Academic case history of chronic median caries. The walls of the carious cavity should be sheer and dense. A spherical bur is inserted into the carious cavity and the overhanging edge of the enamel is removed outward from the bottom of the cavity. When working with a fissure bur

Complaints on admission

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

Anamnesis of the patient's life (Anamnesis vitae)

1. Past and concomitant diseases - SARS, measles, chickenpox. Tuberculosis, syphilis, alcoholism, mental illness in the family did not hurt.
2. Intolerance medicinal substances - allergic history not weighed down.
3. Household history -

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

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

History of present illness (Anamnesis morbi)

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

The present state of the patient (Status praesens)

1. General state sick -

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

Height - 185 cm.

Weight - 67 kg.

Body temperature - 36.6 * C.

The skin is pale Pink colour well hydrated, elastic. Rash, hemorrhage, scratching, peeling and ulcers were not detected.

The degree of development of subcutaneous fat is moderate.

The distribution is even. Edema was not found.

The condition of the organs according to the patient is good. Acute and chronic processes not found.

2. External examination maxillofacial region.

Facial configuration is not changed, skin pale pink normally hydrated. Skin rashes and no swelling. Red border of lips without pathological changes, lips are normally moistened, there are no cracks, erosions, ulcerations.

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

3. Examination of the oral cavity -

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

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

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

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

Tonsils are not enlarged purulent plugs in the lacunae is not revealed, there is no plaque.

Dental formula:

Bite on orthognathic type.

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

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

1. Description of the diseased tooth.

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

Additional research methods

X-ray diagnostics was not performed.

Diagnosis and its rationale

Diagnosis - caries media.

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

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

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

Additional research methods:

The tooth pulp responds to a current of 3 μA.

Differential Diagnosis

Average caries differentiate:

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

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

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

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

Therapy and prevention

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

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

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

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

Stages of tooth preparation and filling:

1. Opening of the carious cavity

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

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

The criterion is the absence of undermined enamel edges.

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

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

2. Cavity expansion

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

3. Necrectomy

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

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

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

1. Formation of a carious cavity.

• this creation best conditions for fixing the filling material.

Principles of cavity formation:

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

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

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

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

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

1. Finishing

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

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

1. Medical treatment of the carious cavity.

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

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

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

Means for antiseptic treatment of the carious cavity.

Rp.: Sol.Hydrogenii peroxydi dilutae 50 ml

Rp.: Sol.Chloramini 2% - 30 ml

D.S. For the treatment of carious cavity.

Rp.: Sol.Chlorhexidini 0.06% - 50 ml

D.S. For the treatment of carious cavity.

Rp.: Sol. Furacilini 0.02% - 20 ml

D.S. For the treatment of carious cavity.

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

D.S. For the treatment of carious cavity.

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

D.S. For the treatment of carious cavity.

Rp.: Sol. Dimexidi 5% - 100.0

D.S. For the treatment of carious cavity.

Rp.: Sol. Aethonii 1% - 100.0

D.S. For the treatment of carious cavity.

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

D.S. For the treatment of carious cavity.

Rp.: Sol. Aetheris medicinalis 50ml

D.S. For the treatment of carious cavity.

1. Applying an insulating pad.

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

The overlay has the following objectives:

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

An insulating liner covers the floor and walls of the cavity up to the enamel-dentin border thin layer, without changing the configuration of the cavity, without going beyond the prepared cavity, there should be no "bald patches" in the gasket, as well as bumps and pits.

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

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

1. Placement of a permanent filling.

Filling the carious cavity is an important step.

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

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

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

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

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

Etching of enamel.

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

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

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

1. Grinding and polishing of fillings.

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

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

Prevention

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

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

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

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

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

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

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

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

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

Schematically everything preventive actions can be divided into 4 groups:

1 - endogenous drug-free prevention of dental caries. Means the introduction of food into the body, rich in proteins, amino acids, macro- and microelements, vitamins. Recommendations on diet, calcium and fluoride foods allow you to regulate the process of teething and maturation of tooth enamel;

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

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

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

The presence of soft and calcified dental deposits to a large extent depends on the quality of hygienic care for the oral cavity and teeth.

Of course, other local factors also influence the rate of formation of dental plaque (the presence of dento-jaw deformities, the intensity of salivation, the state of the soft tissues of the oral cavity, etc.), as well as common factors However, it should be emphasized that the importance of regular oral care cannot be underestimated.

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

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

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

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

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

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

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

Anti-caries toothpastes

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

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

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

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

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

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

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

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

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

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

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

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

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

Preparations for the prevention of dental caries.

Fluorine compounds

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

D.S. For rinsing the mouth.

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

Rp.: Phthorlacum 25 ml

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

Rep.: Tab. Natrii fluoridi 0.0011 № 50

D.S. 1 tablet per day.

Rep.: Tab. Natrii fluoridi 0.0022 No. 50

D.S. 1 tablet per day.

Rp.: Vitaftori 115 ml

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

Remineralizing agents

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

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

1. For applications on hard dental tissues.

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

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

Rp.: Remodenti 3.0

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

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

Rp.: Remodenti 3% - 100.0

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

Rp.: Sol. Calcii glycerophosphatis 0.5

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

S. 1 tablet 3 times a day.

Rp.: Sol. Calcii glycerophosphatis 2.5% - 100.0

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

Rp.: Tab.Unicap-M No. 30

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

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

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

Rp.: Phytini 0.25

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

Rp.: Methionini 0.1

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

1. 1 tablet 3 times a day after meals.

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

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

The tooth pulp responds to a current of 3 μA.

DS: caries media.

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

Favorable.

Etiology and pathogenesis

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

Etiology

Theories of the origin of dental caries.

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

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

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

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

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

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

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

Theory of A.E.Sharpenak (1949)

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

The modern concept of the etiology of caries.

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

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

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

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

General factors:

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

Local factors:

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

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

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

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

Pathogenesis

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

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

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

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

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

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

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

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

pathological anatomy

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

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

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

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

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

List of used literature

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

clinical picture. With average caries, patients may not complain, but sometimes pain occurs from exposure to mechanical, chemical, temperature stimuli, which quickly pass after the elimination of the stimulus. In this form of the carious process, the integrity of the enamel-dentine junction is violated, however, a rather thick layer of unaltered dentin remains above the tooth cavity. When examining the tooth, a shallow carious cavity is found, filled with pigmented softened dentin, which is determined by probing. If there is softened dentin in the fissure, the probe is delayed, stuck in it. In the chronic course of caries, probing reveals a dense bottom and walls of the cavity, a wide inlet. With an acute form of medium caries - an abundance of softened dentin on the walls and bottom of the cavity, undermined, sharp and brittle edges. Probing is painful along the enamel-dentine junction. The tooth pulp responds to a current of 2-6 μA.

Differential diagnosis of secondary caries. Medium caries is differentiated with a wedge-shaped defect, which is localized at the neck of the tooth, has dense walls and a characteristic wedge shape, is asymptomatic; with chronic apical periodontitis, which can be as asymptomatic as middle caries: no pain when probing along the enamel-dentin border, no response to temperature and chemical stimuli. The preparation of a carious cavity with medium caries is painful, but not with periodontitis, since the pulp is necrotic. The pulp of the tooth with an average caries reacts to a current of 2-6 μA, and with periodontitis - to a current of more than 100 μA. On the radiograph in chronic apical periodontitis, a uniform expansion of the periodontal gap, destructive changes in the bone tissue in the area of ​​​​the projection of the root apex are detected.

Treatment of medium caries. With medium caries, the preparation of a carious cavity is mandatory. The treatment consists of instrumental processing of enamel and dentin, which form the walls and bottom of the carious cavity, and its subsequent filling with a filling or inlay. Surgical excision of necrotic and destroyed tooth tissues as a result of the carious process consists in the removal of functionally defective and infected tooth tissues that are incapable of regeneration. Like any intervention, surgical treatment of hard dental tissues should be painless. Treatment of medium caries is reduced to compliance general principles and stages of preparation and filling of teeth.

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Full name: Elena Igorevna

Age: 28 years old

Complaints:

Pain of medium intensity in a certain tooth, due to temperature stimuli, passing after elimination. Complaints about the condition of the mucous membrane denies.

Anamnesis of life:

Past and concomitant diseases: Children's infections, SARS. Syphilis, HIV infections and tuberculosis were not ill in the family.

Intolerance to medicinal substances - According to the patient, allergic reaction for painkillers, antiseptics and filling substances.

Bad habits - smoking, drinking alcohol, drugs denies.

Medical history:

The tooth began to disturb 2 days ago. The pain came from hot tea. Rarely went to dentists for the treatment of diseased teeth.

External examination of the maxillofacial region: Satisfactory.

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

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

The tongue is pink, clean, the papillae are without pathological changes, the tongue is normally moistened, the integrity is not broken.

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

Bite on orthognathic type.

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

There is no soft plaque. Tartar is absent.

Description of the diseased tooth.

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

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

Provisional diagnosis:Dentin caries, tooth 4.5-K02.1

Additional research methods: EDI: The dental pulp responds to a current of 3 μA.

X-ray diagnostics was not performed.

Final diagnosis: Dental caries, tooth 4.5-K02.1

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

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

The tooth reacts to chemical and temperature stimuli. When probing, it is determined that the carious cavity is filled with pigmented softened dentin, it does not communicate with the tooth cavity. Probing is painful along the enamel-dentine junction. Percussion is painless. EDI: The dental pulp responds to a current of 3 μA.

Differential Diagnosis: Average caries differentiate

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

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

Medium caries is characterized by a small cavity located within its own dentin. The bottom and walls of the cavity are dense, probing is painful along the enamel-dentin junction.

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

Treatment plan

The treatment will take place in 1 visit.

Let's start with antiseptic treatment of the oral cavity (Chlorhexedine, Hexoral or Miramistino)

Let's produce application anesthesia mucosa of the left lower jaw letvi Sol.Lidocaini - 5-15% aerosolum. Then we will do mandibular anesthesia Sol. Ubistesini-4%.

Chemical (classical glass ionomer cement and chemical curing composites) and light curing materials can be used as filling materials.

The treatment will be carried out with a composite material of chemical curing Composite, but a few more materials can be cited as an example: Prism, Charisma, ChemFlex.

Stages of treatment:

1. Color choice

The choice of the color of the filling material is made after cleaning the surface of the enamel of the restored tooth. If necessary, the surface can be cleaned prophylactic paste, rinse with water. Make sure your teeth are moist before choosing a color.

2. Cavity preparation

When preparing a cavity using the preparation method, a deviation from Black's classification is possible, especially in cases where there is good microretention due to etched enamel surrounding the cavity from all sides. The main requirement of the preparation is to remove the enamel at an angle of 45°, which increases the area of ​​retention. For this purpose, turbine diamond burs, diamond heads or discs for mechanical handpieces are used.

3.Isolation

A prerequisite for a good connection of the filling material with the tissues of the tooth is the thorough drying of the prepared enamel surface. Contamination of etched and dried surfaces is not allowed. For insulation, rubber dams or cotton rolls can be used. isolation neighboring teeth produced using matrix strips.

4. Gel etching

If necessary, we use matrix strips to protect adjacent teeth from the effects of the etching gel. The gel is applied with a brush on the enamel surface to be etched for 15 - 60 seconds. Rinse the etched surfaces with a stream of water for at least 30 seconds and dry with a stream of clean, dry air.

5. Application of adhesive.

The mixed adhesive is immediately applied to the etched enamel surface in a thin layer, spread evenly with a jet of air. The filling material can be introduced into the cavity after 1.5 - 3 minutes without waiting for the final curing of the adhesive. Working time adhesive up to 3.5 min. caries tooth filling dentin

6. Mixing the composite material

Using opposite ends of a resin spatula, place equal volumes of base and catalytic paste of the chosen color onto the mixing pad. Knead the pastes for 30 seconds until smooth. The resulting paste of the composite material is placed into the prepared cavity with an appropriate tool, using “smearing” movements. To give a contour to the seal and prevent inhibition of the material by atmospheric oxygen, we use matrix strips, which must be held on the surface of the seal until complete curing (at least 3 minutes).

7. Filling processing.

Remove the matrix strip. After 7-10 minutes from the moment of mixing the material, you can start processing the seal. To give the seal the desired contour and shape, processing should be carried out with finishing diamond or carbide burs with water cooling. To polish the surface of the filling, use alumina discs, strips, silicone polishing tools of varying degrees of abrasiveness.

Do not use dyes (coffee, wine) for 2 hours. Brushing your teeth 2 times a day (morning and evening), using anti-caries toothpastes (Colgate, Blend-a-med, Agua-fresh) and dental flosses (Oral-B). You can also recommend the use of a 3% remodent solution, which is widely used for the prevention of dental caries in the form of applications. Visit the dentist six months after the filling.

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A diary

Industrial practice

"Dentist's Assistant"

For 4th year students

Student ______________________________

Groups _______ subgroups ______________

Base institution address _____________

______________________________________

Beginning of practice ________________

End of practice _____________

NALCHIK - 2016

In the KBR, the basic medical institutions are the RSP, GPS-1, GSP-2, the polyclinic of the SPH of the KBSU, the dental clinics of Prokhladny, Baksan, Nartkaly, Tyrnyauz.

Students living outside the CBD may be assigned to practice at their place of residence upon submission of a personal application and written notice to the supervisor medical institution where the practice will be carried out, on the consent to accept this student for practice.

Industrial practice pursues the following goals:

1) test knowledge and consolidate practical skills related to the diagnosis, treatment and prevention of dental caries and periodontal disease;

2) practical development of the structure of the dental clinic;

3) organization of its work to provide dental care population;

4) gaining experience in hygiene education.

The practice is carried out after the end of the spring examination session in the VI semester for all students.

During the internship period, students work according to the schedule of the medical institution, adhering to the internal regulations established for the employees of this medical institution. A student-trainee is busy daily at the reception of patients for 6 hours as an assistant to the dentist and conducts an independent reception of patients under the guidance of a doctor of the therapeutic department.

During the internship, the student must:

Comply with the internal labor regulations in force in the institution;

To study and strictly observe the rules of labor protection, safety and industrial sanitation;

Be responsible for the work performed and its results;

Must remember and follow the basics of deontology;

Be sensitive and Attentive attitude to the sick;

Strictly adhere to the principles of professional ethics, properly build your relationships with staff medical institution;

Participate in health education and professional activities;

Participate in medical scientific and practical conferences.

The student must complete the documentation:

Outpatient medical history of the dental patient;

Diary of daily records of patients;

Journal of appointment of patients;

A diary of a student's industrial practice, in which to record the results of their work daily.

During the internship as an assistant to a dentist, a student must:

know:

– organization therapy room(branches);

– sanitary and hygienic requirements;

– anatomical and histological structure of milk and permanent teeth;

- the structure of the pulp and periodontium;

– cavity topography various groups teeth;

- dental instruments;

- etiology, clinic, pathological anatomy caries, pulpitis, periodontitis, non-carious lesions of hard dental tissues;

– new research methods used in therapeutic dentistry (rheodentography, rheoperiodontography, Doppler flowmetry, radiovisiography, etc.);

– modern filling materials used in therapeutic dentistry;

- modern methods of treatment.

be able to:

– conduct anesthesia (application, injection);

- to carry out remtherapy in order to prevent and treat the initial forms of caries, the application of remineralizing preparations (fluorine-containing varnishes, gels, etc.);

- dissect carious cavities I-V classes, atypically located cavities;

- carry out antiseptic treatment and drying of carious cavities;

– mixing filling materials for temporary and permanent fillings, root canals, therapeutic and insulating linings;

- apply medical and insulating pads, temporary fillings and dressings;

- filling carious cavities with cement, amalgam, composite materials;

– grind and polish fillings;

- apply pastes for pulp devitalization;

- delete temporary and permanent fillings;

– open the cavities of the teeth of all groups, trepan the crowns intact teeth;

– carry out amputation and extirpation of the pulp;

– carry out mechanical treatment of root canals in case of pulpitis;

– carry out mechanical treatment of root canals in periodontitis;

- conduct drug treatment and drying root canal;

– seal root canals with pastes;

– seal root canals using pins (lateral and vertical condensation);

- seal the root canals with a thermophile;

- prepare a resorcinol-formalin mixture;

- to impregnate poorly passable channels with a resorcinol-formalin mixture;

– to substantiate the choice of instruments for mechanical treatment of the root canal using the Step back method;

– to substantiate the choice of instruments for mechanical treatment of the root canal using the crown down method.

own:

- examination of the patient:

- collection of anamnesis;

– examination of the maxillofacial area;

- percussion;

- probing and palpation;

– differential diagnosis;

- drawing up a plan of examination and treatment;

- determining the type of plaque on the teeth, tartar, its color, consistency;

- professional oral hygiene;

- training and monitoring of oral hygiene;

– determination of the working length of the root canal X-ray method;

- determination of the presence of destructive processes in periodontal tissues on the radiograph;

- determination of indications for various methods treatment of dental diseases;

– registration of documentation (outpatient dental card, a daily record of the work of a dentist, a diary of treatment and preventive work, etc.).

- preparation of prescriptions, directions.

At the end of the internship, the student is obliged to submit to the head of the practice a written report on the completion of all tasks, as well as:

Diary of industrial practice;

Recording medical history;

Abstract;

Conclusion of the head of the medical institution;

Sanitary and educational work

2. Issue a sanbulletin.

Educational research work

In order to increase creative activity, each student in the process of industrial practice is obliged to complete a study that has relevant scientific and practical significance.

Topic UIRS

1. The main indicators of the work of a dentist-therapist.

2. The volume of work of a dentist-therapist working on a differentiated therapeutic approach.

3. Precinct principle of public service. Main types of work.

4. Analysis of accounting for the work of a dentist-therapist.

5. Dental morbidity of the served population.

6. Analysis of morbidity with temporary disability.

7. Dispensary care by a dentist-therapist.

8. Clinical examination of patients with dental and general somatic diseases.

9. The effectiveness of clinical examination of dental patients.

10. Mistakes and complications in the treatment of dental caries.

11. Mistakes and complications in the treatment of pulpitis.

12. Mistakes and complications in the treatment of periodontitis.

13. New methods for diagnosing dental caries.

14. New methods for diagnosing caries complications.

15. Preventive work dentist-therapist.

16. Consultative work of a dentist-therapist.

17. Sanitary and educational work of a dentist-therapist.

18. Analysis of scientific articles periodicals in therapeutic dentistry for the last year.

Essay topics

1. Methods of examination of a dental patient.

2. Caries, etiology, pathogenesis.

3. Caries, clinic, differential diagnosis, treatment.

4. Modern filling materials, their properties, indications for use.

5. Non-carious lesions of hard tissues of the tooth.

Topics of sanitary education work:

1. Means and methods for the prevention of dental caries.

2. Prevention of complications of dental caries.

3. Condition of teeth and human health.

4. hygiene care oral hygiene and brushing teeth.

5. What is dental caries?

6. Toothpastes, their classification, selection criteria.

7. Bad habits and their impact on the condition and position of the teeth, alveolar arches and oral mucosa.

8. Bleeding gums: causes, treatment, prevention measures

Literature

Main

1. Therapeutic dentistry: Textbook for medical students / Ed. E.V. Borovsky. – M.: MIA, 2011. – 840 p.

Additional

1. Borovsky E.V., Zhokhova N.S. Endodontic treatment: A guide for physicians. - M., 1997. - 64 p.

2. Yakovleva V.I., Davidovich T.P., Trofimova E.S., Posveryak G.P. Diagnosis, treatment, prevention dental diseases. - Minsk, 1992. - 628 p.

3. Dental caries and its complications: Proceedings of the conference. - Omsk, 1996. - 146 p.

4. Ivanov V.S., Urbanovich L.I., Berezhnoy V.P. Inflammation of the dental pulp. - M., 1990. - 208 p.

Case history on the topic "CARIES"