Average caries - the disease of solid tissues of tooth which is characterized by violation of integrity of dentino-enamel connection. Average caries is shown by existence of defect (hollow), short-term pain of moderate intensity, hypersensibility of teeth. When sounding the carious cavity filled with the softened pigmented dentine is found. The diagnosis of average caries is established taking into account data of survey, an elektroodontodiagnostika, X-ray analysis (radioviziografiya). Treatment of average caries consists in preparation of a carious cavity, imposing of the isolating laying, statement of a seal.
Average caries (caries media) – carious damage of tooth with localization of a cavity within enamel and the center of dentine. Caries is the most widespread disease in therapeutic stomatology; at the same time average and deep caries – its most frequent kliniko-morphological forms. Average caries is the intermediate stage between superficial and deep caries. Average caries meets mainly at young and mature age, however quite often affects also milk teeth. From the point of view of a clinical current distinguish sharp and chronic average caries. On localization average caries can be prisheechny, fissurny, contact.
The basis of development of carious process is made by set of three factors: presence of kariyesogenny microflora of an oral cavity, a diet with the increased content of carbohydrates, decrease in resistance of solid tissues of teeth to influence of adverse conditions. According to modern representations, the enzymatic fermentation of carbohydrates which is carried out with direct participation of microorganisms leads to formation of the organic acids promoting demineralization of tooth enamel and penetration of microbic flora deeply in tooth tissue.
In modern stomatology there is a concept of "a kariyesogenny situation", i.e. conditions under which caries develops and progresses quicker. Unsatisfactory hygiene of an oral cavity (existence of a plentiful soft dental plaque and scale), anomalies of teeth (density, the wrong bite, violation of terms of eruption and change of teeth and so forth), the raised bleeding of gums belong to such conditions. The general factors promoting development of caries include somatic diseases, a defective diet and drinking water (deficiency of calcium, phosphorus, fluorine), etc.
Average caries develops when progressing superficial caries and is followed by destruction of dentino-enamel connection therefore process passes directly to dentine. At the same time the microbic masses under the influence of which toxins shoots of odontoblast are exposed to dystrophic and necrotic changes get into expanded dentinny tubules. Waste products of microorganisms nestle close deep into tubules, causing processes of demineralization and a softening of dentine.
Formation of the carious cavity (hollow) having the cone form with the top turned deep into tooth, and the basis - to its surface is a characteristic sign of average caries. The carious cavity is executed by three zones of dentine: the softened dentine with completely broken structure, transparent (calciphied) dentine and replaceable (secondary, irregulyatorny) the dentine reflecting the compensatory reaction directed to stabilization of carious process.
The clinical symptomatology of average caries has the low-expressed character. The increased reaction of tooth to chemical and temperature irritants, short pains of moderate or weak intensity is noted. Usually all unpleasant feelings pass shortly after elimination of a causal factor. Sometimes complaints can be absent absolutely that is explained by existence of the expressed layer of the replaceable dentine weakening action of irritants on a tooth pulp.
In the tooth affected with average caries, patients can notice emergence of a dark stain or a cavity (hollow) in which the food remains accumulate. The last circumstance can serve as the reason of emergence of an unpleasant smell from a mouth.
Chronic average caries can have a long latent current, without significant clinical manifestations and is imperceptible pass into the following stage of development or be complicated by a pulpitis. Average caries, as a rule, develops on chewing or the contact surfaces of tooth, is more rare - in prisheechny area.
Dental survey at average caries reveals the small, superficial carious cavity filled with the softened pigmented dentine, which is not reported with a tooth cavity. At average caries sounding of a cavity on an enamel dentinnoy to border is painful.
Thermotest at average caries yields positive result. Elektroodontodiagnostika reveals reaction of a pulp to current 2-6 mk. When carrying out a X-ray analysis of tooth (radioviziografichesky inspection) of changes in fabrics of a periodontium does not come to light. Differential diagnostics has to be performed between average caries and an erosion of tooth, wedge-shaped defect, deep caries, chronic periodontitis.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Complex treatment of average caries includes a number of strictly consecutive stages of preparation and tooth filling. Usually all complex of therapeutic events is held by the stomatologist-therapist for one visit.
Treatment of average caries is performed under local infiltration or conduction anesthesia. By means of spherical pine forests disclosure and expansion of a carious cavity, removal of the hanging edges of enamel and the softened dentine is made. At a stage of formation of a cavity of tooth optimum conditions for fixing of a seal are created. After a finirovaniye of a cavity medicamentous processing by antiseptics and careful drying is carried out it. On a bottom and walls of a cavity the isolating laying over which imposing of a constant seal, as a rule, from a composite of chemical hardening or materials of light polymerization is carried out is located. The final stage carries out grinding and polishing of a seal.
Forecast and prevention
At respect for all principles treatment of average caries usually successful: pain disappears, esthetic and functional full value of tooth is restored. In the absence of treatment at this stage average caries can progress promptly in deep, leading to development of complications – a pulpitis and periodontitis.
Systematic visits of the stomatologist, holding preventive actions (remineralizing therapies, professional hygiene), timely elimination of initial forms of caries, correction of food are the key to prevention of average caries. It is necessary to remember that regular and correct hygiene of an oral cavity reduces need of dental treatment by 75-80%.