Deep caries: symptoms, features of diagnosis and treatment

Dentists recommend undergoing preventive examinations at least once a year and, if caries is detected, treating it at an early stage. Unfortunately, many patients go to the doctor with an advanced form of the disease. In this article we will tell you why and how deep caries occurs, and we will tell you about treatment methods.

Areas affected by caries and stages of the disease

Caries is a dental disease in which, under the influence of microorganisms and other factors, the structure of dental tissues is destroyed.

The mechanism of development of the disease is due to the vital activity of bacteria Streptococcus mutans and some other species. They have a cariogenic effect and create conditions for the development of the carious process. It goes like this. Bacteria accumulate on teeth and form a biological film called plaque. When we eat foods rich in carbohydrates, plaque bacteria actively process the sugars they contain and produce organic acids that are dangerous to our teeth. They destroy the enamel structure, deprive it of minerals, and penetrate deep into the tooth. The more acids produced by oral microorganisms, the more active and rapid the destruction of dental tissue.

Damage to teeth by caries does not occur instantly; it can take several months from a small spot to the appearance of a hole in the tooth. Based on how deeply the carious process penetrates, several stages of the disease are distinguished.

The earliest is the spot stage.

A small focus of demineralization appears on the surface of the enamel. It looks like a whitish dot or streak. It is almost impossible to notice such changes with the naked eye. And provided that there are no other symptoms (pain or discomfort) at this stage, a person often misses the onset of caries and does not see a doctor.

Superficial caries.

If the stain was not noticed in time, it gradually grows, the enamel tissue is destroyed, and a cavity is formed in it - a small hole. As a rule, there is still no pain, although food may get into the cavity or tooth sensitivity may increase.

Average caries.

The form of average caries is characterized by the penetration of the pathological process into dentin - the bone tissue under the enamel. At this stage, a carious cavity forms in the dentin, pain becomes severe, and the tooth reacts to temperature or taste stimuli. Most often, people go to the dentist with the listed symptoms.

Deep caries.

If for some reason you do not treat average caries, the pathology progresses and approaches the pulp - the dental nerve. This is the most complex and dangerous form of caries, because there is a high risk of infection spreading to the pulp, periodontium and the development of complications.

Tips for preventing tooth decay

To ensure that teeth are no longer susceptible to this pathology after caries treatment, a number of preventive measures must be followed:

regular cleaning of the oral cavity, as well as the use of rinses and dental floss;
abstaining from eating too hot or cold food;
timely visit to the dentist, immediately after the first symptoms of pathology appear;
professional hygiene of teeth and gums at least once every six months.

Regular visits to dentists are, in principle, necessary for the prevention of oral cavity in order to further avoid such painful procedures as: treatment of pulpitis, caries, etc.

If you have any questions, our dentistry in Kazan provides free consultations, and we will be happy to help you, explain everything and provide dental treatment.

Deep caries and its features

Deep caries is always an advanced pathological process. It cannot arise instantly, in a few days. As a rule, the deep form of caries develops over many months, sometimes years. In this case, the person does not consult a doctor and does not take measures to treat the carious process.

The main feature and at the same time the danger of deep caries is that it is located in close proximity to the pulp - the neurovascular bundle - and creates a threat of the development of pulpitis and periodontitis. The risk of infection spreading to other organs and tissues, as well as tooth loss, increases.

The following symptoms are characteristic of deep caries:

Aching pain in the area of the affected tooth, which intensifies from hot, cold or when biting. Acute pain with deep caries can occur when a lot of food debris accumulates in the carious cavity.
Bad breath. Even regular brushing of teeth in compliance with all the rules does not lead to the disappearance of the odor, since it arises due to decay processes in the affected tooth.
A large hole in the crown of a tooth is the most obvious sign of deep caries.

Dentists note that often with deep caries the patient has no complaints. But this does not reduce the risk of complications.

What to do if complications have already occurred?

First of all, seek help from a dentist and do not put off visiting him for a day, even if you have already developed caries and are determined to have a tooth removed! Any tooth damaged by caries is a source of infection, which can spread to any area in the oral cavity, trachea or esophagus and cause a number of other diseases. In addition, the sooner you see a doctor, the greater the likelihood that the tooth can be saved.

If the clinic has modern materials and equipment important in the treatment of periodontitis and the treatment of pulpitis, you can count on a high-quality procedure. In particular, diseases such as advanced periodontitis and periostitis can also be cured, but only surgically. In general, traditional treatment consists of removing the nerve, thoroughly cleaning the canals and filling it. However, after such manipulations the tooth becomes more fragile. And do not forget that with the transition to a more complicated stage of caries, the price of its treatment also increases.

Risk factors for deep caries

Deep tooth decay with caries most often occurs in the presence of the following risk factors:

Poor oral hygiene.
Abuse of sweet and carbohydrate foods.
Lack of calcium, fluorine, phosphorus, vitamin D in the body.
Chronic pathologies of the gastrointestinal tract.
Disturbances in the functioning of the endocrine and immune systems.
Genetic background.

And, of course, one of the main reasons for the development of deep caries is late diagnosis and untimely treatment.

Forms of deep caries

Deep caries can occur in two forms - acute and chronic. Each has its own characteristics. Acute deep caries is characterized by rapid development and can affect a large area of the tooth in a short time. Upon superficial examination, the cavity in the tooth appears small. But further diagnostics show that this is deep-stage caries, and it has almost reached the tooth root. It is acute caries that is most often accompanied by a complication in the form of pulpitis. Therefore, when treating it, the dentist has to not only prepare the tooth and put a filling on the dental crown, but also remove the nerve and fill the canals.

Chronic deep caries, unlike acute caries, is a slow, sluggish process. Although most of the tooth with this form is destroyed, the carious cavity is smaller in area than with acute caries. The patient may complain of periodic aching pain, which does not depend on external stimuli and occurs on its own.

Depending on the affected area, deep caries can be divided into cervical, fissure or located on the front incisors.

Based on the speed of development of the pathological process, it is divided into compensated (relatively slow development), subcompensated (with an average speed of development) and decompensated (with a high speed of development). Objectively, any form of deep caries can be cured, but it will require varying amounts of time and effort.

Publications in the media

Dental caries is a localized lesion of the hard tissues of teeth, manifested by demineralization and progressive destruction of enamel and dentin with the formation of a defect in the form of a cavity.

Epidemiology • Caries occurs at all ages; the prevalence of caries reaches 100%, which, according to WHO experts, makes it possible to classify it as a pandemic • Dental caries damage is assessed by the intensity indicator: “KPU index” - for permanent teeth, “KP index” - for temporary teeth, “KPU+kp index "- in a mixed dentition (the index is the sum of the number of teeth affected by caries [K], filled [P] and removed [U]).

Risk factors • Pathological pregnancy • Acute infectious and chronic systemic diseases • Sensitization of the body • Anti-infectious vaccinations and other conditions accompanied by decreased immunity • Excessive consumption of carbohydrates • Insufficient intake of mineral components and trace elements, in particular fluoride • Inadequate oral hygiene.

Etiology. Dental caries is an infectious disease associated with associated microflora (lactobacillus, veyonella, etc.), where the leading role is played by streptococci (S. mutans, S. sanguis, S. mitis, S. salivarius). The most cariogenic is S. mutans, which produces lactic acid only from glucose.

Pathogenesis. Development is determined by genetic resistance (caries resistance) or predisposition to the disease.

• A decrease in resistance to caries is associated with a decrease in the calcium content in the surface layer of enamel, more precisely with a decrease in the molar ratio “calcium/phosphorus” in hydroxyapatites below the minimum level (1.30).

• Immune disorders are associated with a decrease in the content of secretory IgA in saliva, which normally, by preventing the adhesion of microorganisms to the enamel surface, prevents the formation of soft plaque.

• Microorganisms form dental plaque (soft plaque), which is fixed on the surface of the tooth on the polysaccharide stroma.

• The microflora of the plaque damages the organic basis of the enamel, in which, with the loss of the ability to fix the mineral substrate, the process of incipient demineralization begins to predominate. In the resulting carious defect, microorganisms undergo enzymatic breakdown of the organic substances of the tooth.

Classification

• Based on the depth of the lesion, they distinguish •• initial caries •• superficial caries •• medium caries •• deep caries.

• Based on localization, they distinguish •• fissure caries - damage to grooves and natural depressions •• approximal caries - damage to contact surfaces •• cervical caries - damage to a tooth near its neck •• carious defects in other areas are considered atypical.

• According to the course, caries is distinguished as acute, acute, chronic and suspended.

Clinical manifestations. The clinical picture is very diverse and is determined by the nature of the process and the depth of damage to the hard tissues of the tooth.

• Acute forms (acute and acute) of caries are characterized by rapid development of the process, when within a short time (1–1.5 years) most of the teeth are affected; Often two or several foci are found in them. A carious defect is characterized by slight destruction of the enamel and extensive destruction of the underlying dentin. The walls and bottom of the cavity are formed by softened, low-pigmented dentin. When cold, sour or sweet food gets into the cavity, severe pain occurs. Plaque forms quickly. The viscosity of saliva increases, the activity of salivary blood lysozyme decreases, and the content of secretory IgA decreases. Impairments in the functional state of the autonomic nervous system may be detected.

• Chronic dental caries develops unnoticed when one, or less often 2-3, teeth are sporadically affected, and such damage can go unnoticed for a long time. The carious focus is localized on typical surfaces, affecting molars, premolars and rarely the upper incisors •• Initial caries is a focus of demineralization of the enamel in the form of a spot on the labial and cheek surfaces of the teeth, closer to the neck, small in size, matte, whitish or dirty gray in color. Its contours are uneven, but clearly visible after staining with methylene blue solution. The probe glides easily over the surface without detecting a defect. There are no unpleasant or painful sensations. The teeth are usually abundantly covered with soft plaque •• Superficial caries is an enamel defect that does not cause unpleasant subjective sensations and is easily detected. Has clear spherical outlines; no changes are usually noted in the enamel surrounding the defect •• Middle caries is a cavity defect affecting the enamel-dentin junction and dentin layers. It has clear edges, the bottom and walls are dense and pigmented to varying degrees. There are no complaints or food gets stuck •• Deep caries is a cavity defect extending to the area of deep (suprapulpar) dentin: large in size, usually filled with decaying contents of a dirty gray color. There may be complaints of quickly passing pain when cold or sour food gets into the cavity. Cold stimulus causes pain. Probing the cavity floor is sensitive. The electrical excitability of the pulp is reduced to 20 μA.

Diagnosis of caries is based on complaints and the time period during which damage to several teeth occurs.

• An objective examination includes examination, probing and mandatory assessment of the hygienic condition of the oral cavity.

• Additional methods include thermometry (using water at a temperature below 18 °C), vital staining with 2% aqueous methylene blue or electroodontodiagnostics, radiography.

• To identify hidden and initial forms, transillumination, luminescent examination of the enamel surface and determination of the electrical conductivity of hard dental tissues can be used.

• To identify predisposition to caries, the acid resistance of enamel and its ability to remineralize are determined.

Differential diagnosis • Complicated stages of caries • Dental diseases of non-carious nature.

TREATMENT

Diet. In acute forms of caries, a diet rich in proteins and mineral salts is prescribed; vitamins A, C, D, B1, B6.

Drug treatment • General treatment is indicated for acute forms of caries. Combined calcium preparations are prescribed (calcinova, calcium-D3-nycomed); sodium fluoride orally 4–6 mg/day • Local non-operative treatment of initial caries consists of professional hygiene (removal of dental plaque) and remineralization of the affected enamel, which is carried out using fluorides in the form of solutions, pastes, gels, varnishes, often in combination with solutions of calcium salts, or remineralizing drugs (Remodent).

Surgery. Operative and restorative treatment of caries consists of anesthesia, instrumental treatment (necrectomy) of the tissues forming the bottom and walls of the carious cavity, and its subsequent filling with filling material or inlay.

Non-drug therapy. For initial caries, application or physical treatment methods are used: electrophoresis, ultraphonophoresis. For acute caries, UV irradiation is recommended.

Forecast. Without treatment, caries, with the exception of paused ones, necessarily develops into complicated forms.

Prevention. Aimed at increasing the resistance of teeth to caries and combating plaque formation.

• A balanced diet with mandatory consumption of milk and dairy products, sufficient intake of vitamins, limitation of easily digestible carbohydrates (sucrose, glucose). It is extremely important to introduce fluoride preparations into the body with drinking water (1 mg/l) or other fluoridated products (milk, salt).

• Treatment of acute infectious and concomitant diseases, carrying out general health measures.

• Regular and high-quality oral hygiene plays an essential role: twice-daily brushing of teeth using anti-caries pastes is recommended.

ICD-10 • K02 Dental caries

Features of diagnosing deep caries

Advanced caries often has the same clinical picture as pulpitis and some other dental diseases. Therefore, before starting treatment, the doctor must conduct a differential diagnosis and understand which pathology to treat.

Deep caries can be distinguished from focal pulpitis by a number of symptoms. With pulpitis, probing the cavity with a dental probe will cause pain only in one area - in the area of the pulp, while with deep caries pain occurs over the entire surface of the tooth.

The probing procedure will also help to distinguish deep caries from medium ones. On average, it is almost painless, because a fairly thick layer of dentin remains between the sensitive pulp and the bottom of the carious cavity. With a deep form, the tooth reacts to probing with severe pain. The method of electroodontodiagnostics helps to distinguish deep caries from fibrous pulpitis. In most cases, the doctor will order an x-ray to confirm the diagnosis.

How can deep caries be cured?

A disease such as deep caries can be treated in one or two visits.

The first option is carried out according to this scheme:

The doctor numbs the affected tooth with a local anesthetic.
Opens the carious cavity and, using a drill, cleans it of dead and diseased tissue until dense walls and bottom remain.
If caries is complicated by pulpitis, endodontic treatment is carried out, that is, the dental canals are filled.
To treat inflammation, isolate the sensitive pulp from the effects of filling material, and build up dentin, a therapeutic or insulating pad is placed at the bottom of the cavity.
After all the above manipulations, the tooth is closed with a filling.

Treatment in two visits is carried out according to this scheme.

During the first visit, pain relief is performed, the cavity is opened and the affected tissue is removed. A medical pad is placed in the cavity and closed with a temporary filling. On the second visit after a few days or weeks, if the patient has no complaints, the temporary filling is replaced with a permanent one.

Treatment in two visits is considered preferable because it is possible to observe the condition of the tooth before installing a permanent filling. If pain, discomfort and other symptoms occur, additional therapeutic procedures can be performed to ensure that the affected tissue is completely removed. When treating a tooth in two visits, complications and relapses of caries occur much less frequently.

Why is advanced caries dangerous?

If caries is not treated, the following pathologies occur:

Pulpitis. If a tooth hurts after caries, there is a high probability that the pathology has affected its nerve (pulp). If pulpitis occurs after treatment of caries, this indicates the gradual death of the pulp. Because of this, the supply of food to the tooth stops.
Periodontitis. After deep caries, a pathology such as periodontitis also develops. This disease is characterized by purulent discharge near the root of the tooth.
Cyst. The destruction of tooth tissue causes the appearance of purulent granulation. In this case, even after treatment, deep caries will lead to the need for surgical intervention.
Flux. A symptom of this disease is a swollen cheek and increased sensitivity after caries treatment. If this pathology occurs, it is necessary to resort to medical or surgical methods of treating it as quickly as possible.