What does initial caries look like? Early caries: what is this disease?

The word “caries” is translated from Latin as “rotting” - this complex destructive process occurs over a long period of time, passing through several stages. Due to the action of various external and internal factors, there is a process of gradual and consistent tooth destruction, while the stages of caries differ in their characteristics, have characteristic signs and can be amenable to various treatment methods.

Important! According to statistics, more than 90 percent of the world's population suffers from this insidious disease, to one degree or another. The trend in the development of caries is so rapid that it makes dentists all over the world sound the alarm: even young children, whose age is barely 3 years old, are susceptible to the disease and seriously risk not only losing their primary bite faster than expected, but also getting problems with a permanent one.

What is the essence of the problem

The peculiarity of dental caries is that this disease affects the hardest of all tissues of the human body - enamel, and the scale of its spread is such that 9 out of 10 inhabitants of our planet suffer from this disease to one degree or another. But don’t be upset, because there are currently various ways enamel restoration - read more about them.

On a note! The development of caries can occur at a fairly high speed, leading not only to problems of an aesthetic nature, but also to physical pain, from which a person cannot find relief.

We should not forget that harmful bacteria, the activity of which causes the development of the disease, can also negatively affect the digestive processes. And tooth decay can lead to difficulties with nutrition, the appearance of complexes regarding being in society, the desire to hide your smile from others, to serious inflammation in the oral cavity, in periodontal tissues, and so on. That is why it is important to begin the fight against the disease as quickly as possible, so as not to lead to serious health problems.

Stages of problem development

The most understandable classification of the development of the disease is one that is based on several successive stages associated with the degree of tissue damage:

: characteristic feature there is a change in the color of the enamel. It still remains hard, but the process of destruction, disruption of its structure and integrity, its demineralization is already beginning, therefore, it is so important to start treatment as early as possible so that the disease does not spread further. At this stage of the disease, the enamel becomes pale whitish, matte (rather than transparent). It can be quite problematic to notice it with the naked eye, especially on the chewing elements of a smile. This is why dentists insist on annual preventive examinations, because for professionals, noticing pathology is not a problem,
: the process of demineralization of the enamel begins and a person experiences discomfort, manifested by painful sensations, from cold, hot, sweet or sour foods,
(medium caries): pain not only increases, but also becomes longer and more intense. The damage penetrates deeper, the damage becomes more noticeable, and the carious area increases. Here we are talking about the appearance of a fairly large “hole” in which pieces of food begin to get stuck. What is characteristic is that this stage can develop rapidly and, in the absence of proper measures, lead to pulpitis,
(deep caries): the result is . The peripulpal dentinal area is affected by the disease, and this stage is dangerous even with the complete loss of a tooth or removal of its nerve.

Features of the initial stage of the disease

The main symptom of the initial stage of the disease is clearly presented in the photo. As you can see, it is the stains that “report” in this case about problems with the tooth. They can be matte, barely visible, brown, dark and even almost black. But most often, white demineralized pigmented areas appear on the enamel. The main reason for their occurrence is a lack of calcium salts, leading to weakening protective functions enamels.

But we should not forget that among the classical causes of any caries, the palm still belongs to the accumulation in the oral cavity of a large number of harmful microorganisms that settle on different types plaque and deposits (hard stone and soft plaque). This state of affairs is often accompanied by insufficient oral hygiene, neglect of professional hygiene procedures, long-term treatment (taking antibiotics and potent drugs) and weakened immunity after illness.

What’s interesting is that this stage occurs unnoticed and painlessly for a person; sometimes increased sensitivity can manifest itself, but this happens rarely.

Important! Cure caries with such symptoms will not be particularly difficult. Moreover, here it will be possible to do without boron and anesthesia. Enamel remineralization procedures, fluoridation, and fissure sealing will help effectively solve the problem. Naturally, you need to strengthen the body from the inside; for this it is important to adjust your diet, including vitamins and foods containing calcium and fluoride.

Over time, if no action is taken, the stain begins to darken, which is a sign of tissue damage and gradual decay; if this is not responded to in any way, this can lead to damage to the upper layer of the tooth and the development of superficial caries.

The second stage of tooth damage

Here, due to demineralization processes, painful sensations begin to manifest themselves as a consequence of various types of influences, primarily hot and cold, as well as sour and sweet. Discomfort also occurs when there is mechanical pressure on the tooth (during the process of cleaning it with a brush and paste, or when pressing). This is already superficial caries and there is no way to delay treatment any longer.

Middle stage of the disease

The stage of intermediate caries is manifested by the formation of a hollow in the tooth, as the moment of destruction of dentin comes, and the painful sensations are characterized by increasing intensity. It may, however, turn out that symptoms will not appear if the dentin layer is thick enough, but this is not common.

Interesting! Those with naturally yellow teeth can boast of unusually strong dentin – this is confirmed by recent studies. A yellow tint to a smile from birth is not always a reason to be upset. This may mean that your dentin has a rich mineral composition and is less susceptible to decay. True, in this case there is one disadvantage - to bleach the yellowness traditional ways If it doesn’t work, the problem will have to be solved with veneers, lumineers or crowns.

If a cavity forms in the affected area, then food debris begins to get into it, which provokes the appearance of a strong unpleasant odor due to its rotting and accelerates the development of the inflammatory process. At the stage of average caries, the disease can behave unpredictably. It can develop for a long time or rapidly (it all depends on the provoking factors), after which it will develop into deep damage to dentin.

Deep tooth damage

At this final stage, the pathology process provokes severe pain, which, however, does not last a very long time and usually manifests itself after food, drinks or other irritants enter the cavity. If food remains remain in the cavity for a long time, then the pain may become longer.

A companion to this stage of the development of the disease will be halitosis, that is, an unpleasant and rather strong odor from the mouth that occurs as a result of rotting and disintegration of tissues. If treatment is ignored here too, the patient risks getting additional problems as a result of one or another.

When choosing a treatment method, the dentist, first of all, relies on diagnostic measures, how quickly the disease develops, and the depth and speed of spread of carious tissue damage.

Features of pathology in children

Children's teeth are also susceptible to caries, and by no means to a lesser extent than adults. The main reasons for its occurrence in children are:

insufficient attention to oral hygiene,
features of the composition of children's saliva: it does not yet contain the necessary enzymes that provide the oral cavity with a balance of harmful and beneficial microflora,
frequency of consumption of carbohydrates, which become the main breeding ground for pathogenic bacteria in the mouth: naturally, we are talking about sweets, and the lack of rinsing after eating them. This also includes the so-called development of bottle caries, when the risk of getting a problem occurs even in children under one year old – parents give their kids snacks with sweet mixtures and juices at night,
lack of adequate amounts of essential minerals and vitamins.

The symptoms, as well as the stages, are no different from permanent ones; moreover, the disease can affect several teeth at the same time. Today, many methods of combating the disease are used, of which the most widespread are:

: This is only relevant when we are talking about the middle and deep stages of the disease. The previously affected area is drilled with a bur and thoroughly cleaned,
silvering: the procedure stops the development of initial caries, but these days it is performed less and less due to the aesthetic component. The fact is that during the treatment process, the doctor applies a special composition enriched with silver ions to the baby’s teeth - it prevents the development of the disease - but in this case the child’s smile darkens, which causes a lot of concern in older age,
remineralization: enrichment of enamel with minerals, calcium and fluoride is indicated for those children who are prone to the constant appearance of carious formations. The procedure will be useful not only as a treatment for caries in the spot stage (and, by the way, not only for children, but also for adults), but also as a preventive measure(several times a year on an ongoing basis).

Read more about caries treatment methods in the corresponding article.

Possible complications

Of all possible complications The greatest dangers of caries are pulpitis, periodontitis and granuloma:

: Sharp and sharp pain is a classic sign of this disease. It occurs unsystematically and does not depend on the time of day (it often bothers patients at night) or on food intake. It is often not easy to determine which tooth is affected, since it can radiate into the jaw or ear,
: if pulpitis is not treated, then advanced deep caries turns into periodontitis, most often localized at the root apex. Symptoms include halitosis, a reaction to temperature changes, the appearance of an abscess on the gums and swelling of the periodontal tissues, enlarged lymph nodes, increased body temperature, and general weakness. Treatment depends on the type and classification of periodontitis: it can be therapeutic or surgical. In some cases, it is necessary to remove a tooth,
granuloma: the symptoms of granuloma can be quite for a long time does not manifest itself in any way, but if the disease worsens, then severe pain appears. The main danger of granuloma is the development of various pathological processes. After all, an infection with blood can spread throughout the body, leading to cardiac and neurological disorders, as well as the appearance of flux, cysts or phlegmon, osteomyelitis, and blood poisoning.

Do not forget that these are not all the complications that a person may encounter as a result of an advanced form of the disease. He may lose a tooth, and then he will have to restore it using prosthetic bridges or implantation. Here we will already talk about significant costs. And if you ignore the problem, it will result not only in various complexes against the backdrop of impaired smile aesthetics, but also in difficulties with chewing food and with health: you will suffer gastrointestinal tract, spine, headaches will appear, articulation and facial symmetry will be disrupted.

Principles of prevention

Preventing caries is much easier than treating it later. For effective prevention, the following actions should be followed:

Take good care of your oral cavity: it is important to purchase yourself, in addition to a brush with medium-hard bristles and toothpaste, additional accessories. These include floss, irrigator, rinses,
reduce the amount of sweets you consume: try to end your meal with a piece of solid vegetables or fruits, rather than carbohydrates. This will help naturally clean the enamel surface from plaque, bacteria and deposits,
use fluoride-containing pastes: you should be careful here and use these compounds only after consulting your doctor. In some regions of Russia, the water contains a high content of fluoride, which is fraught with the development of fluorosis for people. The use of prophylactic pastes in this case can only worsen the situation,
brush your teeth correctly: no horizontal or sudden movements with the brush - this will harm the integrity of the enamel, cracks will appear on it, where bacteria will happily penetrate
use rinse aids,
undergo regular dental examinations: adults – several times a year, children 3-4 times a year.

Full information on caries prevention is also posted in a separate article, click and get ready to have healthy teeth!

A late visit to the doctor means that the danger of tooth extraction is very high, so it is necessary to start treatment at the earliest stages, when the first stains appear on the surface of the teeth.

Diagnosis and treatment

As for diagnostic measures, this can be a visual examination of the patient using a special mirror, identifying an area of demineralized enamel using dyes, radiography, palpation.

Treatment is based on the removal of those areas of tissue that are “captured” by the disease. This is done in most cases (except for the stain stage) using a drill. Naturally, this procedure violates the shape of the tooth, its aesthetics and anatomical features. Accordingly, after such removal it is necessary to restore it using filling material.

The easiest stage to treat is the spot stage, when demineralization can be stopped with the help of drugs that have a high calcium and fluorine content. Subsequent stages require more serious dental intervention, the use of anesthetics, drills and other treatments.

Video on the topic

According to statistics, today only 20% of children do not know what caries and the dental chair are. Parents do not take this disease too seriously due to its high prevalence. And really, why worry if all children equally have bad teeth? In fact, early caries is a complex problem that requires comprehensive solution. Today we will talk about the causes and prevention measures, as well as the available treatment options. This information will be extremely important for all parents, as it will allow them to avoid a number of troubles.

What is caries

This is the process of destruction of hard tooth tissues. There are quite a few reasons for this; today we will analyze them in detail. These can be both external and internal reasons, that is, it also affects general condition body, immunity first of all.

However, the main reason why early caries develops is dental plaque, or more precisely, bacteria that live in the oral cavity. How do they get there? Everything is very simple, the mother becomes their carrier. They licked the pacifier, let the baby eat from his spoon, and so the teeth began to deteriorate, before they had time to really grow. But that's not all. If the mother did not treat her teeth before pregnancy, then the baby is guaranteed early caries, because he will initially be infected.

How does the process of tooth decay proceed?

We have already learned that there are bacteria in the oral cavity that are responsible for the development of this disease. But early caries is caused by their waste products. This results in a classic power circuit. Bacteria eat sugars and produce acids. As a result, the acid-base balance in the oral cavity is disrupted.

This is the answer to the main question about why early caries develops so quickly. The enamel of baby teeth is very weakly mineralized, this is especially noticeable in the first 2 years and 5 months of life. It is because of this that dentists recommend giving up sweets at least during this period of a child’s life and not giving him too cold or hot food.

So, the resulting acid washes away minerals from the enamel, which means that the destruction process proceeds very quickly. In just a few months, early caries turns into complicated forms, in which dentists remove teeth. Imagine that the child at this moment may still be only a year old. At the age of 2 to 3 years, these processes slow down, but most often by this time it is too late, and most of the teeth are in poor condition.

Causes of early childhood caries

Let us now discuss in detail why such a disease develops. Many parents think that if they do not give their baby sweets, then they are completely protected from the development of caries. In fact, it’s too early to relax. The list of reasons is much wider:

Improper oral hygiene. Even if teeth are just emerging, they immediately need proper care. This is wiping the gums with a damp cloth, and later brushing with a wet brush without toothpaste. When a child has 6-7 teeth, you can start using the first fluoride-free toothpaste.
Infection with pathogenic microorganisms. We've already talked about this, but it's worth repeating. It is impossible to eat with a child from one spoon, especially if you have carious teeth in your mouth.
Genetic predisposition. This is a violation of the development of enamel, which begins during intrauterine formation, due to maternal smoking or taking certain medications.
Lack of vitamins and minerals, in particular fluoride and calcium, in the child’s diet.
Long-term breast-feeding, no matter how strange it may be. By the time baby teeth form, the baby should be fed five times a day. But if a child continues to breastfeed without restrictions, at any time of the day or night, without performing oral hygiene after this, then plaque and carious cavities will form.
Mixtures and juices, milk, sweet compotes - all this contributes to the development of caries. This factor is especially serious if the child does not part with the bottle day and night. After a year, he should only receive water at night. During the day, after each feeding, it is necessary to perform oral hygiene.
Cookies and buns, sweets and marshmallows that are given to a child are also important factor, since food for bacteria is constantly present in the mouth. It is not necessary to completely deprive your child of sweets, but convey to him that after sweets he needs to chew gum, rinse his mouth, or at least drink water.

Important for everyone to know

Once again, to summarize, I would like to note that early caries in children occurs largely due to fractional and frequent feedings on demand, as well as unlimited access to snacks during the day and, most importantly, at night. Replace all sweets with fruits. The fructose they contain does not pose any danger. In addition, the diet should have enough calcium, the main source of which is cottage cheese and cheese. No less important is vitamin D, which we get from fish. In addition, the body can produce it independently when exposed to sunlight. The third required component is fluorine. You can buy special water filters enriched with this element.

Preventive actions

Early caries of primary teeth is much easier to prevent than to treat. And first of all, maintaining hygiene will help you. All the measures described above (rinsing the mouth, wiping the first teeth and their subsequent brushing) are also aimed at reducing the risk of developing the disease. If you notice bright white stripes on your child's teeth, you should contact your dentist as soon as possible. Soon enough they will turn into dark spots.

Early childhood caries can be stopped in the first stages if you use drugs that increase the mineral composition of tooth enamel. From birth to six years, doctors prescribe special gels, for example, ROX Mineral. Mom will rub it into her gums, and the minerals will effectively strengthen tooth enamel. After six years, Remars Gel is prescribed, which also gives very good results.

Consequences of advanced forms of the disease

Often parents believe that nothing bad is happening. These are baby teeth, they will fall out and that’s it. Photos of early caries in advanced stages present a rather unpleasant picture, but you need to think not only about the aesthetic side of the issue. If the disease is not treated, then a general decrease in immunity occurs. How could it be otherwise when a breeding ground for bacteria grows in the tooth cavity and tends to invade other organs. As long as the immune system is strong, it will keep the number of bacteria in check, but as soon as it fails, hostile microorganisms take over.

The child is often sick

What does uncontrolled bacterial growth lead to? First of all, these are constant problems of the ENT organs. The closest are the tonsils, followed by the bronchi and lungs. In this case, parents are faced with endless sore throats, coughs and other manifestations of acute respiratory infections.

Gastrointestinal diseases are rarely associated with caries, but there is also a direct relationship here. The child ingests a large number of bacteria of the streptococcal flora along with waste products. It is clear that this does not have the best effect on the digestion process.

Moreover, all this along the chain leads to orthodontic problems. Since the teeth hurt and the respiratory organs are constantly in an inflamed state, a malocclusion and the habit of breathing through the mouth gradually develop. This is even reflected in the formation of specific facial features. You see how much an untreated tooth means.

What can you do

In fact, parents can, if not completely cure, then significantly stop early caries. We’ll talk to you now about how to get rid of a rapidly progressing disease at home. The first thing to remember is that only in the early stages can home treatments be effective.

You can determine it yourself. If the damaged tooth still does not hurt, even when exposed to too cold or hot water, there are no black spots, and the caries itself looks like a whitish strip, then it is worth taking a number of measures to prevent further development of the clinical picture. In principle, this is the prevention that was described above. If you realize it at this stage of the development of the disease, then a photo of early caries in children will be practically no different from a healthy smile, with the exception of bright white spots. So:

Urgently choose a special paste and use it twice a day.
Additionally, treat your teeth with gels and compounds to strengthen the enamel.
Use rinse aids.
Follow your diet. That is, replace sweets with vegetables and fruits and enrich your diet with fermented milk products.

Folk recipes

First of all, this is the use of medicinal herbs and decoctions from them:

For these purposes, dentists recommend using sage. It destroys microorganisms and normalizes the acid-base environment in the oral cavity. To do this, pour 100 g of dry grass with the same amount of vodka. After two weeks, the product can be used in the form of applications.
An infusion of finely chopped roots is often used for rinsing. To do this you will need a glass of raw materials, cut into pieces. They are poured with a liter of vodka and left for 7 days. After this, the tincture is used for evening rinsing, diluted with water.
Mint strengthens tooth enamel. To do this, the leaves are cut and placed on water bath for a few minutes. You can add a little wine vinegar to them for better preservation. Used for rinsing.
A decoction of onion peels effectively kills bacteria.
Simple soda and salt perfectly inhibit the development of caries. To do this, add 40 g of one or another substance to a glass of water. Every time after eating you need to rinse your mouth with this solution.

Further development of the disease

Until now we have only talked about early caries. It will not be possible to get rid of deeper lesions at home. In this case, you should definitely consult a doctor. Even the superficial stage is characterized by the appearance of defects in the enamel, which creates a favorable environment for the development of microorganisms. The middle stage is associated with the destruction of not only enamel, but also dentin. Painful sensations already arise here when in contact with cold and hot, when eating sour and sweet. The deep stage of caries is damage to the internal cavities of the tooth. Now the disease is approaching the nerve endings. Accordingly, the pain becomes more and more pronounced.

Instead of a conclusion

As you can see, taking care of the oral cavity is largely the task of parents. It is you who can create all the conditions to make trips to the dentist rare and enjoyable. In our article we provide photos of early caries of baby teeth so that you have a good idea of where it all begins. There is no need to wait until black spots or holes appear on your teeth. If you start acting now, your chances of stopping the disease are much higher. And of course, you can’t do without consulting a professional doctor, at least once every 6 months.

A mother brought her 18-month-old son to the clinic for a regular check-up. The child is practically no longer fed from a bottle, but he still receives it before bed. During the day, the child uses a special drinking cup from which he drinks everything from milk to soda. His mother started giving him bottled apple juice instead of milk because the child tends to be constipated. When examining the oral cavity, the doctor noticed “white spots” on some of the child’s teeth (Fig.). The doctor talked about the child’s dental hygiene and prescribed a local fluoridated gel.

EPIDEMIOLOGY

DRAWING. Demineralization at the gum margin, which manifests itself as a characteristic whitish color .

Early childhood caries is the most common chronic disease childhood. In children in age It's 5-7 years old meets at five times more common than asthma and seven times more common than hay fever.
Caries strikes more 25% of children in the United States are between the ages of 2 and 5, and nearly half of children are between the ages of 12 and 15.
Untreated primary dental caries occurs in 32% of Mexican American and 27% of black African American children aged 2 to 11 years, compared with 18% of non-Hispanic white children.
Early childhood caries is defined as “the presence of one or more carious (superficial or cavitary) lesions, removed (due to caries) teeth, or filled dental surfaces of any primary tooth in a child aged 71 months or older.
The consequences of early childhood caries include: low self-esteem, delayed physical development, reduced learning ability, a higher risk of new caries and additional costs.

DRAWING. Severe damage to the central incisors of the maxilla and bilateral lateral incisors of the maxilla with an area of demineralization at the gum line (yellowish-brown color). The upper incisors are often the first teeth to become affected by tooth decay due to bottle feeding. .

ETIOLOGY AND PATHOPHYSIOLOGY

Dental caries is a multifactorial infectious disease that is caused by demineralization of tooth enamel in the presence of a substrate of sugar and acid-forming cariogenic bacteria, Streptococcusmutatis(also known as mutatisstreptococci), which are considered to be the primary strain causing destruction and are found in a soft gelatinous biofilm.
Tooth decay can develop any time after teeth erupt. Early teeth are in principle susceptible to caries, which is caused by transmission Streptococcusmutatis from the mouth of the person caring for the child or other children in the family into the mouth of the baby. This type of tooth decay is called formula-fed tooth decay or early childhood caries.
Risk factors for caries include: o Frequent consumption of liquids.
Frequently sipping liquids containing sugar (juice, milk, medicine, soda).
Eating sticky food.
Feeding for pleasure, sleeping with a bottle, tooth decay in the caregiver.
Drinking non-fluoridated tap water or bottled water, which often lacks fluoride.
Low socio-economic status.
Taking medications that contain sugar or cause dryness, poor oral hygiene.

DIAGNOSIS and CLINICAL SIGNS

Areas of demineralization develop on the surfaces of teeth between teeth and in crevices and cracks. These areas are painless and clinically appear as dull or brown spots.
As the infection progresses, a cavity develops that can spread into the dentin and through the dentin (the component of the tooth located under the enamel) to the pulp (consisting of nerves and blood vessels; pulp infection is called pulpitis), causing pain, necrosis and sometimes abscess.

DRAWING. Severe form of early childhood caries in a four-year-old child with intensive destruction of all four incisors of the upper jaw .

DRAWING. Severe early childhood caries in a three-year-old child with multiple areas of cavity carious lesions on the incisors lower jaw and loss of maxillary incisors due to carious destruction .

TYPICAL LOCATION

Areas of demineralization (white or brown spots) and carious lesions are usually observed at the gingival margins of the upper incisors, and then the first and second molars.

LABORATORY STUDIES AND RADIATION DIAGNOSTICS

Foci of demineralization are invisible on a radiograph, but radiography can reveal progressive carious lesions on and between the occlusal surfaces.

DIFFERENTIAL DIAGNOSIS

Depressions or defects in embryonic development. There are defects on the surface of the teeth (for example, the thickness of the enamel varies noticeably) or noticeable grooves.

TREATMENT

Patients are explained the importance of maintaining oral hygiene and during a preventive examination of the child, the risk of developing caries is assessed.
They refer you to a dentist for a consultation on possible sealing of cavities and cracks.
Before prescribing a fluoride supplement, a physician should determine the fluoride concentration in the source drinking water for a child. If your public water supply is not fluoridated, well water exposed to fluoride minerals and some fruits and vegetables grown in soil irrigated with fluoridated water may be sources of fluoridation. Fluoride supplements are not recommended for individuals living in areas with optimal public water fluoridation (0.7-1.2 ppm or >0.6 mg/L).
It is recommended to show your child to the dentist when the baby is one year old.
The use of fluoridated varnish twice a year in children at moderate and high risk prevents the development of caries on demineralized enamel.

The mother or caregiver should be told how the child's teeth are developing and what level of dental development should roughly correspond to the child's age. Before teething, it is necessary to clean the baby's mouth with a napkin or gauze swab to prepare the transition to using a toothbrush. A child's teeth should be brushed by an adult until the child can do it himself (usually by the age of seven). Fluoridated products are not recommended for children under three years of age, as the child may swallow the toothpaste while brushing their teeth. To brush your teeth, it is recommended to apply a pea-sized amount of toothpaste to your brush. Parents should be aware of the benefits of fluoride, as well as fluoride and the side effects of too much fluoride. You should teach your child to drink from a cup as early as possible and avoid giving your baby milk, juice or soda from a bottle or cup before putting the child to bed.

Advise the mother not to breastfeed her baby close to bedtime, as this creates an ideal environment for the growth of cavity-causing bacteria and tooth decay.

OBSERVATION

Ensure that a child with white spots on teeth or visible decay is taken to the dentist for monitoring and treatment, so that the teeth can be saved from decay or treated.

Caries affects children's teeth from the moment they erupt. And before the age of 7, the disease is diagnosed in 80% of cases. However, most parents still do not pay attention to this problem.

Both baby and permanent teeth of a child must be treated! Otherwise, you will encounter pulpitis, purulent infection or other complications. To cure caries, it is not necessary to drill teeth; there are minimally invasive techniques for children - silvering, fluoridation, infiltration.

Features of treatment of caries of primary teeth

Treatment of baby teeth should be gentle and painless.

5 rules of child therapy

Two-stage anesthesia - first, the gum area is numbed with a gel or spray with lidocaine, and only then an injection is given. For children, the finest (carpule) needles are used.
The safe concentration of anesthetic in injection is 2% lidocaine or 4% articaine, administered from 1/6 to 1/2 of the “adult” dose, depending on the baby’s weight. Anesthetics with adrenaline are contraindicated under 4 years of age.
Removal of carious tissues using hand tools- excavators, curettes, scalers.
The use of filling materials that are applied in one go and also contain fluorides and other beneficial minerals.
The duration of the session is no more than 30 minutes, otherwise the child will get tired and begin to be capricious.

Diagnosis of caries

Caries in children develops faster and more aggressively than in adults. This is due to the fact that the enamel of baby teeth is weak and riddled with micropores, where bacteria easily penetrate. Once the carious process begins, the tooth is destroyed in just a few months. This is why it is so important to visit a pediatric dentist every 3-4 months.

Symptoms of caries at different stages:

Initial caries

First, white (chalky) spots appear on the enamel. Then they acquire a yellowish tint, and the surface of the tooth becomes rough. The baby does not feel pain yet, but a reaction to hot and cold food is possible. Initial caries is treated without drilling with a drill. This is the only stage at which it is still possible to restore the enamel and do without a filling.

Average caries

The enamel layer is destroyed and a carious “hole” is formed. Sharp pain appears when exposed to mechanical or chemical stimuli. Softened dentin and food debris accumulate at the bottom of the cavity. Gentle methods and prevention will no longer help - you need to put a filling. The dental cavity is open and needs to be sealed hermetically with a filling material.

Deep caries

The carious “hole” increases and becomes very noticeable. The enamel and a significant part of the dentin (bone dental tissue) are affected. When probing the bottom of the cavity, a large amount of softened dead tissue is discovered. Deep caries in children is treated with filling. But sometimes the enamel is so destroyed that there is no point in putting a filling; the baby tooth has to be removed.

Visual examination and probing are enough to determine the stage of caries in a child. But sometimes the carious lesion is located in a place that is difficult to access. In this case, an x-ray is prescribed or an intraoral camera is used.

If it is difficult to recognize initial caries, the doctor uses a caries detector. This is a liquid that turns infected tissue blue or pink color. Don't worry, the drug is safe for your child's health.

Methods for treating caries in young children

Treatment of caries of primary teeth without a drill at an early stage

Silvering

An outdated technology that is still used in most dentistry. The doctor applies a solution of silver nitrate (30%) to the carious area of enamel. Silver has bactericidal properties and destroys cariogenic microflora. Everything goes quickly and painlessly, no anesthesia is needed. But after treatment with silver, baby teeth acquire a persistent black color, this is fraught with psychological complexes in the child. The method is indicated for children under 3 years of age.

Fluoridation

Fluoridation, or remineralization, is the strengthening and restoration of enamel, saturation of weakened areas with useful minerals. The dentist treats the surface of the teeth special solution, containing calcium, fluorine, phosphorus and other trace elements. The method stops the development of caries at the spot stage and is an excellent prevention of the disease. The effect lasts for six months. Recommended for children over 6 years old.

Ozone therapy

A non-contact and painless method that is indicated for children of all ages. Ozone is a powerful oxidizing agent that destroys pathogenic microflora on teeth. The procedure takes only 10-20 seconds. Ozone gas is supplied under high pressure through a special fine tip, which is directed to the affected area. After treating the enamel, the carious process stops.

Icon (infiltration method)

The doctor treats the carious area with a special etching gel, after which the infected tissues soften. They are delicately washed with a stream of abrasive mixture. The surface is then dried warm air and apply the infiltrant - liquid filling Icon. The material hardens under the influence of light from a curing lamp.

The infiltrant “seals” all the pores on the enamel surface, smoothes out irregularities and roughness, and prevents the development of caries. The procedure for treating caries of primary teeth lasts 15-20 minutes and is used for children over 3 years old.

After silvering of a child's teeth

Sealing

Filling of baby teeth is carried out according to a standard template. The dentist carefully cleans out carious, dead tissue using hand instruments or a drill at low speeds. Then he rinses the cavity with a disinfectant solution and fills it with filling material. At the end of the session, the surface is ground and polished.

The filling material should not be harder than the enamel of a baby tooth, since it wears off quickly. Don't worry, this is a natural process. But if the filling is too hard, it will start to protrude around the edges.

Glass ionomer cements are best suited for the treatment of primary teeth. They are applied at a time, and not layer by layer, unlike photo composites. In addition, cement contains calcium and fluoride compounds, which helps strengthen dental tissues. The material wears off evenly with tooth enamel.

Modern clinics also use Twinky Star colored fillings for children. They look colorful, so children like them. The child can choose the color he likes. The filling consists of a compomer - it combines the properties of glass ionomer cement and photopolymer. The material is safe for health and contains beneficial fluoride ions.

Treatment of caries of permanent teeth

Treatment of permanent teeth in children is carried out in the same way as in adults. The main method of therapy remains filling. Photopolymer composite is considered the ideal filling material. Durable, perfectly conveys the shade and aesthetics of natural enamel.

Stages of filling

Injection of local anesthesia.
Preparation of carious tissues with a drill, cleaning of softened dentin.
Rinsing the cavity with an antiseptic solution - furatsilin, etonium, etc.
Air drying.
Application of a phosphate cement insulating gasket.
Layer-by-layer filling with a composite - each layer is illuminated with a photopolymer lamp.

In the early stages of caries, the Icon method, ozone therapy and enamel remineralization are also used. But silvering is contraindicated for permanent teeth. After all, no one wants to walk around with a black smile all their life.

Dental treatment for children under anesthesia

Local anesthesia

Treatment is usually carried out under local anesthesia, which comes in two types: application (without an injection) and infiltration (with an injection). The first option is used for superficial anesthesia and the danger is that the child may swallow a solution with a high concentration of lidocaine. Injection anesthesia is more reliable; it completely blocks pain in the receptor area.

Anesthesia

Some children are too restless and hyperactive, while others are afraid of dentists and refuse to open their mouths. How to treat teeth in this case? The problem is solved with the help of general anesthesia.

Do not be afraid of this method; it has long been used in Western countries to treat children from one year old. Some parents worry that anesthesia affects the child's memory or disrupts speech development. This is theoretically possible, but in practice this happens extremely rarely. But the cause of complications is not the anesthesia itself, but the child’s severe stress in dentistry or the presence of a chronic disease in combination with general anesthesia.

In the case of multiple bottle caries, anesthesia is the only way to carry out the necessary manipulations in one go. After all, it is unlikely that your child will be able to withstand 2 hours while the doctor fills all the teeth.

Tests before dental treatment in children under anesthesia

general blood and urine analysis;
biochemical blood tests;
blood for sugar;
electrocardiography.

6 hours before anesthesia you should not eat food, and 4 hours before you should not take any liquid, including water. The child gradually falls into a state of sleep after several breaths of a gaseous sedative based on sevoflurane. You can wake up the baby at any time, you just need to increase the dose of oxygen. Within 15 minutes all reflexes return to normal.

Complications and consequences of caries in children

Some parents believe that baby teeth do not need to be treated because they will soon fall out. It is not right! The formation of a normal bite depends on the condition of the primary teeth. If the carious infection progresses, it will penetrate into the deep tissues and damage the rudiments of the permanent dentition.

Premature removal of a baby tooth destroyed by caries also leads to disastrous consequences. Jaw growth is disrupted, new (permanent) teeth grow out of place, crowding and other problems appear. The child will have to wear braces.

In addition, advanced caries is complicated by pulpitis (inflammation of the dental nerve), periodontitis, or the formation of a cyst on the gum in the root area. It is very difficult to treat such consequences; it is necessary to fill the root canals.

In turn, periodontitis turns into osteomyelitis or an abscess, which not only reduces general immunity, but also threatens the child’s life!

Prices for treatment of caries of primary teeth

Caries can be cured in a public children's clinic or private dentistry.

Average prices in paid clinics:

installation of a cement filling on a temporary tooth - 1,700 rubles;
photopolymer filling - 3500-4000 rubles;
silvering of one baby tooth - 500 rubles;
remineralizing therapy session - 2400 rubles;
Twinky Star color filling - RUB 2,300;
use of general anesthesia - about 10,000 rubles. in 1 hour.

Remember to have regular checkups with your pediatric dentist. Most institutions provide consultation free of charge.

Enamel of baby teeth thinner than the indigenous ones, so it is more susceptible to various damages. Children younger age often faced with a problem such as caries of temporary teeth.

At the same time, the carious process develops more rapidly often has a multiple form, in which they are damaged immediately several teeth.

Many parents believe that baby teeth do not need treatment, but that's not true.

Reasons for appearance

Increase in quantity pathogenic microorganisms in the child’s oral cavity (most often the causative agents of caries - bacteria of the genus streptococci enter the oral cavity through shared cutlery, toys, pacifiers).
Lack of full caring for baby teeth.
Poor nutrition(in particular, untimely introduction of complementary foods, excessive eating sweets, too much solid products, usage pacifiers And bottles with nipple, night feedings).
Carefully! Caries in primary teeth can lead to development of numerous problems in the future. It's premature loss, violation of the integrity of the dentition, formation malocclusion, carious damage to molars, and in severe cases it suffers speech and general development of the child.
Incorrect formation dentition, malocclusion.
Genetic factor determining the strength and sensitivity of tooth enamel.
Persistent disruption of the immune system, diseases respiratory, digestive, dry mouth, change quantity and composition of saliva.

Symptoms and signs

Carious process develops gradually initially changes color and structure tooth enamel. She gets covered spots, which first have white and then more dark shade.

Photo 1. Stains on the surface of the enamel of the front milk teeth brown tint speak of the presence of a carious lesion.

Further damage develops pretty quickly since the enamel of primary teeth is very thin and fragile. Appear on its surface more noticeable defects(chips, cracks), and subsequently a carious cavity is formed.

Attention! The clinical picture of the pathology depends on stage of its development.

As destructive processes develop, the child begins to worry about the following: complaints:

Pain syndrome(depending on the depth of the damage, the pain may be short-term or permanent, have different degree of intensity, from moderate to pronounced).
Increased sensitivity diseased tooth, which reacts most acutely to hot or cold temperature, sour or sweet products.
Unpleasant smell from oral cavity child (food debris accumulates in the carious cavity, bacteria, decay products of tooth tissue, all these elements gradually rot, decompose, which leads to the appearance of a specific putrid odor).
Moodiness and irritability associated with pain and discomfort in the mouth.

Diagnostic methods

Stages of development and stages of pathology

Highlight 4 stages development of caries of primary teeth in children.

Early

initial stage lesions of primary teeth are characterized mild symptoms. The only sign that allows us to identify pathology is a change in tooth enamel. There are no noticeable defects on its surface yet, but specific spots. Initially the stain has unnaturally white shade, the structure of the enamel is gradually damaged, its smoothness is lost on the affected area. Over time it darkens and becomes brown or almost black tint.

Surface

At the superficial stage of a carious lesion, the focus covers only tooth enamel, without affecting deeper areas.

Children appear on the enamel defects, which can be found when visual inspection or feel it with your tongue.

The area of the carious process grows very quickly, becomes deeper.

Average

At average caries the cavity is spreading not only on enamel, but also on dentin, which has a more porous structure (the destruction process occurs in a more intense form). On the surface of the tooth it is already possible to clearly distinguish carious canal, having dark shade.

Deep

This type of caries in primary teeth is the most dangerous form of pathology. At this stage, destructive processes cover areas of dentin located near the pulp. Often there is damage to the pulp itself and the roots of the tooth. The child is being disturbed frequent and severe pain, stable appears smell of rot from the mouth.

Features of caries on the front teeth in children

Most often, caries affects the area front milk teeth. This is due to the peculiarities of their structure, increased load(used for biting off pieces of food).

The front teeth have thinner enamel and dentin, especially in the gingival area. Therefore, damage characteristic of caries is formed Firstly in these areas.

Another feature of this form is intensive development carious lesion. Initially, the child may not feel any discomfort, but as the disease progresses, the enamel begins to chip away, revealing deep carious canals.

Attention! Defects often occur on lateral walls of teeth. Due to the structural features of this area of the dentition, food remains get stuck between adjacent front teeth, while very difficult to remove. This is a prerequisite for the development pathology.

Types of carious lesions in temporary teeth

Total exists four types of caries in primary teeth.

Bottle

Shape most typical for children 1-3 years. The main reason for the development of pathology is considered eating disorder(frequent night feedings, habit of pacifiers and bottles).

Mother's milk or infant formula contains: large amounts of sugar- a favorite treat for pathogens. And if the child cannot refuse night feedings, the likelihood of developing pathology increases, after all, after such a meal, the baby immediately falls asleep without brushing his teeth, and bacteria, eating leftover milk, are actively reproducing.

Circular

This type of pathology is considered the most dangerous as it leads to rapid destruction of tooth tissue, damage to nerve endings located in soft areas. Initially defects appear in the cervical area, quickly spread to deeper areas. At the same time, the enamel in the early stages has minor damage, but, as the carious process develops, it begins break off in large pieces exposing diseased areas.

Attention! Circular caries is more often damaging front milk teeth, leading to their complete destruction. The disease requires complex and lengthy treatment.

Flowering

This form is characterized by acute and intensive development, pronounced clinical picture. Blooming caries is considered decompensated form of pathology, in which destructive processes occur much faster than regeneration.

Photo 3. Blooming caries of primary teeth is a severe form of pathology. The result can be dangerous complications.

Stages of development of pathology (from initial to deep caries) proceed quickly, and within a short period of time the child develops deep damage and develop dangerous complications.

Carefully! During several weeks blooming caries can lead to the need removal of a diseased tooth. Pathology often carries multiple character.

Cervical

This form is characterized by the formation of a carious cavity. at the base of the tooth(the area where the crown meets the gum). Cervical caries is formed as complication of gum disease, when they form in the oral cavity gum pockets. They accumulate bacteria, which release aggressive substances, destroying enamel, and then deeper areas. The crown part of the tooth does not lose its integrity, however, the presence of deep damage in the cervical area may eventually lead to chipping, separation of large pieces of enamel and dentin.

Dr. Komarovsky about childhood caries of primary teeth

Many parents don't pay attention on the appearance of defects in the enamel of a baby tooth, considering that temporary teeth do not need treatment.

They begin to show concern only when the source of destruction affects deeper layers and the child feels pain.

It is important to understand that even baby teeth, which will be replaced by permanent ones, require proper care and treatment. After all untreated caries, especially if it tends to progress rapidly, will lead to problems with the oral cavity in the future. And these problems are very unpleasant.

Starting with the fact that a child can develop damage to permanent teeth, which will replace dairy products. In the absence of therapy the correct bite is disrupted, and in severe cases this may entail speech development disorders.

A child with bad teeth cannot function normally chew food what is a common cause disorders of the digestive system. We should not forget that caries is a source of constant infections in the body, and the presence of infection steadily leads to decreased immunity, frequent viral diseases, as a result, this has a negative impact on general development child. child's diet

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