How to cure cervical caries. Difference between cervical caries and wedge-shaped defect

Cervical caries is the most dangerous type of caries. The carious process manifests itself in the area where the tooth comes into contact with periodontal tissues. The danger of this pathology is that in the first stages of progression, symptoms may not appear at all. Cervical caries remains unnoticed until the first severe pain occurs. Also, in the area of the neck of the tooth, the thickness of the dentin is much less than in all other areas, so this type of caries quickly reaches the pulp chamber and degenerates into a deep process.

If cervical caries has reached the pulp, then absolutely all dental canals are affected, complications may develop, and in most clinical situations it is not possible to save the tooth. Therefore, it is important to promptly identify the progression of the pathological process and prevent its further development. As practice shows, cervical caries mainly affects people after 30 years of age.

Causes

The main reason for the occurrence of cervical caries is that the dentin in this area is much thinner than in other places. Also, the area of the neck of the tooth is very difficult to fully clean. Due to poor oral hygiene, a large amount of soft plaque and stone accumulates in the cervical area. In these structures, pathogenic microorganisms that secrete acids begin to actively multiply. It is these substances that destroy tooth enamel. Heredity can also be attributed to the causes of the disease.

Predisposing factors to the formation of cervical caries:

demineralization of enamel. This occurs as a result of the activity of bacteria that are in the mouth, as well as due to changes in the biochemical composition of saliva. As a result of bacterial activity, lactic acid is released, which leads to the destruction of enamel (one of the main causes of caries);
avitaminosis. If there is not enough certain vitamins in the human body, then specific gum pockets can form, into which food debris can fall. As a result, pathogenic microorganisms will begin to multiply in these formations;
ignoring the appearance of chalky stains on the enamel. This is the first sign that indicates the development of cervical caries. If you start treating it at this stage, then the entire root part of the tooth is not damaged and the tooth can be completely saved.

Stages

The carious process in the cervical region occurs in several stages:

spot stage. A small whitish spot forms on the surface of the tooth, which may not change at all for a long time. It is best to treat cervical caries at this stage of development, since it is possible to preserve tooth tissue and completely eliminate the pathological process;
The carious process damages the surface of the tooth. It affects the top part of the tooth - the enamel. The tooth begins to react to stimuli;
average caries. The carious process penetrates deeper and affects both enamel and dentin. The patient develops strong sensitivity to various stimuli - chemical, mechanical, temperature. Painful sensations, as a rule, pass quite quickly;
deep caries. The pathological process affects the deep tissues of the tooth, which are located in close proximity to the neurovascular bundle. The pain is unbearable and often occurs at night.

Symptoms

the appearance of a spot or cavity of various sizes;
pain while eating;
the tooth reacts to various stimuli - cold, hot, sour, sweet, etc.;
headache;
night pain (with deep cervical caries);
painful sensations when brushing your teeth.

Treatment

Treatment of cervical caries depends on what stage of the pathological process is observed in the patient. At an early stage of disease progression, when only chalky spots are noticeable on the enamel, it is advisable to resort to conservative treatment. If a carious cavity of any size has formed, it is recommended to sanitize the cavity and fill it with composite materials.

Treatment of caries in the spot stage

The essence of the treatment of cervical caries at this stage is that the demineralized area of enamel again needs to be saturated with calcium. For this purpose, dentists use remineralizing agents that contain active calcium and fluoride. Before applying such medications, it is recommended to remove plaque and tartar from the surface of the affected tooth.

Treatment of caries in the formation of a carious cavity

Caries, in which the integrity of the tooth enamel has already been damaged, can only be treated with the help of a drill. Other methods are not appropriate in this case. The entire treatment process is divided into the following stages:

removal of plaque and tartar from the tooth surface;
The second stage is very important - determining the color. It is important to most accurately select the color of the composite material so that it matches the color of the patient’s enamel as closely as possible;
preparation of an existing carious cavity. It is carried out only under local anesthesia;
tooth isolation;
covering the formed cavity with adhesive;
filling the cavity and giving the tooth an anatomical shape. At this stage, the functionality and aesthetics of the tooth are restored;
polishing and grinding.

Prevention

Cervical caries is easier to prevent than to treat later. Prevention includes the following activities:

regular teeth cleaning;
for the purpose of prevention, it is recommended to visit a qualified dentist once every six months;
After drinking drinks, coffee, sweets, juices, you should definitely rinse your mouth;
A balanced diet is also very important for the prevention of cervical caries. A person must consume sufficient amounts of vitamins and minerals;
strengthening the immune system.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Bottle caries is a disease that affects young children between the ages of two and four years. Its name is quite original and is due to one of the reasons for the development of this pathological condition - bottle caries in children often develops due to the habit of drinking formula from a bottle at night. As a result of this, a large amount of food remains in the baby’s mouth all night, which is the main reason for the progression of caries.

Caries is a pathological process that leads to the destruction of enamel, a layer of dentin, resulting in a “hole”. If treatment is not started in a timely manner, this pathological process can lead to complete tooth loss.

– a carious process localized in the gingival region, that is, in the area of the neck of the tooth. Depending on the stage, cervical caries can manifest itself as darkening of the tooth enamel in the peri-gingival area; increased sensitivity of the tooth to temperature, chemical and mechanical stimuli; formation of carious cavities of varying depths, pain syndrome. Cervical caries is diagnosed during a dental examination and dental x-ray. Treatment of cervical caries is carried out taking into account the stage of carious lesions of the tooth and does not differ from that for other types of caries.

General information

Cervical caries is a type of caries characterized by the destruction of hard tissue at the border of the crown and root of the tooth, next to the gum. According to the classification adopted in dentistry, depending on the location, fissure, cervical (cervical), contact (approximal) and ring (circular) caries are distinguished. Cervical caries can affect the labial, buccal, and lingual surfaces of the lateral and anterior teeth. Cervical caries most often occurs in people aged 30-60 years. Cervical caries is one of the most dangerous types of caries, affecting the tooth in the most vulnerable place and contributing to its rapid destruction.

Causes of cervical caries

In general, caries in the cervical region develops due to the same reasons and mechanisms as carious processes in other localizations. At the same time, the occurrence of cervical caries is favored by the special conditions existing in the gingival region. First of all, this is the inaccessibility of this area for high-quality hygienic care, and, consequently, increased accumulation of plaque and the formation of tartar in the cervical area. There is a direct connection between cervical caries and gingivitis.

In addition, in the area of the tooth neck the thickness of the enamel is only 0.1 mm, while in the area of the cusps it is 1.7 mm, and in the area of fissures it is 0.6-0.7 mm. The thin layer of enamel is relatively easily damaged when brushing teeth with abrasive pastes, tooth powders, and hard brushes.

Among other factors, the development of cervical caries can be facilitated by frequent consumption of acidic foods, taking medications that increase enamel porosity, and pregnancy. If several teeth are affected by cervical caries at the same time, you should most likely think about endocrine dysfunction (diabetes mellitus, thyroid diseases).

Symptoms of cervical caries

In its development, cervical caries goes through the same stages as any other carious lesion: the stage of spot, superficial, medium and deep caries. In the initial stage, the enamel in the area of the tooth neck loses its shine and becomes matte; a light (chalky) or pigmented spot with a smooth surface appears on it; There are no clinical manifestations.

Subsequently, the surface of the stain becomes rough, which indicates the beginning of the destruction of the enamel; subjective sensations are characterized by a short-term painful reaction to chemical, mechanical and temperature stimuli. This indicates the transition of cervical caries to the next clinical and morphological stage - superficial.

Weakness of the enamel in the area of the tooth neck contributes to the fairly rapid progression of cervical caries into the stage of medium and deep caries, which are clinically manifested by the formation of a carious cavity, food getting stuck, and a painful reaction when talking, eating, or brushing teeth. Deep caries can be accompanied by significant tooth destruction and complicated by the development of pulpitis. Cervical caries is usually localized on the labial or buccal surface of the teeth; sometimes the lesion covers the entire root neck of the tooth, similar to circular caries.

Diagnosis of cervical caries

During the diagnostic process, cervical caries should be distinguished from a wedge-shaped defect, enamel erosion, and fluorosis. If a patient has several teeth affected by cervical caries, he should be referred for consultation to an endocrinologist to exclude pathology of the endocrine system.

Treatment of cervical caries

Treatment methods for cervical caries depend on the stage of contacting a specialist. In the early stages (stain stage), it is advisable to carry out remineralizing therapy - a course of applications of fluoride-containing drugs, periodontitis, gingivitis. Advanced cervical caries can lead to destruction and loss of a tooth, the restoration of which will require prosthetics or dental implantation.

Prevention of cervical caries includes regular and thorough dental care using individually selected products (toothpastes, rinses, dental floss), adherence to the correct teeth brushing technique, professional oral hygiene, prevention of gum disease and endocrine disorders.

When cervical caries occurs, many people, instead of running to the clinic as soon as possible to treat the tooth, keep delaying this undesirable moment. This is partly due to various conflicting information on the Internet about the possibility of treating cervical caries even at home (in its initial forms), about the possibility of using remineralizing toothpastes and other available products that supposedly will help effectively restore tooth enamel and thereby save a person from Problems.

We will talk further about what is the truth and what is the myth, what methods of treating cervical caries are really effective and what can be done at home. We will also consider the mechanism of development of pathology and features associated with the localization of caries in the cervical area of the tooth.

Features of cervical caries and characteristic clinical picture

Cervical caries appears, generally speaking, for many of the same reasons as any other caries, and is associated with the activity of microorganisms that convert carbohydrates into organic acids. As a rule, the pathology develops against the background of unsatisfactory oral hygiene and, without timely treatment, progresses very quickly

The lack of brushing skills developed from childhood and ignoring dental floss (starting from adolescence) leads to the fact that the most caries-sensitive surfaces of the teeth are affected, where dental plaque accumulates abundantly.

On a note

Most dentists are inclined to believe that cervical caries is a rather aggressive form of dental disease, which is due to a number of factors.

The area affected by cervical caries has an insignificant thickness of protective tissue, and often the enamel is not sufficiently mineralized. A tooth consists of a crown, neck and root. The neck of the tooth is normally located under the edge of the gum, and the entire area next to the border of the neck is called “cervical”. Selective damage by caries to this particular weak zone often involves active destruction of enamel and dentin, right down to the pulp (“nerve”) with the rapid appearance of painful sensations characteristic of each stage of the disorder. It is for this reason that cervical caries, without timely treatment, can develop into complications in a short period of time: pulpitis, periodontitis, etc.

Combined defects. The specificity of the localization and spread of the lesion lies in the fact that often cervical defects “spread” throughout the entire cervical region, reaching the middle of the tooth crown, going deeper under the gum or capturing contact surfaces with the transition to the so-called circular caries. In such cases, the tooth is covered with caries in a circle, which without treatment often leads to the breaking off of part or the entire crown.

The photo below shows an example of circular caries of primary teeth:

Another feature of cervical caries is that often the defects are located in the “smile zone”. If the areas of destruction are located on the lateral group of teeth, or on surfaces inaccessible to view, then most often this does not cause serious aesthetic consequences or worries, however, short-term pain from various irritants and the risk of caries developing into its complications without treatment are possible.

When a cervical lesion appears (especially in the “smile zone”), serious psychological problems often arise, including a nervous breakdown. This is especially true for people whose work involves constant business contacts or public activities (journalists, artists, managers, teachers, doctors, etc.).

Symptoms of cervical caries can be very diverse, but they all fit into the general rule: the pain is always short-term and quickly passes after the irritant is removed. It is this aspect that makes it possible to make a correct preliminary diagnosis and not confuse it with caries complications.

Cervical caries in the spot stage, as a rule, manifests itself only visually: a change in the color of the enamel in the cervical area: from a white spot to a pigmented one, depending on the activity of caries and the options for its staining with food dyes. Sometimes there is a quickly passing feeling of being set on edge from chemical irritants (especially sour ones). At this stage, treatment is possible with conservative methods, without preparing the tooth with a drill.

Superficial cervical caries without timely treatment can cause a more varied clinical picture with the development of pain from cold, hot and sweet foods, although sometimes it also develops asymptomatically.

If you do not start treatment, then cervical caries from the superficial form passes into the middle, and then deep. In this case, pain most often appears from chemical (sweet and salty), temperature (cold and hot) and mechanical (when solid food gets in) irritants. It is worth emphasizing once again that all pain is short-term in nature and quickly passes when the causative factor causing it is eliminated.

When pain appeared in my front tooth from cold water, at first I didn’t understand what was wrong. I looked in the mirror and was horrified: near the gum near the upper tooth there was a barely noticeable dark spot that went under the gum. I went to a dentist I knew for treatment. He told me that it was cervical caries. The treatment took about 40 minutes, they put a filling similar to the color of my tooth, now I drink cold water as much as my heart desires...

Valery, Tambov

Treatment of cervical caries at home: reality or myth?

For many people, the very fact that it is possible to treat cervical caries at home allows them to avoid seeing a dentist for professional help for a long time (for example, due to childhood fears of a terrible toothache during dental treatment). Well, the good news for such people is that some therapy at home may indeed be worthwhile.

Cervical caries in the spot stage can be cured at home by long-term use of hygiene products and preparations with increased concentrations of fluorides and calcium to saturate the weakened crystal lattice of the enamel in the area of discoloration (contraindications are possible). You can, for example, use remineralizing gels, as well as special toothpastes for cervical caries.

However, with such treatment there are some important points to consider:

Cervical caries and its characteristics are individual for each person: location, depth of lesion, area, enamel structure, etc. Moreover, the carious process in the cervical area (areas) often occurs against the background of various aggravating factors, which may include poor oral hygiene, age, presence of other dental problems, general health. There is no guarantee that independent choice at home will take into account all the nuances of not only the oral cavity, but also general, equally important characteristics, on which the success of therapy directly or indirectly depends.

The range of products (drugs) for professional and home treatment and prevention of cervical caries is too diverse and wide. Again, there are no guarantees that the independent choice of one or another remedy will be so successful that it will not only solve the problem of treating cervical caries in the spot stage in a short time, but will also not cause harm to the general health and health of teeth due to high concentrations of, for example, fluorides (which can be dangerous if used incorrectly).

Cervical caries can be treated with conservative methods only at the spot stage. And with what degree of probability can you assume that your cervical defect is caries in the spot stage, and not superficial, medium or deep (or in general a disease of non-carious origin - enamel hypoplasia, fluorosis, wedge-shaped defect; or banal dental deposits - pigmented plaque or stone)?

From the experience of a dentist

Even at a professional appointment, to clarify the diagnosis, even a dentist carries out not only clinical diagnostics (questioning, examination, probing), but also special research methods (staining the spot with dyes, X-rays, EOM, transillumination, etc.). Sometimes it takes from 10-15 to 60 minutes. After all, the correct tactics for further treatment of cervical caries depend on the correct diagnosis.

Often, cervical caries in the spot stage masks defects in deep-lying tissues (deep layers of enamel and dentin), as well as common complications of caries - pulpitis and periodontitis. When pulpitis (or periodontitis) is detected, treatment tactics are reduced to treating the tooth canal with the elimination of the infectious process in it. Placing a filling in the cervical area without treating and filling the canal(s) would soon lead to even more serious complications, including tooth loss.

Popular folk remedies for the treatment of cervical caries

Cervical caries is often accompanied by painful sensations that may not go away for a long time until the cause that causes them is eliminated: sweet, cold, hot - all this can cause pain of varying degrees of intensity. Sometimes it can cause very severe pain while eating, which is already typical for deep cervical caries.

In folk medicine, there are many ways to temporarily get rid of pain if an appointment with a doctor is postponed for some time due to insurmountable circumstances.

Among the popular methods of treating caries with folk remedies are:

Infusions for mouth rinsing: from sage, lemon balm, blueberries, blackberry leaves, mallow herb, knotweed herb, oregano;

Decoctions for rinsing the mouth: from oak bark, aspen, tricolor violet, flowering branches of wormwood, valerian;

Roots for chewing: angelica, calamus;

Propolis tincture for rinsing, previously diluted with water.

Folk recipe for pain due to caries

One of the simplest folk remedies for relieving pain from caries is sage infusion. It is necessary to pour 2 tablespoons of dry herbs with half a liter of boiling water, then leave for about 30 minutes in a closed container. Be sure to strain the resulting product and rinse your mouth with a warm solution 4-5 times a day, mainly after meals. This will not restore your teeth, but it will give you the opportunity to hold out for some time before going to the dentist for normal treatment.

Relief of pain from cervical caries after the use of folk remedies is temporary and can even mask serious problems, for example, the transition of cervical caries to pulpitis. Therefore, be careful and try to contact a specialist as soon as possible.

Features of filling gingival defects at the dentist

Cervical caries is one of the most difficult carious lesions to treat in the clinic.

The easiest way to treat cervical caries in the spot stage is with a conservative method, that is, without the traumatic use of a drill and filling. The most common means are drugs for remineralizing therapy and deep fluoridation.

Gluflutored;

Enamel-sealing liquid;

Remineralizing gel R.O.C.S. for office use;

Belagel Ca/P, Belagel F;

Remodent;

"Ftorodent";

"GC Tooth Mousse."

Treatment of cervical caries in the spot stage using remineralizing therapy includes the following steps:

Professional oral hygiene with cleaning of teeth from dental deposits (plaque, tartar).

Application of remineralizing gels or application of fluoride-containing preparations in 2-3 visits at the intervals required according to the instructions.

Home use of medications and hygiene products prescribed by the dentist to further strengthen the enamel.

Despite the often good overview of the carious cavity for the doctor and the convenience of approaching it, the subgingival location causes many problems in the treatment of superficial, medium and deep cervical caries using mechanical treatment of the cavity, namely:

inconvenient location of the cervical defect cavity for filling (especially when combined with subgingival caries);

moisture entering the work area;

penetration of blood from the inflamed or injured edge of the gum into the working field.

Let us list the basic principles of treatment of cervical caries using methods of mechanical cleaning of the carious cavity and subsequent filling:

Cleaning tooth surfaces from dental deposits;

Isolation of the working field with a rubber dam if the clinic is well equipped;

Cavity preparation with water-air cooling with excision of carious and pigmented tissues;

Formation of a cavity for the selected filling material;

Installation of filling material in compliance with filling techniques;

Filling correction: grinding, polishing.

Among the main modern materials for the treatment of cervical caries with filling, glass ionomer cements (GIC), light-curing composites, compomers and ormocers (organically modified ceramics) can be noted.

This is interesting

A prominent representative of the ormokers is Admira. Ormokers are a group of light-cured restoration materials, or organically modified ceramics. They have high biocompatibility, are easier to model and have lower shrinkage than classic “light fillings”, and are resistant to abrasion. They are used for filling defects of all classes, including cervical caries.

Currently, combined technologies are used to fill cervical caries using 2-3 different materials to maximize the positive properties of each and minimize the negative effects. This makes it possible not only to cope with complex clinical situations associated with the gingival or subgingival localization of cavities, but also allows you to restore the aesthetic and functional parameters of the tooth, in other words, to preserve a beautiful tooth for many years.

The photo shows what teeth look like after treatment of deep cervical caries:

Prevention is the best protection against cervical caries

Prevention of cervical caries is many times better and more profitable than any treatment. However, most people either do not know its basics or neglect the basic rules that make it possible to protect teeth from cervical caries even in those who are prone to developing this pathology.

If the mechanism of caries development has been known for more than a hundred years, then it is enough to simply break the links leading to it, namely:

Limit the consumption of easily fermentable carbohydrates with high culinary processing (sweets, flour products). This will not only allow you to usefully adjust your diet, but will also reduce the risk of caries.

Follow the culture of eating carbohydrates if it is not possible to completely abandon them: in no case should you eat them in the intervals between main meals, in large quantities, and especially at night without performing oral hygiene.

Increase your intake of roughage (solid) food, especially at the end of the meal. Alternating hard fruits (apples) and vegetables (carrots) creates a procedure for self-cleaning the surfaces of teeth, which is not an innovation, but was the dietary culture of even the ancient Slavs.

As a mandatory procedure, you should brush your teeth after eating. Brushing your teeth before breakfast is a practically useless procedure, since plaque after eating begins to form within the first hours.

Improve your teeth brushing skills as quickly as possible, either with a dentist (hygienist) or with the help of an educational video. The level of hygiene and protection of teeth from cervical and any other caries depends on the correct adherence to the technique of cleaning surfaces accessible to the brush.

It is imperative to include dental floss (floss) in the list of hygiene procedures due to their high effectiveness against cervical caries that occurs on contact surfaces in the spaces between teeth that are not fully accessible to a toothbrush.

Special products that can be used at home:

Toothpastes for cervical caries with fluoride concentrations from 1000 to 1500 ppm;

Dental floss impregnated with fluoride;

Fluoride rinses.

Most hygiene products for protecting teeth from cervical and other types of caries available on the market (for example, toothpastes) are safe for teeth and general human health, but there are always risks. In each age group, depending on the cariogenic situation in the oral cavity, the structure of tooth enamel, the level of hygiene, the number of fillings and extracted teeth, the concentration of fluoride in drinking water in a particular area, general health and the presence of concomitant pathologies, etc., an individual a set of products for professional and home strengthening of teeth and protection against cervical and other types of caries. These can be pastes, gels, and solutions.

This is a competent, systematic approach in the dentist’s attitude to the health of his patient. Therefore, if you are not sure about the correctness of your actions regarding prevention, you should contact a specialist for professional advice.

Interesting video about the features of cervical caries

Causes of caries and effective methods of protection against it

Cervical caries is a caries that develops at the base of the tooth. The affected area is located at the very bottom of the tooth crown, and sometimes even extends under the gum. In the early stages of the disease, a white chalky spot appears on this area of the tooth; later it transforms into a carious cavity. However, one should not confuse cervical caries and wedge-shaped defect - a common disease of non-carious origin.

What are the causes of cervical caries?

Any type of caries is caused by pathogens that are contained in dental plaque or tartar. Cervical caries is no exception, so its main cause should be considered poor oral hygiene. The problem is aggravated by the fact that the enamel at the base of the tooth is quite thin, and caries develops here very quickly.

What are the symptoms of cervical caries?

In general, cervical caries differs from other varieties only in localization. And the symptoms of the disease are:

darkening of the enamel in the neck of the tooth;
increased sensitivity of the tooth to mechanical, temperature and chemical stimuli;
the appearance of a carious cavity at the base of the tooth, which can go under the gum.

What is the danger of cervical caries?

The source of infection is located at the very base of the tooth, and since the thickness of the enamel and dentin here is much less than in other areas of the dental crown, caries reaches the pulp much faster. Thus, it is very important to identify the disease at an early stage and start treatment on time.

What are the indications for the treatment of cervical caries?

Indications for treatment are: the appearance of spots, darkening, carious cavities in the cervical area; painful sensations from contact with sweet, sour or salty foods on the lower part of the tooth; sharp pain from cold or hot.

What is the treatment method for cervical caries?

If cervical caries is diagnosed, treatment is reduced to the following measures:

in the early stages, when the top layer of enamel is not yet damaged, conservative treatment is prescribed using the remineralization method (weakened enamel is saturated with calcium using special preparations);
in the later stages, doctors use filling (first the tooth is cleaned of plaque and stone, then the affected tissue is removed, after which the anatomical shape is returned to the tooth).

What are the features of filling for cervical caries?

Since the lesion is located close to the gum, and sometimes extends under it, good gum retraction is necessary. In other words, the gum must be carefully moved away from the carious cavity so as not to be damaged during treatment and filling.
Due to the nature of the loads in the area of the tooth neck, it is necessary to use fluid, plastic materials, for example, “Filtek flow” when filling.
Due to the structure of dentin (the dentin layer is thin, with wide and short dentinal tubules), a laser is often used to treat such cavities.

The best way to prevent the recurrence of cervical caries is to brush your teeth regularly, trying to thoroughly clean them all the way to the neck. In addition, visit the dentist regularly, because if caries is detected at the initial stage, it will be quite possible to get by with simple remineralization. Once every six months, it is recommended to have your teeth professionally cleaned to remove deposits that contain cariogenic microorganisms.

What are the possible complications?

If deep cervical caries is not treated in time, it is fraught with diseases such as pulpitis, periodontitis, and gingivitis. In its advanced form, the disease leads to complete destruction and loss of the tooth.

What are the criteria for quality of treatment?

The quality of treatment for cervical caries is assessed according to several parameters:

no pain in the tooth;
high-quality marginal seal of the filling;
restoration of the anatomical shape and aesthetic appearance of the tooth;
low probability of relapse.

How much does it cost to treat cervical caries?

The price for the treatment of cervical caries depends on both the stage of the disease and the materials used. The approximate cost of this service at the DentaBravo clinic is indicated in the price list. An accurate calculation is possible after consultation with a specialist.

From the point of view of the causes and development of the pathological process, caries under the gum is no different from caries on the surfaces of the teeth visible to the eye - contact, cheek, palatal and others. Its main feature is its unusual location and the associated difficulties in timely detection and treatment of this form of the disease.

At the stage of stains and superficial caries, when such pathology does not yet cause severe pain, it is impossible to detect dental damage covered by the upper part of the periodontal tissue with a simple examination of the oral cavity. For this reason, treatment of a diseased tooth with caries localized under the gum usually has to be undertaken already at the stage of progressive pulpitis, which reveals the pathological process with pain of varying severity.

Today, subgingival caries is successfully diagnosed and treated in the early stages of development, but this requires high consciousness of the patient himself, who agrees to visit the dentist only for examinations and detection of the disease at those stages when it does not yet cause concern. Much in the diagnosis of caries under the gum depends on the doctor, who must be able to correctly assess the cariogenic situation in the oral cavity and suspect the presence of a disease with a non-standard localization, even without obvious signs of its presence.

Localization of caries under the gum

When localized under the gum, caries can be located, generally speaking, on any side of the tooth. However, practice shows that more often it develops on proximal surfaces, that is, in the interdental area (interdental caries, which initially began above the gum, tends to quickly go under the soft tissue, which can lead to root caries).

The photo below shows an extracted tooth with a caries-affected root area:

The entire cavity formed as a result of caries was located below the edge of the gum, and therefore outwardly the tooth looked healthy, but at the moment, after some time, one can observe the advanced carious process that led to such a radical decision by the dentist.

In many cases, when caries develops under the gum, the pathological process does not involve areas of enamel visible to the eye even in the later stages of development, and as a result, the disease successfully develops to the stage at which the pulp is affected.

On a note

Caries located under the gum should not be confused with a disease that some patients call “gum caries.” The second nosology is a typical cervical caries, developing exactly along the edge of the periodontium. At the same time, it, of course, does not spread to the gum itself, since it can only affect tooth tissue. Caries developing under the gum can sometimes spread to areas above the periodontal edge, but when treating it and cleaning carious cavities, it is quite clearly visible when caries develops on the neck of the tooth, and when - under the gum with further capture of surrounding areas of enamel.

A carious cavity under the gum is a kind of “food collector” that provokes regular irritation of the gums with the development of traumatic or infectious inflammation such as gingivitis or even periodontitis.

Dangers and consequences of caries under the gum

Like other forms of caries, subgingival caries may show minimal signs on the outer surface of the enamel, but penetrate deeply into the internal tissues, leading to unnoticed tooth decay. Therefore, quite often in such cases, pulpitis develops and depulpation (removal of nerves) is required.

Much less often, untreated caries that develops under the gum can so seriously affect the root that the tooth has to be removed.

In addition, it leads to inflammation of the pulp faster than caries that develops from the surfaces of the tooth located above the gum. The distance from the root wall to the pulp is small, and even a not very extensive lesion is enough for the soft tissues of the tooth to become involved (popularly called “nerves”).

In addition, it is under the gum that caries has more opportunities to develop into periodontitis. As it develops and the enamel is destroyed, the space between the tooth and the gum increases, more and more food accumulates and rots in it, which leads to rapid irritation and inflammation of the gums. Although in most cases, already at the stage of pulpitis, tooth pain becomes so acute that before periodontal inflammation, the patient already consults a doctor and receives appropriate treatment.

Reasons for the development of pathology

Cavities under the gums can develop for many reasons. The main one is gum disease, in which pockets form between the surface of the tooth and the gum adjacent to the neck of the tooth. Such pockets are easily penetrated by food debris and bacteria that produce cariogenic acids. As a result, a very favorable environment for the development of caries is formed here.

In addition, the disease can develop for the following reasons:

incorrect installation of crowns, in which the gums recede or are mechanically retracted (flakes off) from the tooth;
lack of normal oral hygiene;
some diseases due to which the secretion of saliva decreases or its composition and, as a consequence, bactericidal activity changes.

And, of course, as with other types of caries, the destructive process under the gums can be triggered by a diet with an abundance of carbohydrates (mainly sugar and flour) and hereditary factors - tooth susceptibility to caries, thin enamel and others.

Symptoms and diagnosis of caries localized under the gum

Caries located under the gum practically does not show itself with the symptoms that are characteristic of cases where pathology is localized in open areas of enamel. Since the affected areas of the outer walls of the tooth are protected by periodontal disease, cold and hot foods practically do not reach them, and therefore even deep-seated caries here may not cause pain.

Only in cases where the pocket between the gum and the tooth is filled for a long time with the remains of rotting food, the patient may be a little worried about both the tooth itself and the gums that are injured or irritated by the leftover food. With some experience, the patient will be able to distinguish between these types of painful sensations, and the doctor, using his words, will implement the correct diagnostic methods.

Thus, the development of caries under the gum can be suspected only when pain appears in the tooth or adjacent soft tissues, and before that, the lesion can be detected only by chance during a special diagnosis of adjacent teeth using X-rays, transillumination or laser devices.

The doctor will not specifically order x-rays of apparently healthy teeth without suspicion of caries. Therefore, it is very important to pay attention to the first signs of tooth pain in time and come for an examination as soon as possible. With such self-discipline, even caries hidden under the gums can be diagnosed at a stage when drilling and filling the tooth is not required to eliminate it.

Specifics of treatment of caries under the gum

Fundamentally, the treatment of caries under the gum does not differ from the tactics of caries management in other areas of the tooth.

If the enamel is only partially damaged and the pathological process has not spread into the dentin layer, it is possible to clean the affected area with special polishers and undergo a course of mineralization procedures. This allows the enamel to be restored.

If part of the dentin is affected by the disease, the doctor removes the area of defective enamel covering it, cleans out the carious cavity and installs a filling. When the pathological process affects the soft internal tissues of the tooth, it is necessary to depulp the tooth.

Subgingival carious processes almost always require gum correction (excision, coagulation, etc.) at the beginning of work and further isolation of the working area from blood and saliva. These manipulations, on the one hand, complicate the treatment and take extra time, but on the other hand, they make it possible to qualitatively treat a tooth with such a problem.

On a note

To create maximum dryness of the surgical field and to control gum bleeding, dentists often use a rubber dam in such cases. This is a piece of rubber (latex) whose function is to isolate individual teeth from the mouth during treatment.

If it is not possible to use a rubber dam, the dentist is forced to use glass ionomer cements as filling materials that are resistant to moisture during placement, since it will not be possible to completely prevent the entry of saliva and blood into the working area. However, these materials have low strength compared to composites, high abrasion and poor polishability. These negative properties directly or indirectly affect the quality of the future filling installed under the gum, but this is better than a composite filling that falls out in a day or immediately. At least the GIC can be guaranteed.

If the clinic uses a rubber dam, then even with relatively deep lesions of the tooth root, it is possible to effectively isolate it from saliva and blood, and use more aesthetic and versatile composites as a filling material. Although in a number of clinical situations it is necessary to use, again, glass ionomer cements and compomers (fillings that combine the properties of GIC and composites).

On a note

The use of rubber dam today has not yet become a standard in domestic dentistry, and such film can be seen mainly in elite and very expensive clinics. However, practice shows that with its use in more difficult places it is possible to install the strongest and most durable fillings, and in general the treatment is of a higher quality.

Depending on how far the pathological process has progressed, different treatment options for caries are possible:

In case of a minor lesion, when the pulp is not involved in the pathological process, the carious cavity is cleaned out using a drill and filled with filling material.
When more than 60% of the tooth tissue is damaged by caries or when one or more of its walls is significantly destroyed, inlays are installed. Sometimes it is only possible to install an inlay with a pin. This is done in cases where at least one tooth root and a significant part of the crown are affected, of which at least one wall remains after cleaning the carious cavity.
If carious damage covers the entire crown of the tooth, but its roots remain intact, it is possible to install an artificial crown on a living tooth;
If one or more roots are affected, as well as a large part of the crown, the latter is removed, the tooth is depulped, a core inlay and an artificial crown are installed.

In some situations, tooth decay that develops under the gum may lead to the need to remove a tooth. This happens if the deep parts of the root are affected by a pathological process. It is extremely difficult to clean them due to the fact that the alveolus interferes with the tool, and even if this can be done, there will be nothing to attach the pin for the tab. In these cases, the tooth is removed, and at the patient’s request, a prosthesis is subsequently installed in its place.

Making a decision on one treatment option or another is possible only after opening the carious area, cleaning it and determining the extent of tissue damage.

Treatment of caries under the gum is almost always carried out under local anesthesia. Therefore, for the patient this process is painless and does not cause much discomfort.

Prevention rules

The main way to prevent the development of caries under the gum is to have regular dental check-ups. This is a universal measure that will protect both those who boast healthy and strong teeth, and those who have teeth that are quite susceptible to caries.

It is also important to have dental treatment and crowns installed by a doctor with extensive experience. He will not make a mistake and will not place a crown in such a way that this operation will provoke the development of caries.

For the prevention of caries under the gum, all the rules common to other types of caries are relevant: regular thorough brushing of teeth, diet correction to limit sweets and starchy foods, removing food debris from the mouth, eating foods with a temperature close to body temperature. And of course, it is very important to monitor your own feelings and consult a doctor at the first sign of tooth pain. This will guarantee timely and successful treatment.