Dental caries (caries dentis) is a pathological process that manifests itself after the eruption of teeth, in which there is a focal demineralization and destruction of the hard tissues of the tooth with the formation of a defect in the form of a cavity. According to another definition, caries is a local complex pathological process that occurs after tooth eruption due to a complex of adverse external and internal factors, and metabolic disorders manifest in the tooth's hard tissues with subsequent destruction, necrosis, and formation a cavity defect.
Dental caries is currently the most common disease of humankind. In economically developed countries, the population affected by it reaches 95-98%. According to the WHO, caries tends to increase; in particular, the incidence is growing sharply among the population of developing countries, especially in areas of intensive urbanization.
Dental caries is a critical problem in dentistry, very interesting in theory, and extremely important in practice.
Clinical manifestations of dental caries are pretty diverse: from the chalky color of the stain on the enamel surface to the pronounced destruction of the tooth's hard tissues. These numerous forms of caries are essentially only successive stages (in the absence of treatment) of tooth decay. The progression of the carious process inevitably leads to the destruction of the entire thickness of the hard tissues of the tooth, perforation of its cavity, and inflammation of the pulp (pulpitis) or periodontitis (periodontitis).
Consider the prevention of dental caries
Our dental clinic is most often visited with such a dental disease as caries, the development of which usually begins with damage to the enamel. The condition will progress without caries prevention, penetrating deep into the tooth. As a result, cavities appear in it, in which various complications often begin. If you do not start treatment in time and start the disease, its destructive effect will lead to tooth loss.
Brushing your teeth at home, as well as all personal hygiene measures, are individual prevention. There are procedures performed by a dentist. They are classified as occupational prevention. So professional measures of primary caries prevention are sealing of fissures. They are called "professional" because a doctor performs them. And "primary" - named because they prevent the development of diseases such as caries. If the set of measures is insufficient or ineffective, caries will develop. It will be essential to detect carious foci as early as possible in such a situation. If the cavity is small, a small filling will be a reliable treatment, and the tooth retains its vitality (pulp viability). There are government programs for early caries diagnosis, such as preventive examinations in schools and kindergartens. And this is secondary prevention.
Causes of carious lesions
Caries, the causes of which lie in the adverse effects of certain types of bacteria on dental tissue, can develop very rapidly. In the human oral cavity, many different microorganisms multiply quickly. Even after high-quality teeth cleaning for 3-4 hours, their number reaches one million. They are fixed on the surface of the enamel, having a detrimental effect on it and gradually destroying it, which leads to caries. The main pests are streptococci. Their active activity mainly depends on immunity and the presence of provoking factors.
Very quickly, the bacteria begin to multiply in a favorable environment, which is created by the following moments:
- non-compliance with hygiene rules, irregular or poor quality teeth cleaning;
- existing diseases of the stomach, esophagus, and intestines, so the treatment of caries should be carried out simultaneously with the elimination of other pathologies;
- improperly composed diet, which is dominated by foods high in carbohydrates and few fresh fruits and vegetables;
- reduced immunity;
- hypovitaminosis;
- drinking water is poor in minerals such as fluorine, calcium, and phosphorus.
To prevent tooth decay, all conditions that promote the reproduction of harmful bacteria should be excluded.
Diagnosis of caries
Sometimes a person can detect carious lesions of the teeth by changing the color of the enamel, the appearance of small holes in the tooth, or other signs. But only a dentist can make an accurate diagnosis after a thorough examination. The following methods are used to detect caries:
- Congratulatory enamel painting. This method can detect caries at the earliest stage of its development. A special dye is applied to the surface of the teeth, which are first thoroughly cleaned and dried. Damaged areas of the enamel will not change color. In this case, the treatment of caries is carried out by remineralization, which helps restore the structure of dental tissue. This method is used in routine preventive examinations to detect the disease early.
- Ultraviolet radiation. Teeth are pre-cleaned of plaque and thoroughly dried. There is no luminescent glow in those areas where there are carious lesions under ultraviolet light, which emits healthy enamel.
- Radiography. Preliminary preparation of teeth with this method of diagnosis is not required. With such tools, the doctor can detect the degree of damage and the condition of the tissues around the affected area.
Initial caries lesions
Patients complain of spots (white, chalky, or pigmented) less often - the appearance of low sensitivity, tingling from the action of various irritants, mostly chemical (sour, sweet).
The appearance of spots is associated with disorders of the mineral composition of the enamel, dysmineralization, and demineralization. The process clinically begins with the loss of natural characteristics of intact enamel shine. In a limited area, the enamel becomes matte and becomes white (chalky) or brown. The latter is caused by penetration into the demineralized (hypomineralized) area of pigments (food, tobacco, pigment-forming microflora) in the case of a sufficiently long existence of the pathological process.
Superficial caries
In the case of acute superficial caries, patients complain of minor pain and, more often - the feeling of tingling in the tooth, which arise from chemical stimuli and occur quickly after the cessation of their action. Occasionally there may be short-term pain from thermal and mechanical factors, more often at the site of the defect, possibly due to irritation of a susceptible area of the enamel-dentin joint.
During the examination of the tooth in the chalk-color area, a shallow cavity (defect) is found within the enamel. The fault is filled with softened yellow-gray enamel, somewhat painful in the case of probing. Sometimes there may be only a rough surface when probing, but in the case of further preparation, a focus of softened enamel is found under it.
Chronic superficial caries is almost painless; sometimes, there may be slight pain from the action of chemical stimuli, which ceases immediately after their removal. On the enamel surface, find a small depth (within the enamel) cavities filled with a relatively dense enamel of yellow-brown or brown color.
The cavity has a wide, open, without overhanging edges of the inlet. Probing the carious defect is almost painless. Their edges can be preserved if superficial caries is localized in the fissure area. The diagnosis of superficial caries is based on:
- patient complaints of short-term pain, often from chemical stimuli, which disappears immediately after cessation of their action;
- detecting shallow, within the enamel, carious cavity, or pigmentation of fissures on the chewing surface during probing.
- pain during boron preparation of the carious cavity due to the close location of the enamel-dentin joint.
Medium caries
Due to the destruction of the enamel-dentin joint by pathological processes, caries quickly begins to spread to the dentin. Under secondary caries is understood as a condition in which the carious cavity is located within the mantle dentin. Quite often, patients with acute secondary caries may experience almost no pain. It can often be weak and emerges only under the influence of stimuli (chemical, thermal, mechanical). A chalky carious spot with a defect in the center is found on the tooth surface. Its dimensions are difficult to determine during inspection due to the narrow inlet. A complete examination of the carious cavity is possible only after removing tools (excavator, drills) overhanging chalky edges of the enamel.
Chronic moderate caries is almost asymptomatic. In some cases, there may be mild pain caused by chemical, less often - thermal and mechanical stimuli and ceases immediately after their elimination.
Patients with acute deep caries complain of causal pain (which occurs due to thermal, mechanical, or chemical stimuli and disappears immediately after eliminating incentives). Applying a tampon to the carious cavity with hot (not above 50 ° C) or cold water and ether usually causes a sharp pain reaction, but the pain stops immediately after removal of the irritant.
In the case of acute deep caries, probing the bottom of the carious cavity should be performed very carefully. At the points of projection of the pulp horns, the vault of the tooth cavity is very thin, and the dentin is softened, so it is elementary to pierce it with a probe and injure the pulp. There is a sharp pain if this happens, and a drop of blood appears in the carious cavity.
In the case of chronic deep caries, complaints of pain are almost non-existent, or there may be minor, short-term pain after exposure to thermal, chemical, and mechanical stimuli. The defect of hard tissues within the pulp dentin is quite large - it occupies a significant part of the tooth crown, open to the outside (overhanging edges of the enamel break off due to fragility), so the transverse dimensions of the cavity exceed its depth.
Treatment of dental caries
Depending on the stage of development of the pathological process and the nature of its course, a number of general and local actions (remineralizing therapy, filling) are used to treat caries. In the early stages (initial caries), these measures aim to eliminate or reduce the effect of demineralizing factors and the restoration (remineralization) of partially demineralized tooth tissues. When the pathological process spreads to the enamel-dentin joint, affects the dentin, and forms a carious cavity, conservative (remineralizing) therapy may not be effective. This is because the hard tissues of the teeth cannot restore (regenerate) their original shape in the area of the formed defect. Therefore, for the local treatment of carious cavities, the preparation of the cavity is used, followed by its filling with filling material and restoration of the anatomical shape of the tooth.
Thus, there are now two methods of local treatment of caries:
- without dissection and filling - remineralizing therapy;
- operative removal of the affected tissues with a subsequent filling of the carious cavity.
The choice of treatment depends on the stage of development and the nature of the carious process, the location of the cavity, age and general condition of the patient.
It is necessary to comply with several conditions to achieve favorable results of caries treatment by surgical method (preparation and subsequent filling of the carious cavity):
complete removal of caries-affected hard tissues of the teeth to carry out with the use of specific methods of anesthesia;
create the best conditions for reliable and robust fixation of the seal in the prepared carious cavity;
combine antiseptic treatment with thorough drying of prepared hard tissues of teeth;
make the correct selection of sealing material and follow the rules of preparation (kneading) of the material and methods of sealing;
carry out finishing, grinding, and polishing of the seal.
Thus, the treatment of caries by surgery consists of several stages:
- preparation of the oral cavity,
- anesthesia,
- preparation of carious cavity,
- the imposition of an insulating or medical lining,
- filling; processing,
- grinding and polishing of seals.