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Dental caries (tooth decay)


Dental caries (tooth decay)

Dental caries (tooth decay) - is a complex, slow-growing and slow current pathological process in dental hard tissues. Dental caries (tooth decay) resulting from combined effect of adverse external and domestic, general and local factors, characterized by the beginning of the development of focal demineralization of the inorganic enamel, the destruction of its organic matrix and ending, as a rule, destruction of dental hard tissue with the formation of a defect (cavity) in the enamel and dentin.

Left untreated, dental caries (tooth decay) can lead to inflammatory complications from pulp and periodontium.

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Dental caries is the result of the pathogenic effects of microbial "tooth" plaque on tooth enamel.


Causes of dental caries (tooth decay)

Dental caries (tooth decay) is the result of the pathogenic effects of microbial "tooth" plaque on tooth enamel. The origin and development of dental caries requires time and the three conditions:

  • the presence of cariogenic microorganisms
  • intake from food and the delay on the surface of tooth enamel carbohydrate
  • reduction kariesrezistentnosti (resistance to cariogenic factors)


Classification of dental caries (tooth decay)

According to black, there are following classes of cavities:

  1. Class 1 of dental caries (tooth decay) - a cavity located in pits and fissures on the chewing surfaces of molars and premolars, the lingual surface of the upper incisors and in the vestibular and lingual fissures of molars related to the chewing surface.
  2. Class 2 of dental caries (tooth decay) - the cavity at the contacts (approximal) surfaces of molars and premolars.
  3. Class 3 of dental caries (tooth decay) - the cavity at the contact (approximal) surfaces of incisors and canines that do not require removal and restoration of the cutting edge.
  4. Class 4 of dental caries (tooth decay) - the cavity at the contact surfaces of incisors and canines, which demand the restoration of cutting edge.
  5. Class 5 of dental caries (tooth decay) - the cavity in the cervical area of all groups of teeth.
  6. Class 6 of dental caries (tooth decay) - the cavity at the cutting edge of the front and on the tops of knolls posterior teeth.


Stages of dental caries (tooth decay)

Topographic classification provides for four stages of dental caries (tooth decay):

  • caries in the stage of spots - focal enamel demineralization without cavity formation
  • surface caries - cavity of decay within the enamel
  • average caries - cavity of decay within the surface layers of enamel and dentin
  • deep caries - cavity of decay within the enamel and vasodentin


Treatment for dental caries (tooth decay)

Treatment of caries of the tooth is composed of the following stages:


Tooth cavity preparation

Disclosure cavity of the tooth - this step is to remove all overhanging edges and podrytyh enamel to obtain (a) vertical walls. The purpose of this phase - ensuring access to further manipulations and a good overview of the cavity.

The expansion cavity (prophylactic extension) of the tooth - preventive extension - extension phase of the disclosure cavity. The purpose of it - to prevent "relapse" caries. At this stage, create the final outer shape of the cavity

Necrectomy (nekrotomiya, "removal of tooth decay") of the tooth - this phase involves the complete removal of the softened and pigmented dentin caries from cavities.

If this operation is performed poorly, the next to seal some time to observe the development of carious lesions ("ongoing", "recurrent" caries). When non-removed infected dentin from the bottom cavity may develop pulpitis.

Cavities tooth - the purpose of this phase - giving cavity forms, providing the sealed tooth sufficient resistance, and resistance in functional stress and lasting retention of the seal. At this stage, create the final shape of the cavity.


Filling of tooth cavity

The purpose of filling a tooth with dental caries - the restoration of anatomical shape, appearance and function of the tooth, preventing further development of (recurrent) caries.

Requirements for an "ideal" filling materials for dental caries were formulated at the end of the last century, Miller and remain relevant to the present.

Sealing (restorative) material for dental caries should:

  • be chemically stable (not dissolve under the action of saliva, liquid nutrition, oral and dental tissue fluid)
  • be mechanically strong, as during chewing there are significant load (30-70 kg)
  • be resistant to abrasion
  • fit snugly inside the cavity walls (an adaptation to the walls)
  • this implies micromechanical retention and chemical bonding material to the tooth structure and other materials (adhesion)
  • long retain its shape and volume, not to shrink, the seal to ensure long-term dimensional stability
  • be minimally dependent on the moisture in the process of filling and solidification
  • be harmless to the tissues of the tooth, oral mucosa and the whole body (biocompatible filling material)
  • conform in appearance to natural teeth
  • has low thermal conductivity to prevent thermal stimulation of the pulp
  • have a coefficient of thermal expansion, similar to the coefficient of thermal expansion of the dental tissues
  • have good manipulative characteristics: sufficient ductility, easy to put into the cavity, do not stick to tools, etc.
  • be radiopaque
  • have protivokarioznym action
  • have a long shelf life, does not require special storage conditions and transportation

Although modern materials and allow to come close to solving many of these problems, not so far created an ideal material that meets all these requirements with a tooth caries. Therefore, dentists are forced to combine different materials, at the same time impose a cavity formed in layers 2-3, and sometimes 4 different material according to the nature (depth and location) cavity, the negative and positive properties of the materials used, individual peculiarities of caries in this patient.

Modern filling materials for dental caries can be divided into the following groups:

  • materials for dressings and temporary fillings tooth
  • materials for medicinal pads (linings)
  • materials for insulation pads (pads) of the tooth
  • materials for the permanent tooth fillings
  • fillings (filling) the root canal tooth


Dressings and temporary tooth fillings

Basic requirements for filling materials of this group, the following:

  • ensure tight closure of the tooth cavity
  • have sufficient compressive strength
  • be indifferent to the pulp, the tooth and Drug
  • easy to input and output cavity
  • not dissolve in saliva and saliva
  • does not contain ingredients that violate the processes of adhesion and hardening of the permanent filling materials

Bandage for a period of 1-14 days. As the bandages are used: the artificial dentin, dentin-paste tsinkoksidevgenolovye cements vinoksol, gutta-percha.

Temporary plombyrasschitany for several months (usually up to six months). The most commonly used for this purpose: evgenolny zinc, zinc phosphate, sometimes - polycarboxylate or glass ionomer cement.


Isolation tooth strip

Most modern permanent filling materials have an adverse impact on the pulp. Therefore, between the permanent seal and the bottom cavity (especially if the cavity - within the dentin) must be placed strip, perform several functions.

This strip (pad) must meet certain requirements:

  • ensure long term protection of dentin and dental pulp from chemical, thermal and galvanic effects, to prevent sensitization after preparation and filling
  • withstand the mechanical stresses associated with redistribution of chewing pressure
  • improve the fixation of permanent fillings
  • easily be introduced into the cavity, quickly harden and form a bond with the tooth structure stronger than regular filling materials in the event of shrinkage of the latter did not arise separation strip from the bottom of the cavity
  • have protivokarioznym action to influence the subject remineraliziruyuschee dentin
  • has no toxic effects on pulp
  • does not violate the properties of the permanent restorative material
  • strip must not break under the influence of gingival and dentin fluid


Therapeutic tooth pads

The basic principle of modern dentistry is a gentle attitude toward the tooth. Should avoid removing the pulp in cases where the pathological changes are reversible, and it is possible its preservation. In such situations it is necessary curative pharmacological effects on the pulp, which is docked inflammatory process, would prevent limiting its spread, would stimulate the healing process. To solve these problems apply therapeutic pads. They contain the active substances for various purposes.

Materials for medicinal pads should:

  • provide anti-inflammatory, antimicrobial, odontotropnoe action
  • not to irritate the tooth pulp
  • provide a solid seal to be dentin bond with the tooth, cushioning and permanent filling materials
  • meet the physical and mechanical properties of permanent filling materials

Therapeutic pads are shown in the following clinical situations in caries tooth:

  • treatment of deep caries
  • treatment of acute focal pulpitis by the biological method
  • conservative treatment of an accidental opening of the tooth cavity (traumatic pulpitis)

Methods of caries of the tooth to preserve the vitality of the inflamed pulp and the restoration of its function, suggest different ways of pharmacological effects. Treatment of tooth decay in such cases are conducted in two phases:

Stage 1 caries (tooth decay) treatment - cupping the inflammatory process in the pulp, the impact on the microflora, reducing pain. For this purpose, use drugs, which have strong but short-lived effect. Usually they are superimposed on some days as a medical bandage.

Stage 2 caries (tooth decay) treatment - stimulation of substitution of dentin, the normalization of the exchange in the dental pulp.
At this stage of tooth caries using drugs with long, soft action, does not decompose during long-term presence in cavity. They are imposed in the form of therapeutic pads under the temporary or permanent fillings.

In the treatment of deep caries tooth, usually limited to imposing treatment with a long strip odontotropnym and antiseptic effect.


If you have any questions about the diagnosis or treatment of tooth decay, you can specify them with our dentist or dentist on the phone:
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