Caries cement clinic diagnostics differential diagnostics treatment. Cement caries - a hidden pathology, fraught with complications

What you will learn in this article:

• What is this anyway? Root caries, definition.
• Its prevalence and urgency of this problem. Epidemiology of root caries.
• What is it like? Root caries classification.
• What is causing this problem? The mechanism of the development of tooth root caries.
• How to find this disease in a patient? Root caries diagnostics.
• What will we see in the mouth? Clinical manifestations of root caries.
• How is it treated? Tooth root caries treatment.

Ready? Then let's get started!

Definition of Caries of the tooth root.

The smart book says that root caries is the result of the interaction of a complex of unfavorable factors leading to the emergence and progression of the process of demineralization in the area of \u200b\u200bthe tooth root.

Simply put, this is caries that has appeared on the root of the tooth,exposed due to gum recession.

Epidemiology of root caries

The incidence of root caries is constantly increasing in the elderly. This is due to the fact that:

• There are more people with periodontal disease, as their prevention is ineffective
• Dental care has improved and retirees now have many more teeth in their mouths.
• Well, life expectancy has increased, where without it

Be that as it may, in our country today, root caries suffers

• 1.3% aged 25-29
• and 35.2% (aged 55-64)

Root caries classification

In the International Classification of Diseases (ICD-10), root caries is located in the K02 section of dental caries. This classification is:

K02 Dental caries

• K02.0 Caries of enamel
• K02.1 Dentin caries - and here
• K02.2 Caries of cement - here he is
• K02.3 Suspended dental caries - and here
• K02.4 Odontoclasia
• K02.8 Other specified caries of teeth
• K02.9 Dental caries, unspecified

Leus classification of root caries

Leus P.A. , Borisenko L.G.

By the depth of damage to the root tissues:

1. No cavity formation
2. With the formation of a cavity

Downstream of root caries:

1. Active defeat
2. Secondary caries (active or inactive)
3. Unspecified

The mechanism of development of tooth root caries

Here we will discuss the risk factors leading to root caries. They are divided into 2 groups:

• Factors that affect the periodontium are:
• Insufficient prevention, incl. hygiene, both personal and professional
• Periodontal disease itself, and the associated gum recession (root exposure)
• Elderly age
• Anatomical features of the patient's mouth (small vestibule, short bridle, bite pathology)

AS A RESULT - disruption of gum attachment and root exposure

• After the root is exposed, the factors that cause caries come into play
• Poor nutrition (carbohydrates)
• Lack of fluoride (in food and toothpaste)
• Insufficient amount or composition of saliva

AS A RESULT - the development of caries on the root surface.

One more question remains, why does caries develop faster at the root than at the crown of the tooth?

Answer: Because root cement is more sensitive to acids than highly mineralized enamel. For comparison: dissolution of enamel begins at a pH of less than 5.5. And cement - at 6.2 - 6.7. There is a difference?

Root caries diagnostics

They diagnose root caries like other diseases using the main and additional methods research:

• The main ones are interrogation, examination, probing, percussion, palpation. With their help, you can see the carious cavity on the root surface, determine its topography (on which root surface is located), depth, edges, etc.
• Additional:

1. This is an index of hygiene (OHI-S, PLI), gingival condition (GI, gingival recession index), periodontal condition (CPI)
2. Also, diagnostic tests: (saliva pH test).
3. X-ray examination (bite-wing-radiography, orthopantomogram)

With the help of X-rays, you can find hidden carious cavities under the gum, or adjacent to the adjacent tooth.

Clinical manifestations of root caries.

The first is complaints. The patient often complains about:

• Aesthetic defect (not beautiful) if caries is on the vestibular surface of the front teeth.
• Discomfort while eating, pain when brushing your teeth
• Periodontal disease symptoms (bleeding gums, tooth mobility, etc.)
• Short-term pain from irritants (Teeth come from ice cream, hot tea). The pain disappears when the cause is removed.

With the flow of root caries happens:

• Active lesion - while the edges of the cavity are undermined. The cavity is filled with softened tissues. There is a tendency for its size to grow rapidly.

• Suspended caries - the edges of the cavity are smooth, dense, flat (not undermined). The bottom of the cavity is dense and shiny. Do not strive to increase.

• Secondary caries is the resumption of the process in the field of remission or after treatment (at the place of the filling).

By the depth of the lesion:

• No cavity formation - a white spot. The density is less than that of
  normal cement.

• With the formation of a cavity - any of those described in paragraph 1. carious defects.

Depending on which surface of the tooth it affects

Caries can affect any root surface, or 2 surfaces, or all surfaces in a circle (circular spread)

And lastly, according to ICD-10. Allocate caries of cement and caries of dentin

• Cement caries affects only the cement of the tooth root
• Dentin caries also extends deeper into dentin

The classification is over, as well as clinical manifestations.

Generally speaking, root caries is a stain or cavity on the surface of the tooth root. Its edges are undercut or smooth edges.

The cavity can be located above or below the gum.

Root caries treatment

Treatment of root caries, like simple caries, starts with motivation and prevention. Read more about this in our article on the link.

Caries in the stain stage is treated with conservative remotherapy. Apply:

• Fluorine preparations - varnishes, gels, solutions (Fluorine in the form of sodium fluoride, aminofluoride, tin fluoride, etc.)
• Calcium preparations (10% Calcium gluconate).
• Antiseptics (Chlorhexidine 1-2%)

The applications of these drugs contribute to the remineralization of tooth tissues, suspension and reverse development caries in the spot stage. Root cement (due to its porosity) is easier to remineralize than other tooth tissues.

• Desynthetics - reduce teeth sensitivity.

Caries in the stage of a defect in hard tissue is treated with preparation and filling.

1. Disclosure. In case of root caries, the entrance to the carious cavity is wide, without overhanging edges. Therefore, no disclosure is made.
2. Expansion. Prophylactic expansion of the cavity (preparation of healthy dentin) is carried out only with rapidly progressing root caries.
3. Necrectomy. Because the distance from the bottom of the cavity to the pulp is small, necrectomy is performed carefully. Only softened dentin is removed.
4. Formation carious cavity... The cavity is oval. If it is located on the proximal surface, create an additional platform on the oral. If the cavity is located in the enamel area, create a bevel, 2-5 mm wide.
5. Filling. Due to the high humidity near the gums (gingival fluid), a filling material is chosen that is not afraid of moisture. This is JRC, amalgam or compomer.

And in conclusion, we summarize the main elements of the article:

• Root caries is a cavity at the root of a tooth
• Prevalence 35.2% in age group 55-64 years old
• WHO classification - caries of cement. And the clinical classification of prof. Devina
• 2-stage development mechanism: root exposure + cariogenic factors
• Diagnostics - as standard caries + periodontal examination.
• Clinic: Caries spots and Cavity caries. Rapidly progressive with submerged edges and remission with a smooth surface
• Treatment: Rem. Therapy - spot caries or preparation / filling - cavity caries.

That's all. Learn, develop, read other articles. Good luck!

Tooth Root Caries updated: December 22, 2016 by the author: Alexey Vasilevsky

Cement caries, or root caries, is less common than cervical caries, but it is considered more dangerous and destructive to the tooth. The fact is that the root walls have a small thickness and therefore caries destroys them faster and reaches the pulp. Root caries often becomes a complication of cervical caries or occurs as an independent disease. Its official name, cement caries, indicates the dislocation of the lesion - under the gum. This is precisely the problem. Common caries can be seen with the naked eye by the characteristic spots, and root caries is invisible.

Causes of occurrence

The main cause of root caries is gum disease. With such a disease, the gum does not completely adhere to the tooth and a pocket is formed where food debris and plaque fall. As a result of the hardening of the plaque, a stone appears, which becomes a provocateur of the development of caries. But there are other causes of the disease:

• cervical caries, which descends to the exposed root;
• poorly installed crown, which lowers the gums and exposes the root;
• medicines that increase salivation;
• poor oral hygiene;
• poor nutrition.

Root caries has another name - caries of the elderly. Age changes in the oral cavity, a decrease in local immunity and a loss of skills in caring for the body and teeth, in particular, lead to an active multiplication of bacteria that easily penetrate the root.

Diagnostics of the caries of cement

Alas, it is impossible to diagnose the disease on your own. The patient can only feel a reaction to cold and hot drinks. This discomfort is fleeting and most people don't pay attention to it. And only a comprehensive dental examination will make it possible to make the correct diagnosis.

For diagnostics, a specialist of "Family Dentistry":

• cleans the gums and removes subgingival deposits using hand instruments, ultrasonic instruments and processing with the Air Flow apparatus;
• isolates the root from saliva secretion with a rubber dam - a special latex membrane;
• probes the root surface with a sharp probe to detect roughness characteristic of caries;
• prescribes radiovisiography, which will detect even the smallest subgingival and gingival defects and carious process at any stage;

After a complex of examinations, the dentist may prescribe additional ones, which allow confirming the diagnosis of caries of cement and refuting suspicions of pulpitis or periodontitis. This can be thermometry (checking the reaction of the tooth to hot and cold), EDI (checking the reaction of the pulp to current), etc.

Treatment

The stages of caries treatment of dental cement are generally similar to the stages of treatment of conventional caries:

• excision of the affected tissue;
• treatment with medicinal and antiseptic drugs;
• the root is filled with the reconstruction of the shape.

The difference arises in the complexity of access to the focus of the disease. First you need to clean your pocket and expose the root. As a rule, the treatment takes place in two steps - on the first day, carious tissues are removed and the cavity is filled with a temporary glass ionomer filling. At the second visit, the doctor examines the gum for healing and installs a permanent filling. To treat caries of cement in "Family Dentistry" they use materials that are not affected by saliva, blood and gingival fluid - composites and glass ionomers.

If caries of cement is not treated, then pulpitis, periodontitis may develop, which will lead to tooth loss. To avoid such consequences, you should visit your dentist every six months. At the consultation, the doctor will be able to detect signs of caries and, with little effort, get rid of this problem.

Cement caries is such form of pathology, at which carious cavities are located in the subgingival regionaffecting the tooth root.

Disease prone to rapid development, since the walls of the root are very thin and fragile.

This form is much less common the rest, but it is the most dangerous, since it can lead to damage to the pulp and the inability to save the tooth. Often carious cavities develop on the front teeth in the area of \u200b\u200btheir adherence to the gums.

What is dental cement caries? Its code in ICD 10

Caries of this form has specific development... Bacteria penetrate the inner tissues of the tooth, affecting the cementum and root. In this case, superficial areas such as enamel and dentin, remain unchanged.

With caries of cement destruction of tissues located in the subgingival region occurs.

This form is characterized by the appearance of symptoms such as bare root, which contains a large number of nerve endings, development of severe pain syndrome, mobility teeth.

In the area of \u200b\u200bthe affected gums a specific pocket is formed, in which an even greater amount of various deposits and bacteria accumulates, which leads to even more intensive development pathology.

In the International Classification of Diseases, caries is assigned different categories, depending on depth defeat. The code caries of cement - K2. 02.

Besides physical discomfort, tooth decay gives the patient and aesthetic inconvenience, significantly worsening the appearance of the dentition. And this, in turn, contributes to the emergence of self-doubt, causes problems in communication and psychological discomfort.

Etiology and risk factors

Leads to the appearance of caries activation of microorganisms, increasing their number... However, this requires a number of predisposing factors, such as:

Disruption of the saliva production process, changing its composition. Saliva prevents the reproduction of pathogenic microflora, protects the oral cavity from various infectious lesions.

With a decrease in its amount happens an increase in the number of pathogenic bacteria.

1. Failure to comply with the rules of care behind the oral cavity. In hard-to-reach areas, in particular, in places of contact of the tooth with the gums, the smallest food residues accumulatewhich decay over time, becoming a food source for microbes.
2. Untreated caries, in which carious cavities are located in the neck of the dental root. This pathology progresses rapidly, damaging nearby tissuesin particular dental cement and root.
3. Violation of prosthetics technologywhen the crown does not fit snugly against the gum surface. The resulting voids accumulate food particles and bacteria that damage dental cement.
4. Improper nutrition, insufficient intake of minerals necessary to maintain dental health (phosphorus, fluoride, calcium), and excessive consumption of carbohydrates, sweets, carbonated drinks and other products harmful to the oral cavity.
5. Inflammation of the gums (periodontitis), in which the structure of the gums, its shape is disturbed... As a result, the space between the gum and the tooth expands. Into this space pathogens penetrate - causative agents of caries.
6. Structural features gums and dentition.
7. Patient age... According to statistics, the pathology of this form is found mainly in the elderlywhen gum atrophy is observed, a violation of the structure of their tissues (the gums become looser over time).
8. Oncological diseases and the use of radiation therapy to treat them.

Attention! Various microorganisms constantly develop in the human oral cavity, and not all of them are friendly... In particular, bacteria of the genus streptococci and lactobacilli promote tissue damage tooth and the development of caries.

Typical symptoms

Pain not always pronounced, often the patient experiences only minor discomfort. However, it all depends on the form and depth of development carious process.

Important! The main manifestation of cement caries is pain. Unpleasant sensations occur at the time of eating, talking, movingjaws.

So, for initial stage caries slight discomfort is characteristicarising from various effects on the affected area. In the superficial form, when the dental cement and small areas of dentin are damaged, the pain wears more pronounced and long-term character.

Photo 1. A snapshot of an adult's teeth with progressive cementum caries symptoms.

With a deep form of caries, cement deeper areas are damaged, sometimes the lesion also affects the pulp. In this case, the patient tormented by strong and constant pain , which occurs even at rest.

Clinic

With caries, cement, in addition to pain, other symptoms occur... First of all, the formation of a carious cavity. The focus of caries lesion is located in the subgingival region, that's why on initial stageswhen these cavities are still small, it's quite difficult to recognize them on your own.

The color also changes the affected tooth. It acquires an uncharacteristic dark brown shade... Initially, areas with altered pigmentation are formed in the affected area, but, over time, the color of the tooth changes completely.

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Diagnostics

Caries diagnostics includes several stages. First of all, it is patient interviewfor his troubling moments. At this stage the doctor determines the nature and intensity pain, which indicates the degree of damage. After that visual dental examination required, allowing to determine the presence of other clinical manifestations.

Attention! Important is instrumental diagnostics, ways to obtain a more detailed picture of the course of the disease.

They use methods such as:

Professional cleansingsurfaces of teeth.

For this procedure in the dental office use special devices: ultrasonic caps, curettes, devices for removing tartar.

During the procedure the doctor removes soft plaque and harder deposits... This allows you to see the lesions in more detail, to determine their depth.

Rubber dam technique for thorough drying of the affected area from salivary fluid. For the procedure use special latex material, with the help of which the affected tooth is isolated from other elements of the dentition.

it improves the visibility of the damaged area, protect it from saliva ingress at the time of examination and other dental procedures.

1. Sounding using a special dental probe. During the procedure, the doctor directs the sharp edge of the probe under the gum, and with its help determines the structure of tissues, the degree of their softening, reveals uneven edgescarious cavity (for root caries, the formation of a cavity with chipped borders is characteristic).
2. X-ray... The X-ray image clearly shows tissue structure disordersdental cement and root. This method is very informative, detects even minor damage, which cannot be recognized with the naked eye.

Thermal diagnostics- treatment of the affected tooth with cold or hot water, allows you to determine the nature of painful sensations, the degree of their intensity, and based on this, the doctor draws a conclusion about the stage of development of pathology.

Since cement caries is characterized by increased sensitivity of the teeth, an acute reaction to cold or hot temperatures, this method also allows you to get a detailed understanding of the stage of development carious process.

3. Electroodontometry - the effect of electric current on the affected areas of the tooth also causes pain to the patient. AND the more pronounced the unpleasant sensations, the deeper the stage caries of cement develops in the patient.

Treatment

The choice of a particular method of therapy depends on the stage of development caries, the degree of its neglect. In the initial stages, conservative methods of treatment, and deep forms of caries should be eliminated with the help of special operational manipulations.

Conservative treatment

To repair minor damage in dental clinics the following methods are used:

Dental cleaning... This method implies thorough removal of plaque and calculus, removal of stuck food particles, waste products of pathogenic microorganisms.

Hygienic cleaning used as preventionthe development of caries, and as a preparatory stage for subsequent treatment.

1. Remineralization teeth, allowing you to eliminate minor superficial damage. To the affected tooth apply a special compositionrich in minerals such as fluoride, calcium, phosphorus, as well as antiseptic components, detrimental to the causative agent of pathology.

Operative therapy

Operative treatment takes place in several stages:

1. Anesthesia - the use of special anesthetic drugs in the form of injections, gels or sprays.
2. Cleaning the channel from plaque, the formation of a wider cavity.
3. Removal of part of the gum and amputationof the affected nerve (this stage is not necessary in all cases, but only with deep damage in hard-to-reach places). During the procedure, special hemostatic agents are used.
4. Antiseptic treatment of the affected area, followed by its filling.

Photo 2. The picture shows an example of cement caries in an adult on the teeth lower jaw.

Important is correct choose filling material... The following formulations are used by dentists:

• Amalgam... Applicable quite rare, as the technology of installing such a seal is quite difficult (Before installation, it is necessary to thoroughly remove all moisture, which is not always possible). Besides, the material contains mercury, which can be detrimental to the condition of the pulp. However, for all its shortcomings, amalgam fillings are the strongest and most durable.
• Compomers are well suited for filling small cavities... Material considered durable, withstands mechanical stress well. However, the fixation of such a filling in the tooth cavity not always reliable.
• Glass ionomers are used to eliminate large cavities... The material is durable, securely fixed even in a humid environment. In its composition it is necessary to exclude the reasons that can lead to its development.

Cement caries is called root caries, which occurs as a result of a bare tooth root or the formation of a dental pocket.

This is one of the types of caries, the most insidious and aggressive. Pathology does not tolerate neglect of treatment, and can lead to serious consequences.

General information

The disease is only the third most common in dental practice, but it is quite dangerous, as thin root walls are affected. The first sign is tooth sensitivity.

There are 3 stages in the development of the disease:

• initial;
• superficial;
• deep caries of cement.

In addition, the disease can develop slowly or rapidly. The rapid development of the disease begins with the destruction of the root, and if untreated, it threatens to lose a tooth.

Development reasons

The main reason for the appearance of cement caries is the presence of microorganisms that provoke the development of pathology.

Among other factors, doctors distinguish:

1. Poor oral care that results in food deposits on the surface of the tooth. At the same time, the food rots and creates favorable conditions for the reproduction of bacteria.
2. The enlargement of the gum pocket occurs when the gums are detached from the tooth neck. A cavity appears in which food debris is collected.
3. Cervical caries, which was not stopped in time, continues to progress, and leads to the development of cement caries.
4. The presence of crowns that were incorrectly installed, for example, with a small gap between the tooth and the structure.
5. Unbalanced nutrition entails metabolic disorders, weakening bone tissue... A large amount of carbohydrates in the diet provokes the development of carious microorganisms.
6. A decrease in the volume of saliva secreted causes demineralization of the enamel, which weakens the protective functions of the body as a whole.

At risk are people who have undergone radiation therapy, as well as patients who have been diagnosed with periodontal disease.

Symptoms

Symptoms depend on the form of the pathology and the place of its localization. Some patients do not even feel discomfort, while others cannot even fully open their mouths.

During the development of caries in the pocket, reddening of the gums appears, but the pocket itself is closed.

This form is called closed. In this case, the patient has a slight, or complete absence painful sensations.

In the open form, a small brown spot appears on the surface of the tooth, and eventually a black spot.

In addition to the aesthetic damage, the patient feels discomfort when eating spicy, hot, acidic food, painful sensations from various stimuli appear.

A person begins to brush his teeth more carefully, which leads to a lower quality surface treatment, and further development of the disease.

The first call for many is the appearance of blackness on the border of the gums and the actual tooth.As a rule, such a stain cannot be cleaned with toothpaste, it cannot be removed on your own.

If you find even a slight darkening on your teeth, you should immediately contact the dental office for the help of a specialist.

Diagnostics

With the development of a closed form, it is impossible to independently conduct the correct diagnosis. When examining a patient, the dentist determines the degree of damage, location, and treatment method.

To do this, apply:

1. Soundingis carried out with a sharp instrument in order to visually distinguish healthy tissue from the affected. The inflamed gums have a rough surface, slight or intense redness.
2. X-ray allows you to examine the tooth root without painful manipulations, without violating the integrity of the gum surface. This technique makes it possible to detect not yet manifested changes in the roots, the most realistic assessment of the degree of damage to the dental root.
3. Using the visiographmakes it possible not only to see the hidden lesions of the root, but also to explore the focus of the disease at different angles, with an increase in the image.

   This diagnostic method allows you to get the most accurate idea of \u200b\u200bthe development of caries, to make the best decision on the treatment of the disease.

4. Thermal diagnosticsor thermometry makes it possible to study the response of the tooth to low and high temperature... For research, use cold water and a heated dental instrument.
5. Electroodontometry- diagnostics by exposing the tooth to a discharge of a certain electric current. The procedure is carried out with a special apparatus that allows you to study the response of the nerve to the stimulus.

Based on the analysis of the patient's examination data, the doctor decides on the choice of therapy.

Treatment

Therapy depends on various indicators:

• locations;
• stages of development;
• the rate of the disease.

Specialists use conservative and surgical treatment.

Conservative

Conservative treatment is resorted to before a destructive process appears.

The main goal of therapy at this stage is to eliminate the focus of pathology, cleanse the tooth from layers and preserve the integrity of the enamel.

The procedures are performed without filling according to the following scheme:

1. Cleansingoral cavity professional means.
2. Eliminate root causescausing caries of cement - periodontal treatment, correction of prostheses.
3. The enamel is treated with a remineralizing agent... For this purpose, fluoride-based preparations and antiseptics are used.

If a deeper impact is required, a sealant with fluorides and copper or calcium ions is used. In difficult cases, they resort to surgical intervention.

Operational

It is performed in a closed form, when the pocket closes the lesion, and the gum bleeds, and does not allow filling.

The open lesion is treated and a temporary oily dentin or glass ionomer cement filling is placed.

The second visit to the doctor is scheduled taking into account the time for the healing of the gums. During the follow-up visit, the temporary filling is removed and a permanent one established.

The sequence of actions of the doctor during surgical treatment is as follows:

1. Anesthesia of the lesion site (by injection or spray).
2. Softened and different in color soft tissue excised by diathermocoagulation method.
3. Unaffected areas remain.
4. Drying of the edges is carried out using hemostatic threads.
5. Trimmed tissues are removed, the surface is cleaned. To determine the state of the cavity, a caries indicator is used.
6. If necessary, the nerve is removed and the canals treated.
7. A temporary filling compound is applied.
8. After a time determined by the attending physician, a temporary filling is removed, the affected area is washed with a special compound.
9. A permanent seal is installed.

For the treatment of cement caries, filling mixtures are used that are resistant to the composition of saliva, blood, gingival fluid.

The following are used as filling materials:

1. Amalgams... The material is durable in comparison with other mixtures, but it is rarely used, since it contains mercury. In addition, some difficulties arise during installation, since the material requires absolute dryness.
2. The compomer is intended forinstallations in small areas of damage. The material is durable, aesthetic, but it is fixed on the surface relatively weakly.
3. Glass ionomer materialsthe most popular among dentists, as they fix well in a humid environment, contain components that restore structure, and are suitable on large surfaces affected by caries.

For the best control of the result of therapy, the patient visits the doctor 2-3 days after the installation of a permanent filling.

In order to avoid relapse or regular development on another element of the dentition, preventive examinations are carried out at least once every six months.

The cost

The price of treatment depends on the status medical institution, the cost of the materials used, the qualifications of a specialist, the complexity of the procedure.

Clinics set a separate price for the use of devices in the treatment of a disease, for materials for fillings.

The final cost of the procedures is influenced by many factors, one of which is the number of visits to the doctor for manipulations.

Price conservative treatment varies within 1,500-3,000 rubles.

On average, the cost of filling with an operative method of treatment costs 3,000-6,000 rubles, when installing a crown on a tooth, the price of the service increases 2-3 times.

When treating anterior teeth, doctors use technologies that allow maintaining a good aesthetic appearance. This treatment is more expensive.

Possible complications

The danger of the disease is that in the initial stages the pathology does not manifest itself.

The development of the disease leads to a violation of the integrity of the root tissue, inflammation of the gums. At first, the sensitivity of the teeth increases, the patient experiences discomfort when eating.

In the absence of proper treatment, the disease progresses. The area of \u200b\u200bthe disease is rapidly increasing, with significant lesions, the nerve is exposed.

The gum tissue becomes inflamed, bleeding appears. Thinning of the cement layer occurs, which leads to loosening and subsequent loss of the tooth.

Prevention

In order to avoid the problem, you should follow simple rules:

1. Brush your teeth competently.
2. Choose the right toothpaste and a brush.
3. Get regular checkups with your dentist.
4. Monitor the condition of dentures and crowns.
5. Quit smoking, normalize food.

Such measures have long been known to everyone, but failure to comply with them can lead to disastrous consequences.

From the video you will learn about the morphology of the tooth root and the treatment of caries.

- a pathological destructive process, characterized by the destruction of hard tissues of the intraosseous (root) part of the tooth. The disease can be completely asymptomatic or manifest as a cosmetic defect, provoke pain during eating, brushing teeth. A carious root lesion can be suspected already at the stage of examination of the oral cavity and confirmed by thermal tests, instrumental diagnostics (dental radiography, EDI). The main methods of treatment are filling the carious focus, remineralizing therapy.

ICD-10

K02.2 Caries of cement

General information

Dental caries is common on all continents and affects all segments of the population, the incidence is almost total - 80-98%. The prevalence of root caries (cement caries) correlates with age and ranges from 4% in patients under 30 years old to 35-50% in the group over 65 years old. The lesion is more often detected in persons with impaired gingival attachment - patients suffering from periodontal disease, and elderly people with age-related atrophy of bone tissue. A particularly aggressive course is observed in those who receive radiation to the head and neck area. Cement caries can occur on any tooth, but most often it affects molars.

Causes

Modern researchers distinguish three main conditions that provoke the appearance of a carious focus in the area of \u200b\u200bthe tooth root - the disease develops only in the case of their complex simultaneous effect. That is, none of these reasons alone (in the absence of the other two) is capable of inducing the onset of a pathological process:

• Cariogenic microflora... Bacteria dominate among the various microorganisms that colonize the oral cavity. Some of them, for example, Mutans streptococci, actinomycetes and certain types of lactobacilli, produce organic acids from carbohydrates supplied with food, which cause cement demineralization. This leads to an increase in its permeability, the appearance of a carious focus.
• Use of simple carbohydrates. Sucrose has the highest cariogenicity, the main source of which is refined sugar. Bacteria break down it, synthesizing acid and glucan, a substance involved in plaque formation. Other carbohydrates are also dangerous: for example, fructose and starch. To start producing organic acids, carbohydrates need to stay a little on the surface of the cement so that bacterial cells have time to absorb them.
• Reducing caries resistance. This is a deterioration in the resistance of tooth tissues and the body as a whole to the occurrence of a carious process. Many reasons can lead to this condition: a decrease in the calcium content in the structure of hard root tissues, insufficient salivation, bad habits, etc. There is a decrease in the strength of cement and dentin, the process of natural cleaning of the tooth surface with saliva is disrupted.

The likelihood of developing the disease increases in the presence of predisposing factors. The risk of carious damage to the root zone increases in people over 60 years of age, when, due to age, bone tissue atrophy and exposure of dental roots occur. People with periodontitis, periodontitis, gum recession, in which there is a violation of the periodontal attachment, are often exposed to root caries. The danger increases due to non-observance of oral hygiene, a decrease in the local immunity of the mucous membrane.

Pathogenesis

When eating foods containing sucrose or other cariogenic carbohydrates, the microflora of dental plaque ferments these substances, forming organic acids: pyruvic, lactic, formic, etc. This leads to a violation of the acid-base balance on the surface of the tooth, in particular, in the cervical zone ... If the root is exposed, the cement covering it is exposed to acids, which, due to the concentration gradient, penetrate into it and dissociate, causing demineralization.

In the future, the pathology can progress and affect the dentin, causing the appearance of a carious cavity. It is usually filled with food debris, microorganisms, elements of the oral fluid and decayed dental tissue. The dentin lining the walls of the defect is demineralized, infected, its deeper layers are sclerosed, gradually turning into intact tissue.

Classification

In the central part of the tooth root there is a root canal with blood vessels and nerves. It is surrounded by dentine, which is covered with cement on the outside. Both of these tissues, which are composed of mineral salts and organic compounds in different proportions, can undergo a carious process. Depending on the depth of the lesion in therapeutic dentistry, there are three forms of root caries:

• Initial. It is characterized by partial destruction of cement, but the boundary with dentin remains. In this case, a brown or dark spot may appear on the surface of the root.
• Superficial. The cement-dentinal junction is destroyed, a shallow brown defect is formed, surrounded by an upper layer of dentin. The depth of the cavity does not exceed 0.5 mm.
• Deep. This form is characterized by the spread of the process to a depth of more than 0.5 millimeters. The carious cavity is separated from the pulp chamber only by a thin layer of dentin.

Root caries symptoms

The process can be asymptomatic, especially at the initial stage, but it can provoke pain during brushing with a toothbrush, taking sour, salty or sweet foods, which quickly pass after the irritant is removed. Hot or cold foods sometimes cause discomfort. If the pathological focus in the form of local darkening of the cement is located on the labial surface of the anterior teeth, the patient complains of unsatisfactory aesthetics. Sometimes the stain practically merges with the root surface or hides under plaque or calculus.

When the carious process reaches the cement-dentinal junction, penetrating into the surface layers of dentin, the cavity becomes deeper, filled with dead tissues, food gets stuck in it or dental floss... Short-term pain is also induced by chemical, thermal and mechanical factors, but may not be present at all. If caries affects the layers of dentin that border the tooth cavity, pain often occurs when eating hot or cold food. Otherwise, the symptoms of a deep form of caries are similar to those in its previous stages.

Complications

If no attempt is made to cure root caries, the process can reach the cavity of the tooth and cause pulpitis. At the same time, the painful sensations are so unbearable that it becomes impossible to postpone the visit to the doctor any longer. If you endure pulpitis pain, then it can disappear on its own, which indicates the chronicity of the process. In the future, the infection with a high probability will provoke inflammation of the connective tissue ligament of the tooth - periodontitis, and this, in the case of untimely seeking medical help, is fraught with destruction of the underlying bone and loss of the tooth.

Diagnostics

The presence of tooth root caries is detected by the dentist-therapist. The diagnosis is made in stages at the first clinical appointment. The examination process is aimed at clarifying the patient's complaints: the presence of pain, its nature and accompanying circumstances. Additionally, various tests and studies are performed:

• Tooth probing... The study of the dentition is carried out using a dental mirror and a sharp probe. Examination of a rapidly progressive carious lesion reveals its soft or "leathery" consistency and uneven, sharp edges. The surface of the pathological focus at the stage of remission is usually shiny, smooth, hard with smooth, dense edges.
• Temperature samples.To distinguish deep caries of the tooth root from pulpitis, use cold water and heated wax. At the same time, attention is paid to the duration of the pain: if the discomfort disappears immediately or quickly after the removal of the irritating agent, as a rule, a carious lesion is diagnosed.
• Electroodontometry.Using a special device, the state of the tooth pulp is determined, depending on its reaction to an electric current of a certain strength. In the case of root caries, the sensitivity of the dental tissue to the current strength is in the range of 2-6 μA (sometimes more), with pulpitis - approximately 20-90 μA. Indicators over 100 μA raise suspicion of the death of the pulp and the development of periodontitis.
• X-ray examination.The patient undergoes an intraoral sighting image of one or two or three diseased teeth. The size and depth of the lesion are well visualized on it, which makes it possible to assess the integrity of the boundary between dentin and cement. Special attention the distance from the bottom of the carious cavity to the pulp chamber is given.

Root caries treatment

The treatment regimen is developed based on the stage and speed of the carious process, the number of affected teeth. In this case, the state of the entire oral cavity (mucous membrane, occlusion) and the presence of concomitant pathology in the patient must be taken into account. The main modern techniquesused to eliminate root caries include:

• Remineralizing therapy.This method, as the only method of treatment, is suitable only for the initial stage of the disease. The cement of the tooth is exposed to local or general preparations with a high content of calcium and fluoride, which eliminate or stabilize the focus of demineralization. Remotherapy as an auxiliary method is also indicated for rapidly progressing caries, when the pathological process affects a large number of teeth in a short period of time.
• Preparation and filling.If the cement-dentinal border is damaged, the carious focus under local anesthesia is gradually opened and processed with burs. Then the formed cavity is filled with a filling. In modern hospitals, the most common filling materials based on polymers are light-curing composites.

Patients are often advised to visit a surgeon and periodontist to close the exposed root with a gingival flap and treat periodontal disease. If the cement is protected by the gum tissue, bacteria and carbohydrates cannot penetrate to the surface. Also, the patient may be referred to a gastroenterologist or endocrinologist, since gastrointestinal diseases and endocrine disorders are risk factors for carious lesions.

Forecast and prevention

The prognosis of a properly treated tooth root caries can be considered favorable. However, a secondary carious process often occurs around the filled cavity, the appearance of which depends on the patient's state of health, his approach to the implementation of oral hygiene. Currently, the development and clinical trials of new filling materials are underway that can permanently prevent the recurrence of the disease.

To keep your filled and intact teeth healthy for many years, you need to regularly floss, brush your teeth with a toothpaste brush twice a day after the first and last meal. During the day after meals (especially confectionery products, sweet fruits), it is recommended to rinse your mouth with alkaline mineral water. Also, for 5-10 minutes after eating, up to 3-5 times a day, you can use chewing gum without fruit fragrances, if there are no contraindications.