CARIES OF TEETH
CARIES OF TEETH - a pathological process, manifested by demineralization and subsequent destruction of the hard tissues of the tooth with the formation of a defect in the form of a cavity.
The enamel demineralization occurs as a result of the action of organic acids on it, mainly lactic and pyruvic, which are formed on the enamel surface as a result of the fermentation of carbohydrates by the microorganisms of dental plaque. At the same time, along with the direct destructive action of organic acids on the minerals of the enamel, a prolonged increase in the concentration of hydrogen ions is of importance, contributing to the dissolution of the crystals of apatite enamel. In the future, there is the penetration of microorganisms in the deeper tissues of the tooth.
General and local factors contribute to the occurrence of dental caries. The most important among the common factors is alimentary (insufficient intake of proteins, vitamins, mineral salts, a number of trace elements, including fluorine, excessive consumption of easily fermentable carbohydrates), as well as impaired functions of other organs and body systems, stressful situations. Local factors include quantitative and qualitative changes in saliva, a prolonged delay in the oral cavity of food debris containing carbohydrates. Important in the development of caries is tooth resistance, which depends on the structural features and chemical composition of the enamel.
During the carious process, there is an early stage - the spot (white and pigmented) stage and the late stage - the stage of the formation of a defect in hard tissues (superficial, medium and deep caries). Caries in the stage of the stain is asymptomatic and is detected only during the inspection. Superficial caries occurs at the site of a white or pigmented spot and is characterized by the destruction of enamel tissue. It may be accompanied by short-term pain when exposed to mechanical and thermal stimuli, more often there is no pain.
An average caries damages the surface layer of dentin. The symptomatology, as a rule, is absent, small short-term pain sometimes occur. On examination, a carious cavity with softened dentin is detected.
With deep caries, the process involves a large part of the dentin. Patients complain of short-term pain when exposed to mechanical, chemical and temperature irritants, passing after their removal. On examination, a deep carious cavity with a softened dentin is detected, and sounding of the bottom of the cavity is painful. The progression and transition of the process to the pulp leads to the development of pulpitis.
Treatment depends on the nature of changes in the tooth tissues. In the white spot stage, the treatment is carried out without preparation. Calcium and phosphorus ions are injected into the demineralization area. For this purpose, a 10% solution of calcium gluconate, a 1.5–3% solution of “Remodent” is used. The tooth surface is dried, plaque is removed, and then cotton swabs moistened with remineralizing solution are applied to the lesion site for 15–20 minutes. The course of treatment consists of 15 procedures. With the initial changes, the white spot disappears completely, with significant demineralization the spot decreases in size, but does not completely disappear. Relapses are possible, and therefore there is a need for re-treatment.
With superficial, medium and deep caries, a carious cavity is prepared with subsequent restoration of the anatomical shape of the tooth - filling.
Prevention is aimed at eliminating conditions conducive to the development of caries, and increasing the resistance of tooth enamel. First of all, it is necessary to limit the consumption of excess carbohydrates, eliminate sweets in the intervals between meals, and also not to eat sweets as the last dish, before going to bed, after brushing your teeth. It is better to replace sugar with carbohydrates that do not undergo fermentation - xylitol, sorbitol, etc. Solid food (vegetables, fruits) is introduced into the diet, chewing of which promotes self-cleaning of the teeth (exemption from food debris, soft plaque).
Leading importance in the prevention of caries belongs to oral hygiene. It is necessary to brush your teeth in the morning after breakfast and especially thoroughly (at least 3 minutes) in the evening before bedtime. Children should begin brushing their teeth from 2 - 3 years of age, from 4 years - twice a day. Toothpastes in connection with a less pronounced abrasive effect are more widespread than tooth powders. Along with hygienic pastes, you can use the paste of therapeutic and prophylactic action, containing those or other medicinal substances. It is recommended to brush the teeth with an artificial bristle toothbrush. If the bristles lose their shape, it begins to break down, breaks out, the brush must be replaced. Remove food debris produced with a toothpick. To remove plaque from the surface of the tooth, dental floss is used from the interdental spaces. Auxiliary hygienic means are dental elixirs, which are used after brushing or after eating.
An important role in the formation of tooth resistance to adverse factors belongs to nutrition. During pregnancy, when the fetus starts laying and developing teeth of a milk bite, the nutrition of the expectant mother should be varied, it is necessary to include dairy products in the diet. Of particular importance is the nature of the child's nutrition in the first year of life (laying and development of permanent teeth). Breastfeeding provides the body of the newborn with all the necessary components.
The most important for the prevention of caries, especially during the period of mineralization of hard tissues of teeth and their eruption, has fluoride. In case of insufficient intake of fluorine into the body, it should be administered additionally in various ways. The cheapest and most effective way of introducing fluoride into the body, recommended by WHO, is fluoridation of drinking water. Use also means intended for local use: a solution of sodium fluoride, fluorine-containing varnish, "Remodent."