teeth to prevent or eliminate a cariogenic situation Before orthodontic treatment, during and after its completion.

According to the level of exposure and the methods used, remineralizing therapy can be:

General - oral administration of drugs;

Local - direct impact on the hard tissues of the tooth: rinses, applications of remineralizing agents on the hard tissues of the teeth, electrophoresis of remineralizing preparations.

General remineralizing therapy implies taking fluoride tablets, which reduce the growth of caries by 20-30%. Sodium fluoride tablets are effective during the development and maturation of dental tissues, so they must be given before and after teething. The dose of sodium fluoride is as follows: 0.25 mg - up to 2 years, 0.5 mg - from 2 to 4 and 1 mg - from 5 years. Tablets are prescribed daily until the age of 14-15. Contraindications to the appointment of tablets: a) the content of fluorine in the environment is more than 50% of the optimal; b) any other ways of taking fluoride orally.

The products intended for local remineralizing therapy include fluorine-, phosphate and calcium-containing solutions, varnishes, gels, films, toothpastes and discs. The introduction of elements directly into the hard tissues of the tooth has become quite widespread among the methods of preventing dental caries.

For remineralizing therapy, the following preparations containing calcium, phosphates, and other trace elements are used:

1. 10% calcium gluconate solution,

2. 5 - 10% solution of acidified calcium phosphate,

3. 2.5 - 10% solution of calcium glycerophosphate,

4. 5 - 10% calcium lactate solution,

5. 3% remodent solution (water),

6. calcium phosphate containing gels.

E.V. Borovsky and P.A. Leus proposed a method for the prevention and treatment of the initial manifestations of dental caries by using calcium gluconate and sodium fluoride. Before a prophylaxis session, patients brush their teeth for 2-3 minutes with a hygienic paste. Next, the teeth are lined with cotton swabs moistened with a 10% solution of calcium gluconate. The application lasts 3 - 5 minutes. Upon completion of the application of gluconate, the second stage of the procedure is carried out: the teeth are covered with rollers moistened with a 2% solution of sodium fluoride for 1-2 minutes. The course recommends three procedures every other day. After 5 - 6 months, a second series.

Methodology T.F. Vinogradova:

a) application of 10% calcium gluconate solution for 2-4 minutes;

b) oral bath or rinsing with 0.05 - 0.2% sodium fluoride solution for 1 - 2 minutes or coating teeth with fluorine varnish.

Method Leus P.A. ( 1997):

a) electrophoresis with 10% calcium gluconate solution 3 - 5 min;

b) application with 2% sodium fluoride solution 1 - 2 min. Course: 3 times a week.

The composition of the drug includes:

Calcium - 4.4%; phosphorus - 1.4%,

Magnesium - 0.15%; potassium - 0.20%,

Sodium - 16.0%; chlorine - 30.0%,

Organic matter - 44.0%,

Trace elements - up to 100%.

"Remodent" is used in the form of rinses, applications (3% solution) and in the form of brushing teeth with a paste containing 3% of "Remodent" by weight.

Before application, the teeth are cleaned with a hygienic paste, then tampons moistened with the Remodent solution are applied for 15-20 minutes. 3-5 procedures are recommended per year. After them, it is not recommended to eat and brush your teeth for 2 hours. For rinsing for 3-5 minutes, 10 ml of a 3% solution is used.

The effectiveness of the preventive action reaches 50%. The most pronounced caries-prophylactic effect on chewing surfaces.

57 The concept of planned sanitation of the oral cavity. The value of sanitation of the oral cavity in the improvement of children. Organizational forms and methods of sanitation.

Sanitation of the oral cavity- a set of measures to improve the oral cavity. It includes the treatment of caries and the elimination of defects in tooth tissues of a non-carious nature by filling, the removal of tartar, the treatment of periodontal diseases, the removal of decayed teeth and roots that are not subject to conservative treatment, orthodontic and orthopedic treatment.

There are three types of oral hygiene:
▲ individual, or sanitation of the oral cavity by negotiability, provides for the cure of all diseases of the oral cavity in persons who independently applied to a dental institution;
▲ one-time or occasional, - complete cure of all diseases of the oral cavity in limited contingents of the population;
▲ planned, or treatment-and-prophylactic, - the systematic cure of dental diseases in organized groups of the population who are on dispensary care.
Distinguish between centralized and decentralized methods of sanitation.
At centralized method examinations and sanitation of the oral cavity are carried out in medical institutions (district, city or regional clinics).
At decentralized method examinations and sanitation are carried out in treatment rooms established at enterprises or schools. In educational institutions (schools, vocational schools) with 800-1200 students or more, stationary dental offices are being created. Each school is assigned to a specific dentist.

Sanitation of the oral cavity in children

Particular attention is paid to the health of children's teeth. Their mineralization is not yet complete and they are more vulnerable to various aggressive influences. Therefore, children should undergo preventive examinations more often than adults - up to 4 times a year. The frequency of visits to the dentist depends on the individual predisposition of the child and the progression of carious processes.

Dental care for children and adolescents is organized in close cooperation with the administration of schools and preschool institutions. From the age of 3, babies are annually examined by a doctor. The planned rehabilitation of schoolchildren includes the treatment of children in grades 1, 5, 9 and 11.

Sanitized children are those in whom all milk and permanent teeth affected by caries are cured, roots that cannot be restored are removed, and all inflammatory processes in the oral cavity are eliminated.

The concept of objects and means of oral hygiene. Basic and additional items of oral hygiene, the requirements for them.

questions 53 and 55

59 The concept of primary, secondary and tertiary prevention in dentistry.

Prevention- this is a system of social, medical, hygienic, educational measures aimed at preventing diseases by eliminating the causes and conditions for their occurrence and development, as well as increasing the body's resistance to the effects of adverse environmental factors, natural, industrial and domestic environments that can cause pathological changes .

Primary prevention is a complex of state, social and medical measures aimed at preventing the occurrence of dental diseases.

It provides for the improvement of the oral cavity as a result of:

1) health education of the population on oral hygiene;

2) development of nutrition programs aimed at improving the condition and diet;

3) periodic examination of the oral cavity by a doctor to prevent diseases.

The main role of dental personnel at this level is reduced to health education, training of medical workers and the population in prevention methods, and monitoring the effectiveness of preventive measures.

Key elements of primary prevention are:

1. Water fluoridation (at its low content).
2. Rational and balanced nutrition with the optimal content of proteins, fats, carbohydrates and minerals (calcium, fluorine, phosphorus), vitamins. Trace elements are of great importance for the body, due to their active participation in many metabolic processes.
3. Proper care of the teeth and oral cavity with good nutrition and a healthy lifestyle is the most important part of the dental disease prevention program.

High efficiency of caries reduction is observed when Teaching children one-on-one how to brush their teeth and selection of hygiene products (toothbrushes, pastes).

Secondary prevention provides for therapeutic intervention at early signs and symptoms of the disease in order to prevent its development. The tasks of secondary prevention are health education on oral hygiene regarding the removal of dental plaque, the application of fluorine preparations and remineralizing agents in primary carious lesions of the teeth, as well as the identification and elimination of the causes of plaque accumulation, including tartar. This includes the planned treatment of dental caries and periodontal diseases in the early stages of diseases. Tertiary prevention includes the treatment of advanced diseases aimed at preventing their progression, preventing complications and consequences, restoring the lost function of the dentition as a result of tooth loss using prostheses and other means.

60. Therapeutic and prophylactic toothpastes and gels. Classification, composition. Indications for use.

Toothpastes are a complex system, in the formation of which abrasive, moisturizing, binders, foaming, surfactant components, preservatives, flavoring agents, water and therapeutic and prophylactic elements participate.

Toothpaste consists of: an abrasive, a moisturizing agent, flavoring agents, a binder, medicinal additives, surfactants and preservatives.

Therapeutic and prophylactic toothpastes, in addition to known components, include active additives with therapeutic and prophylactic properties. Depending on the active components included in their formulation, therapeutic and prophylactic pastes divided into 8 classes:

3. Salt

7. Decreasing enamel sensitivity (K, Sn)

8. Whitening (peroxide compounds)

I. To modern toothpastes, containing herbal supplements (I class, I subclass) include: "Premier" (tea tree oil) "Periodontol" (nettle, yarrow) "Phytodent" (a set of herbs) "Zodiac" (sea buckthorn) "Extra" (chlorophyll, carotene) "Spirulena" (algae) "Forest" (chlorophyll ) "Chamomile" (chamomile infusion) "Rosodont" (rose oil) "Chlorophyll" "Maraslavin" (a set of herbs).

To toothpastes containing vitamins (class I, subclass II) include: "Aronal" (vitamin A) "Silka" (vitamins E, C, nicotinic acid) "Terra" (retinol) "Arlekino" (panthenol) "Forest" (vitamins C, D)

These pastes have a pronounced anti-inflammatory effect, eliminate bad breath, reduce gum bleeding, improve metabolism in the oral mucosa and stimulate the regeneration process.

II. Class II toothpastes (containing antibacterial agents) are also subdivided into subclasses depending on the incoming antiseptics. To second-class pastas, containing triclosan(I subclass) include: "Blendamed complete" "Colgate total" "Antiplaque" "Gingilacer" "Periodontil"

Pastes of the second class (II subclass), containing chlorhexidine: Borzolino Chlorhexidine Lacer Hexodent Forte Helos Super Elgidium Lakalut Active

These pastes act mainly on soft plaque and plaque, which are the initiating phase of dental caries and periodontal disease.

III. Salt toothpastes (Class III), containing various salts and mineral components, as well as a set of microelements, antiseptics, have a beneficial effect on periodontal tissues, improve blood circulation, activate metabolic processes in the soft tissues of the oral cavity. Salts, which are part of the pastes, prevent the formation of plaque by dissolving mucus. Salt toothpastes include domestic "Balsam", "Marine", "Jubilee", "Pearl", as well as foreign-made pastes: "Blendamed" (bicarbonate soda) "Colgate" (bicarbonate soda) "Natural tea free" (sodium chloride) Zephyr (mineral waters) Azure (Bulgarian mineral waters) Safari (sodium bicarbonate) Pomorin (Pomeranian brine) Balsam (Bulgarian mineral waters)

IV. Fluoride toothpastes(Class IV) are widely used for local prevention of dental caries. The following are introduced into the composition of these pastes: sodium fluoride, tin fluoride, monofluorophosphate, zirconium fluoride, etc. The most effective anti-caries concentrations of fluorine are in the range of 1-2%. The active anti-carious effect of fluorine is especially manifested during the period of maturation of the hard tissues of the teeth after their eruption. Among the pastes containing NaF in their basis, the most justified use is: "Oral Bi" "Colgate Junior" "Flavor Fluoride" "Colgate Total" "Blendamed Complet". Containing monofluorophosphate: "Biodent" "Colgate Junior Super Star" "Pomorin Fluorine" "Fluoxytil" Containing NaF and MFF: "Aquafresh" "Borzolino" "Colgate". Domestic fluoride-containing toothpastes: "Ftorodent" "Cheburashka" "Pearls with fluorine". Topically applied fluorides increase enamel resistance by forming a strong surface layer structure. Gel toothpastes are especially effective in this regard.

V. Toothpastes containing mineralizing preparations (Class V). This group includes pastes containing calcium and phosphate salts. Phosphates and calcium actively penetrate from the pastes into the tissues of the tooth, strengthening the crystal lattice of the enamel. Unlike fluorides, the predominant phosphorus-calcium compounds are quite effective not only during the maturation of teeth, but also in later age periods. The anti-caries effect reaches 40% reduction in the growth1 of dental caries. The most common pastes of this class in the retail network are: Aquafresh (Ca - glycerophosphate) Fluoxytil (Ca - glycerophosphate) Pearl (Ca - glycerophosphate) Colgate - protector (dicalcium phosphate) Oral - bi (hydroxyapatite) Paradontol (hydroxyapatite) Garant (hydroxyapatite, dicalcium phosphate) Forest (phosphates) Safari (eggshell) Phosphodent (phosphates, NaF) Remodent (remodent, trace elements) IV. Toothpastes with increased cleansing action (Class IV) include, first of all, pastes, which include enzymes: "White - pink", "Special", "Phosphatase", "Transparent", "Crystal", "Smile". As active cleansing components, these pastes include pancreatin, lysozyme, ribonuclease, tween - 40, polyvinylpyrrolidone, nettle leaf infusion, etc. The pastes actively contribute to the removal of soft dental deposits, have a pronounced therapeutic and prophylactic effect on periodontal tissues, by cleaning the surface of the teeth provide the best conditions for the physiological processes of enamel remineralization, providing a certain degree of anti-caries effect. The arsenal of modern pastes of this class includes: "Bioten" (lysozyme) "Pepsodent" (pepsin) "Protodent" (proteolytic enzymes) "Firsch" (lactoperoxidase) "Enchantress" "White-pink" (pancreatin).

VII. Class VII toothpastes - desensitizing hard tissues of teeth- in their composition contain ions K and Sn, providing this therapeutic effect. This class includes: "Protect" (potassium nitrate) "Dentsiblen" (potassium nitrate) "Oral-bi sensitive" (potassium nitrate) "Sensodyne" (KS1) "Sensogel" "Sensodyne classic"

VIII. Whitening toothpastes (Grade VIII) carry out their therapeutic and prophylactic effect by including peroxide compounds or active abrasive substances in the composition: "Localut White" "Colgate soda peroxide" "Aquafresh whiting" (peroxides)

The industry produces a large group of so-called "special" toothpastes. This group primarily includes children's toothpastes. They are distinguished by excellent taste and deodorizing qualities, as well as low abrasiveness, which is important for thin, “ripening” tooth enamel. The most popular representatives of this group of toothpastes (for children) are: Blendy, Colgate Junior, Elmex, Lokalut (Blue Bear) »

Focal demineralization is the primary destruction of tooth enamel at the initial stage of caries. If treatment is started at this stage, then it will be possible to stop the destruction of the surface of the teeth and the spread of the infectious process beyond the limits of hard tissues - into the pulp and neurovascular formations.

Tooth enamel consists of minerals that are constantly renewed, maintaining the hardness and beauty of the teeth. With the demineralization of tooth enamel, the mineral components disappear, which negatively affects its condition. Weakened teeth decay quickly. Pronounced carious defects appear on their surface, and the pulp can subsequently become inflamed.

Why does enamel demineralization occur?

Demineralization of tooth enamel occurs when the pH of the tooth surface drops to 4-4.5 with frequent consumption of sugars and foods containing simple carbohydrates (sweets, chocolate, sugary drinks). At the same time, a critical pH value remains under the plaque for a long time, which leads to the active release of acids that corrode the enamel of the teeth.

When visiting a dentist, demineralization is detected, especially in the cervical part. After drying the enamel with an air jet and examining it using special tools, the doctor notices pretty areas. After removing the plaque, you can see places with tarnished enamel or pigmented spots with a rough surface. This indicates a decrease in valuable minerals in the surface layer of enamel.

The most quickly damaged areas are hard to reach for cleaning with a toothbrush - the cervical region, at the junction of the gums and the crown of the tooth. Here, cariogenic microorganisms actively multiply in humid conditions, releasing harmful waste products. Demineralized teeth become sensitive to thermal, chemical irritants. They lose their characteristic luster, look lifeless, and if no measures are taken to restore damaged and porous enamel, a pronounced carious process may appear.

French Dental Clinic is open for you! We treat caries, restore demineralized enamel using modern methods and preparations enriched with calcium and fluorine. Here they help adults and children to keep beautiful smiles, strong teeth and good mood. The clinic is equipped with the most modern equipment, so any dental intervention takes place in the most comfortable conditions, without pain and fear.

Healthy teeth and good health

FDC will be a pleasant find for you and your family on the way to impeccable aesthetics and good health.

Related Articles

Chronic recurrent aphthous stomatitis

Chronic recurrent aphthous stomatitis(HRAS) is a chronic inflammatory disease of the oral cavity, with a high probability of recurrence and recurrent rash of ulcers and aphthae. It manifests itself in adults and children over 4 years of age and is characterized by a long course and recurrent exacerbations.

Distal bite

Correction of distal occlusion in children and adults. Treatment of all stages of the disease. Modern techniques: trainers and caps. Fast result. Clinic of French dentistry in Moscow. French specialists, Russian hospitality and European technologies.

Ulcerative necrotic stomatitis

Treatment of ulcerative necrotic stomatitis in children and adults, elimination of all symptoms and causes of the disease, an integrated approach. Modern French technologies and means of treatment. Fast results, no relapses

Mesial occlusion

Treatment and correction of underbite in children and adults in the clinic of French dentistry in Moscow. Experienced specialists from France, modern technologies and Russian hospitality. We take on the most difficult cases.

Candidal stomatitis

Treatment of all types of candidal stomatitis in children and adults using modern French technologies. Relief comes after the first visit to the dentist. No discomfort or pain during and after treatment.

Cervical caries

If you notice blackening near the neck of the tooth (near the gum itself), a chalky spot, or just darkening, then most likely you have cervical caries. Cervical caries is an unpleasant variety of this disease.

Deep bite

Treatment of gingivitis of all forms and types. Clinic of French dentistry in Moscow. Professional approach, quick cure, no side effects, increased comfort and coziness, friendly attitude towards patients.

Retention (dystopia)

Treatment of retention and dystopia of teeth, including wisdom teeth, canines and incisors. Clinic of French dentistry in Moscow. We will take care of the health and strength of your teeth, the beauty and charm of your smile.

Oral diseases - how do they affect health?

Dental disorders lead not only to inflammation of the tissues located in the mouth, but can also provoke the spread of the infectious process to neighboring organs, causing diseases of the upper respiratory tract and even the brain.

Common gum disease

Basically, people go to the dental clinic only when they have obvious problems with their teeth, be it caries, pulpitis, or much more serious problems. Coming to the clinic with a toothache, patients often forget about their gums, which should never be done.

Why are the gums inflamed and bleeding?

Teeth started to darken, what is the reason?

White, beautiful teeth are the hallmark of a successful person. Therefore, if the teeth begin to lose their whiteness, it upsets and upsets. There is an internal discomfort that can interfere with business negotiations, successful career development can be jeopardized.

TOP dental diseases

Today, every person dreams of having good and healthy teeth and a beautiful smile. Now dentists are treated only with severe toothache or in the presence of caries.

Causes of dental plaque

If you do not pay due attention to your teeth, then over time you can notice a plaque that has appeared on the enamel, which not only thoroughly spoils the appearance of the teeth, but also has an extremely unpleasant odor. In fact, plaque does not pose a threat to the teeth, just makes them unsightly.

Problems such as too high tooth sensitivity, pain when drinking hot and cold drinks are inherent in half of the earth's population. In this case, even cool air and daily oral hygiene (brushing your teeth) can become a source of sharp pain.

Dental fluorosis: description and causes of the disease.

Each disease of the tooth is reflected not only in its appearance, but also in the functionality and general well-being of its owner. It is important to consult a specialist on time, at the first signs of the disease, so that the treatment is simple and effective. Fluorosis is a dental disease that occurs as a result of an excessive amount of fluoride in the body.

White plaque on the teeth is a hidden enemy of your health

Plaque on the teeth can be attributed to one of the most common dental problems. Plaque is soft deposits on tooth enamel that are difficult to notice without specialized equipment. It may seem to many that these deposits are not capable of harming our teeth and are in the nature of an exclusively aesthetic problem. Professional dentists say this misconception can lead to serious oral problems.

All about yellow plaque on the teeth and how to deal with it

Even those who brush their teeth thoroughly every day are not immune from the appearance of yellow plaque. Over the years, our body produces "secondary dentin", which stains the teeth.

Green plaque on the teeth: why does it appear and how to deal with it?

Plaque creates an increased cariogenic environment in the oral cavity - if it is not removed in a timely manner, the risk of tooth decay and the development of a pronounced inflammatory process increases. Most often, the cause of the appearance of green plaque on tooth enamel is a chromogenic fungus that occurs on milk teeth in children or adolescents (with hormonal failure).

Dental plaque: how and why does it form?

It only takes a few weeks to neglect your teeth and traditional hygiene procedures, as your teeth will be covered with a brown dense coating, which can only be removed with the help of dentists. Therefore, never start the oral condition and keep the surface of the teeth, cheeks and tongue clean.

How does caries occur?

If we translate the word "caries" from the Latin, we learn that it means "decay". At first, this terrible word was called osteomyelitis, a disease in which the bone marrow becomes inflamed. Now they designate only a disease of the teeth.

What threat is fraught with malocclusion?

Pathological bite is an incorrect mutual arrangement of the teeth of the upper and lower jaws, in which there is a violation of the functions of the dentoalveolar system, and as a result, other body systems, morphological and aesthetic disorders.

Can tooth sensitivity be treated?

Hyperesthesia is an increased sensitivity of the hard tissues of the teeth. Hyperesthesia manifests itself in the form of short-term pain sensations that occur in response to the action of various stimuli (chemical, temperature or tactile).

Causes of caries

The initial stages of caries often go completely unnoticed. A white or brown stain appears on the surface of the tooth. However, the integrity of the enamel is not yet violated. Further, a carious cavity is formed, and the process extends to the pulp of the tooth, provoking pain. But it must be remembered that the causes of caries lie deep inside the body. Therefore, this disease is often called "carious disease."

Varieties of caries

Caries is the most common dental disease. Almost all inhabitants of the planet face various forms of caries. Caries is the destruction of hard tissues of the teeth over a period of time, and the dentin and enamel are destroyed. How to keep your teeth healthy?

Symptoms of pulpitis

Pulpitis is an inflammation of the neurovascular bundle of the tooth. Often this bundle is simply called the "nerve", but its scientific name is the pulp, from which the name of the disease comes. It is characterized by paroxysmal progressive pain, often spreading to the entire jaw, radiating to the ear and temple, aggravated at night. With timely treatment, the outcome is favorable.

Formation of caries

Caries is a very common dental pathology, which consists in a violation of the hardness of the dental tissue and the formation of a cavity defect in it. Perhaps this is the most common disease of mankind, which they learned to deal with relatively recently. After all, before his main treatment was the extraction of teeth.

What is deep caries?

Dental caries is the destruction of bone or tooth tissue due to a dystrophic or infectious process in the bone or periosteum. Deep caries is the final stage of this pathological process, when the bacteria have already eaten away the entire hard shell of the tooth and reached the pulp. Remember that already at the first signs of caries, the tooth will not become the same and the main task is to prevent its loss. Caries is very insidious, and only a dentist can deal with it.