Dental caries is the process of demineralization and destruction of hard tooth tissues with the formation of a cavity defect. It is characterized by the appearance of a yellowish-brown pigment spot on the enamel, bad breath, tooth reaction to sour, sweet, cold or hot food, aching pain. With the development of deep caries, the formation of cysts, the addition of pulpitis, and then periodontitis is possible. Neglected caries can lead to tooth loss. The presence of non-sanitized carious cavities increases the risk of developing acute and chronic diseases of the body.
K02 Dental caries
Dental caries is a destructive process of a dystrophic or infectious nature that occurs in the bone or periosteum and ends with complete or partial destruction of the tooth. Disease is the most common disease among the adult population. According to WHO, the incidence of dental caries in different countries and among different populations ranges from 80% to 98%. In the last two decades, there has been a trend of increasing morbidity among children, especially in economically developed countries, and by the age of 6-7, 80-90% of children have caries of different depths.
Dental caries is not an independent disease, and an important pathogenetic link in its development is the pathological conditions of the body as a whole. Thus, a decrease in general and local immunity, gastrointestinal pathologies and errors in the diet contribute to the development of caries.
To date, there are about four hundred theories about the occurrence of caries, but most of them are based on the fact that due to a violation of oral hygiene, plaque appears on the enamel, which leads to the development of disease. Plaque appears due to improper and irregular brushing of teeth, especially in places that are difficult to clean and in places where it is not removed naturally during chewing (lateral surfaces of teeth, recesses of chewing surfaces). Plaque binds firmly to the surface of the tooth and is a habitat for bacteria, most of which are streptococcal flora. Mineral salts, which are contained in saliva, contribute to the compaction of plaque. Such formations of plaque and mineral salts are called dental plaque.
Bacteria living in dental plaque produce lactic acid, which demineralizes tooth enamel. Demineralization of tooth enamel is the first stage of the carious process. Dextran polysaccharide, which is produced by streptococci from sucrose, promotes the process of demineralization, which is why the development of caries is associated with eating a large amount of simple carbohydrates.
The activity of microorganisms in the dental plaque and the process of demineralization depends on the individual characteristics of the organism. In most people, resistance to cariesogenic bacteria is poorly expressed, whereas in people with a good immune system and in the absence of concomitant diseases, resistance is quite high. In individuals who have immunodeficiency conditions, caries develops more actively. And in children with exudative diathesis and rickets, disease is diagnosed 2 times more often.
When the composition of saliva changes, when the ratio of mineral salts in it is violated and its natural antibacterial properties decrease, the risk of developing caries increases. Somatic diseases and errors in the diet with a deficiency of minerals, especially during the formation of teeth, significantly reduce resistance. Hereditary enamel pathologies (aplasia or hypoplasia of enamel) and extreme effects on the body in combination with other factors increase the likelihood of disease.
Living in industrial areas, unfavorable environmental conditions and the inferiority of drinking water reduce the overall protective functions of the body, which can become an important pathogenetic link in the appearance of caries. Sticky residues of carbohydrate food and deviations in the biochemical composition of the hard tissues of the tooth are the main local factors that contribute to the development of the carious process. The condition of the dental system during the period of laying, development of teething and formation of teeth is of great importance in the further state of the dental system.
Depending on the depth of the lesion of the hard tissues of the tooth, 4 forms of caries are distinguished.
- At the stage of a carious spot, the enamel of the tooth becomes cloudy. There is no visible destruction of the hard tissues of the tooth, an instrumental examination with a probe is not informative, since at this stage there are still no signs of changes in the structure of the hard tissues of the tooth. Sometimes a regression of the spot is possible, the causes of this phenomenon have not been clarified, but dentists associate self-recovery with the activation of the immune system.
- The second form of caries is superficial caries. Dark pigmentation appears on the surface of the tooth, during an instrumental examination, softening of the enamel is detected in the pigmentation zone. Sometimes, already at the stage of superficial caries, all layers of tooth enamel are involved in the destructive process. But usually the defect is limited and does not go beyond the enamel. The carious lesion looks like a dirty gray or brown spot with a rough bottom.
- With average caries, enamel and dentin tissues are affected.
- With deep caries, a complete lesion of all tooth tissues occurs, up to the complete destruction of the tooth. Subjective sensations depend on the depth of the lesion and the severity of the course of caries. Usually, patients complain of acute pain when they get sour, sweet or cold food on the affected surface or into the carious cavity. When the irritating factor is eliminated, acute toothache subsides, as a rule, there are no spontaneous pains with caries.
In the acute course of caries, a number of teeth are simultaneously affected, the affected tissues are dirty gray, softened, the focus of destruction has irregular outlines, its edges are covered, the pain syndrome is more pronounced. The acute course of caries is characterized by the defeat of almost all teeth, while in each tooth there are several foci of carious lesions.
The chronic course of disease is characterized by pigmentation of the affected areas, their compaction and smoothness of the edges. Individual teeth are affected, usually the process has a sluggish flow. In the absence of treatment, caries is complicated by pulpitis and periodontitis, which is the main cause of tooth decay and their subsequent removal.
Caries is diagnosed during visual and instrumental dental examinations. The subjective feelings of the patient allow us to judge the depth of the process, but they are not the main diagnostic criteria. In the process of diagnosis, targeted radiography of the tooth, electrodontometry is carried out.
The main principle of caries treatment is the removal of the affected tissues and restoration of the tooth with filling materials. During the sanitation of the carious cavity, all affected tissues are removed. The cavity is thoroughly disinfected, sometimes temporary seals are installed for this, under which disinfectants are located. The better the disinfection of the carious cavity is performed, the stronger the seal will hold. The qualitative strengthening of weakened tissues depends both on the qualitative removal of the carious focus and its disinfection, and on the stage at which the development of disease treatment has begun.
The classical preparation of a carious focus occurs with the help of a drill, but today there is an alternative option – laser preparation. The procedure is characterized by painlessness, noiselessness and quality of preparation of the tooth cavity for further filling.
Treatment of superficial caries is possible in several ways. A common method is the preparation of the tooth and the subsequent filling of the carious cavity. A prerequisite for this method of treatment is the creation of a cavity within the dentin, but when creating a shallow cavity, the conditions for creating a two-layer seal from an insulating gasket and the seal itself are not enough. These factors are taken into account when filling carious cavities on the chewing and contact surfaces of premolars and molars.
Another technique is the use of new composite materials with high adhesive properties, which will allow filling surface caries without deep preparation of tooth tissues. The third method consists in grinding the carious area with subsequent remineralization. Enamel remineralization is carried out with the help of applications or electrophoresis with 1% sodium fluoride solution (deep fluoridation of teeth) or with the help of other authorized remineralizing drugs. With average caries, only the method of preparing the hard tissues of the tooth with subsequent filling of the carious cavity is possible.
The treatment of deep caries is associated with certain difficulties, since the restoration of an almost completely destroyed tooth requires not only professionalism from the doctor, but also the choice of methodology. Sometimes with deep caries, the pulp of the tooth is covered with a layer of undamaged dentin, in some cases the doctor is forced to leave pigmented and softened dentin in the carious cavity. Such cases of deep caries require the application of a therapeutic pad to the bottom of the carious cavity (calcemin paste is most often used). This pad has an anti-inflammatory effect and stimulates dentinogenesis. That is, the filling for deep carious lesions consists of three layers: a therapeutic gasket, an insulating phosphate cement gasket and a permanent filling material, most often it is amalgam.
The choice of filling material is based on the group membership of the teeth. In order to restore the anatomical shapes of the front teeth – incisors and canines as a result of filling, requirements are imposed on the seal, both in strength and aesthetics. For filling these groups of teeth, the material is selected according to the color of the patient’s teeth, which allows silicate cements and composite materials.
It is mandatory to observe the technological process when preparing the filling material, because the use of good components in case of non-compliance with the technology of preparation of the material and in case of non-compliance with the technique of installing the seal significantly reduces its durability.
Preparation of the carious cavity for filling consists in careful removal of dentine sawdust using a jet of water or air. Further, the cavity is disinfected and dried, because even minor traces of moisture significantly impair the adhesion of cements, light polymers and composite fillings.
After the seal has solidified, it is sanded and polished, removing excess protrusions before that. The better the surface of the seal is polished, the less microorganisms and food residues linger on its surface. The uniformity of the outer layer reduces the likelihood of corrosion of the seal and prevents its rapid destruction. Treatment of even chronic and neglected caries with the help of filling allows you to restore the integrity of the tooth surface, prevent pulpitis and complete destruction of teeth.
Prevention of caries is the fight against soft plaque, which includes the use of high-quality toothpastes and toothbrushes, the use of dental floss, regular passage of professional oral hygiene procedures. If the tooth enamel is weakened, then fluoridation of teeth with fluoride-containing preparations is shown to strengthen it: pastes, solutions and varnishes. A balanced diet with a high content of solid foods and a low content of simple carbohydrates prevents the proliferation of microorganisms in the oral cavity. In areas where the quality of drinking water is low, it is recommended to use water from other regions.
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