Caries in dentistry: causes, symptoms and stages of development with photos, dental treatment. Elements of the formed carious cavity

The term “internal caries” is usually understood by an ordinary patient of a dental clinic as a disease that affects tissues deep under the tooth enamel. At the same time, doctors know that, by and large, any caries affects the internal tissues of the tooth, which are softer and more easily damaged than enamel. Therefore, the phrase "internal caries" can be applied to almost any case of the disease and by and large is a tautology.

In some cases, they talk about internal caries when they mean a pathological process under a crown or a poorly installed filling. Here, caries inside the tooth develops absolutely imperceptibly for both the doctor and the patient, and gives itself out only when the pathological process covers the enamel around the filling (crown) or when pain occurs. But then again, this is still the same ordinary caries, just with non-standard localization.

In most cases, at the first examination of the teeth, their walls (surfaces) affected by caries are striking. These are often not carious cavities at all, but simply gray, tarnished enamel that has lost its healthy appearance due to demineralization.

Often the dentist sees a kind of "tunnel" in the gap between the teeth, but the probe may not pass into the hidden internal carious cavity due to the density of the interdental gap. Usually, the doctor shows the patient in the mirror grayish shades of enamel against the background of developed internal caries and begins the treatment of the tooth after anesthesia.

When a bur touches gray enamel, in almost 90% of cases it breaks off in a couple of seconds and the bur falls into the internal cavity with an abundance of carious, pigmented, infected and softened dentin. If the anesthesia is performed correctly by the doctor, there is absolutely no pain.

The doctor carries out cleaning and filling of the tooth strictly according to the protocol for the treatment of caries. If the tooth already has a communication with the pulp chamber (the cavity where the nerve is located), then the doctor performs depulpation and filling of the canals, followed by a permanent filling in one or two visits.

The photo below shows a tooth in which deep internal carious cavities are visible under bright light:

The following photo shows, that is, localized in the area of \u200b\u200bthe natural relief of the teeth. Under such darkening inside, significantly destroyed tissues are also often hidden, which are not immediately detected during a routine examination:

At home, such "internal caries" is almost impossible to detect. He will give himself away only with extensive damage to the dentin and the appearance of pain in the tooth when the pulp is included in the pathological process. That is why preventive visits to the dentist are so important, who, using special methods, will be able to detect caries in any of its localization and cure the tooth before its depulpation (removal of the nerve) is required.

Reasons for the development of deep caries

The causes of caries in deeply located tissues of the tooth are similar to those for caries with any other types of its localization. The disease develops due to the following factors:

The constant presence in the oral cavity of acids, both got here with food (fruits, vegetables), and produced by bacteria that consume the remains of almost any carbohydrate food - flour, sweets, cereals.
Reduced secretion of saliva or its low bactericidal activity. It may be caused by other diseases or metabolic disorders.
Mechanical and thermal damage to tooth enamel.
hereditary factors.

Usually, caries develops under the influence of a complex of several such factors.

In any case, it is in the deep parts of the tooth that are under the enamel that caries develops most rapidly due to the greater susceptibility of the tissues here to the action of acids. Therefore, situations are not uncommon when, under a barely noticeable (or even invisible to the naked eye) hole, there is an extensive cavity destroyed by the carious process.

On a note:

That is why the enamel almost always breaks off (comes off in a piece) when a large carious cavity has already formed, affecting the layers of softened infected dentin. That is, the enamel can hold the load for a long time, hanging over the hidden carious cavity, often without giving it away.

Features of the diagnosis of caries inside the tooth

Caries inside the tooth is much more difficult to diagnose than the usual one, which has manifestations on the surface of the enamel. It can be clearly seen when using the following diagnostic methods:

In addition, neglected internal caries causes pain in the patient, at first mild and occurring mainly when chewing hard food and getting very cold foods on the tooth, and intensifying as the disease progresses. If a tooth without visible damage begins to hurt regularly, you should definitely come to the dentist for an examination.

The following methods can be used as auxiliary methods for diagnosing and confirming caries inside the tooth:

Rules for the treatment of the disease

In all cases of development of caries inside the tooth, its treatment requires opening the enamel, removing the affected dentin and filling the cleaned cavities. In advanced form, internal caries leads to the need to remove the nerve and fill the canals.

Even more difficult are the situations when a very significant amount of tissue is damaged by caries from the inside of the tooth, and either after their removal, or simply because of softening, it splits. In this situation, it is often necessary, according to indications, to remove a tooth with the subsequent installation of an implant at the request of the patient, or to manage with modern methods of prosthetics.

On a note

A split is different for a split, therefore, tooth-preserving techniques may include, for example, the restoration of a tooth on a titanium (anchor, fiberglass) pin after its thorough intracanal treatment + the installation of a crown (metal ceramics, stamped, solid cast, etc.), may involve tooth preparation under the tab, installation of tabs + crowns. There may be many options.

Sometimes the damage is quite extensive, but with them it is possible to save the roots of the tooth by removing the pulp from them. In such cases, it is possible to dispense with the installation of a crown.

In any case, after detecting a carious cavity, the doctor cleans it with a bur. If such tissues come close to the pulp, their removal can be painful and is most often done using local anesthesia.

From dental practice

There are ambiguous situations when the pulp area is not yet opened during cleaning of the carious cavity, but the patient is already beginning to experience pain during the work of a doctor. It is impossible to say unequivocally whether it is worth depulping here or not. Without depulpation after the filling is installed, it can begin to disturb the nerve endings when chewing and cause pain. Some doctors tend to depulp such a tooth so that they do not have to carry out repeated work if, after installing the filling, the patient begins to experience pain. Other dentists explain the situation to the patient in detail and make a decision together with him. It should be borne in mind that many patients are very sensitive to the preservation of their teeth in a “live” form and are ready to take risks in order to walk with a tooth with preserved pulp for a few more years if there is no pain after a simple filling.

In general, even with deep caries, it is necessary to remove the nerve, according to statistics, in less than a third of cases, and the removal of the tooth itself due to deeply penetrated caries is generally a rather rare situation.

Prevention of deep caries

You can avoid the development of caries deep inside the tooth if you regularly undergo preventive examinations at the dentist and detect the appearance of the disease even at the stain stage. With this approach, with a high degree of probability, it will be possible to avoid depulpation, and in the absence of hidden caries, it will even be possible to do without opening the tooth and filling.

To prevent the appearance of even the earliest signs of caries, the following preventive measures must be observed:

brush your teeth thoroughly at least twice a day - after breakfast and before bed;
rinse your mouth after eating;
do not get carried away with sweets and sweets;
remove food debris stuck between teeth;
avoid getting too hot or too cold foods and drinks on your teeth.

If you are predisposed to carious lesions of the teeth, you should consult a doctor and, on his recommendation, take calcium and fluorine preparations in the form of tablets or special solutions.

An additional preventive measure can be chewing gum containing xylitol instead of sugar. They should be chewed within 10-15 minutes after eating to increase saliva production and clean the gaps between the teeth.

In combination, with the systematic use of such preventive measures, they will provide reliable protection against damage to the teeth, and even with the first signs of caries, the doctor will be able to eliminate the pathology even before it spreads into the deep tissues under the enamel.

Interesting video: preparation and restoration of a tooth with deep caries

An example of a two-stage technique for the treatment of deep caries

In other words, a "carious cavity" is the destruction of teeth by caries. The occurrence of caries largely depends on lifestyle - diet, oral hygiene, the presence of fluoride in water and toothpaste. The predisposition of teeth to caries also depends on heredity.

Caries is most common in children, but adults are also affected. There are the following forms of caries:

Superficial caries - most common in both children and adults, affects the chewing or interdental surfaces of the teeth.
Deep caries - with age, the gums sink, exposing the roots of the teeth. Since the roots of the teeth are not protected by enamel, cavities easily form in the affected areas.
Secondary caries - carious cavities affect previously sealed teeth. This is because plaque often accumulates in such areas, which can eventually turn into a carious process.

Adults who suffer from dry mouth syndrome, a disease associated with a lack of salivation, are most susceptible to caries. Dry mouth syndrome can be caused by an illness, as well as a side effect of certain medications, radiation, and chemotherapy. It can be temporary and last from several days to several months, or permanent, depending on the causes of the disease.

The formation of carious cavities is a serious disease. Without timely proper treatment, a carious cavity can destroy a tooth and damage the neurovascular bundle in the center of the tooth, which in turn can lead to inflammation of the root canals. Once inflammation (also known as "pulpitis") occurs, treatment is possible only through depulpation and other surgical procedures, or by removing the tooth.

How do I know if I have cavities?
Only a dentist can accurately diagnose caries. This is due to the fact that the carious process begins below the surface layer of enamel, where it is invisible at first glance. When eating foods rich in carbohydrates (sugar and starch), the bacteria in plaque converts it into acids that destroy tooth enamel. Over time, the enamel layer is destroyed from the inside, while the surface remains intact. With a progressive tissue defect, the surface layer also collapses over time, forming a carious cavity.

The deepening of the chewing surfaces of the molars, interdental surfaces, and surfaces in contact with the gingival margin are most often subject to the formation of caries. Regardless of where it occurs, the best way to diagnose and treat caries is to visit the dentist regularly for periodic check-ups, which will help prevent caries from progressing to more severe stages.

How to prevent the development of caries?

Brush your teeth at least twice a day, and also use dental floss daily to remove plaque from the interdental spaces and cervical part of the gums.
Visit your dentist regularly. Preventive measures allow you to avoid the occurrence of diseases, or to stop their development at an early stage.
Eat a balanced diet with limited starch and sugar. When including foods rich in starch and sugar in your diet, consume them at main meals, not between them - this will limit the time during which the teeth are exposed to acids.
Use fluoride-containing oral care products, including toothpaste.
Make sure children drink water enriched with fluoride. If the water in your area is not fluoridated, your child's dentist and pediatrician may prescribe fluoride supplements.

Formed carious cavities can be simple (cavities are located on one of the surfaces of the tooth) - cavities of classes I, V; and complex (several cavities on different surfaces of the teeth are connected into one) - cavities of II, III, IV classes. In complex cavities, a main cavity and an additional one (support platform) are distinguished. The main cavity is formed at the site of localization of the carious lesion and its size is determined by the degree of spread of caries. An additional cavity is created involuntarily by excision of intact enamel and dentine tissues and serves to improve the fixation of fillings.

Both in simple and in complex formed cavities, edges, walls and bottom are distinguished. The edge that outlines the inlet and separates the formed carious cavity from the surface of the tooth is called its edge. Depending on which surface of the tooth the walls of the cavity are directed to, they are called lingual (palatal), vestibular (buccal or labial), gingival and contact: distal and medial. The bottom of the carious cavity forms a surface that faces the tooth pulp. It can have the form of a single plane (as in cavities of classes I, V) or consist of two or more surfaces (cavities of classes II, III, IV). The walls and the bottom of the cavity form angles between themselves, which are called according to the names of the walls: lingual-medial, bucco-distal, etc.

Stages of carious cavity preparation

Pain relief is achieved by using local anesthesia techniques (infiltration or conduction).

Opening and expansion of the carious cavity(Fig. 9). The carious process in the hard tissues of the teeth is distributed unevenly. In dentin, it occurs much faster than in enamel, and therefore the size of the carious cavity is much larger than the size of the inlet, especially in acute caries. The opening of the carious cavity is aimed at removing, excising the overhanging edges of the enamel, providing good access and visual inspection of the cavity for the subsequent stages of preparation.

It must be remembered that with insufficient disclosure of the carious cavity, the overhanging edges remain devoid of nutrition from the pulp. In the future, with a chewing load (pressure) on the tooth, they break off, which can cause the development of secondary caries, a violation of the anatomical shape of the tooth, or the loss of a filling.

Rice. 9. Opening and expansion of the carious cavity

To open the carious cavity and excise the overhanging enamel, spherical and fissure burs are used. They are selected in such a way that the size of the working part is no larger than the inlet of this carious cavity.

When opening a carious cavity located on the chewing surface, a spherical bur is brought under the overhanging edges of the enamel. The drill is turned on and with careful comma-shaped (as if putting a comma) movements, the overhanging edges of the enamel are removed when the bur is removed from the carious cavity. When opening the cavity with a fissure bur, it is inserted perpendicular to its bottom and, moving along the perimeter of the cavity, the overhanging edges are cut off with the lateral cutting edges of the bur. With the correct execution of all actions at this stage, a cavity with sheer walls is formed. When "opening" the carious cavity, diamond or carbide burs are used with a rotation speed of up to 400,000 rpm. with water cooling.

To open carious cavities located on the contact surfaces of the teeth, they are first accessed through one of the surfaces of the tooth. It is most expedient to display such a carious cavity on the chewing, lingual or palatine surfaces, only in some exceptional cases it is displayed on the vestibular (labial, buccal) surface. To do this, small spherical or fissure burs are used, further opening of the cavity is performed as described above.

Expansion of the carious cavity carried out within the limits of practically healthy, caries-free hard tissues of the tooth. In addition, during expansion, excision of the affected fissures, alignment of the enamel edge, rounding of sharp corners along the perimeter of the cavity are provided. This manipulation is carried out in order to prevent the occurrence of secondary caries. It is most expedient to expand the cavity with fissure burs.

The volume of opening and expansion of the carious cavity in clinical conditions depends on the nature of the course and the depth of the carious process. In the traditional preparation of the carious cavity, its expansion is carried out completely within the projection of the carious cavity on the surface of the tooth crown, for example, chewing. If the preparation takes place in accordance with the principle of "biological expediency", then a minimal expansion of the carious cavity is possible. In such cases, the cavity is filled with filling materials that have a caries-prophylactic effect, such as glass ionomer cements. Therefore, the inlet may be narrower than the cavity, and the cavity itself, after formation, acquires a round shape. If the risk of caries is high, then an extended opening of the carious cavity is carried out with excision of the so-called caries-susceptible areas to caries-immune zones. The fissures of the chewing surface are excised to the slopes of the tubercles of the chewing surface.

Rice. 10. Necrectomy of non-viable hard tissues of the tooth

necrectomy- this is the final removal from the carious cavity of all non-viable hard tissues (mainly dentin) and their decay products. The volume of necrectomy is determined by the nature of the clinical course of caries, localization and depth of the carious cavity (Fig. 10). It is carried out using various sizes of excavators, spherical, fissure or reverse cone burs with a rotation speed of up to 4500 rpm.

Manipulation begins with a sharp excavator, selected according to the size of the carious cavity. Working with an excavator is less painful, since significant layers of softened dentin can be removed relatively quickly. It is important that the working edge of the tool is sharp. Further features of the manipulations depend on the depth of the carious cavity. In shallow and medium-depth cavities, excavation of dentin can be carried out, starting in turn from each of the walls of the carious cavity. With the sharp edge of the working part of the excavator, they go deep into the softened dentin and remove the dentin layer with lever-like movements. In this case, it is necessary to take into account the structural features of the various layers of dentin. In mantle dentin, the fibers of its main substance are located radially, so the excavator should be directed vertically in the direction of the tooth axis; in the peripulpal dentin, the fibers are located tangentially, so the excavator should be directed in the transverse direction (it is desirable to remove the dentin layer parallel to the bottom of the carious cavity). Necrectomy, especially in a deep cavity, should be carried out carefully so as not to open the cavity of the tooth and not injure the pulp. Removal of infected, but more dense dentin is continued with a drill using spherical, fissure and reverse cone burs.

A properly prepared cavity should not have softened and pigmented dentine. Sometimes, after the preparation of the carious cavity, invisible demineralized areas of hard tissues remain. In such cases, chemical and physical methods are used to detect them. To determine the boundaries of carious and clinically healthy dentin, a carious detector "Caries detector" should be used, which is a 0.5% solution of basic fuchsin, or a 1% solution of red acid in propylene glycol, which stains carious tissues red. A swab with a dye is introduced into the cavity for 15 seconds, while the non-viable dentin layer is stained, but the healthy one is not. The stained areas are removed with boron. The method allows economical excision of tooth tissues due to the partial preservation of the demineralization layer. The hardness of the remaining dentin is checked with a pointed probe. This should be done especially carefully when preparing the teeth of the anterior group in order to achieve a good cosmetic effect.

There are several preparations with the effect of caries detector: Caries Detector ("H&M"), Caries Marker ("Voco" company), SEEK and Sable ("Ultradent" company), Canal Blue (VDW), Radsi-Dent ("Rainbow-R" company). ").

With deep chronic caries, when the bottom of the carious cavity is very thin and there is a real danger of opening the pulp, necrectomy should be carried out mainly with spherical burs of a rather large size. In these cases, it is permissible to leave dense pigmented dentin at the bottom, and in case of acute deep caries, even a small layer of softened dentin, subject to further drug (remineralizing) action on it.

Formation of a carious cavity- a very important stage of preparation. Its goal is to create such a form of a carious cavity that would be able to hold the filling material for a long time and preserve the filling. To do this, it must meet a number of requirements.

General rules for a classically formed carious cavity:

the walls and bottom of the carious cavity should be located (one plane relative to the other) at a right angle and have a smooth surface.

the bottom of the cavity, as a rule, is flat or, to a certain extent, repeats the shape of the chewing surface of the tooth.

it is necessary to ensure that the angles between the walls and the bottom are straight and well-defined (with the exception of class V cavities), since in these places there is an additional fixation of the filling material that does not have pronounced adhesion to the hard tissues of the tooth (Fig. 11).

When preparing teeth, cavities with sheer walls and a flat bottom, that is, in the form of a box, are considered typical. The optimal is the rectangular shape of the cavity, in which the walls are located at a right angle relative to the bottom plane. A rectangle is the most convenient form for holding a filling, but depending on the spread of the carious process, oval, triangular, cruciform, cylindrical cavities are possible. For better fixation of the filling, it is sometimes recommended to create retention points on the walls of the cavity in the form of grooves, recesses, cuts. Somewhat less often, with a shallow and wide cavity, its walls can be tilted at an angle of 80-85 ° relative to the bottom plane, as a result of which the dimensions of the inlet of the formed cavity will be somewhat smaller than the dimensions of its bottom.

When forming a carious cavity with deep caries, it is necessary to take into account the topography of the pulp (tooth cavity). In these cases, the bottom of the carious cavity does not always have the shape of a flat plane, but somewhat repeats the configuration of the pulp and its horns. When caries is localized on the contact surfaces, for better fixation of the filling, it is necessary to create additional cavities on other surfaces of the tooth. Often they are formed on the chewing, vestibular, lingual surfaces in the form of a triangle, dovetail, cruciform, etc.

Rice. 11. Formation of a carious cavity (A) and additional elements for fixing a filling (B): 1 - wedge-shaped recess; 2 - recess for the parapulpal pin; 3 - furrow

To form a carious cavity, fissure, reverse-conical, cone-shaped and wheel-shaped burs are used.

In clinical conditions, when forming a cavity, it is necessary to take into account the nature of the course and the depth of the carious lesion. With a small risk of a carious process and its chronic course, a small cavity can be formed with rounded edges: filling is carried out with glass ionomer cements or composites (can be fluid) - using the adhesive filling technique. Small cavities can be pear-shaped (with an inlet smaller than the bottom). In this case, overhanging, but not affected by the carious process, the enamel edges of the cavity can be left. If it is intended to use filling materials that do not have adhesive properties (amalgam, silicate cements), then right angles and retention points should be clearly formed in the cavity. For better retention of such a filling material in the cavity, it is desirable to give it a rather complex configuration according to the course of the fissure of the masticatory surface. When using composite materials, this is undesirable due to the effect of the C-factor: a more complex cavity configuration creates additional polymerization stresses in the filling material. The internal contours and corners of the cavity should be smoothed and rounded to avoid tearing the composite from these areas of the carious cavity.

In the presence of two cavities on the chewing surface, with a low risk of caries, two separate cavities are formed, with a high risk, they are combined into one with the expansion of the cavity to caries-immune zones. In premolars, it is desirable to preserve the zone of resistance - the enamel ridge connecting the lingual (palatal) and buccal tubercles of the chewing surface.

Processing (finishing) of the edges of the carious cavity- the last stage of cavity formation. Care must be taken to ensure that the outer portions of the enamel prisms are well supported by the underlying dentin. Otherwise, the overhanging edges of the enamel will be deprived of nutrition and support from the pulp, will not be able to withstand the chewing pressure and break off. All this can lead to a violation of the marginal fit of the filling material and hard tissues of the tooth, the occurrence of a retention point, recurrence of caries, destruction or loss of the filling. Therefore, with finishers and carborundum heads, carefully (because the enamel is rather fragile and can easily break off), the enamel edge is processed, excising (cutting off) the overhanging areas of the enamel. The enamel edge should be formed according to the direction of the enamel prisms. Depending on the use of one or another filling material, it may be necessary to bevel the enamel edge at an angle of 45 ° or round it (Fig. 12).

It is generally recommended to bevel the enamel edge when filling with amalgams. This is due to the fact that in amalgam with a small layer thickness, a high risk of marginal breakage is possible. When using amalgams of the latest generations (third generation, non-gamma-2-amalgams), the enamel bevel can be omitted. This is due to their higher strength and less fluidity. The enamel bevel is not created when filling the cavity with cements - they are less durable and easily break off along the bevel line.

Rice. 12. Treatment of the edges of the carious cavity and options for their formation

The use of adhesive technologies of composite materials provides for the creation of a strong bond between the material and the tissues of the tooth: enamel and dentin. For a strong attachment of the composite to the enamel, a sufficient thickness of the enamel layer is required - at least 1 mm. Therefore, it is recommended to bevel the edge of the enamel at an angle of 45° or even more to achieve the optimum thickness of the enamel. It is also recommended to adhere to this rule when forming the vestibular wall of carious cavities of III and IV classes. This creates a smooth color transition between the composite filling material and the enamel, which makes the filling less visible on the vestibular surface of the anterior teeth. The same goal is achieved by creating a bevel with a concave surface on the vestibular wall - a concave or gutter-like bevel. Microhybrid, micromatrix and viscous composite materials have significant strength (up to 420 MPa in compression), so when using them, the enamel edge can not be beveled. In general, it should be noted that when using composite materials, the bevel angle can be in the range from 10° to 45°, depending on the class of the carious cavity (more on the vestibular wall of class III and IV cavities) and the strength of the composite material.

At the end of the formation of the edge of the cavity, the created edge of the enamel is finished. At the same time, small cracks, irregularities, areas with fragmented enamel prisms that have no connection with the underlying tissues (dentin) that have arisen during the preparation are removed with finishers. This improves the marginal fit of the composite filling material and improves the filling efficiency.

When preparing a carious cavity, it is necessary to take into account a number of provisions that will help achieve the greatest efficiency of its filling and, consequently, the treatment of caries:

It is necessary to remove all the hard tissues of the tooth affected by the carious process, forming a prepared cavity within the healthy tissues of the teeth. In the clinic, certain exceptions to this rule are allowed, depending on the nature of the course and the depth of the carious process.

The formation of a carious cavity should be carried out taking into account the characteristics of the filling material. If materials are used that do not have adhesion to the hard tissues of the teeth (amalgam), then the cavity being prepared is given a more complex shape and retention points are formed to mechanically hold the filling. When using composite materials, the cavity configuration should be simpler to compensate for the C-factor.

Under clinical conditions, the prepared carious cavity should be dry and not contaminated with saliva or other biological fluids (blood). If necessary, it is treated with antiseptic solutions and dried thoroughly before filling.

When preparing carious cavities, it is necessary to adhere to certain rules for the purpose of high-quality, less painful (atraumatic) and safe preparation. According to modern requirements, the preparation of teeth with living pulp must be carried out with the use of anesthesia. The manipulation of the preparation itself should be carried out with sufficient lighting and constant visual control of the doctor over the position of the instruments in the carious cavity. To do this, it is necessary to comfortably position the patient in the chair so as to provide the doctor with the best access to the prepared tooth. So, for example, when manipulating the teeth of the lower jaw, the head of the patient sitting in the chair should be fixed in an almost straight position, and when manipulating the teeth of the upper jaw, it should be tilted back. When treating a patient in the supine position, his head, as a rule, is placed in the most reclined position. When using modern dental units and filling techniques, the patient is often placed in a prone position, which provides more convenient working conditions for the doctor and comfortable for the patient.

The appearance of cavities in the teeth is associated with caries. Caries called the process of destruction of the structure of the tooth. Caries can affect both the enamel (the outer covering of the tooth) and the inner dentin layer.

Caries develops when particles of food containing carbohydrates (sugars and starches) linger on the teeth - for example, bread, cereals, milk, sugary soft drinks, fruits, pastries and sweets. Bacteria inhabiting the oral cavity feed on these particles, converting them into acids. These acids combine with bacteria that produce them, food debris, and saliva to form soft plaque that covers the surface of the tooth. The acids contained in the plaque dissolve the enamel of the tooth, and holes form in it, called carious cavities or simply caries.

Who gets caries?

Many people think that carious cavities are formed only in children, but age-related changes associated with the aging of the body make this problem relevant for adults as well. In particular, gum recession (separation from the roots of the teeth) - a phenomenon that accompanies the increasing incidence of gingivitis (inflammatory gum disease) - leads to the fact that the roots of the teeth are also exposed to plaque. Cravings for sweets, which are sometimes observed in pregnant women, also increase the risk of dental cavities.

A common problem in adulthood is caries around the edges of fillings in older people. Many of them in their youth could not take advantage of fluoride prophylaxis and other modern methods of caries prevention, so they often have several dental fillings in their mouths. Over the years, fillings loosen, microcracks can form in them, which allows bacteria to accumulate in tiny voids where caries.

How can I find out if I have cavities?

The doctor will identify the existing carious cavities during a routine dental checkup. When touched with a special tool, softening of the affected areas of the tooth surface is felt. An x-ray image allows you to identify carious cavities even before they become visible to the eye.

With advanced tooth decay, toothache can occur, especially when taking sweet, hot or cold foods or drinks. Other clear signs of caries are visible depressions and holes in the tooth enamel.

How is caries treated?

Methods for the treatment of carious cavities may be different depending on the depth of the carious lesion. In case of non-spread caries, the affected part of the tooth is removed using a drill and replaced with a filling made of silver alloy, gold, ceramic or composite resin. These filling materials are considered safe for health. There have been concerns about some of these materials, particularly mercury-based silver amalgam fillings, but both the American Dental Association and the Federal Drug Administration (FDA) still claim that these materials are safe. Cases of allergy to silver amalgam, as well as to other filling materials, are quite rare.

With widespread caries(when little is left of the original tooth structure) crowns are used. In such cases, the part of the tooth destroyed or eroded by caries is partially removed, partially treated, and then a crown is placed on the remaining part of the tooth. For the manufacture of crowns, gold, ceramics or cermets are used.

In cases where caries leads to the death of the nerve or the pulp of the tooth, a root canal filling is performed. In this procedure, the contents of the central part of the tooth (including the nerve, blood vessel, and surrounding tissues) are removed along with the areas of the tooth affected by caries. The root canal is then filled with sealing material. If necessary, the sealed tooth is covered with a crown.

A number of new treatments are currently being developed. One of the experimental technologies is based on the use of fluorescent light to detect carious cavities much earlier than traditional diagnostic methods allow. With early detection of the carious process, in many cases it can be stopped or reversed.

In addition, scientists are working on the creation of a "smart filling" that prevents the development of caries due to the constant slow release of fluoride into the surrounding tissues of the filled tooth and into the tissue of neighboring teeth.

The review was prepared by the doctors of the dental department of the Cleveland Clinic.

Caries is one of the most well-known diseases in all countries that affects the hard tissues of the tooth with the formation of foci of thinning of the enamel, softening of the deeper dentin and the formation of a carious cavity. The degree of activity of the process and its duration depend on various factors, largely determined by the conditions in which the tooth was formed or that it was affected after eruption. In children, the course of caries is much faster than in adults. This is due to the structural features of the tissues of temporary teeth, their strength and density. Among the main reasons for the development of caries are heredity, the effect on the fetus of adverse factors during fetal development, the quality and regularity of oral hygiene, the presence of chronic diseases of organs and systems, bad habits, metabolic and nutritional characteristics.

Caries classifications

Depending on the depth of the spread of the pathological process, 4 stages of caries are distinguished.

In terms of damage intensity:

Caries of an individual tooth (single foci of different localization).
Multiple caries (or carious disease, in which defects appear on several teeth at once). An important role in this form of caries is played by the general state of immunity and the presence of chronic diseases.

Clinical classification of caries

Initial caries (caries in the stain stage).

G. M. Pakhomov identified 5 forms of initial caries (stain stage): white, gray, light brown, brown, black.

Superficial caries (foci of damage to the enamel).
Medium caries (formation of a cavity within not only enamel, but also dentin).
Deep caries (deep cavity, the bottom of which is close to the nerve).

Children according to this classification (for milk teeth) do not have a diagnosis of "deep caries". This is due to the anatomy of temporary teeth, their size and the proximity of the nerve. With a very deep cavity, caries is considered medium-deep or considered and treated already as chronic pulpitis.

Classification of caries by flow:

Acute (very rapid appearance of defects on several teeth at once).
Chronic (prolonged destruction, the cavity and tissues of the tooth have time to darken).
Acute or blooming caries (the appearance of multiple foci on most teeth and in different places that are not typical for caries).
Recurrent (secondary caries around or under fillings).

International classification of the disease according to WHO:

Enamel caries.
Dental caries.
Cement caries.
Suspended.
Odontoclasia (a condition of resorption of the roots of milk teeth).
Another.
Not specified.

Classes of carious cavities according to Black:

1 class. Caries in natural depressions, pits, fissures on the chewing, buccal or palatal surfaces of molars and premolars.

Grade 2 Caries of contact surfaces of molars and premolars.

Grade 3 Caries of the contact surfaces of the incisors and canines without disturbing the cutting edge of the teeth.

4th grade. Carious cavities on the contact surfaces of incisors and canines with a violation of the integrity of the cutting edge.

Grade 5 Cervical carious cavities.

In order of occurrence:

Primary caries (develops on the tooth for the first time).
Secondary caries (new caries occurs on previously treated teeth, next to or around fillings).
Relapse (caries under filling).

According to the development of the process, forms are distinguished

Caries can be uncomplicated or complicated by pulpitis or periodontitis.

Simple caries (uncomplicated).
Complicated caries (as a result of the process, inflammation of the pulp (nerve) or tissues around the tooth develops - pulpitis or periodontitis).

Separately allocated "bottle" caries develops in children who are accustomed to night feeding, drinking sugary drinks, juices from a bottle. In this case, the anterior incisors are first affected from the inside, the defects are not visible for a long time. The process then spreads further. Before going to bed or at night, carbohydrates of sweets settle on the surfaces of the teeth in contact with the nipple or horn, the viscosity of saliva increases markedly during sleep, which contributes to the rapid development of caries on the teeth.

Classification of caries in children according to T. F. Vinogradova

Compensated caries (in a child, pigmented carious cavities are found, more often single, the tissues of the walls and bottom of the cavity are dense);
subcompensated caries;
decompensated caries (carious cavities in large numbers; tooth tissues are destroyed quickly, so they do not have time to be strongly stained with pigments - light, the walls of the cavities are soft, pliable).

This classification is based on the calculation of the caries intensity index, which is defined as the sum of carious, filled and extracted teeth (KPU) in one child. If there are both milk teeth and permanent teeth in the oral cavity, then the amount is calculated for them separately (KPU + KP). Removed milk teeth are not taken into account.

MMSI classification

Clinical forms:

Spot stage

progressive (white, yellow spots);
intermittent (brown spots);
suspended (dark brown spots).

carious defect

superficial caries (enamels);
caries of a dentin: average depth and deep;
cement caries (damage to the tissues covering the root of the tooth. For example, when the necks of the teeth and roots are exposed).

By localization:

fissure (caries of the chewing surface, on which there are natural depressions - fissures);
caries of contact surfaces (between teeth);
cervical caries (the area between the crown and the root is closer to the gingival margin).

Along the process:

fast flowing
slow-flowing
stabilized

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dentalux46.ru

How do I know if I have cavities?

Only a dentist can accurately diagnose caries. This is due to the fact that the carious process begins below the surface layer of enamel, where it is invisible at first glance. When eating foods rich in carbohydrates (sugar and starch), the bacteria in plaque converts it into acids that destroy tooth enamel. Over time, the enamel layer is destroyed from the inside, while the surface remains intact. With a progressive tissue defect, the surface layer also collapses over time, forming a carious cavity.

How to prevent the development of caries?

Brush your teeth at least twice a day, and also use dental floss daily to remove plaque from the interdental spaces and cervical part of the gums.
Visit your dentist regularly. Preventive measures allow you to avoid the occurrence of diseases, or to stop their development at an early stage.
Eat a balanced diet with limited starch and sugar. When including foods rich in starch and sugar in your diet, consume them at main meals, not between them - this will limit the time during which the teeth are exposed to acids.
Use fluoride-containing oral care products, including toothpaste.
Make sure children drink water enriched with fluoride. If the water in your area is not fluoridated, your child's dentist and pediatrician may prescribe fluoride supplements.

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The appearance of cavities in the teeth is associated with caries. Caries is the process of destruction of the tooth structure. Caries can affect both the enamel (the outer covering of the tooth) and the inner dentin layer.

Who gets caries?

Typical areas of development of caries

How can I find out if I have cavities?

The doctor will identify existing carious cavities during a standard dental examination. When touched with a special tool, softening of the affected areas of the tooth surface is felt. An x-ray image allows you to identify carious cavities even before they become visible to the eye.

With widespread caries (when little is left of the original tooth structure), crowns are used. In such cases, the part of the tooth destroyed or eroded by caries is partially removed, partially treated, and then a crown is placed on the remaining part of the tooth. For the manufacture of crowns, gold, ceramics or cermets are used.

The review was prepared by the doctors of the dental department of the Cleveland Clinic.

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What is caries?

Caries is a pathological process in the hard tissues of the tooth that develops after teething. This process consists in the demineralization of the hard tissues of the tooth, which leads to the formation of a carious cavity.

A healthy tooth is made up of enamel, dentin and pulp. Under the action of various bacteria that are in plaque, enamel is destroyed - the hardest protective shell of the tooth. Bacteria then destroy the dentin. If at this stage caries is not cured, then bacteria enter the pulp. Pulpitis develops - a complication of caries.

Caries of milk teeth develops much faster and painlessly, so parents should monitor their child's teeth. Early loss of milk teeth leads to serious problems with the eruption of permanent teeth.

caries symptoms

Sharp aching pain in cold air, cold water, sweet, salty and sour. Unlike pulpitis, such pain disappears immediately after the removal of the irritant.
Food gets stuck in the carious cavity, which causes bad breath.
The carious cavity has sharp edges and cavities that are felt by the tongue.

Reasons for the development of caries

Poor oral hygiene
Malnutrition (lack of fluorine, calcium, phosphorus in the body)
hereditary predisposition
External influences on the teeth that destroy the enamel (for example, seeds)
Violation of the composition of saliva
Low fluoride content in water
Anatomical structure of the tooth (deep fissures)

caries classification

Stain stage - a white or yellowish stain forms on the tooth.
Superficial caries - the stage of pigmentation - a dark spot appears on the surface of the tooth. When diagnosing with a probe, softening of the enamel is observed. There may be pain when brushing your teeth.
Medium caries - deeper lesions of the tooth. Small carious cavities appear in which food can get stuck. There is pain when brushing your teeth, when taking sour, sweet, salty.
Deep caries - deep lesions of the tooth. Before the pulp remains a thin layer of healthy dentin. If the tooth is not treated at this stage, caries quickly turns into pulpitis.

According to the localization of the carious process

Occlusal caries - fissure - destruction begins with fissures of the chewing surface
Interdental caries - the carious process begins on the contact surfaces of the teeth. Very often in children, such caries occurs on the front teeth.
Cervical caries - the carious process begins at the very base of the tooth, where it comes into contact with the gum
Root caries - cement caries - the main reason for the appearance of such caries is the untimely treatment of caries of contact surfaces. The carious process goes on the root of the tooth under the gum. It can be seen on an x-ray of the tooth. Unfortunately, such teeth are removed, since it is impossible to put a seal under the gum.

According to the intensity of the damage to the teeth

Caries of an individual tooth - single lesions of different localization
Multiple caries is a carious disease when several teeth are affected at once. The main reason for the development of such caries is a weak immune system.

caries treatment

The main principle of the treatment of caries is the removal of the affected tooth tissues and the restoration of the anatomical shape of the tooth. In modern dentistry, there is a huge selection of filling materials of different colors. Before treating caries, the dentist matches the color of the material to the color of the teeth. With a high-quality filling, it may not be noticed.

At the stain stage, it is enough to grind the stain and treat it with a remineralizing preparation. Anesthesia can be omitted.
With superficial and medium caries, anesthesia is first performed, then the affected tooth tissues are removed. In order not to remove healthy tooth tissue, a special caries detector is used, which stains the affected areas. Then the cleaned cavity is treated with an antiseptic solution, dried and the tooth is restored using a filling material.

With deep caries, they are also first anesthetized. Then the affected areas of the tooth are removed and the cavity is treated with an antiseptic solution. After drying, a remineralizing preparation is applied to the bottom of the cavity to strengthen the remaining dentin. The tooth is then restored with a filling material. Some doctors, after remineralization of the bottom of the cavity, put a temporary filling. A permanent tooth filling is prescribed after a few days. This is due to the fact that deep caries can turn into pulpitis. And if a permanent filling was placed immediately, and deep caries passed into the stage of pulpitis, then a new filling will have to be removed in order to treat the canals.

Caries in children is treated in the same way as in adults. Only special remineralizing filling materials are used.

Prevention of caries

Proper nutrition - foods containing calcium (dairy products) and phosphorus (seafood) must be present in the diet.
Good oral hygiene
Mandatory professional cleaning once every six months
Reducing the amount of carbohydrates in food (flour, sweet)
Fissure sealing

At home, it is impossible to get rid of caries, since the carious cavity needs to be cleaned and the shape of the tooth restored. It is necessary to treat caries in the early stages. The cost of caries treatment is much less than the price of pulpitis treatment.

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Black classification

The most recognized among dentists today is the Black classification of caries, which reflects the depth of the process, as well as the location of caries:

First grade ( surface). The cavities are located in the zone of natural depressions and fissures. Surface damage.

Second class ( weak). The process develops on the contact surface of the lateral teeth.
Third class ( moderate caries). Carious lesion affects the contact surface of the canines and incisors.
fourth grade ( severe form). Advanced stage of moderate caries. Carious lesions move to the dentin at the incisal angle.
Fifth grade ( very heavy). The gingival margin of the lateral or anterior teeth suffers. Root caries develops.
Sixth grade ( atypical). The destruction of the cutting edge is observed.

Classification of the disease according to ICD-10

ICD-10 proposes to divide caries into the following classes:

K02.0 - caries affecting the enamel;

K021 - dentine caries;
K02.2 - cement caries;
K02.3 - caries, the development of which has stopped;
K.02.3 - odontoclasia (resorption of the root of milk teeth);
K02.8 - other types of dental caries;
K02.9 - unspecified caries.

The classification proposed by ICD-10 is quite popular and is distinguished by its dignity - the separation of the class of suspended caries and cement caries.

Classification of the carious process according to the depth of the lesion

Dentists consider this classification of caries the most convenient. Therefore, it has become widespread in the domestic space. Specialists distinguish forms of the disease related to uncomplicated and complicated course of the disease:

Classification by the presence of complications

This classification involves the allocation of two types of caries:

Types of disease according to the degree of activity

Distinguish:

compensated caries, characterized by the absence of a clear progress in the carious process, the teeth are slightly affected, which does not cause discomfort to the patient;
subcompensated, characterized by an average development speed;
decompensated, which is characterized by an intense course, at this stage, acute pain in the tooth is diagnosed.

How fast does the carious process develop?

In this case, the classification is an arrangement of the following four categories of caries:

Classification of the disease according to the intensity of the process

This classification assumes the presence of:

single caries, in this case, only one tooth is affected;

plural(systemic) caries, with this form of the disease five or more teeth are affected in children, six or more in adults.

Among patients with a similar diagnosis, most often are those who are sick with acute infectious diseases, ailments of the cardiovascular and respiratory systems. Among children suffering from multiple caries, there are those who have been ill with chronic tonsillitis, scarlet fever.

Classification by process localization

Depending on the localization, specialists distinguish the following types of caries:

fissure in which the natural depressions of the surface of the teeth are affected.

Interdental carious process developing on the contact surface of the tooth. For a long time, the disease may not be diagnosed due to a specific form of development of the disease: caries, in the process of damage to the tooth surface, develops towards the center of the tooth, and the cavity itself is covered with healthy enamel layers.
Cervical, which is localized between the root and crown of the tooth, in the area adjacent to the gum. The reason for the development of the process is insufficient oral hygiene.
Annular affecting the circumferential surface of the tooth. Outwardly, it looks like a yellowish or brown belt on the neck.
Hidden carious process, developing in a difficult-to-view area - the tooth gap.

Classification according to the primacy of development

It is easy to guess that such a classification divides caries into:

primary, which affects either a healthy tooth or an area that has not previously been treated;
secondary, which is recurrent in nature, since it develops in previously healed places, sometimes this type of carious process is called internal: the disease is often localized in the area under a filling or crown.

Choice of methods of therapy

The choice of treatment method for caries depends on its type and degree of development.

Spot treatment

It implies a conservative method that eliminates the need to drill the tooth. At the initial stage, a remineralization procedure is performed.

The need for it is quite understandable: the carious process is accompanied by leaching of calcium from the tooth enamel, and the therapy used in this case is aimed at filling the resulting white stripes or spots with the same calcium.

The drugs used today in the treatment of caries at the initial stage are much more effective than the calcium gluconate tablets used in the past.

Modern products contain calcium and fluorine in an ionized form, which easily penetrate tooth enamel, which cannot be said about calcium gluconate, which consists of an almost insoluble salt.

The dentist will tell you about the treatment and prevention of caries:

Treatment of superficial caries

In the process, the dentist performs a number of the following manipulations:

Removes plaque using a brush and a special polishing paste.
Isolates the tooth from saliva. This is necessary to prevent the development of secondary caries and the rapid loss of fillings. Isolation is carried out using a rubber dam.
Etches enamel with acid and then washes it off the tooth surface.
Applies adhesive, which acts as an adhesive for fillings. The agent is applied to the area of the defect and illuminated with a light polymerization lamp.
seals. A certain portion of the filling material is applied, after which the doctor models the missing part of the tooth from this composition, and then also illuminates it with a lamp.
Grinds and polishes fillings using special dental equipment.

Treatment of medium caries

With an average form of the disease, it is necessary to prepare a carious cavity. At the same time, the algorithm of the specialist’s actions remains classic:

Treatment of deep tooth damage

You can start treatment only after preliminary anesthesia. After cleaning the cavity, the doctor fills it - this is the most typical option.

However, in the case of a deep form of carious process, damage to the dental nerve is possible. In this case, the dentist resorts to depulping the tooth - removing the soft tissues of the pulp, including the nerve.

In the case of timely treatment with deep caries, it is possible to keep the tooth alive without removing the pulp. In case of belated action, the affected tooth must be removed.

Despite the general awareness of the disease, caries carries a huge threat: the process sometimes proceeds very rapidly, affecting the dentin, and then penetrating into the soft tissues of the pulp, leading to the development of pulpitis and periodontitis (flux). Therefore, timely treatment of the disease is a guarantor of a further favorable prognosis for the patient.

After all, modern technologies can not only relieve pain, but also restore the functionality and aesthetic appearance of the affected tooth without pain and threat to the patient's health.

dentazone.ru

Who gets caries?

How can I find out if I have cavities?

With advanced tooth decay, toothache can occur, especially when taking sweet, hot or cold foods or drinks. Other clear signs of caries are visible depressions and holes in the tooth enamel.

How is caries treated?

Which toothpaste to choose Why bad breath