Enamel caries: from diagnosis to treatment methods

Most people firmly believe that the right toothpaste, all kinds of advanced toothbrushes, rinses, etc., reliably and almost guaranteed to protect them from caries. Moreover, often when choosing hygiene products serious errors are made or a reappraisal of their capabilities occurs.

Enamel caries often develops contrary to these beliefs, and there are certain prerequisites ...

 

Provoking factors: microbial effects

Usually caries of enamel gradually forms under the thickness of plaque covering the tooth for a long time. In the layers of plaque, numerous microorganisms feed on carbohydrate residues.

Gram-positive bacteria, streptococci, play a decisive role in the formation of a carious spot on tooth enamel. At the same time, the anaerobic bacteria Streptococcus mutans are considered the most important "destroyers" of enamel mineral structure. Due to the enzymatic processing of carbohydrates (for example, sugar), they form organic acids, leaching mineral components from enamel (calcium, phosphorus and fluorine compounds).

It is interesting

Already in 1890, thanks to Professor W. Miller, people learned about the chemical-parasitic theory of caries through his many years of work “Microorganisms of the human oral cavity”. From this year begins the countdown of a scientifically based approach to the problem of tooth decay. It was Miller who first expressed the opinion that microorganisms and carbohydrates on the enamel surface create a favorable environment for the development of caries.

The formation of organic acids (lactic, malic, acetic, pyruvic, etc.) as a result of the fermentation of food residues on the teeth allows the pH (level of acidity) to drop to very low values. The doctor conducted his experiments on extracted teeth and received unique at the time results, proving the current chemical-parasitic theory of caries.

 

Elements of early diagnosis

In most cases, the patient cannot recognize enamel caries in the early stages, as the clinic of this pathology is poorly expressed. When a white or pigmented spot appears, many attribute it to plaque or tartar, not understanding the severity of the problem.

The color of the affected enamel can be different, depending on the features of regularly taken food and the presence of certain dyes in it.

Only the dentist has the opportunity to carry out a complex of simple diagnostic measures aimed at establishing a hidden carious lesion. Already at the first stages of the examination of the teeth and their probing, it is possible to determine the nature of the lesion:

1. If smooth areas of enamel are detected on chalky-white and pigmented spots during a probe’s passage along its surface, it is difficult to immediately talk about the presence of caries. The second stage is important - staining of doubtful areas with special dyes (more on this below).
2. The presence of a rough surface when conducting a dental probe along a suspicious area immediately determines this phenomenon as a defect or initial “softening”. In another way, it is caries of enamel at the stage of surface destruction.

In the photo below, caries of enamel is presented as the initial stage of the lesion with characteristic signs of this particular stage:

Dentist Opinion

Most often you can observe hidden caries lesions in the field of fissure. It is in these numerous grooves that plaque easily accumulates, which cannot be brushed for a long time. In some cases, the sounding of these pits immediately gives an answer, whether there is a roughness, a hidden defect, or demineralization that began in the subsurface layers.Sometimes there may be short-term painful sensations from sounding, but treatment cannot be started without diagnosis.

 

Diagnosis of enamel caries with dyes

Professional use of a 2% solution of Methylene Blue is perhaps the fastest and easiest way to find out exactly what is in front of us: caries of enamel or some kind of non-carious lesion (hypoplasia, fluorosis, pigmentation, etc.).

With a carious spot, the dye easily penetrates into the demineralized (porous) enamel, stably staining the entire area of ​​the lesion. Other dye preparations are sometimes used for diagnosis of caries Enamels:

1. 0.1% methylene red solution;
2. Carmine;
3. Kongorot
4. Tropeolin;
5. Silver nitrate solution.

Luminescent diagnosis of enamel caries is a rare diagnostic method that has not been widely used in dental clinics. It is based on the phenomena of fluorescence of healthy tooth tissues under the influence of ultraviolet rays.

Special lamps, such as OLD, illuminate teeth in a dark room at a distance of about 20 cm. At the same time, healthy enamel tissues give a bluish or light green hue, and areas with caries of enamel do not emit it. The method is quite effective, but has a high attachment to complex expensive equipment.

 

Clinical picture: slurred symptoms

The enamel caries blade is not bright in most cases. Spotted forms of caries may not cause any painful reactions from irritants at all, only in exceptional cases can discomfort and a feeling of “boredom” occur when carious foci are located in the area of ​​sensitive neck of teeth.

Since enamel caries is also, in addition to spots, surface disturbances in the enamel front, in this case certain symptoms are associated with this:

1. Reaction to temperature effects (cold, hot);
2. Reaction to mechanical stimuli (when eating hard foods);
3. Reaction to chemical factors (sweet, salty, sour).

In most cases, all these symptoms are mild and quickly subside when the cause is eliminated.

Damage to the caries of the enamel of the contact surfaces in the dental spaces is the most insidious option for the development of pathology. Due to the long hidden course of the destructive process between the teeth, there is a likelihood of late detection of the lesion and its transition to the stage of dentin caries - a more serious form of the pathological process.

The enamel caries clinic can also manifest itself in the aesthetic imperfection of the tooth (or teeth), causing a certain psychological discomfort to the person.

Feedback

In the last month of pregnancy, my dentist suddenly found in me a white border next to the gum on almost every front tooth. I noticed this a month ago, it began to worry me a lot, because even it became impossible to smile normally. The doctor said that I have this caries in the spot stage and that it will not go away by itself: I need either treatment with fluoride-containing agents or drilling a tooth already, but it depends on what will be observed after the first option. I somehow don’t really want to walk with two-tone teeth, now I don’t know what to do. I would like to try the fluoride option, there you just need to coat the enamel with varnish. The dentist also said that quickly getting a normal color will not work, and that the fluoridation course will last more than one visit. I will save my teeth.

 

The relevance of the treatment of caries enamel without a drill

General rules for the treatment of caries enamel include:

1. Thorough oral hygiene using fluoride pastes;
2. Compliance with diet;
3. Remineralizing therapy;
4. The use of sealants;
5. The use of special fluoride preparations;
6. Tooth preparation followed by filling.

From this list, one should select everything except the last item, characteristic of violation of the integrity of enamel with the formation of roughness or a small cavity. Here, preparation with a drill is inevitable.

If caries is in the spot stage, remineralizing therapy with gels, fluoride varnishes, sodium fluoride solutions, etc. can be used.

To accelerate the restoration of the enamel structure, dentists also use the “Enamel-sealing liquid”, which consists of two liquids. When alternately applying them to the enamel, the pores are filled with crystals of fluorine-containing compounds of calcium, magnesium and copper. They remain in the pores from 4-6 months to 2 years, constantly releasing fluoride ions.

 

Spot caries treatment at home

Before treatment primary caries it is important to consult a dentist, as home methods can delay professional help in time, which can potentially lead to the development of the next stage of carious lesions. The preferred option - when home therapy is used as an adjunct - to enhance the effect of the treatment of enamel caries, for example, in a clinic.

So, independent treatment of caries in the spot stage is possible only after consultation with the dentist and with his permission. Usually these are small areas of enamel demineralization, the treatment of which is not difficult.

We note some common tools that can be used in this case.

Dental gels providing enamel restoration:

• Tooth Mousse - a gel from a casein extract of milk, which includes calcium and phosphorus compounds;
• R.O.C.S. Medical Minerals is a special remineralizing gel containing magnesium, calcium and fluorine. Being applied to the teeth, these components restore the mineral structure of enamel.

Separately, fluorine-containing pastes with a high content of fluorides can be distinguished, which also provide a good restoring effect in caries of enamel:

• Elmex is a fluoride gel-paste for brushing your teeth, characterized by a high fluoride content (1400 ppm). It has a fixing effect if used after remineralizing gels.
• President Classic is a therapeutic fluoride paste (fluoride content of 1,400 ppm) with an anti-inflammatory effect aimed at reducing bleeding gums (2 in 1).

 

The importance of preventive measures

Generally speaking, for the occurrence of caries, it is enough to have only 2 factors in the oral cavity: the presence of carbohydrate residues and the presence of a large number of cariogenic bacteria. When plaque and tartar are formed on the surface of the teeth, tooth decay is almost inevitable.

It is important to understand that proper oral hygiene and limiting the intake of easily fermentable carbohydrates can reduce the risk of enamel caries by 3-5 times or more.

Here are some simple ways to prevent the destruction of tooth enamel:

1. Regular brushing of teeth at least 3 times a day. A standard method for brushing teeth that is understandable to anyone involves cleaning all surfaces with brushes and flosses (dental floss). In this case, it is best to use toothpastes containing fluorides, and flosses - also impregnated with fluorine-containing compounds. Brushing teeth is just as important only after eating, and not before, as previously thought.
2. The use of fluorine-containing rinses strengthens the enamel and prevents the destructive action of organic acids secreted by bacteria. Antiseptic substances contained in such rinses reduce the number of bacteria themselves.
3. Limiting snacks between main meals. This is an important point, since its non-observance and frequent consumption of food during the day, especially sweet, delays self-cleaning of teeth for a long period. And this is enough for the development of caries of enamel.
4. Visit the dentist once every 6 months for the purpose of routine inspection or professional oral hygiene: removal of plaque and stone from all surfaces of the teeth (especially at intervals) and, if necessary, deep enamel fluorination with special gels.

Keep your teeth and be healthy!

 

How can cure caries without using a drill, that is, without drilling teeth

 

Interesting facts about tooth decay and other dental problems