Caries of teeth – process of demineralization and destruction of solid tissues of tooth with formation of band defect. It is characterized by emergence on enamel of a pigmentary spot of yellowish-brown color, an unpleasant smell from a mouth, reaction of tooth to sour, sweet, cold or hot food, the aching pain. At development of deep caries formation of cysts, accession of a pulpitis, and then and periodontitis is possible. The started caries can lead to loss of tooth. Existence of not sanified carious cavities increases risk of development of sharp and chronic diseases of an organism.
Caries of teeth
Caries of teeth is the destructive process of dystrophic or infectious character proceeding in a bone or a periosteum and which is coming to an end with final or partial fracture of tooth.
The carious disease is the most widespread disease among adult population. According to WHO data incidence of caries of teeth in the different countries and among the different contingent fluctuates from 80% to 98%. In the last two decades the tendency of growth of incidence among children is noted, especially in economically developed countries and by 6-7 years at 80-90% of children caries of different depth is observed.
The carious disease is not an independent disease and an important pathogenetic link in its development pathological conditions of an organism in general act. So, decrease in the general and local immunity, pathology of digestive tract and an error in a diet promote development of caries.
Today theories about developing of caries about four hundred, but their most part is based that because of violation of hygiene of an oral cavity on enamel there is a dental plaque which leads to development of a carious disease. The raid appears because of the wrong and irregular toothbrushing, especially in places, remote for cleaning, and in places from where it is not removed in the natural way to chewing time (the side surfaces of teeth, deepenings of chewing surfaces). The dental plaque strongly contacts the surface of tooth and is the habitat for bacteria of most of which part is made streptococcal flora. Mineral salts which contain in saliva promote consolidation of a raid. Such educations from a dental plaque and mineral salts are called a tooth plaque.
The bacteria living in a tooth plaque produce lactic acid which will demineralize tooth enamel. Demineralization of tooth enamel is the first stage of carious process. Polysaccharide a dextran which is produced by streptococci from sucrose promotes demineralization process for this reason development of caries is connected with consumption of a large amount of simple carbohydrates.
Activity of microorganisms in a tooth plaque and process of demineralization depends on specific features of an organism. At most of people resistance to kariyesogenny bacteria is expressed poorly whereas at people with good shape of immune system and in the absence of associated diseases resistance is rather high. At persons who have immunodeficiency caries develops more actively. And with ekssudativny diathesis and rickets the carious disease is diagnosed for children twice more often.
At change of composition of saliva when in it the ratio of mineral salts is broken and its natural antibacterial properties decrease, the risk of development of caries increases. Somatic diseases and errors in a diet with deficiency of minerals, especially during formation of teeth, significantly reduce resistance. Hereditary pathologies of enamel (an aplaziya or a hypoplasia of enamel) and extreme impacts on an organism in combination with other factors increase probability of developing of a carious disease.
Accommodation in industrial regions, adverse ecological conditions and inferiority of drinking water reduce the general protective functions of an organism that can become an important pathogenetic link in emergence of caries. The sticky remains of carbohydrate food and a deviation of biochemical composition of solid tissues of tooth are the major local factors which promote development of carious process. The condition of zubochelyustny system in the period of a bookmark, development of eruption and formation of teeth is of great importance in a further condition of zubochelyustny system.
Depending on depth of defeat of solid tissues of tooth allocate 4 forms of caries. At a stage of a carious spot there is a tooth enamel turbidity. There are no visible destructions of solid tissues of tooth, tool inspection by the probe maloinformativno as at this stage there are no signs of change of structure of solid tissues of tooth yet. Regress of a spot is sometimes possible, the reasons of this phenomenon are not found out, however stomatologists connect self-recovery with activization of immune system.
The second form of caries is superficial caries. On the surface of tooth dark pigmentation appears, during tool survey in a zone of pigmentation the enamel softening comes to light. Sometimes already at a stage of superficial caries all layers of tooth enamel are involved in destructive process. But usually defect is limited and does not go beyond enamel. Carious defeat looks as a dirty-gray or brown spot with a rough bottom.
At average caries fabrics of enamel and dentine are surprised, and at deep caries there is a checkmate of all tissues of tooth, up to final fracture of tooth. Subjective feelings depend on depth of defeat and sharpness of a course of caries. Usually patients complain of an acute pain at hit on the struck surface or to a carious cavity of sour, sweet or cold food. At elimination of the irritating factor the twinge of toothache calms down, as a rule, spontaneous pains at caries does not happen.
At the sharp course of caries a number of teeth, the struck fabrics of dirty-gray color at the same time is surprised, are softened, the center of destruction has the wrong outlines, its edges of a podryta, the pain syndrome is expressed more brightly. The sharpest course of caries is characterized by damage of almost all teeth, at the same time in each tooth there are several centers of carious defeat.
The chronic course of a carious disease is characterized by pigmentation of affected areas, their consolidation and a smoothness of edges. Separate teeth are affected, usually process has a slow current. In the absence of treatment caries is complicated by a pulpitis and periodontitis that is the main reason for destruction of teeth and their subsequent removal.
Diagnostics and treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Diagnose caries during visual and tool surveys of the stomatologist. Subjective feelings of the patient allow to judge process depth, but are not the main diagnostic criteria. The basic principle of treatment of caries is removal of the struck fabrics and restoration of tooth sealing materials. During sanitation of a carious cavity all struck fabrics are removed. The cavity is carefully disinfected, sometimes for this purpose establish temporary seals under which there are disinfectants. The better disinfection of a carious cavity is made, the seal will keep stronger. High-quality strengthening of the weakened fabrics depends as on high-quality removal of the carious center and its disinfection, and on at what stage of development of a carious disease treatment is begun.
Classical preparation of the carious center happens to the help of a drill, however today there is an alternative option – laser preparation. The procedure differs in painlessness, noiselessness and quality of training of a cavity of tooth to further sealing.
Treatment of superficial caries perhaps in several ways. A widespread method is preparation of tooth and the subsequent sealing of a carious cavity. An indispensable condition for this method of treatment is creation of a cavity within dentine, but during creation of a small cavity of conditions for creation of a two-layer seal from the isolating laying and actually the seal is not enough. These factors are considered when sealing carious cavities on chewing and contact surfaces of premolyar and painters.
Other technique is in use of new composite materials with high agdezivny properties that will allow to seal up superficial caries without deep preparation of tissues of tooth. The third method consists in a soshlifovyvaniye of the carious site with the subsequent remineralization. Remineralization of enamel is carried out by means of applications or an electrophoresis with 1% sodium fluoride solution (deep fluoration of teeth) or by means of other resolved remineralizing medicines. At average caries only the method of preparation of solid tissues of tooth with the subsequent sealing of a carious cavity is possible.
Treatment of deep caries is accompanied by certain difficulties as restoration of almost completely destroyed tooth demands from the doctor not only professionalism, but also the choice of a technique. Sometimes at deep caries the pulp of tooth is covered with a layer of the intact dentine, in certain cases the doctor is forced to leave the pigmented and softened dentine in a carious cavity. Such cases of deep caries demand imposing of medical laying on a bottom of a carious cavity (kaltsemin-paste is most often used). This laying has anti-inflammatory effect and stimulates . That is the seal at deep carious defeats consists of three layers: medical laying, the isolating fosfatnotsementny laying and constant sealing material, most often is amalgam.
The choice of sealing material is based on group accessory of teeth. In order that as a result of sealing to restore anatomic shapes of foreteeth – cutters and canines, requirements, both on durability, and on esthetics are imposed to a seal. For sealing of these groups of teeth material is chosen according to color of teeth of the patient that silicate cements and composite materials allow.
Observance of technological process at preparation of sealing material because use of good components at non-compliance with technology of preparation of material and at non-compliance with the technology of installation of a seal significantly reduces its durability is obligatory.
Preparation of a carious cavity for sealing consists in careful removal of dentinny sawdust by means of a stream of water or air. Further the cavity is disinfected and dried up because even insignificant traces of moisture significantly worsen a prilipayemost of cements, svetopolimer and composite seals.
After hardening of a seal it is ground and polished, having removed before it excessive ledges. The better the seal surface is ground, the less microorganisms and the remains of food linger on its surface. Uniformity of an external layer reduces probability of corrosion of a seal and prevents its bystry destruction. Treatment even of the chronic and started caries by means of sealing allows to restore integrity of a surface of tooth, to prevent a pulpitis and final fracture of teeth.
Prevention of caries is fight against a soft dental plaque that includes use of qualitative toothpastes and toothbrushes, use of tooth thread, regular passing of the procedure of professional hygiene of an oral cavity. If tooth enamel is weakened, then for its strengthening the flyuorization of teeth by means of fluorinated medicines is shown: pastes, solutions and varnishes. The balanced food with the high content of firm food and low content of simple carbohydrates prevents reproduction of microorganisms in an oral cavity. In areas where quality of drinking water low, is recommended to use water from other regions.