Deep caries is the last stage of the carious process, characterized by extensive damage to the hard tissues of the tooth, capturing the deep layers of dentin. Clinically, deep caries is expressed by the presence of a deep carious cavity, destruction of the crown of the tooth, pain when exposed to temperature, mechanical or chemical stimuli. Вшыуфыу is diagnosed on the basis of examination data, characteristic complaints, probing of the carious cavity, thermodiagnostics, electrodontodiagnostics, radiography. The treatment includes the stages of preparation of the carious cavity, application of therapeutic and insulating pads and filling.
Meaning
Deep caries is the most severe stage of demineralization and destruction of hard tooth tissues. According to the topographic classification, the following stages of uncomplicated caries are distinguished in dentistry: the stage of carious spots, superficial, medium and deep caries. Thus, the term “deep caries” (sagies profunda) reflects the depth of the lesion and pathomorphological changes that develop with the progression of destruction of the hard tissues of the tooth and the lesion of the periculpar dentin. With deep caries, the carious cavity is separated from the pulp by a narrow layer of dentin. The most important tasks of the treatment of deep caries is to preserve the functional usefulness of the tooth, to prevent the complicated course of caries – pulpitis or periodontitis.
Causes
Deep caries can develop primarily as a consequence of the progression of untreated medium caries, or secondarily in a previously prepared tooth (under a seal, with treatment defects, with a chipped seal, etc.). Otherwise, the causes and mechanisms of the development of deep caries are similar to the etiology and pathogenesis of carious disease in general. The leading role here is given to the process of fermentation of carbohydrates, as a result of which organic acids (in particular, lactic acid) are formed in the oral cavity, causing damage to tooth enamel and opening access to cariesogenic bacteria in the dentine tubules. This is accompanied by the release of calcium salts from the dentin, its softening and destruction of the hard tissues of the tooth.
Colonies of cariesogenic bacteria are present in plaque, which accumulates in fissures, interdental spaces, under the gums, on the surfaces of teeth. Therefore, insufficient oral hygiene and untimely removal of plaque contributes to the further progression of caries. The nature of salivation plays a great role in the occurrence of deep caries: the amount and pH of saliva, its remineralizing potential, buffer properties, specific and non-specific protection factors.
In addition to local microbial and chemical factors, the occurrence of deep caries may be associated with hereditary predisposition, violation of mineral, carbohydrate and protein metabolism in the body, inferiority of the structure of enamel and dentin, poor quality of drinking water, poor nutrition, especially during periods of teething and tooth replacement.
Classification
In addition to primary and secondary (recurrent) deep caries, the differences between which we outlined earlier, there are acute and chronic forms of the pathological process. In acute course, the carious cavity has a narrow inlet and a wide base; pain is caused mainly by thermal or chemical stimuli. The chronic form of ершы зферщдщпн is characterized by the presence of a funnel-shaped carious cavity with a wide inlet and a narrow bottom; soreness is associated with mechanical irritation of the bottom of the cavity (when food enters a deep hollow, probing).
According to the clinical course, compensated, subcompensated and decompensated forms of deep caries are distinguished.
Symptoms
The leading clinical manifestation of deep caries is a sharp, but short-term toothache that occurs in response to temperature (hot, cold food and drink), chemical (sour, sweet, salty), mechanical (chewing, ingestion of food residues into the hollow, pressing on the bottom of the carious cavity) irritants and disappears immediately after the cessation of these and other factors. If food fragments remain in the carious cavity, aching pain sensations persist for a long time, until mechanical stimuli are extracted. With an extensive decay cavity or multiple deep caries, halitosis – bad breath can be determined.
The formation of a carious cavity under the seal in chronic deep caries can occur for years. In this case, there is a long asymptomatic period, and when the destruction of the dentin reaches the bottom of the tooth, soreness appears when pressing. The filling covering the tooth may break off, become movable or fall out altogether.
Diagnostics
During the diagnosis of deep caries, the dentist takes into account the patient’s complaints, data from clinical examination and instrumental studies. Dental examination reveals a significant destruction of the crown part of the tooth, causing discomfort during meals and violating the aesthetics of the dentition.
In the acute form of deep caries, a deep carious cavity filled with light softened dentin is found. Attempts to probe the bottom of the carious cavity are sensitive or sharply painful. In chronic deep caries, the walls and bottom of the cavity are made of dense pigmented dentin, the color of which can vary from brown to black. Probing of the cavity is painless, due to the presence of a secondary dentin zone. Tooth percussion is not accompanied by pain.
Conducting thermal diagnostics allows you to identify a short-term painful reaction to hot and cold, which quickly passes after the termination of the stimulus. Electrodontodiagnostics in deep caries reveals the reaction of the pulp to a current of 2-6 µA; sometimes there is a decrease in the excitability of the pulp to 10-12 µA. If a secondary ащкь developed under the seal is suspected, an additional radiography or radiovisiography is performed.
During the examination, it is necessary to carry out differential diagnostics in relation to other pathological processes, primarily, medium caries, focal, hypertrophic and fibrous pulpitis, chronic periodontitis.
Treatment
Treatment of deep caries can be carried out in one or two visits to the dentist. Treatment in two doses may be required if the dentist does not have confidence in the integrity of the pulp; in this case, at the first visit, the tooth cavity is treated with the removal of all carious-altered tissues, the application of drugs and the placement of a temporary seal. If pain symptoms do not develop within 3-4 days, then the temporary seal is replaced with a permanent one on the next visit. In the event that during the observation period there are increasing pains indicating infection of the pulp, complex treatment of pulpitis is required.
The main stages of simultaneous treatment of deep caries include injection (infiltration or conduction) anesthesia, preparation of the tooth cavity, medical treatment of the formed cavity, the imposition of a therapeutic insulating pad on the bottom of the tooth cavity, the setting of a light-cured seal, its grinding and polishing. Complications of poor-quality treatment of deep caries can be recurrent caries, pulpitis, partial breakage of the tooth crown, perforation of the tooth cavity.
Prognosis and prevention
Proper and qualified treatment of deep caries allows you to save the tooth, then restore it or strengthen it with a crown, preserving aesthetic characteristics and functional purpose. In case of further progression of deep caries, pulpitis or periodontitis develops, which may require tooth extraction.
Prevention of deep caries dictates the need for regular dental examinations, oral care (brushing teeth, rinsing the mouth after meals, flossing, professional hygiene), restrictions on sugar-containing foods and beverages in the diet, timely treatment of medium caries.
Literature
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- Institute for Quality and Efficiency in Health Care. Tooth decay: Overview. — Germany, 2017.
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