Caries is a complex, usually slowly progressing, pathological process of destruction of hard tooth tissues due to the complex effect of the so-called cariogenic factors on them.
When for the first time in the Roman Empire the surgeon Archigen “drilled” a tooth for a patient and successfully carried out the treatment of caries, his experience was gradually forgotten and remained only in historical documents. It took more than one century for caries treatment to be remembered again.
In the Middle Ages, people were very interested in the causes of tooth decay and pain in the teeth. However, the fact that caries is a disease became known much later.
By the way, back in the 1st century A.D. the Roman physician Scribonius tried to suggest that tooth decay is associated with "bad juices" that enter the mouth with food. Since then, several dozen theories have appeared about what caries is and what are the causes of its occurrence and development, some of which have survived to this day.
Bacterial nature of caries
Miller's chemical-parasitic theory of the development of dental caries arose as early as 1884 and is still considered the best interpretation of the modern understanding of the causes of this pathological process. With minor corrections, it is actively used today.
Thanks to this work, mankind learned that the main cause of caries is the vital products of microorganisms, which are released when they ferment carbohydrates in the oral cavity, in particular, on the surface of tooth enamel. In other words, sugar from food is a breeding ground for bacteria (for example, for anaerobic Streptococcus mutans), which are found in large quantities in plaque.
Isolation of organic acids, which are products of carbohydrate fermentation, determines the main reason for the dissolution of tooth enamel with leaching of fluorine, calcium, and phosphorus compounds from it, which, in turn, leads to a gradual destruction of the crystal structure.
It is interesting
Even then, Miller recognized the existence of certain factors, such as the amount and composition of saliva, the nature and diet, the composition of drinking water, as well as the influence of heredity and enamel ripening conditions, on which the possibility of caries directly depended.
It was found that usually just a few minutes after eating carbohydrates is enough for the pH in the oral cavity to drop from 6 to about 4. And the lower the pH (in other words, the higher the acidity of the medium), the higher the rate of destruction of enamel, the faster it progresses caries.
Among the acids formed in plaque, lactic acid was found, as well as formic, propionic, butyric, and, to a lesser extent, some others. It is interesting to note that the main carbohydrate needed by the bacteria in our oral cavity to form these acids is sucrose. Significantly less intensive cariogenic acids are formed during the fermentation of fructose and glucose.
But xylitol or sorbitol, for example, is practically harmless from the point of view of caries-provoking factors: the enzymatic system of plaque microorganisms is not capable of converting these substances into acids at any significant speed.
Today, thanks to numerous additional studies, we can argue that tooth decay is a local pathological process that occurs only after teething and is associated with focal demineralization of enamel, followed by softening of hard tissues, leading to the formation of a cavity.
A number of important points follow from this:
- Tooth decay is a pathology that requires timely treatment, so that the destruction does not lead to a carious cavity.
- Caries is precisely a local pathological process, that is, one tooth cannot “infect” the other.
- Caries never occurs before teething. This means that the disease develops on the surface of the tooth amid the action of cariogenic factors.
The etiology of caries continues to be studied (in particular, issues related to the influence of heredity, various harmful environmental factors, etc.).
Disease of modern society
Caries on the teeth appeared in ancient times, but there is reason to believe that this problem was not widespread, and the treatment was reduced to a banal tooth extraction. However, already in the Middle Ages, caries became a problem for most people. Scientists attribute this to a change in the human diet, as well as environmental and everyday conditions.
Starting from about the XVIII century, the incidence of caries is inexorably beginning to grow, and today its prevalence in several regions on the planet reaches 100%. Moreover, the incidence of caries in Western Europe is relatively low, while in Africa and Asia these figures reach 80-97%.
Such statistics are explained by a whole range of complementary factors:
- The nature of the diet (in particular, excess or lack of carbohydrates);
- The content of fluoride, as well as other micro and macro elements in drinking water;
- Social and climatogeographic conditions (the level of dental care for the population, consumption of drinking water containing fluorides, etc.).
According to studies by several authors, carious lesions are observed in approximately 80-90% of children with milk teeth, and at the time of graduation from school, about 80% of children also have caries - already with permanent teeth.
As for adults: in developed countries, about 95% of them have at least one filling in the tooth.
Caries classification
For practical use, the most convenient is perhaps the classification of caries by the depth of the process. In this case, caries is divided into two large groups: uncomplicated and complicated, the last of which includes various types of pulpitis and periodontitis.
As for actually uncomplicated caries, it is classified into the following types:
- Caries in the spot stage (the enamel is locally demineralized, as a result of which its color changes, and its hardness and smoothness can also decrease; pain at this stage, as a rule, is absent. caries diagnosis in the spot stage, it is important to differentiate it with non-carious lesions of the teeth - for example, with hypoplasia and fluorosis).
- Superficial caries (a white or chalky spot becomes rough at this stage, may begin to pigment. A characteristic feature of the clinical picture of superficial caries is the appearance of pain from acidic, sweet, cold. At this stage, it is far from always possible to do without filling).
- Medium caries (the area of destruction penetrates deeper into the tooth tissue with dentin damage, pain from irritating factors becomes more pronounced and intense).
- Deep caries (the lesion reaches the peri-pulp dentine. If treatment is not started at this stage, then the pulp chamber will be affected and it is highly likely to require depulpation - removal of the “dental nerve.” With deep caries, the pain can be very strong and prolonged).
There are other types of caries classifications (according to the severity of the process, according to localization on the teeth, according to the duration of the course, according to the WHO, etc.)
What is dangerous caries
Currently, acute and chronic caries teeth.In a chronic course, caries can be at the same stage of development for a very long time.
For example, the appearance of a white carious spot on the surface of the tooth can gradually become pigmented due to dyes from food, but for a long time not lead to the destruction of the upper layers of enamel. In the chronic form, the transition to superficial caries can occur only many years after the start of the demineralization process.
What can not be said about acute carieswhen, in a matter of weeks or months, a surface defect develops first from a pigmented or white spot, and then the cavity develops as medium or deep caries. Without treatment, such a fast-moving process usually leads to complications of caries: pulpitis and periodontitis.
In the treatment of pulpitis, the so-called depulpation is performed - removal of the dental nerve. A dead tooth in most cases will serve less than a living tooth.
Removal of teeth as a result of periodontitis is the worst option for a bite: in the absence of one or more teeth, the others often begin to gradually shift relative to their original normal position. That is why timely treatment is so important already at the initial stages of the development of pathology (caries spots), when conservative methods of therapy can be dispensed with.
Often great difficulties arise with multiple lesions of the so-called “bottle” caries of deciduous teeth in young children aged 2 to 3-4 years.
On a note
As a rule, bottle caries occurs in children with reduced immunity, various concomitant pathologies, however, cases of its development in healthy babies are not uncommon due to the inferior tissue structure of enamel and other factors that cause caries. These include, mainly, improper feeding and lack of proper oral hygiene after it. Food residues after feeding (especially at night) with weak salivation and (or) insufficient mineral component of saliva allow microorganisms formed on the teeth of plaque to quickly lead to tooth decay.
The following photos show some examples of bottle caries:
It all starts with the usual zones of focal demineralization or a spot in the cervical region, and then the onset of destruction can turn into a severe form of cervical caries - circular caries, up to breaking off part or all of the tooth crown. At the same time, the teeth may not be sick for a long time due to the protective capabilities of them to form replacement dentin, which saves from accidentally opening the pulp (“nerve”).
If you do not start treatment on time, the consequences of bottle caries can be very serious. No one knows exactly what day the pain from decaying teeth will begin, but it is at the most inopportune moment that the baby will refuse to eat normally and even sleep.
Incorrectly chosen painkillers can damage the overall health of the child, and stopping the pain for a while is not a positive result, but imaginary well-being. After some time, serious inflammatory processes can occur on the roots of milk teeth (often manifested by "flux" on the gums), leading to the need for tooth extraction.
Multiple removal of milk teeth entails a violation of the milk bite. Carious infection, inflammation, premature extraction of deciduous teeth - all this directly or indirectly affects the normal development and teething of permanent teeth. In order to prevent such terrible consequences, it is necessary to timely treat caries even on milk teeth, without justifying inaction by the fact that they will soon fall out.
Do not underestimate the effect of diseased teeth on the quality of human nutrition. With deep caries, eating and normal chewing can be significantly complicated, and over a long period of time this usually has a general negative effect on the body.
In addition, decayed teeth in the smile zone often lead to psychological complexes, especially in children. Fear of smiling broadly, constant covering during the mouth laughing with your hand - all this can be attributed to a kind of psychological dangers associated with the presence of caries.
Dental caries
Caries in the stage of a white spot is the most favorable for conservative treatment in dentistry without the use of a drill. For this, various drugs and technologies can be used.
Popular treatment options for the focus of enamel demineralization are remineralizing drugs and agents for deep fluoridation:
- Glufthored;
- Remodent;
- Enamel-sealing liquid;
- Belagel Ca / P, Belagel F, etc.
The action of these drugs is based on the fact that enamel demineralization is reversible during initial caries. Moreover, the process of its restoration in normal conditions in a healthy person is ongoing: all the mineral components necessary for this are already contained in saliva (for this reason, saliva is even called “liquid enamel”).
The concentration of mineral components in remineralizing preparations is hundreds of times higher than in saliva, therefore, in a short period of time, they are able to saturate tooth enamel with all necessary components in quantities sufficient for intensive recovery processes. However, such restoration is not always possible: the criterion of reversibility of the destruction of enamel by caries is the preservation of the protein matrix, which determines the ordered arrangement of mineral particles in tooth tissues. If the collagen fibers of the matrix are destroyed, then conservative methods of treatment will not be enough, and the installation of a seal will be required.
The above drugs are intended exclusively for professional use, but they can be combined with the treatment of caries at home - toothpastes and remineralizing gels:
- Remineralizing cream for teeth GC Tooth Mousse;
- Remineralizing gel O.C.S. Medical Minerals;
- Active Fluoride Toothpaste Fluorodent;
- Another fluoride toothpaste is New Fluoride Pearl;
- Colgate Maximum;
- Lacalut Fluor;
- Pepsodent
And etc.
Among the modern technologies for the treatment of caries in the spot stage, the non-invasive ICON technique is gaining popularity - the treatment of caries without a drill, which involves the infiltration of polymer resins of the drug into the zone of prepared and processed demineralized enamel in advance.
Treatment of superficial, middle and deep caries most often does not do without the use of a drill and consists of several stages:
- Anesthesia (general or local anesthesia, if indicated);
- Removal of plaque (stone) from the surface of the teeth;
- Isolation of the surgical field with rubber dam or conventional cotton swabs;
- Preparation using turbine tips or tips for a micromotor with obligatory air-water cooling;
- Expansion of the cavity with the removal of softened and pigmented (in some cases) dentin and defective enamel;
- The formation of a cavity for a pre-selected material for a seal;
- Setting the seal according to the instructions for it;
- Finishing
Listed below are some modern materials from the arsenal of a professional dentist:
- Composites;
- Glass ionomer cements;
- Compomers;
- Ormoker (organically modified ceramics).
Means of prevention: we separate the truth from advertising
Most commercials make you believe that the use of toothpastes containing high concentrations of fluoride will lead to reliable disposal of tooth decay. The same goes for fluoride conditioners.
One always wants to believe in a miracle, especially when dental specialists advise on the screens explaining their experience in using these hygiene products.In fact, the mere use of fluoride paste or rinse aid will be extremely insufficient, since the implementation of the tasks of preventing the occurrence and development of caries requires a series of sequential measures:
- Limit the intake of carbohydrates (any confectionery);
- Mandatory eating solid foods, such as fruits and vegetables;
- Mandatory oral hygiene after each meal (at least rinse your mouth after eating);
- Performing the correct brushing technique - all available surfaces.
It is interesting
In a number of industrialized countries, babies under 1 year old already have carious tooth decay. By the end of 2 years of life, the number of children with caries is approximately doubled. At the age of 5, caries is diagnosed in approximately 75% of children.
Fissure decay predominates in milk teeth, and the proportion of approximate (contact) caries increases with age. This is largely due to the culture of nutrition and the predominance of high culinary processing of food in developed countries.
And although the advertisement is silent about many things, it is far from always lying: fluoride-containing toothpaste will be especially useful if used in combination with a fluorine-containing mouth rinse, as well as when using dental floss to clean the interdental spaces.
It should be borne in mind that the composition, quantity and bactericidal properties of saliva in each person are individual. Not everyone is lucky with high remineralizing rates of oral fluid, but there are those who have everything in order with this. This means that there are many people who, although they regularly consume sweets, may not brush or do not follow the technique of brushing their teeth, but they do not have problems with caries.
However, in any case, you should not rely solely on the capabilities of your body, without putting any effort into maintaining the health of your own teeth. Regular caries prophylaxis requires not so much effort to neglect it, so take care of your teeth from youth and be healthy!
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