From the point of view of the causes and development of the pathological process, caries under the gum is no different from caries on the surfaces of teeth visible to the eye - contact, buccal, palatine, and others. Its main feature is the unusual location and the difficulties associated with it in the timely detection and treatment of this form of the disease.
At the stage of stain and superficial caries, when such pathology does not cause severe pain, it is impossible to detect tooth damage covered by the upper part of periodontal tissues with a simple examination of the oral cavity. For this reason, the treatment of a diseased tooth with caries localized under the gum usually has to be taken already at the stage of progressive pulpitis, which produces a pathological process with pains of various severities.
Today, subgingival caries is successfully diagnosed and treated in the early stages of development, but this requires a high consciousness of the patient himself, who agrees to visit the dentist only for examinations and detection of the disease at those stages when it is not yet a concern. Much of the diagnosis of caries under the gum also depends on the doctor, who should be able to correctly assess the cariogenic situation in the oral cavity and suspect the presence of a disease with non-standard localization even without obvious signs of its presence.
Localization of caries under the gum
Caries with localization under the gum can be located, generally speaking, on either side of the tooth. However, practice shows that more often it develops on proximal surfaces, that is, in the interdental region (interdental caries, which began initially above the gums, tends to quickly disappear under soft tissues, which can lead to root caries).
The photo below shows a removed tooth with a decayed root area:
The entire cavity formed due to caries was located below the edge of the gum, and therefore the tooth looked healthy outwardly, but at the moment, after some time, you can observe the launched carious process, which led to such a radical decision by the dentist.
In many cases, with the development of caries under the gum, the pathological process does not capture the enamel areas visible to the eye, even in the late stages of development, and as a result, the disease develops safely to the stage at which the pulp is affected.
On a note
Caries located beneath the gums should not be confused with a disease that some patients call "caries on the gums." The second nosology is a typical cervical caries developing exactly along the edge of the periodontium. At the same time, of course, he does not transfer to the gum itself, since only tooth tissues can affect. Caries developing under the gum can sometimes spread to areas located above the edge of the periodontium, but with its treatment and cleaning of the carious cavities, it is quite clearly visible when caries develops on the neck of the tooth, and when - under the gum with further capture of the surrounding enamel areas.
The carious cavity under the gum is a kind of “food-collection”, which provokes the gums to regular irritation with the development of traumatic or infectious inflammation of the type of gingivitis or even periodontitis.
The dangers and consequences of caries under the gums
Like other forms of caries, caries localized under the gum can have minimal signs on the outside of the enamel, but penetrate deeply into the internal tissues, which leads to imperceptible tooth decay. Therefore, quite often in such cases, pulpitis develops and depulpation (removal of nerves) is required.
Significantly less untreated caries developing under the gum can so seriously affect the root that the tooth has to be removed.
Moreover, tooth decay it leads to inflammation of the pulp faster than caries, developing from the surfaces of the tooth located above the gum. The distance from the root wall to the pulp is small, and even a not very extensive lesion is enough to make the soft tissues of the tooth get involved (they are called “nerves” in the people).
In addition, it is under the gum caries that has more opportunities to develop into periodontitis. As it develops and enamel breaks down, the space between the tooth and gum increases, more food accumulates and rots in it, which leads to rapid irritation and inflammation of the gums. Although in most cases, already at the pulpitis stage, the pain in the tooth becomes so acute that before the inflammation of the periodontium the patient already goes to the doctor and receives appropriate treatment.
Reasons for the development of pathology
Caries under the gum can develop for many reasons. The main one is gum disease, in which pockets form between the surface of the tooth and the gum adjacent to the neck of the tooth. Food pockets and bacteria producing cariogenic acids easily penetrate into such pockets. As a result, a favorable environment for the development of caries is formed here.
In addition, the disease can develop for the following reasons:
- improper installation of crowns, in which the gum is lowered or mechanically removed (exfoliates) from the tooth;
- lack of normal oral hygiene;
- some diseases, due to which the release of saliva decreases, or its composition and, as a result, bactericidal activity change.
And, of course, as with other types of caries, the destructive process under the gums can be triggered by a diet with an abundance of carbohydrates (mainly sugar and flour) and hereditary factors - the sensitivity of the teeth to caries, the subtlety of enamel and others.
Symptoms and diagnosis of caries localized under the gum
Caries, located under the gum, practically does not give itself away with those symptoms that are characteristic of cases of localization of pathology in open areas of enamel. Since the affected areas of the external walls of the tooth here are under the protection of the periodontium, cold and hot products practically do not fall on them, and therefore even deep-seated caries here may not cause pain.
Only in cases when the pocket between the gum and the tooth is filled for a long time with the remnants of decaying food, the patient himself and the tooth, which is injured or irritated by the remnants of food, can be a little disturbed. With some experience, the patient will be able to distinguish between these types of painful sensations, and the doctor, according to him, will carry out the correct diagnostic methods.
Thus, it is possible to suspect the development of caries under the gum only with the appearance of pain in the tooth or adjacent soft tissues, and before that, the lesion can only be detected by chance during a special diagnosis of neighboring teeth using x-rays, transillumination or laser devices.
Important!
A doctor will not prescribe an x-ray of apparently healthy teeth without suspecting caries. Therefore, it is very important to pay attention to the first signs of tooth soreness in time and come to the examination as soon as possible. With such self-discipline, even a caries hidden under the gum can be diagnosed at a stage when reaming and filling the tooth will not be necessary to eliminate it.
The specific treatment of caries under the gum
Fundamentally, the treatment of caries under the gum does not differ from the tactics of caries in other parts of the tooth.
If the enamel is only partially damaged and the pathological process has not spread to the dentin layer, it is possible to clean the affected area with special polishes and undergo a course from mineralization procedures.This allows you to restore the enamel.
If part of the dentin is covered by the disease, the doctor removes the area of inferior enamel covering it, cleans the carious cavity and installs a seal. When the pathological process covers the soft internal tissues of the tooth, it is necessary to depulpate the tooth.
Subgingival carious processes almost always require gum correction (excision, coagulation, etc.) at the beginning of work and further isolation of the working area from blood and saliva. These manipulations, on the one hand, complicate the treatment and take extra time, but on the other hand, they provide an opportunity to qualitatively cure a tooth with such a problem.
On a note
To create maximum dryness of the surgical field and to control gingival bleeding, dentists often use rubber dam in such cases. This is a piece of rubber (latex), the function of which is to isolate individual teeth from the oral cavity during treatment.
In the absence of the ability to use cofferdam, the dentist is forced to use glass ionomer cements, which are resistant to moisture during formulation, as filling materials, since saliva and blood cannot be completely eliminated from the work area. However, these materials have low strength compared to composites, high abrasion and poor polishability. These negative properties directly or indirectly affect the quality of the future seal placed under the gum, but this is better than a seal falling out of the composite every other day or immediately. At least, you can give a guarantee on SIC.
If the clinic uses rubber dam, then even with relatively deep lesions of the tooth root, it is possible to effectively isolate it from saliva and blood, and use more aesthetic and universal composites as filling material. Although in a number of clinical situations it is necessary to apply, again, glass ionomer cements and compomers (fillings combining the properties of SIC and composites).
On a note
The use of rubber dam today has not yet become the standard in domestic dentistry, and you can see such a film mainly in high-end and very expensive clinics. However, practice shows that with its use in more difficult places it is possible to install the most durable and durable fillings, and in general the treatment is better.
Depending on how far the pathological process has gone, different treatment options for caries are possible:
- With a small lesion, when the pulp is not involved in the pathological process, the carious cavity is cleaned with a drill and filled with filling material.
- If more than 60% of the tooth tissue is damaged by caries or if one or more of its walls is significantly destroyed, tabs are installed. Sometimes it is only possible to install a tab with a pin. This is done in cases when at least one tooth root and a significant part of the crown are affected, from which at least one wall remains after cleaning the carious cavity.
- If carious damage covers the entire crown of the tooth, but its roots remain intact, it is possible to install an artificial crown on a living tooth;
- If one or more roots, as well as a large part of the crown, is affected, the latter is removed, the tooth is depulped, a stump tab and an artificial crown are installed.
In some situations, caries developing under the gum can lead to the need to remove the tooth. This happens if the deep parts of the root are covered by the pathological process. It is extremely difficult to clean them because the alveolus interferes with the instrument, and even if this can be done, there will be nothing to attach the pin for the tab to. In these cases, the tooth is removed, and at the request of the patient, a prosthesis is installed in its place.
Deciding on a particular treatment option is possible only after opening the carious region, cleaning it and determining the extent of tissue damage.
Almost always, caries treatment under the gums is performed under local anesthesia. Therefore, for the patient, this process is painless and does not cause much discomfort.
Prevention Rules
The main opportunity to prevent the development of caries under the gums is to undergo examinations at the dentist on time. This is a universal measure that will protect those who can boast of healthy and strong teeth, and those who are quite susceptible to caries.
It is also important to carry out dental treatment and install crowns at a doctor with extensive experience. He will not make a mistake and not put the crown so that this operation will provoke the development of caries.
For the prevention of caries under the gum, all the rules common to other types of caries are relevant: regular thorough brushing of the teeth, correction of the diet with restriction of sweet and starchy foods, removal of food residues from the oral cavity, eating foods with a temperature close to body temperature. And of course, it is very important to monitor your own feelings and consult a doctor at the first sign of tooth pain. This will guarantee timely and successful treatment.
The main causes of caries (including under the gum)
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