The use of caries markers (indicators) in dentistry

Contains a red color indicator for staining necrotic dentin affected by caries.

Caries Marker facilitates visual inspection of the surface of teeth damaged by caries. Healthy tooth tissues - enamel and even mineralized dentin will not be stained, which will facilitate the gentle removal of the affected area of the tooth. Healthy unstained dentin must be preserved in the treatment of caries.

Areas of use:
Caries Marker is used to color the surface of a tooth damaged by caries.
- to determine residual caries, the field of removal of visible foci of infection.
- for a clear delimitation of the damaged tooth surface from the healthy one, especially for secondary dentin that differs in color
- to control the complete removal of carious dentin
- to detect caries in hard-to-reach areas of the tooth
- to demonstrate to the patient areas damaged by caries
- for training purposes, for example, on an extracted (removed) tooth
- detection of obliterated nerve channels
- to detect micro-cracks in fillings

Directions for use:
First, clean the surface of the tooth from heavily discolored soft plaque.
Treat the cavity (affected area) with Caries Marker for 5-10 seconds (no longer!) and rinse with water.
The application of the liquid is recommended to be carried out using a Pele Tim sponge swab.
Dentin damaged by caries will turn intense red.
Completely remove stained areas of dentin, while carefully preserving unpainted areas. Repeat the cycle until no more discolored dentine surfaces appear.
Plaque and residual caries are also stained with Caries Marker and must be removed.

Instructions and warnings:
The intensity of the marking can be enhanced by air drying the affected area of the tooth.
it is not permissible to expose the tooth surface to the effect of the coloring preparation for too long (no more than 10 seconds).
At the end of the procedure, thoroughly rinse the treated tooth.
Otherwise, discoloration and subsequent removal of the pore dentine will occur.
Do not apply to areas in close proximity to the pulp to avoid erroneous removal of areas stained with blood.
Avoid contact with skin and clothing (danger of staining).
Remove from clothing with a mild vinegar solution.

Caries Marker contains propylene glycol, contact with concentrated Caries Marker may cause

A caries marker is a special substance that, when applied to tissues affected by caries (demineralized enamel, dentin), is fixed on them, and due to its bright, noticeable color, allows the doctor to detect a carious zone or clearly define its boundaries. At the same time, the caries marker does not linger on healthy tooth tissues and is easily washed off when washed with water.

Simply put, the caries marker stains caries-damaged denatured areas of the tooth in bright contrasting colors and makes them easier to detect.

At the same time, the terms "caries detector" and "caries marker" should be distinguished. A caries marker is just one type of caries detector, although some authoritative authors believe that these are absolute synonyms.

A caries detector is a broader concept, it refers not only to chemicals that help to visually highlight carious areas, but also to special devices and technologies that allow caries to be detected in other ways.

But caries indicator and caries marker are synonyms. However, in dentistry, it was the second version of the name that turned out to be more popular. Some authors also understand the term “caries indicator” as a separate component of the caries marker, which is responsible for binding the drug to the affected surface, but there are about the same number of such authors as those who call the drug as a caries indicator as a whole.

Thus, the caries marker significantly increases the reliability of caries diagnosis. It effectively stains carious areas at any stage of the development of the disease, including the stain stage, while penetrating to a certain depth of the affected tissue and helps the doctor also at the stage of removing necrotic areas of the tooth.

After treating the carious cavity with a dye solution, it is enough for the doctor to clean out the tissues stained with the indicator with a drill, and after each removal, treat the walls of the cavity with a new portion of the marker. This procedure is repeated until the walls of the cavity are no longer stained at all, which will indicate complete removal tissues affected by caries.

On a note

Sometimes a caries marker is used to differential diagnosis caries. For example, areas of enamel with stains from fluorosis or with hypoplasia, the marker does not stain.

The caries indicator has proven itself very well for the purpose of teaching young doctors and students, as well as for demonstrating the affected areas to the patient himself. Often it is also used to control the condition of enamel areas near crowns and fillings (it helps in violation of the marginal fit of fillings, cracks, incorrect staging), in fissures, where you can see developing caries on early stages very difficult.

The use of markers somewhat reduces the speed of tooth treatment, but eliminates the element of doubt when cleaning the affected dentin, thereby making the therapy better and more reliable.

Classification of caries detectors and their components

Today in the world dental practice Several types of caries detectors are actively used:

Chemical detectors are just the same markers, the principle of which is based on the interaction of a brightly colored substance with a surface affected by a carious process.
Optical detectors, in which a beam of light with a wavelength of 405 nm is used to detect pathological changes in the tooth. According to the degree of its refraction in each part of the tooth, a special analyzing program displays on the computer screen different colors, thus forming a visual multi-colored image of the tooth, on which, in the presence of caries, damaged areas are clearly visible.
Laser detectors, the principle of operation of which is similar to optical, but as a sensitive element it works laser ray.

Optical and laser detectors are very convenient in diagnosing caries, but with their help it is more difficult to control the quality and completeness of cleaning of damaged areas of the tooth. In addition, they are expensive to purchase and today are the property of only elite clinics.

Caries markers are much more affordable than laser and optical instruments, and therefore they are used in most clinics, including fairly budget ones. Their use does not lead to an increase in the cost of caries treatment, while significantly facilitating the work of the doctor.

Of the active ingredients in caries markers, acid fuchsin is most often used - a well-known synthetic dye, in aqueous solutions having an intense red color. The photo shows how well they stain the carious areas of the tooth:

More rarely, methylene blue is used to detect caries, which works similarly to magenta, but turns the lesions blue.

Instructions for using markers

The instructions for using the caries marker are simple. To diagnose caries using markers (for example, in the stage white spot) the teeth are washed with water, dried and a preparation is applied to the surface of their enamel. You can squeeze out the marker directly from the syringe, but you can also use special foam balls for this.

The drug is left on the enamel for 5-10 seconds, after which the tooth is washed with water. Areas affected by caries remain stained with the indicator.

The drier the surface of the tooth before applying the marker and the higher the microporosity of its tissues, the more intense the color of the painted surfaces will be.

During treatment with a drill, all tissue stained in the color of the indicator is removed with a burr. After that, the walls of the cavity are again treated with a marker for 5-10 seconds and rinsed again with water. When new colored areas appear, they are again removed. The procedure is repeated until, when processing all the walls of the cavity, the staining with the marker stops.

This instruction is universal for all standard caries indicators, including methylene blue.

Caries marker stains not only carious surfaces but also plaque on the teeth and tartar. Therefore, it is important not to confuse them with areas of carious lesions.

Caries markers are not intended for home use. It's exclusive professional tools, which are used only by a doctor, and more than half of the cases of using such tools are not associated with the diagnosis of caries, but with their use to increase the efficiency of stripping carious cavities during therapy.

Marker staining is especially helpful in removing necrotic, infected dentin, which often leads to complications of caries. It is the remnants of necrotic dentin, which were not removed by a doctor by mistake, that can lead to the development of caries under crowns and fillings (secondary caries). With strict adherence to the instructions, the caries marker allows you to completely clean the cavity from infected tissues.

On a note

Caries markers are used at the dental appointment, where there is no hard time limit, as in most budget institutions. To use these tools as an additional diagnostic method, it is required that the treatment be carried out for at least 30-60 minutes. Saving time on this stage, especially when deep caries, can lead to serious injuries pulp ("nerve").

The point is that only complete excision of the affected, non-viable carious dentin can reduce the risks of "postoperative sensitivity", recurrent caries and infectious inflammation pulp. A caries marker (detector) is recommended for practicing dentists to ensure the quality of the treatment provided that all diagnostic conditions are met.

Warnings and Safety Precautions

The main danger that must be avoided when working with a caries marker is the possibility of staining with a healthy, undamaged indicator. This situation occurs when the marker is too long on the tooth - more than 10 seconds. Therefore, the optimal tooth treatment time is about 7 seconds.

Also, with a significant deepening inside the tooth, it is necessary to correctly distinguish between areas painted with red indicators from those with pink color dentin near the pulp.

Caries markers are harmless to human health. However, some of them contain propylene glycol and can cause allergic reactions in especially sensitive patients if they come into contact with mucous membranes. Unpleasant symptoms pass quickly after washing the mucous membranes with water.

On a note

Due to the rich coloring, caries markers are able to leave permanent marks on clothing and skin surfaces. You can wash them off with a cotton swab dipped in vinegar, but you need to do this immediately after the marker gets on the skin or fabric, since later the stain will be more difficult to remove.

Prices for caries markers from different manufacturers

The most famous and often used in clinics are caries markers from the following manufacturers:

These prices vary greatly, depending on the city, as well as on the clinic that includes them in the calculation of the cost of treatment. However, the difference between the cost different drugs The figures given are correct.

At the same time, the fundamental difference in operation and application different markers no. Usually the dentist tries to work with several of them, and eventually settles on the preparation that is most convenient for him to work with.

Interesting video: an example of using a caries marker in practice

Use of a caries detector in tooth preparation

Caries Marker - Caries Marker

Marks in red the areas of the tooth infected with caries, Voco

Caries Marker

Contains a color indicator (red acid dye) to stain infected carious dentin. Thus, Caries Marker allows you to visually control the presence of carious areas. Healthy, as well as uninfected, remineralizing dentin does not stain. This allows gentle excavation. Uninfected (unstained) dentin should be preserved as much as possible

Areas of use:

Caries Marker is used for the purpose of staining
carious tissues of the tooth:
- to determine the residual carious areas after
removal of visible caries;
- for a clear distinction between carious and healthy
dentin, especially differing in the color of the secondary
dentin;
- to control the results of the removal of carious dentin;
- to detect caries in areas of the tooth with difficult
visual control;
- to demonstrate carious areas to the patient;
- for educational purposes extracted teeth);
- for recognition of obliterated root canals
- to detect microcracks in fillings and on
border areas.

Directions for use:

First, remove softened and heavily stained dentin. Treat the cavity with Caries Marker, leave for 5-10 seconds (no longer!) and then rinse with a water spray. The fluid is best applied with a Pele Tim foam ball. Carious dentin stains intense red. Stained areas of dentin must be completely
remove, while carefully protecting unpainted areas. Repeat the procedure until the dentin stops
be painted. Plaque and residual caries of tooth enamel under the influence of Caries Marker also become red and must be removed.

Instructions and warnings:

The intensity of staining can be enhanced by briefly drying the cavity. Staining should not be carried out for a long time (no longer than 10 s), the stain must be completely removed by thorough washing, otherwise there is a danger of staining and subsequent removal of healthy dentin. Do not use in areas close to
pulp, in order to avoid erroneous opening of the pulp (areas of dentin with a maximum approximation of the pulp have a pinkish color). Avoid contact with skin and clothing (danger of staining). Remove from clothing with a weak solution of vinegar (first check for shedding of clothing!) Caries Marker contains propylene glycol, contact undiluted
Caries Marker with mucosal surfaces may cause a reaction (eg irritation, allergy) in sensitive patients.

How to know for sure if you have caries? To do this, they came up with a caries marker. it Chemical substance, which stains the carious area in bright color- in blue or pink. And if the tooth is healthy, then it will remain the same white.

Caries indicators are indispensable for identifying early caries, carious foci and cracks near fillings, in hard-to-reach places for inspection. At the same time, the boundary between healthy and diseased tissues is clearly marked.

How to identify caries

The dentist takes a viewing mirror and carefully examines each tooth. But sometimes it is difficult to recognize a carious focus, even using tools.

A caries marker is a liquid that stains areas of a tooth affected by caries. The carious focus is highlighted in a contrasting color, which greatly simplifies the diagnosis. It is immediately noticeable which tissues will have to be dissected (drilled).

It is necessary to distinguish between the concepts of "caries-marker" and "caries-detector". Caries detector is a broader definition that includes all sorts of methods disease recognition. Caries marker (or indicator) is just one of the types.

Types of caries detectors

Chemical detectors

These are caries markers, which are available in the form of a solution. Their operating principle is based on chemical reaction active substance with carious dental tissues. The active ingredient is acid fuchsin (Acid magenta) or methylene blue (Methylenum coeruleum) - synthetic dyes.

Optical detectors

Diagnostics is carried out using computer equipment. Optical detectors generate light waves with a length of 405 nanometers. Light is reflected differently depending on the condition of the tooth surface. A computer program analyzes the data, and as a result, a multi-colored picture is obtained, where the boundaries and the degree of development of caries are clearly visible.

Laser

The mechanism of action is similar to the previous one, but a laser beam is used instead of light. Diagnosis is carried out by the German apparatus "Diagnodent Pen". Laser indicators are not cheap, therefore they are used mainly in elite clinics.

Operating principle

The chemical instantly stains carious areas, regardless of the stage of the disease: necrotic (decayed) dentin or initial stage chalky spot.

The coloring pigment penetrates into demineralized areas of enamel and dentin. These are hard dental tissues where there was a decrease in minerals, and the carious process began. At the same time, the caries marker does not affect healthy enamel, as well as fluorescent spots and other non-carious lesions.

The doctor removes the stained areas with a drill and reapplies a portion of the substance. The procedure is repeated until the dental tissues finally stop staining. This will mean that the carious infection has been eliminated.

Instructions for use

Universal guide for caries indicators:

The patient rinses oral cavity water.
The enamel is dried with a stream of warm air - the drier the surface, the brighter the color will turn out.
The doctor applies a caries marker immediately from the syringe that comes with the kit, or using a foam swab.
The drug acts for 5-10 seconds, then it is washed off with water.

In addition to foci of demineralization, the indicator stains bacterial plaque and tartar, so the dentist carefully differentiates them from a carious defect.

Precautionary measures

If the dye exposure time exceeds 10 seconds, the caries marker can stain healthy and undamaged enamel. Optimal time processing - 7 seconds. Therefore, you should not process several teeth at once, this reduces the efficiency of the procedure.

Markers are safe for health, but in rare cases the drug causes allergic reaction upon contact with mucous membranes. Discomfort disappears immediately after rinsing the mouth with water.

If the caries marker accidentally gets on your clothes, treat the stain with cotton wool soaked in a solution of vinegar.

Caries indicators are for professional use only. It is not recommended to use them at home!

Prices

Chemical indicators are an inexpensive diagnostic method common in economy-class dentistry. The use of a caries marker does not increase the cost of treatment, but it greatly facilitates the work of the dentist.

The cost of known drugs:

"Voco" (Germany) - about 450 rubles per 1 gram;
"Kuraray" Japanese manufacturer - 2500 rubles. for 6 ml;
"Color test No. 2" domestic production- 100 rubles / 20 ml;
"Omega" (Russian company) - 200 rubles / 8 ml.

Caries marker - universal remedy, with the exception of diagnostics secondary caries under a seal. In areas close to the pulp, it is dangerous to use a marker because of the risk of confusing the carious areas stained with the reagent with the pulp (also pinkish in color). For such a case, one resorts to alternative methods diagnostics - sighting x-ray or computed tomography.

According to medical statistics, caries is by far the most common dental disease, which in the absence of timely therapy leads to severe consequences for the teeth.

To discover it and more exact definition the degree of damage, dentists use caries markers.

A caries marker (an indicator in another way) is a special tool that allows you to accurately determine areas affected by caries. Application is shown in cases where necessary:

identify residual carious areas after removal of visible areas of pathology;
control the result of the removal of dental tissues;
identify affected tissues in places inaccessible to visual inspection;
to demonstrate to the patient the extent of the spread of the disease on his chewing elements;
to detect small, not visible to the eye, cracks in the enamel;
determine the nature of the defect.

A marker is a special solution in which a coloring substance is present. For its manufacture, the following coloring components are mainly used:

DDC-sodium- fast acting reagent. Its high stability allows the pigment for a long time retained in dentine tissues.
Propanediol- natural dye, which is produced from corn sugar. Substance dissolves organic compounds, which are located in the pores of the enamel, and delivers the dye to all layers of tissues affected by caries, even the deepest.
Eosin-B- a red pigment that stains even at the cellular level.
High purity water.

Important! The marker substance helps to detect caries, regardless of its stage, instantly changing the color of the areas in which the pathological process develops.

Pigments, getting into the demineralized areas of enamel and dentin, stain them, without affecting healthy areas, fluorous spots and other non-carious types of lesions (i.e., they do not stain). From all these surfaces, the indicator is easily washed off with water or removed with a swab.

After applying the marker, the dentist removes the stained areas, and then applies it again. The manipulation is repeated several times until the fabrics stop dyeing. This means that the affected areas are completely eliminated.

Advantages

The detection of infected tissues using an indicator is used in practice by almost all dentists, since this technique for diagnosing a disease has a number of advantages:

Accurate separation of infected tissues into healthy ones.
Safety for the patient. The marker contains only safe components (natural or synthetic) that do not cause discomfort to the patient and discomfort not harmful to his health.
This property allows you to use the tool as a demonstration, showing a person clearly the state of his dentition.
The indicator can be used not only for detecting carious superficial areas, but also for examining root canals.
The tool promotes the use of invasive techniques.

Flaws

In addition to these advantages, the technique for determining caries indicator has some disadvantages, namely:

The agent stains all demineralized areas on enamel and dentin, even those with minimal infection levels, and they can be treated with remineralizing preparations.
When turning the stained areas with a drill, a smeared color layer often appears, which makes it difficult to visualize the cleaned tissues and isolate absolutely healthy ones.

Varieties

In world dentistry, several types of detectors are actively used to detect carious infection.

Important! It is necessary to distinguish between definitions - a marker and a detector. The first tool is one of the varieties of the detector, which combines a number of methods and devices.

Today, dentists use the following types of carious detectors:

Chemical. This group includes markers, the action of which is based on the reaction of active components with dental tissues infected with caries. By their persistent staining, the exact dislocation and level of the lesion is determined.
The product is produced in the form of solutions containing safe natural or synthetic (less often) dyes. Main operating components markers are acid magenta (stains tissues red) or methylene blue (stains them blue).
Optic. These are special devices in which caries is detected by light beams with a range of 405 nm. m. According to their magnitude of refraction, computer program defines areas with pathological changes. The analysis of refraction is displayed on the monitor, where infected areas can be viewed on a multi-colored image, their depth and boundaries can be determined.
laser. The principle of operation of a laser device is similar to an optical one. But instead of a light beam, it uses a laser beam. This method is the fastest, but high cost. That is why it is used only in elite dental clinics.

Greatest comfort and convenience for the patient presents diagnostics by optical and laser devices. But it is more difficult for them to trace the completeness of the cleaning of carious cavities.

Chemical detectors are available and inexpensive. Use simplifies the work of a specialist and improves the quality of the treatment.

Application guide

The effectiveness of caries treatmentflax depends on the correct application and processing of the marker. To avoid mistakes, this tool must be used in accordance with the technology.

Since all manufactured markers have an almost identical composition, the instructions for their use, regardless of the manufacturer, will be the same for everyone:

Before applying the marker to the teeth, they are washed with high-pressure water.
With a warm air stream supplied from a special apparatus, the enamel is completely dried. The air also removes water from the pores, allowing them to expand. The enamel must be dried very well. If water remains in its pores, it will prevent the penetration of the dye.
A marker is applied to dry enamel. It can be done different ways- a special dropper, syringe, foam swab. The liquid consistency of the product allows the dye to be evenly distributed over the tooth surface.
The drug is left on the enamel for 7-10 seconds, and then washed off with water.
The teeth are well dried, and then examined. Carious tissues are stained in a color characteristic of active ingredient marker.
Areas with lesions are cleaned with a drill.
Then, in the same sequence of manipulations, the marker is applied a second time, and so on until the dental tissues are no longer stained.

Important! The absence of colored areas after treatment with the agent is explained by the fact that carious tissue removed completely.

Can it be used at home

Markers are only for professional use in dental office. Them independent use at home is impractical, because inept actions and improper application of the product will give the wrong result.

An experienced specialist, when studying colored areas, takes into account the intensity of the color, and using it with great accuracy determines the degree of pathology, as well as areas that can be restored by classical therapy.

The special properties of active pigments to stain infected tissues at the cellular level makes it possible to identify both slightly demineralized areas and necrotic ones located in deep dental cavities.

Insufficiently high-quality cleaning of dead dentinal tissues in all cases leads to the manifestation of secondary carious process, which develops under the delivered seal.

To prevent the development of such a situation, it is necessary to apply the marker several times, followed by cleaning.

The optimal duration of such manipulation is 40-60 minutes.

The holding time of the dye on the tooth surface should be at least 5 seconds so that it has time to get into all layers of the dentin and objectively shows the extent of the spread of the disease.

Even taking into account the fact that the carious marker is completely safe for both the dentist and his patient, it can be used only if special measures precautions.

When using the solution, you should be wary of the following situations:

Discoloration of healthy tissues that can be removed. Similar situation it happens if the product has been on the teeth for more than the maximum time allowed according to the instructions.
Cleaning enamel that could be restored remineralizing agents.
The propylene glycol contained in the marker, although it is an absolutely safe component, in isolated cases can provoke an allergy in a patient. All manifestations of allergies stop immediately after washing the mouth with water.
Some pigments can dye not only fabrics, but also leather, and even textiles. Therefore, if you do not immediately remove the drops of the product from clothes or skin, stains that are resistant to bleaching appear.
Accidental opening of the pulp. It is known that the pulp chamber has a pink color, and an inexperienced doctor can accidentally dissect it.

To prevent development possible problems when cleaning carious cavities, the specialist must adhere to the following rules in his work:

Should not be handled with a marker big number teeth(application is carried out sequentially). During the period while the dentist washes the first units, even healthy tissues can change color in the last elements during this time.
The allowable time for the liquid to stay on one tooth is up to 10 seconds. Longer use leads to the fact that even weakly demineralized areas are stained in the same way as infected ones.
To exclude the manifestation of allergies Before the procedure, the doctor must do an allergy test.
To prevent drops of liquid from falling on the patient's clothes, a disposable napkin should be placed on his chest.
To prevent spots on the lips, they are treated with Vaseline or special means, which must contain vitamins A and E.
To examine the dentin, a marker of a different color should be used. to prevent accidental opening of the pulp.

Price and manufacturers

Of the varieties of caries detectors used in dentistry, namely chemicals most commonly used to diagnose caries. This is due to their low cost, which does not affect the final price of the entire course of treatment of the disease.

The most recognized markers by dentists are:

Kuraray. A tool from Japan, designed to identify the affected dentin. In it, the probability of staining healthy areas is minimized. High quality, hypoallergenic. Produced in a volume of 6 ml, approximate cost- about 2.5 thousand rubles.
Voco. Tool from a German manufacturer. Like the previous marker, it is used to identify infected dental tissues. For 3 ml of the drug, you will have to pay about 1.5 thousand rubles.
Color test number 2. Produced in Russia by VladMiVa, which greatly affects its value. You can buy a marker with a volume of 8 ml for only 200 rubles. With its help, you can quickly detect caries at any stage, determine the degree of its spread.
Omega. The tool is produced in Russia in 2 forms - in the form of a gel and liquid. They stain only carious tissues in a rich red color, without staining healthy ones. You can buy a gel with a bottle volume of 6 ml for 300 r, for the same volume of liquid you will have to pay 200 r.

With such a tangible difference in the cost of markers, characteristics, principle of operation and composition, they are identical to each other. A slight difference lies in the addition of gel-like substances to them that change the consistency.

The video presents Additional Information on the topic of the article.