Dental Carious Lesions: Causes, Treatment, Prevention, and More

Caries is a dental disease that occurs with the destruction of hard tissues. First, a change in their structure occurs, then rarefaction, in the end, complete decay with the formation of cavities of different sizes occurs. Caries is the most common problem that patients go to the dentist about. The disease has been known since antiquity, it has been well studied, and doctors successfully cure it in the early stages.

Causes of carious lesions

Hard tooth tissues are incapable of restoration, or such ability is very limited. There are no living cells in the enamel, they die immediately after the formation of the crown, walled up in the dense products of their vital functions. This is due to the amazing hardness of enamel, superior to the cortical substance of bones. Dentin is able to partially recover since it passes through the tubules – the processes of pulp cell cells that supply tissue with nutrients. Dental cement surrounding the root regenerates worse but also receives nutrition through diffusion from the periosteum.

Given the above, it is clear that it is easy to destroy a tooth, and you should not rely on natural regeneration. But teeth persist for decades with proper care and healthy eating. Fluorides play an important role in protecting against damage. Tiny fluorine ions fit into dense structures. Any material containing them wins in resistance to physical and chemical influences. For example, fluoroplast is the strongest and most refractory plastic grade. In dental tissues, fluorine is combined with calcium and phosphorus, forming microscopic enamel prisms. The functions of “reinforcement” are performed by collagen fibers, once formed by living cells.

The influence of aggressive substances, especially acids causes a loss of fluorine. Toothpastes contain fluorides that replenish the lack of this element. Saturation with fluoride is an even more important task when brushing your teeth than mechanical removal in the summer. Antiseptics are still included in modern formulations, thus, the effect of the paste is “three-component”. And you can’t save on its quality.

Acids are contained both directly in food and are formed by bacteria that have settled in the oral cavity. Some types of microorganisms and their combinations harm more than others. Microbes feed mainly on sugars, so sweet food leads to rapid growth of microflora in the mouth. It’s enough to chew sweets for a few minutes to feel how noticeably the thickness of the plaque on the teeth increases. It consists predominantly of bacteria. Sweet tooth puts the teeth in great danger. Propagation of microbes in the peritoneal pockets of the gums can also cause periodontal disease.

The fluorine-depleted surface layer of enamel is vulnerable to acids and enzymes. The tissue irreversibly loses its protective properties, softens, bacteria settle in it, and the lesion spreads deeper. The intake of fluorine in dentin through the blood vessels must also be sufficient, although an excess of this trace element is harmful and causes fluorosis.

An hereditary factor is important in the occurrence of caries, In some people, enamel is by nature more persistent than in others. Its characteristics are determined genetically and transmitted by inheritance.

The condition of the teeth is affected by the endocrine and immune systems. In particular, an excess of corticosteroids is harmful. Many patients note that “teeth fell off” after emotional shocks, which are accompanied by the release of adrenaline into the blood.

IMPORTANT: With a hereditary predisposition to caries, you should protect yourself from unnecessary emotions, try not to be nervous in difficult situations.

Stages of dental caries

The earliest stage of caries is the stain, or precarious. The damaged area is better visible under special lighting or under a microscope. Enamel changes color, becomes dull. A rough area replaces a smooth glossy surface. The disease is easiest to stop at the stage of a carious spot. It may be even completely cured, without replacing the defect with a seal.

The spots are white and pigmented, but there is no clear sequence in changing their color. The color of the grooves on the surface of the tooth is more dependent on the diet and composition of the microflora. Darkening is not necessarily a sign of caries. On the other hand, even the deepest and most aggressive caries can be completely white. With the rapid progression of the disease, a color change will probably not have time to happen.

With the progress of damage, a “hole” or caries proper appears. By the depth of tissue damage, dentists distinguish superficial, medium and deep. The surface affects only the enamel, the medium penetrates the dentin, the deep reaches the pulp with the formation of a through channel.

In dental classifications, there are also various types of caries by the location of the carious cavity in the tooth. It can be located on the chewing surface, on the side – buccal or lingual, also between the teeth. In the latter case, the prognosis is the worst: it is impossible to reach the cavity from the outside with tools, food is stuffed into it, which is difficult to remove with a brush. The patient does not see caries in the mirror and later consults a doctor.

Dentin is sensitive, and when “decay” reaches the processes of pulp cells, a person feels pain. Painful sensations intensify at night, when there are fewer other irritants. The tooth hurts from the cold, and later hot drinks or food painfully “go” deep into. Dentin sugar and acid are very irritating.

Caries causes a persistent halitosis. The quality of life is noticeably deteriorating. If you do not get rid of the disease in time, serious complications can occur: pulpitis, purulent lesion of the tissues surrounding the tooth, and even sepsis (blood poisoning).

IMPORTANT: You need to contact your dentist when caries is first noticed visually or tactilely. You should not expect pain.

Diagnostics

The first study that the dentist conducts is an examination of the patient in a dental chair. Given the superficial nature of the disease, virtually all carious cavities are detected. It is more difficult to determine how far they extend in depth. Even rarefied hard tissues do not pass the probe, and the patient’s sensations are not enough for diagnosis. Therefore, x-rays are almost always prescribed. Only apparently superficial caries can do without X-rays.

Any good clinic has its own equipment. Pictures are usually taken in lateral projection. Only part of the patient’s head is exposed to minor radiation, other organs are often covered with a lead vest. The teeth contrast well with soft tissues, so long exposure under the radiation source is not required.

The images determine the number, shape and location of defects, assess the condition of adjacent tissues (presence of inflammation, mineral deposits). In people with “bad” teeth, it is necessary to determine which one is affected – the one pointed to by the patient, or the neighboring one. In differential diagnosis, tapping on the tooth also helps. It is most difficult to detect caries hidden under a filling, or developed in a dead tooth with pulp removed.

Treatment

At the spot stage, enamel is remineralized with a special solution. It works faster and more reliably than ordinary toothbrushing, the effect is almost 100%. In children, they also use such a treatment method as sealing fissures. Deep grooves in the teeth are closed with filling materials. On permanent teeth, dentist can subsequently remove the excess layer if it interferes with the correct formation of the bite.

If there is a pronounced defect, it must be replaced. For this, they use filling. There are still no drugs that stimulate the growth of natural tissues, although developments in this direction are underway. Fillings are made of substances that are alien to the human body but mechanically well adhere to dentin, cement and enamel. The seal quickly freezes when a beam of light from a UV lamp is directed at it.

But first you need to remove softened dental tissue. They are already not viable, the seal will not hold well on them, and a relapse of the disease is possible. Superficial caries usually pre-eradicate without anesthesia. With medium and deep dental caries, conductive anesthesia is performed.

The tooth is drilled with a metal or diamond bur. The walls of the cavity are washed with antiseptics, dried, and filled with a filling composition. When it hardens, liquid (saliva) must not get on the surface. You will have to carefully sit in a chair with an open mouth for a few minutes. The doctor covers the mouth of the salivary glands with cotton swabs. To avoid excessive salivation, it is advisable to go to the dentist on a full stomach. People prone to excessive salivation can (on the advice of a dentist) take a medicine that blocks the parasympathetic nervous system.

In severe cases, the pulp is removed from the living tooth, the root canal is prepared, and the pins are inserted. In case of excessive destruction of the crowns, prostheses are attached to the pins. If you still have a lot of enamel and dentin, you can restore the shape of the crown with the help of fillings from special material. In any case, tooth decay during caries is an obsolete method. After this, only implantation or installation of the bridge may help, which is much more complicated and expensive.

IMPORTANT: If the patient has an allergic reaction to injectable anesthetics, this should be reported to the dentist in advance.

Prevention of carious lesions

Caries will not affect your teeth if you:

1. reduce the use of flour, sweet and sour foods;
2. finish the meal with products that “brush” your teeth;
3. rinse your mouth thoroughly after each meal;
4. brush your teeth 1-2 times a day, depending on the diet;
5. choose the right toothpaste, and change the brush more often;
6. remove tartar in time, seal fissures;
7. visit the dentist for prophylaxis every six months.

Children should not be deprived of sweets. Glucose is important for the development of the brain. In addition, baby teeth will still fall out. But you need to teach them to clean teeth at an early age. It is necessary to include fruits and vegetables into the diet as soon as the child is ready to chew them. Parents should set an example by doing all the things described above.