Features of the diagnosis and treatment of dentin caries

Most people have thought more than once about what the word “caries” means, even despite a more or less clear understanding of the processes that occur in a tooth when it is destroyed. But what dentin caries is usually thought of only after a visit to the dentist’s office, when the doctor suddenly “delights” you with a message about the need to put a seal.

On a note

“Caries” is the Latin name for the process of decay. And the word "dentin" comes from the Latin "dentis", which means "tooth". In fact, dentin is the basis of the tooth and is located under enamel.

Given the current classification of carious lesions according to WHO (World Health Organization), the following types of caries are distinguished:

1. Caries enamel;
2. Caries of dentin;
3. Cement caries.

Next, we will only be interested in dentin caries, familiarity with which, let's start with a detailed examination of the causes that cause this pathological process.

 

The main causes of dentin caries

As a result of the vital activity of Streptococcus mutans bacteria and several other species, the formation of organic acids occurs on the surface of plaque, which appears due to the enzymatic decomposition of carbohydrate residues, for example, sugar. It is these acids that cause the “leaching” of the main mineral components from the crystal lattice of tooth enamel (calcium, fluorine, phosphorus).

On the initial stage of caries This demineralization process occurs only within the subsurface enamel layer. As a result, as a result of the active leaching of minerals and their slow return, a carious spot is formed. It can be white or pigmented as a result of staining the "voids" of enamel with food colors and drinks.

Tooth decay is not dentin decay yet. At this stage, pathological changes on the tooth surface are still reversible if measures are taken in time.

According to numerous researchers, a carious spot in most cases can be cured by remineralizing drugs, without the use of a drill. Such preparations include various fluorinating varnishes, gels, calcium preparations and combined formulations.

However, if you look at the stage of enamel damage in the early stages, then an already irreversible process arises - dentine caries. At this stage, the mineral components are washed out already from the dentin itself, which, as you remember, is the basis of the tooth.

It is interesting

Dentin is significantly different in its chemical composition and structure from tooth enamel. It is much less durable and consists of 20% organic compounds. The thickness of the dentin in the tooth reaches an average of 2 to 6 mm. At the same time, dentin is penetrated almost all of its thickness by the dentinal tubules, in which the nerve endings are located.

 

Clinical picture

Dental caries is accompanied by a violation of the integrity of the tooth with the formation of a cavity. However, do not think that a hole will necessarily be visible in your tooth: often a carious cavity is not visualized and can only be found at the dentist’s appointment when probing a tooth with a special tool for diagnosing caries.

However, there are quite common cases when the patient himself sees a cavity formation in the tooth, since with dentine caries the clinical picture is quite rich in the accompanying symptoms. These include:

• Chewing discomfort
• Toothache from temperature irritants (cold, hot food or drinks), sweet;
• Aesthetic imperfection, especially when the front tooth begins to decay.

A pain symptom can occur from one or several irritants at once, but quickly disappears after eliminating the source of irritation.

Sometimes dentin caries does not manifest itself in any way, but only a few are so lucky. Most people with the appearance of at least one or more of the above symptoms are already ready to make an appointment with a dentist so as not to delay or aggravate the process.

 

Diagnostic features of dentin caries

Diagnosis of dentin caries in most cases is not difficult even for an ordinary person. An important characteristic of caries at this stage is the occurrence of pain, which quickly disappears after elimination of the irritant. For example, when you use candy in a problem tooth, severe pain can occur, which quickly disappears as a result of rinsing the oral cavity with ordinary warm boiled water.

The methods for diagnosing dentin caries in a doctor are various, ranging from subjective to objective and instrumental. From the point of view of your symptoms, the doctor, like you, is not always able to immediately and accurately establish a diagnosis. However, even at this stage, you can formulate a preliminary diagnosis and move on to objective research methods.

To clarify the diagnosis in this situation, the following are used:

• The technique of sounding the cavity;
• Tooth percussion (tapping);
• Palpation of the transitional fold near a diseased tooth;
• Thermometry.

Sounding of the cavity is carried out by a dentist using a probe - a special tool pointed at the end. Where there is softening of the tooth tissue, the probe will fail or become stuck. In this case, a feeling of pain is possible.

With percussion, the doctor can determine the condition of the near-root zone, the presence of inflammation in it, which does not happen with dentine decay. Pain when tapped on the tooth (especially sharp) usually indicates the passage of infection deep into the tooth: into the root canals or into the tissue surrounding the root.

In this case, they no longer talk about average caries. If there is no pain, then the diagnosis of dental caries is confirmed.

On palpation of the transitional fold, it is possible to determine the presence of obvious or hidden foci of exudate infiltration or, in other words, the state of "swelling" of the tissues surrounding the tooth. If there are no signs of infiltration, then, most likely, we are not talking about the complications of caries.

Thermometry can help determine the causative carious tooth when a patient complains of a cold, warm, or hot tooth. You can always draw a little water into the syringe and rinse the alleged bad tooth. If signs of pain appear, a causal tooth is found, and the diagnosis is almost made.

There are also reliable complementary and special examination methods when using electrodontometry data for accurate diagnosis of caries. Unfortunately, this technique has not taken root in most medical facilities.

Using X-ray research methods, you can establish the severity of the carious process and the level of its complications. There may be various manifestations of inflammation at the root, and their obvious presence will deny the diagnosis of dentin caries.

Sometimes dentin caries is masked by its complications (for example, by chronic forms of pulpitis or periodontitis). Unfortunately, in such unusual situations, the symptoms may be similar in some aspects. Only a dentist at the appointment can finally determine the diagnosis.

 

Dentin Caries Treatment

If tooth decay has reached the dentin of the tooth - it means that you have already missed the moment when the treatment of pathological changes could be carried out without using a drill. At this stage, a visit to a doctor is usually not complete without drilling teeth and installing fillings.

At the dental appointment, measures will be taken to preserve not only the tooth, but also the pulp (“nerve”) inside its roots. For this, the doctor will sequentially conduct the following stages of treatment:

• Adequate anesthesia so that you do not experience pain;
• Tooth processing from carious and infected tissues (using a drill);
• Washing the formed cavity with antiseptic solutions;
• The setting of linings and seals of that price level, which will be negotiated in advance.

It should be noted that currently they produce modern filling materials that allow for gentle tooth processing without excising healthy tissues, unlike Soviet filling materials (cements, amalgams, etc.). This is due to the possibility of high-tech fillings to enter into chemical bonds with tooth tissues, forming durable and inextricable compounds due to special adhesive systems (or “adhesives”).

 

 

Dentin caries prophylaxis

Modern methods of prevention allow you to recognize caries in the spot stage already in the early stages and begin treatment with non-invasive methods, that is, without the use of a drill. The simplest and most common way to determine the presence of a carious spot is staining with a 2% solution of methylene blue. Only in the presence of a hidden carious process is it possible to stain tooth enamel even after prolonged washing of the dye solution with a water jet.

After diagnosing a carious spot, you should contact your dentist for help. At the reception you will undergo a series of preventive procedures that will stop the development of caries already in the early stages and prevent the destruction process from affecting dentin. Such preventative measures include the following:

• Conducting professional oral hygiene (removal of tartar and plaque).
• Remineralizing therapy: coating with fluoride varnishes, gels or special solutions of the surface of the affected enamel of a problem tooth and healthy teeth to strengthen them. Each drug has its own instruction and course of use (from 1-2 times to 10-20 visits).
• A course of home remineralizing and strengthening therapy (as appropriate).

If the above recommendations are fulfilled, caries in the spot stage will not go into a more severe form - dentin caries. The course of preventive measures will achieve excellent results without the use of a drill, it is only important to consult a dentist in time.

Take care of your teeth and be healthy!

 

Interesting video: tooth structure, caries and its complicated forms

 

Examples of carious lesions of teeth, their drilling and subsequent filling