Dental caries: causes, stages of development and risk factors

Caries (from the Latin process of decay) is a disease of dental tissues with their subsequent destruction. Dental caries account for 90% of all visits to the dentist. Caries develops as a result of the activity of pathogenic microflora. During the life of bacteria, acids are left on the surface of the teeth, destroying the enamel and deeper layers of the tooth.

Pathological processes occur slowly, and symptoms often appear only in the later stages of caries and are caused by exposure of the pulp capsule. If left untreated, caries also affects the pulp, leading to atrophy of the root system and early loss of teeth.

What is caries - main aspects

Dental caries is a long-term process of demineralization of enamel and destruction of hard tooth tissues. The disease is characterized by several stages of development. With a long course, a cavity defect is formed, which can be seen upon careful examination. A dental examination can detect caries at the chalk spot stage, an early stage of defect formation.

Symptoms of the early period of destruction of dental tissue are mild. On the surface of the enamel, spots ranging from pale yellow to gray are barely visible. Increased reaction to temperature and chewing of food. Medium and deep caries increases the intensity of symptoms, pain appears during exercise or at rest.

The disease can be complicated by the formation of retention cysts, pulpitis, and periodontitis. Complications from progressive caries are the main cause of tooth loss. According to WHO statistics, the incidence reaches 97%, with children accounting for 35% of the population. The largest number of cases are recorded in economically developed countries.

Classification and stages

The development of caries goes through several successive stages. The disease is classified not only by stage, but also by location and cause of occurrence. The stages of caries are of particular importance:

1. Stage I. Formation of stains and clouding of the enamel layer. There are no visible destructions, the tissue structure is not changed. Sometimes the spot disappears on its own, which is associated with increased immunity.
2. Stage II. Superficial caries. The enamel undergoes pigmentation, and when examined with instruments, a softening of the structure is felt. Often, superficial damage to a tooth covers all layers of enamel, but is limited. Dentin is still not involved in the pathological process. Visually, a carious defect looks like a dark gray spot with a rough base.
3. Stage III. Average caries. The defect becomes pronounced, the lesion covers all layers of enamel and part of the dentin. Patients are increasingly noticing bad breath and discomfort when drinking or eating.
4. Stage IV. Deep caries reaches the pulp membrane and is accompanied by tooth sensitivity, pain during chewing or at rest. The pain radiates to the temporal regions. The pain can be acute, throbbing, moderate, persistent. It intensifies and subsides involuntarily.

Typically, patients seek help from a doctor when symptoms worsen the quality of life and the dental-root system atrophies. When examining the oral cavity, caries is classified into:

• localized or generalized;
• acute or chronic;
• complicated or uncomplicated.

Carious lesions can be primary or secondary. In the first case, the disease occurs for the first time, in the second, caries develops again, under a filling, crown, bridge, or veneers. Clinically, there is another classification of caries according to Black:

• Class I or fissure caries - characterized by deepening of the natural grooves of the enamel on the chewing surface;
• Class II or carious defect of molars - the formation of defects on the contact surfaces of premolars, molars;
• Class III - damage to the canines and incisors without the defect extending to the cutting edge;
• Class IV - the edges of the canines and incisors are involved in the pathological process;
• Class V - the formation of cervical caries in any group of teeth.

Other types of caries are described in the international classification of diseases. There are unspecified or other caries, odontoclasia (atrophy of the root part of milk teeth), stopped caries after hygienic cleaning, preventive sanitation of the oral cavity.

Complications of caries

Most often, the cause of complications with dental caries is the person himself, however, improper treatment can lead to unpleasant consequences (which is why choosing a dental clinic is so important). The development of untreated dental caries leads to negative changes in the structure of dentin, it becomes infected, the pulp becomes inflamed (the disease is called “pulpitis”), which is accompanied by acute pain. However, pain occurs not only with inflammation of the pulp, but also with deep caries, since the pulp chamber is covered only by a thin layer of affected tissue, which cannot protect against mechanical pressure on the neurovascular bundle during meals.

Teeth can also hurt in the middle stage: the nerve endings in the area of ​​the enamel-dentin line react to external influences, causing pain.

Deep infection often leads to complications. In some cases, phlegmons and abscesses develop, which pose a significant threat to the general condition of the patient, and sometimes even to his life. the body has to devote all its strength to fighting the source of infection, the immune system is weakened, which can lead to the occurrence of systemic diseases. In such situations, it is often necessary to resort to surgery to get rid of the purulent contents and prevent the infection from spreading further.

Causes

Caries is the result of the activity of pathogenic microflora in accumulated plaque or tartar. A person’s immune status plays a major role in the development of carious defects. At particular risk are persons with autoimmune pathologies, AIDS, HIV, metabolic disorders, diabetes mellitus, and those taking immunosuppressive therapy for organ or tissue transplantation for a long time. The following factors can contribute to the development of caries:

• smoking, alcoholism;
• inadequate oral hygiene;
• natural aging (decrease in the body’s defenses, changes in the biochemical properties of saliva);
• metabolic disorders;
• endocrine pathologies;
• lack of food discipline (including prolonged fasting, poor nutrition, anorexia, bulimia);
• gum recession of various nature;
• excessive consumption of sugar and carbonated drinks;
• gastroesophageal reflux;
• bite pathologies;
• violation of hygiene rules when wearing braces and other orthodontic structures for the treatment of pathological occlusion.

Despite the variety of causes, eating disorders, bad habits and organ pathologies are the main etiological triad leading to the development of caries. Caries is not an independent disease. The pathogenetic link in the demineralization of enamel and destruction of the tooth body is a violation of the body's defenses.

Symptoms

Symptoms of caries are determined by its stage and location. Patients practically do not notice the initial stage of the disease, especially if the affected area is outside the smile line or on the inner surface of the tooth. However, pay attention to:

• enamel roughness;
• change in shade;
• minor defects (deepening of fissures, cavity fragments).

As the carious process develops, defects become noticeable upon visual inspection, and the cavities deepen. Patients note an unpleasant odor from the mouth, even stench, mainly in the morning. Pain appears. When the first signs of caries appear, you should consult a doctor.

Acute caries affects several teeth at once. The enamel softens, crumbles, and the focal fragment has an irregular asymmetrical contour. Soreness accompanies a person almost all day. There is an acute form of generalized caries, when almost all teeth or several units in the jaw row are involved in the pathological process.

In chronic cases, enamel pigmentation comes to the fore. Destruction is sluggish, pain occurs rarely.

Lack of treatment for chronic caries naturally leads to the destruction of the pulpous membrane and the pulp tissue itself, and the formation of a cystic component.

For people who love sweets

Quite often, caries appears in children at an early age and in adults who consume sweets excessively. Provided that a person cannot completely eliminate sweets from the diet, it is important to listen to useful recommendations:

• Make sure that sweets are in the mouth for a shorter period of time (no lollipops, lollipops, etc.).
• After eating sweets, you need to rinse your mouth with water or a special mouthwash.
• Don't eat sweets before bed.
• Try to consume sweets as little as possible.
• Whenever possible, replace sweet desserts with any fruits and berries.

To prevent diseases such as tooth decay, a healthy diet is key. As a rule, it is poor nutrition that leads to the formation and development of carious cavities. It is important to remember that caries can quickly develop into a more complex form and cause a lot of problems. If caries was discovered by a person independently, it is necessary to contact a dentist as soon as possible.

General recommendations for treatment

Traditional preparation of the defect is carried out using a drill. If the carious cavity is located within the dentin and does not affect the pulp, then after thorough cleaning, a filling is applied. However, sometimes with a small cavity, applying a multi-layer filling (insulating pad + filling material) is impossible. This feature is taken into account when treating caries on the contact surface of premolars and molars.

Another way to treat shallow caries in dentistry is to use a composite material with adhesive properties. In this case, extensive preparation and creation of a wide cavity is not required. Another method involves polishing a carious defect with remineralization of the enamel with medicinal applications, electrophoresis with a 1% sodium fluoride solution and other approved medications.

Medium caries is treated only by deep preparation and filling. In this case, the cavity is cleaned until the affected tissue is completely removed. High-quality sanitation ensures reliable fixation of the filling and increases its service life.

Some additional facts

Just like that, after some time, the fillings do not need to be changed. The filling may remain with you for the rest of your life. Reason for replacement: breakage of a filling or tooth, as well as caries arising from the filling.

Minor caries is asymptomatic. By waiting for pain to appear, you are dooming yourself to more expensive and complex treatment.

In the treated tooth, caries stops. It may return after a while if the filling comes off and bacteria begin to penetrate into the resulting space between the filling and the tooth.

Often, caries occurs in places that are difficult to reach with a brush, for example, in the interdental spaces. That's why we strongly advise you to use dental floss.

Any cracks in teeth or fragments of teeth are at risk.

Not all tooth sensitivity indicates tooth decay. It can be caused, for example, by gum disease, which exposes the root of the tooth. In any case, only a doctor can name the reason.

When caries is detected in primary teeth, it is recommended to treat them, if possible, rather than remove them. After all, baby teeth save space for molars. In the absence of primary teeth, molars may be positioned incorrectly.

Features of the treatment of deep caries

Removing a carious cavity with deep damage to dental tissue is fraught with difficulties, and the choice of method depends on the degree of destruction of your own tooth. Treatment tactics:

1. With pulpitis. Pulp damage involves deep preparation and removal of the nucleus pulposus along with nerve endings from the root canals. An antiseptic is placed into the lumen of the root canal, and the cavity is closed with a temporary filling or medication. This is necessary for etching and eliminating a secondary infectious process. After 1-3 days, the root canals are filled, and the defect is covered with a composite material.
2. No pulp damage. Sometimes, with deep damage, the pulp remains intact, covered by a small layer of intact dentin. Preparation is carried out precisely to this tissue in order to preserve the integrity and functionality of the root system. Often the therapist has to leave this part of the dentin, despite its softening, friability and pigmentation. In such cases, a pad based on paste-like calcemin is placed at the bottom of the defect for antiseptics and restoration of dentin. An insulating gasket and a permanent filling are also placed into the defect cavity.

In case of significant tooth decay, patients are recommended to restore the body of the unit with a composite material. This method is not considered durable due to abrasion, destruction, and the formation of new carious cavities. The only alternative in particularly difficult cases is implantation, microprosthetics or prosthetics with a bridge structure.

Rules for selecting and making a filling

The key to success when applying a high-quality and durable filling is to follow the technology of its preparation. Even when using high-quality materials, violation of the manufacturing and application protocol sharply reduces its performance characteristics.

The choice of filling depends on the location of the tooth in the dental system, the strength of the chewing load, and the characteristics of the bite. So, if it is necessary to treat teeth along the smile line, the filling should not only be durable, but also aesthetically pleasing and inconspicuous. Dentists choose composite materials, silicates.

Filling a carious cavity as the final stage is performed only after complete cleansing of the prepared area, removal of dentinal fragments, and drying. The absence of moisture and organic sawdust increases the contact of the filling with the natural tooth tissue. After the filling is fixed and completely hardened, the doctor grinds and adjusts it to the anatomical shape (removes excess material, shapes the edges). Once the filling is comfortable for the patient when closing the jaws, it is polished.

Special attention is paid to polishing. The better the filling is polished, the lower the risk of developing recurrent caries. The uniformity and smoothness of the coating prevents corrosion, accumulation of plaque and tartar, and further destruction.

How to treat caries at home

There is a clear answer to this question: “No way!” Dental caries cannot be treated at home; you can only carry out prevention to prevent it from appearing:

• Regular hygiene procedures using calcium and fluoride paste, rinses and dental floss are required
• once every six months - visit the dentist
• Protein foods should predominate in the menu, reduce the amount of carbohydrates
• Additionally, strengthening mineralized gels can be used

Modern methods of caries treatment

Modern technologies for the treatment of caries are based on reducing the invasiveness and aggressive effects of the drill and hard attachments and brushes. Minimally invasiveness and comfort during treatment are especially important in pediatric dentistry. Popular methods:

1. ICON technology. Suitable for the treatment of caries at the chalk spot stage. Rehabilitation of the defect is carried out using the unique ICON resin, which has an antibacterial and regenerating effect. The component literally fills the pores in the enamel layer and prevents the further development of the pathological process. The procedure itself lasts no more than 20 minutes.
2. Ozone therapy. Triatomic gas ozone is a natural oxidizing agent with high antibacterial properties. The substance removes pathogenic microflora and cleans the tooth surface of plaque. Ozone treatment is indicated for early stages of caries, as well as for superficial demineralization of enamel on molars and the cutting surface of teeth. In the treatment of complex cases, ozone treatment is auxiliary.
3. Air abrasive processing. Dental sanitation is carried out using finely dispersed abrasive particles under pressure. This method eliminates the use of a drill and does not injure dead tooth tissue.
4. Laser treatment. A minimally invasive treatment method that in most cases replaces a drill. The exclusion of traditional preparation of a carious cavity is possible only in case of superficial caries. Despite the fact that sanitation occurs with a laser beam, patients require anesthesia. During the removal of affected dentin, the laser somehow reaches the pulp and causes acute pain.
5. Art methodology and artistic restoration. Non-traumatic cleaning of the defective cavity is performed mechanically, followed by filling with glass ionomer material. The method was developed in underdeveloped countries where it is not possible to open full-fledged dental clinics with a wide range of services. Manual cleaning helps to accurately remove affected tissue while preserving the thickness of the healthy part of the tooth as much as possible.

All methods of caries treatment are widely used in modern clinics, but are not advanced. Most often, dentists sanitize pathological cavities and remove dental defects using a drill.

Alternative medicine in the fight against caries

Caries can be eliminated at home only at the initial stage of destructive changes in the enamel. Non-traditional recipes can stop the progression of tooth decay, especially if treatment is currently difficult or impossible according to indications. Popular rinse recipes:

1. Sage decoction. 1 tbsp. raw materials, pour 200 ml of boiling water, infuse until a bright amber-brown hue is obtained, filter and rinse your mouth throughout the day. The plant kills pathogenic microflora and is effective against stomatitis and periodontal disease. You can make lotions with a decoction of sage by applying a gauze pad to the affected area.
2. Infusion of calamus roots. A steep tincture of calamus root helps relieve pain and slow down the development of superficial or medium caries. To prepare, you will need to pour 1 tbsp. crushed raw materials, 200 ml of vodka, alcohol solution of propolis. For greater effect, you can add 10 drops of tea tree ether. The resulting composition is placed in a dark place for 5-7 days. Before rinsing 1 tsp. alcohol infusion is combined with 100 ml of warm water.
3. Mint based recipe. Fresh mint leaves are pounded in a mortar, poured with hot water (not boiling water!), and left for 30 minutes. Then add 1 tbsp. apple or wine vinegar and leave for 3 days. Mint essence prevents further destruction of dental tissue, removes plaque, softens tartar.

You can rinse your mouth with a solution of soda, sea salt, or an aqueous or alcoholic decoction of propolis. Camphor or fir oil, zinc-salicylic paste can be applied to the carious cavity.

Preventive actions

Prevention of caries consists of high-quality removal of tartar and plaque using special means: toothpastes, rinses, flosses, irrigators. Prevention of caries in children comes down to early instillation of oral hygiene skills. Popular recommendations:

• annual dental examination;
• professional teeth cleaning to remove tartar and plaque at least once a year;
• taking vitamins and calcium-containing medications;
• normalization of diet;
• improving food quality, balanced diet;
• timely treatment of chronic diseases of internal organs and systems.

Persons with chronic diseases of the ENT organs, prone to colds and respiratory infections, should take immunomodulators in courses. In case of a burdened dental history or hereditary predisposition, special pastes with a high concentration of fluoride are recommended. For recurrent caries, periodic application of mineralizing, antiseptic and protective drugs and varnishes to the enamel is indicated.

If you have braces, orthodontic aligners or plates, you should use an irrigator and special brushes. However, even careful care does not exclude professional cleaning of the product and teeth from plaque 2-3 times a year.

Timely treatment of dental caries preserves the integrity of the unit, prevents its early loss and complications. Regular sanitation of the oral cavity improves the quality of life, the aesthetics of a smile, and self-confidence.

Diagnosis of the disease

The diagnosis is made in stages. Listening to complaints and visual examination make it possible to diagnose caries only in 13% of cases. Classic probing with a sharp probe and inspection with a mirror are informative. This allows you to examine the dentition.

Thermal diagnostics, electroodontometry and x-rays are also performed. If the patient has massive dental plaque, changes in the enamel will not be visible. In this case, professional teeth cleaning is first carried out to remove plaque and stone. All this is possible in a dental clinic.

At the dental clinic

The following types of studies can be performed at the clinic:

1. Probing with a thin probe with a curved end - it is inserted under the gum, while the doctor has the opportunity to examine the structure of the tooth, its integrity, the presence of irregularities and chips. With rapidly progressing caries, the edges of the cavity are uneven and sharp. In the remission stage, the surface of the pathological focus is shiny, smooth, hard with smooth edges.
2. Electroodontometry - can determine nerve damage and the depth of inflammation. The pulp reacts differently to the current strength.
3. Thermal diagnostics - treatment of different areas of the tooth with a stream of water and heated wax. Unpleasant sensations that disappear after removing the irritant indicate caries.
4. X-ray - a targeted photograph of one tooth or computed tomography. The presence and localization of obvious or hidden inflammation is determined with millimeter precision.
5. Visiography is a special device - a visiograph scans the received data and transfers it to a computer, where the picture is studied from different angles and in detail, revealing the hidden process of inflammation.