Cervical caries: treatment. Dangerous cervical caries: treatment or how to avoid complete tooth destruction Cervical caries of chewing teeth

Caries is one of the most common diseases in dentistry. Pathology can be localized in any part of the tooth and lead to damage to all its layers.

Cervical (root or gingival) caries develops in the root area, near the gums. Without appropriate treatment, the disease rapidly progresses, leading to tooth fracture and its subsequent removal.

Causes

It is quite difficult to independently identify cervical caries in the initial stages. Diagnosis of the disease is complicated by the presence of pigmented dental complications. People do not pay attention to the dark plaque near the gums, considering it only an aesthetic problem. Meanwhile, hard deposits cause the development of demineralization of enamel tissue and caries in the cervical area of the teeth.

Causes of the disease:

systematic violation of oral hygiene;
avitaminosis;
bad habits (smoking, alcohol abuse);
gastrointestinal diseases (gastritis with increased secretion, reflux esophagitis, etc.);
hereditary predisposition;
hypoplasia of tooth enamel;
night feeding of children with formula and porridge from a bottle;
low fluorine content in water;
taking medications that negatively affect tooth enamel;
abuse of sweets and carbonated drinks;
age-related changes (after 40 years, the risk of developing cervical caries increases significantly).

The development of caries is facilitated by hormonal changes in the body that occur during puberty, menopause, pregnancy and lactation. The disease can be prevented by following strict oral hygiene rules and regular dental monitoring.

Symptoms of the disease

Caries is characterized by a persistent course. In the absence of treatment, from the moment the initial symptoms appear until the time of complete tooth destruction, on average, 6 to 12 months pass. In the area of the base of the tooth, the enamel is thinner and can quickly be demineralized. This rule mainly applies to children, pregnant women, elderly people, and patients with endocrine diseases.

The structure of the tooth and the difference in enamel thickness are clearly visible in the photo:

Cervical caries has a rapid course. Complications of the disease are: pulpitis, periodontitis, breaking off the tooth crown. With a timely visit to the doctor, the possibility of saving a dental unit is high; with a late visit, it is low.

Symptoms of cervical caries:

Visual changes. Depending on the stage of the pathology, chalky spots, roughness of the enamel, pigmented plaque, ulceration and darkening of tissue, and the formation of cavities are detected at the base of the tooth.
Pain. Due to the thinness of the enamel in the cervical area and the close location of the nerve fiber, the pathology is accompanied by unpleasant sensations almost from the very moment of formation. Pain occurs when eating spicy, sour, sweet, hot and cold foods. When the nerve bundle of a tooth is damaged, a disease develops, accompanied by acute toothache!
The formation of chips of tooth tissue and breaking off of the crown are the final unfavorable stage of the carious process. It is possible to get rid of the disease with significant tissue changes, but it will require significant investment of money and time.

Important information about cervical caries can be found in the video:

Identification of the primary carious process is carried out during an examination by a dentist. To reduce the risk of complications, you need to visit your doctor every 6-7 months. With the development of a pathological process on the front teeth, patients discover the disease on their own.

Stages of pathology development

Despite the fact that caries at the base of the teeth develops rapidly, it has well-defined stages that can be detected with careful visual examination. The pathological process develops in the area of contact between the tooth and gums. In this place, with a low level of hygiene, in most cases there is a hard pigmented plaque. This is the reason for the late detection of the disease.

Forms of cervical caries:

The appearance of chalky spots (initial stage). The pathology is associated with an imbalance of microelements in the enamel (loss of calcium and fluoride). Roughness appears in the affected area, white spots are found on the surface of the tooth;
Superficial caries. The enamel is affected, and primary discomfort appears when eating and exposed to air. The roughness of the enamel and its pigmentation are visually observed;
Average caries. The pathology is accompanied by increased pain symptoms. Unpleasant sensations appear upon contact with irritants and completely disappear a few seconds (minutes) after its elimination. Upon visual examination, at the base of the tooth there is darkening, loose tissue, and a pathological cavity. Due to the peculiarities of the tooth structure, with the development of moderate cervical caries, mandatory root canal treatment is carried out!
A deep process is accompanied by a high degree of damage to enamel and dentin tissue and the penetration of infection into the nerve fiber of the root canals. The pathology has clear symptoms: severe toothache, without the participation of irritants, the presence of a deep dark cavity, chipped tooth tissue. Quite often, in the presence of multiple affected teeth, patients cannot accurately determine the source of pain due to the tendency to irradiate.

With circular caries, the pathological process covers the entire area of the tooth neck and leads to crown breakage.

The development of cervical caries in children occurs due to violation of feeding rules. Drinking formula, juices or milk porridge from a bottle at night leads to rapid damage to all teeth. Photo of circular (kefir) caries in children:

Treatment of pathology

The treatment method depends on the phase of development of the carious process. The most favorable option is the presence of initial caries. Pathology at the stage of chalk spots can be treated without the use of a drill. By saturating the enamel with calcium and fluoride, the dental tissue regains its resistance and the disease recedes. Remineralization is carried out using special dental gels, creams, rinses and pastes. Treatment is carried out by a doctor in dentistry and at home. To restore the balance of trace elements and minerals in the enamel, people need to adhere to a nutritious diet.

With the development of superficial, medium and deep caries, treatment is carried out using a drill.

The doctor’s tactics include the following steps:

anesthesia;
selection of the color of the filling mass;
thorough removal of carious tissue;
carrying out antiseptic treatment;
restoration of tooth integrity with filling material;
correction of the filling according to the bite and its final processing (grinding, polishing).

Treatment of caries at the base of the tooth has its own characteristics. Due to the close location of the pathological focus to the gum, it is difficult for the dentist to maintain a dry working surface. If there is moisture in the cavity being filled, there is a high risk of the filling falling out in the future. The special knowledge and skills of the doctor, as well as special devices – a saliva ejector and a cofferdam – help improve the quality of work.

Photos before and after treatment of cervical caries:

Question answer

How to treat cervical caries on the front teeth?

When treating teeth in the smile area, it is necessary to achieve a highly aesthetic result. For restoration, special materials are used (composites, cements), which make it possible to achieve exact identity with natural teeth. The price of caries treatment depends on the level of the clinic, the availability of modern equipment and materials.

To cure a tooth with global damage, it is necessary to: completely eliminate carious tissue, treat root canals, restore the tooth using an inlay (or pin) and filling material, and cover it with a protective crown.

How to avoid the development of cervical caries?

Prevention is aimed at eliminating the causes of the disease. It is necessary to observe strict hygienic requirements when brushing your teeth (use dental floss with fluoride, rinses, fluoridated toothpastes, irrigators), give up bad habits and food, and systematically carry out hygienic cleaning of the oral cavity at the dentist.

What can be confused with cervical caries?

People confuse the disease with a wedge-shaped defect and hard, pigmented plaque. If formations are detected on the surface of the tooth, in any part of it, you must contact your dentist!

Which teeth are affected by cervical caries?

Pathology can develop on an incisor, canine, or chewing tooth. Sometimes the pathology affects several units at the same time. The least common is cervical caries on wisdom teeth.

Dental caries is a complex, slowly developing pathological process in the hard tissue of the tooth. First, a focal decrease in the content of mineral salts occurs in the tooth enamel, their dissolution - demineralization. As the pathological process progresses, the hard tissues of the tooth soften and collapse, and a cavity forms. If left untreated, the disease can become complicated by inflammation.

The cause of caries is the pathogenic effect of microbial dental deposits (plaque, tartar) on tooth enamel. When eating carbohydrate foods, organic acids act on its surface. First, they damage the inorganic mineral basis of the enamel - hydroxyapatite crystals, and then the organic matrix of dentin (the hard tissue of the tooth that forms its basis).

The occurrence and development of caries is influenced by time and three components:

the presence of cariogenic microflora in the oral cavity;
retention of simple carbohydrates on the enamel surface;
decreased resistance (resistance) to the effects of pathogenic caries factors.

All people develop plaque, but caries does not always develop. Carious lesions occur when the intensity of the impact of deposits on teeth exceeds the ability of the tooth tissue to resist pathogenic microflora. There is a decrease in caries resistance and favorable conditions for the development of the disease arise.

Treatment of cervical (gingival caries) caries at home

The development of carious lesions is gradual. First, changes occur in the subsurface layer of enamel. At the same time, the surface layer of enamel remains relatively preserved, since they differ in chemical composition.

As a result, a white (pigmented) carious spot appears. Caries in the spot stage is the beginning of the pathological process. From the damaged subsurface area, calcium, phosphorus, magnesium, and carbonates are lost, the density of the enamel decreases, and its solubility increases. At this stage, the disease is reversible and remineralization is possible - partial restoration of the density of damaged enamel.

To treat focal demineralization, drugs are used that compensate for defects in the enamel crystal lattice, increase its resistance to acids, and reduce permeability. Remineralizing preparations should include various substances - calcium, phosphorus, fluoride, strontium, zinc and others.
Fluoride compounds are used to treat the initial stages of caries. They normalize mineral and protein metabolism. This creates favorable conditions for mineralization.

Rinses, applications with sodium fluoride solution

Locally (for rinsing, applications) use 0.05 - 0.2% aqueous solution of sodium fluoride.
It is necessary to rinse your mouth with a solution (a tablespoon for adults, a dessert spoon for children 6–9 years old) after eating and brushing your teeth:

0.05% solution daily 3 rinses for 1 minute;
0.2% solution - 3 rinses for 1 minute every 1–2 weeks.

The procedure is performed over 9 months, the course of treatment is repeated annually.
For applications, use a 0.2% sodium fluoride solution. Before the procedure, the surface of the tooth must be thoroughly cleaned of plaque, cotton swabs should be placed to isolate it from saliva, and dried (wipe with a dry swab). Apply loose cotton swabs moistened with sodium fluoride solution to the surface of the tooth for 4–5 minutes. The course of treatment is 4 – 7 applications 2 times a year.

Applications with 0.2% sodium fluoride solution can be alternated with applications of 10% calcium gluconate solution. Preparation for the procedure is similar to the previous one. Swabs soaked in a 10% calcium gluconate solution are applied to the enamel affected area for 15–20 minutes, replacing them every 4–5 minutes with fresh ones.
After every third application with a mineralizing solution of calcium gluconate, apply a cotton swab moistened with a 0.2% sodium fluoride solution to the treated surface for 2–3 minutes.

Fluoride varnish coating

After completing the course of applications, it is advisable to cover the surface of the teeth with fluoride varnish. This is a composition of natural resins of a viscous consistency of dark yellow color, containing 2.9% fluorine. The composition of fluoride varnish per 100 g includes:

sodium fluoride 5 g;
fir balsam 40 g;
shellac 19 g;
chloroform 12 g;
ethyl alcohol 24 g.

The product is applied to individual affected teeth 1 – 2 times a week. The course of treatment is up to 4 applications. If necessary, after 6–12 months, a second course of treatment with the drug is carried out. The fluoride varnish film remains on the surface for a long time, saturating the surface layer of enamel with fluoride ions. The simultaneous use of solutions of sodium fluoride and fluoride varnish is possible.

It is advisable to include foods enriched with fluoride (table salt, milk) in your diet.

Applications, rinsing with remodent solution

Remodent is a preparation obtained from animal bones. Contains a complex of macro- and microelements necessary for the remineralization of enamel. Approximate composition:

calcium 4.35%,
phosphorus 1.35%,
magnesium 0.15%,
potassium 0.2%,
sodium 16%,
chlorine 30%,
organic substances 44%,
microelements – up to 4%.

Upon contact with enamel, the inorganic elements of remodent intensively penetrate into its surface layer. This leads to a favorable change in the biophysical properties of enamel - permeability and solubility in acids. The inorganic components of the remodent actively penetrate into the pathological focus, contributing to the restoration of the structure.

An aqueous solution of Remodent (3%) is used in the form of applications to treat caries at the spot stage. Swabs with solution are applied to the pre-cleaned and dried enamel surface for 15–20 minutes, the tampons are changed 2 times. After application, it is not recommended to rinse your mouth or eat food for 2 hours. Applications are carried out 2 times a week.

The course of treatment for caries in the spot stage consists of 2 – 28 applications depending on the intensity of demineralization.

An effective way to remineralize caries in the spot stage

First, carious white spots are treated once with a 2% aqueous solution of sodium fluoride by application for 10 to 15 minutes. After the second day from the start of treatment, it is recommended to brush your teeth with a hard brush using calcium phosphate-containing remineralizing gel 2 times a day for 3 minutes. The course of treatment is 2–30 days.

Gel treatment R.O.C.S. Medical Minerals

A modern drug for the treatment of the initial stage of caries is R.O.C.S. gel. Medical Minerals. It contains calcium glycerophosphate, magnesium chloride and xylitol. Thanks to special additives, the gel has adhesive properties and lingers well on the surface of the teeth. This provides conditions for the gradual penetration of mineral components into the tissue.

Treatment of acute initial caries at home (applications in an application tray) will take about 2 months. When applying the gel in a dental clinic, after 15 sessions it is possible to achieve the disappearance of chalky spots in 80% of cases.

Attention! Remineralization therapy is only effective with good oral hygiene. If a pigmented stain occupies a significant (1/3) part of the tooth surface, cervical caries must be filled.

Superficial cervical caries and deeper lesions are treated in a dental clinic, since at these stages of the development of the disease a cavity forms in the tooth and it is necessary to fill it.

If you experience short-term pain from sweet, sour, salty foods, pain from temperature stimuli, which is typical when the lesion is localized at the neck of the tooth, then you need to seek treatment from a dentist.

How is cervical dental caries treated in dentistry?

At the dentist's appointment, a clinical examination of the patient is first carried out:

it is found out what the patient is complaining about;
the oral cavity is examined using a dental mirror and probe;
Probing determines the pain and depth of the affected area of the hard tissues of the tooth.

Next, the carious cavity is prepared. Preparation is the excision of pathologically altered hard tooth tissue. The most common is the mechanical method of treating a carious cavity using burs and hand tools. At the preparation stage, the lesion site is opened, expanded, softened and pigmented dentin is completely removed, and a cavity shape is created that is convenient for filling.

The crown of a tooth has a complex configuration, so the spread of caries on different surfaces has its own characteristic features. A special feature of tooth neck caries is that it can be caused by other diseases of the hard tissues of the tooth:

wedge-shaped defects;
erosion;
hypoplasia;
root caries and others.

Cervical caries usually spreads widely over the surface. The entrance hole of the lesion has the shape of a circle or ellipse. The process develops deeper towards the pulp.

From a technical point of view, it is difficult to treat cervical caries, since it is located close to the gum and sometimes spreads under it. When preparing and filling, the doctor solves additional problems:

protect the gums from damage;
move back the gum to get a good view and treat caries of the tooth neck;
prevent bleeding gums;
keep the cavity dry during filling;
ensure adhesion and tight fit of the seal;
achieve retention of the filling in the cavity, since the filling in the gingival area is subjected to significant loads during chewing.

Given the close location of the pulp, cervical caries is prepared very carefully. When treating cervical caries on the front tooth, not only softened dentin, but also all pigmented dentin is removed for aesthetics.

In order for the filling to hold tightly, during preparation it is necessary to form a special (usually kidney-shaped) cavity shape. The bottom of the cavity is formed convex. If necessary, special cuts in the form of grooves are made in the dentin on the walls of the cavity. There is also a special technique for shaping the edge of the cavity.

Is it painful to treat dental caries?

Very often, a visit to the dentist is delayed due to fear associated with the possible pain of treatment. Up to 14% of patients whose teeth are not healthy are afraid of pain and do not seek treatment from a doctor at all.

Treatment of cervical caries, especially on the front teeth, is painful. The distance from the neck of the tooth to the pulp (loose fibrous connective tissue that fills the tooth cavity, containing a large number of nerve endings) is insignificant; therefore, the area of the neck of the tooth is characterized by increased sensitivity. Therefore, you should not refuse local anesthesia.

The comparative effectiveness and toxicity of some local anesthetic drugs is listed in Table 1.
Table 1

*Name of anesthetic*	*Efficiency*	*Toxicity*
Novocaine	1	1
Lidocaine	1,5 – 2,5	2
Mepivacaine	4	2
Artikain	5 – 6	1

How to avoid pain and fear of an anesthetic injection when visiting a dentist?

Painlessness of all diagnostic and therapeutic procedures is the most important condition for the effective treatment of dental diseases. Therefore, the doctor is obliged to properly numb the tooth when treating caries. However, fear in the patient can be caused not only by the treatment process, but also by the injection of the needle and its movement into the tissues when the anesthetic is administered. But we are solving this issue. Local anesthesia can be done with carpulized drugs.

Carpule anesthesia is carried out with a special metal syringe. Special carpules are placed in it, which contain a solution for pain relief. The kit includes special disposable needles. An injection with a carpule syringe is practically painless, since a high-quality needle is sharpened at a special angle and coated with silicone.
Also, during carpule anesthesia, a special VibraJect syringe attachment is used to reduce pain and fear of an injection. The device blocks the pain signal.

It is worth noting that carpule anesthesia has a number of contraindications, since in addition to the anesthetic itself, the solution contains various additives:

vasoconstrictors that increase the duration and depth of anesthesia - mainly adrenaline (epinephrine) and norepinephrine (norepinephrine, levarterenol);
stabilizers and preservatives – sulfites, EDTA (ethylenediaminetetraacetic acid), parabens;
sodium chloride;
water for injections.

Side effects when vasoconstrictors interact with certain drugs are listed in Table 2.
table 2

Fear of an injection for pain relief can be avoided if anesthesia is administered in three stages:

At the site where the needle was inserted, a local anesthetic (for example, Ultracare, Ultradent gel) is first applied for one to two minutes.
A small amount of anesthetic solution is injected under the mucous membrane of the skin.
After one or two minutes, the anesthetic is injected to the required depth.

This method is also recommended in clinical dental practice and can be used in the treatment of caries in children and adults with increased levels of anxiety.
To relieve anxiety and improve well-being before a visit to the dentist, you can use the drug Tenoten. It increases the pain tolerance threshold.
Method of using Tenoten before visiting the dentist and dosage:

adults with a high degree of anxiety dissolve 2 tablets under the tongue, after 5 minutes another 2 tablets (4 tablets in total) 20 minutes before the start of treatment;
adults with moderate tension dissolve Tenoten under the tongue in a dose of 1 + 1 with an interval of 5 minutes 20 minutes before visiting a doctor;
Tenoten for children can be taken by children from 3 years old, 1 tablet (absorption under the tongue) 20 minutes before the start of treatment.

In terms of stress relief power, Tenoten is similar to the benzodiazepine tranquilizers diazepam and phenazepam, which can also be used to relieve psycho-emotional stress. But Tenoten does not cause side effects such as drowsiness, muscle weakness, or impaired coordination of movements.

When treating tooth neck caries at home, it is important to know that dentists now say that the clinical course of caries has changed. This is due to the fact that remineralizing preparations based on fluorides, phosphates, and active calcium compounds have become widely used for hygiene in toothpastes. When caries develops in places that are poorly accessible when brushing teeth, these active substances maintain the integrity of only the surface of the enamel, while the carious process affects the deeper layers of enamel and dentin. That is, small changes on the surface of the enamel are accompanied by extensive damage to the tissue underneath.

It is difficult even for a dentist to diagnose such caries: the tooth looks healthy, but the pathological process develops. In this case, diagnosis is carried out using additional means:

X-ray;
magnifying devices – lenses, microscope, glasses;
transillumination of the tooth crown with a bright light flux, which is most effective in diagnosing hidden caries of the anterior teeth;
other.

Remember: the smaller the size of the carious cavity on the neck of the tooth, the longer the service life of the filling, the less painful the treatment will be. Don't delay your visit to the dentist.

The area of the tooth where it connects to the gum is the neck. The enamel in this area is thin, and high-quality cleaning with a regular brush is almost impossible, so pathogenic flora often accumulates here. It is not surprising that when the enamel is damaged, caries sometimes develops, which is called cervical caries.

Why is it considered very dangerous?

The patient himself may not detect it at an early stage, when treatment is most effective and less expensive. The disease develops rapidly: the inflammatory process covers nearby tissues, root canals and often leads to tooth loss.

Untreated caries can result in the most serious complications: painful pulpitis, periodontitis, gingivitis, gumboils, and even phlegmon. And this is no longer a cosmetic defect - the inflammatory process has taken over the soft tissues of the neck and head and the patient exposes himself to mortal danger by refusing medical care.

Cervical caries often presents unpleasant surprises. A small dark spot may hide a large carious cavity. This area is inconvenient for treatment, high-quality treatment of the cavity is difficult, the working area may not be dry enough (it is difficult to dry it), so the fillings hold worse than in other areas.

Unfortunately, the sanitation of the oral cavity cannot guarantee a complete cure - cervical caries sometimes returns.

Photo: cervical caries requiring urgent treatment

Diagnostics

Any type of caries begins in approximately the same way: with a loss of shine on the enamel surface in a certain area, a change in its color and the appearance of a white spot. This area becomes rough. Then tissue destruction begins and only after that pain appears. If treatment is not started, the disease affects the canals.

In order to detect pathology as early as possible, in addition to regular preventive examinations at the dentist (at least once every six months), it is necessary to pay attention to the condition of the oral cavity.

If alarming symptoms appear (increased sensitivity to hot and cold, discomfort, change in enamel color), you should consult a doctor. Only a professional can make the correct diagnosis; there are several diseases (wedge-shaped defect, fluorosis, enamel erosion) with similar symptoms.

The capabilities of modern dentistry make it possible to do this at the very beginning of the disease. This is not only a visual examination, but also electroodontodiagnosis, radiography, vital staining and other methods.

The following video will help you visually understand this type of caries:

Why does it appear?

Many of them are the same for all types of this disease:

Poor nutrition. Excessive indulgence in sour, flour, confectionery foods, and carbonated drinks is especially harmful. Insufficient amount of vegetables, fruits, fish, dairy products in the diet.
Bad habits (tobacco smoking).
Bad heredity.

Oral hygiene is lacking or cleaning is performed poorly. Constant use of gel instead of toothpaste (it does not contain abrasive particles) and improper cleaning lead to plaque remaining on the enamel.
Bad water.
Pregnancy.
Treatment with drugs, after taking which the enamel becomes porous.

If cervical caries has damaged the enamel of more than one tooth, dentists usually recommend contacting an endocrinologist. It is possible that these disturbances in the endocrine system provoked the rapid development of the disease.

Features in case of occurrence on the front teeth

In this case, the highest demands are made. They are always in sight - when we talk or smile. You have to carefully select the shade of the material for the filling and take into account that the front teeth are much thinner than the molars, and the load on them is higher. Therefore, their restoration is a difficult task.

In children

Most often, this disease is diagnosed in patients over 30 years of age. But sometimes it occurs even in infants. This is the so-called bottle (milk) caries.

It develops due to the fact that the child is fed and immediately afterwards put to bed. In this case, natural sanitation of the oral cavity does not occur - during sleep, the amount of saliva produced decreases.

Prevention

Mandatory cleansing of teeth, tongue, palate, gums 2 times a day. In this case, it is necessary to remove food debris with a special thread; when brushing, direct the brush movements along the surface of the tooth, and not across it. For cleaning in the morning, it is advisable to use regular pastes or even powder, but at night you can clean with gel. After lunch and snacks, it is recommended to rinse your mouth with warm water and mouthwash and remove any remaining food with floss.
Periodic (twice a year) professional cleaning of the oral cavity, including removal of tartar, polishing the enamel surface and coating it with preparations containing fluoride.
Regular massage of the gums, rinsing with decoctions and infusions of medicinal herbs, using rinses.
Proper nutrition (balanced), it is not recommended to eat too hot or too cold food.

How to treat?

These recipes are used in the early stages of the disease and as auxiliary ones to alleviate the patient’s condition in case of severe pain.

Use of folk remedies

Onion peel decoction. Measure out 1.5 tablespoons of plant material, add 0.5 liters of water, boil for a few minutes, leave for 8 hours, rinse after meals.
Propolis. Pour 4 teaspoons of pharmaceutical tincture into slightly warmed water (1 glass). Rinse 3 times a day. Whole propolis is also suitable for treatment: you need to make a small cake, apply it to the sore spot, and cover it with a cotton pad. Remove the application after 1 hour.
Sage. An infusion is prepared: a tablespoon of dried leaves is poured into 1 glass of boiling water, infused for 1 hour, and used for rinsing.
Camphor alcohol. Soak a cotton pad or a piece of bandage with alcohol, squeeze it out, carefully lubricate the gum near the affected tooth, and then press it against it for a few minutes.
Melissa. The infusion is prepared within an hour: 4 tablespoons per 1 glass of boiling water. Used for rinsing after meals.

Using special paste

Special pastes have appeared on sale that can be used not only for prevention, but also for the treatment of the initial stages of various types of caries, including cervical caries. Dentists advise using them in courses of 30–60 days, using regular pastes in between.

LacalutExtra sensitive. Increases the resistance of enamel, helps strengthen it and remove tartar. As a result of use, inflammatory processes stop, sensitivity decreases, the affected surface is restored faster, and new damage does not appear.

It is considered one of the best pastes for the prevention and treatment of caries. The cost of 1 tube is 170 – 220 rubles.

Presidentsensitive.
It is a low-abrasive paste that cleanses gently and helps strengthen and restore weakened enamel. Costs from 140 rubles for 1 tube.

SilcaCompleteSensitive. Contains sensitivity blocking and acid neutralizing ingredients. Application promotes enamel mineralization. 1 tube costs from 90 rubles.

32 bionorm for sensitive teeth. Strengthens and restores enamel, its sensitivity is blocked by potassium ions, and vitamins (E and A) accelerate these processes. The price of 1 tube of this domestic paste is low (30 - 50 rubles).

What does official medicine offer?

At the beginning of the disease, it is enough to carry out professional cleaning to remove plaque and tartar and ensure remineralization of the enamel - apply special preparations (contain fluorine or calcium) or deep fluoridation. In the future, it is recommended to use special pastes for cleaning.

If the destruction has affected the tooth tissue, the cavities are first prepared, and only then the missing part is restored. In advanced cases, they resort to tooth extraction.

Price

The sooner the patient contacts the dentist, the cheaper it will cost him to bring his oral cavity to normal condition. On average, you will have to spend 1200 – 3600 rubles to treat 1 tooth. This amount includes: the cost of anesthesia and consumables, treatment of the cavity and installation of a filling.

If the disease has affected the root canals, be prepared to shell out another 1,200 - 2,000 rubles (x-ray, cleaning and filling of the canals).

The cost of treatment is determined individually in each case, depending on the status of the clinic, the type and quality of materials used, and the scope of work. For comparison: treatment of caries at the initial stage can cost up to 500 rubles.

Treatment without pain is possible!

A new method of treating caries is already being used, allowing the removal of damaged tissue. laser, without the use of a drill. In Germany, a treatment method has been developed for the sanitation of the oral cavity ozone– mechanical removal of tissue covered by caries is also not required.

Using a special installation, ozone is applied to the diseased tooth, which almost instantly suppresses pathogenic flora. Then the damaged area is covered with drugs that strengthen the tissue.

In this case, the cavity may not even be filled. No anesthesia is required either - the procedure is painless.

The advent of these revolutionary techniques allows us to hope that our children and grandchildren (and us too) will enter the dentist’s office without fear. And the caries treatment procedure itself will be no less pleasant than a massage session.

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From this article you will learn:

favorite places for caries localization on human teeth,
why does dental caries occur?
main stages of treatment of cervical caries.

Cervical caries is a carious lesion of tooth enamel localized in the area of the neck of the tooth. Patients often call this pathology the term “root caries.” It should be noted that tooth enamel in the area of the necks of teeth is one of the most common areas of development of the carious process, along with fissures on the chewing surface of large molars. This is due to the fact that it is primarily in these areas that food debris and bacterial plaque accumulate.

In dentistry, therapy for cervical dental caries, despite the apparent simplicity of localization, often ends in secondary caries next to the filling. On the part of the patient, this is usually associated with still irregular oral hygiene, but also often the cause of relapse can be the dentist’s errors during treatment (for example, poor isolation of the carious cavity from saliva, and, no less important, gingival fluid , which is released from the gingival groove around the neck of the tooth).

Cervical caries: photo

In addition to the problem of secondary caries at the filling/tooth interface, the patient may encounter another important problem that arises during the treatment of cervical caries in the area of the anterior teeth. We are talking about a mismatch between the filling (in color and transparency) and the tooth tissue. The fact is that the color and transparency of the teeth change, starting from the cutting edge to its neck. And not every dentist can use a combination of filling materials of several colors and transparency to create a filling that is invisible against the background of the tooth’s own tissues.

In addition, if you are an ordinary patient, then you need to distinguish cervical caries from caries, which are also located in the area of the necks of the teeth. The difference is that a wedge-shaped defect is a lesion of tooth enamel of non-carious origin, and the surface of such a defect will always have a smooth, shiny surface. You can read more about this pathology at the link above.

Cervical caries: causes

Let us remember that caries is caused by cariogenic microorganisms in the composition of soft plaque and hard tartar. These microbes “digest” food debris in the mouth into organic acids, which in turn leach calcium from the enamel and destroy it. Poor oral hygiene (Fig. 4-5) leads to the development of caries. You can read more about the development of caries in our review at the link below.

In the process of development, cervical caries goes through several stages: from a white spot to deep caries. So, at the very beginning, cervical caries looks like white chalky spots on the surface of the enamel in the area of the necks of the teeth (Fig. 6). At this stage, there is no actual carious defect (carious cavity) yet. These areas range in color from slightly matte to bright white.

If negative factors (soft microbial plaque and food debris) continue to act, then caries in the form of white spots transforms into a superficial, then medium and deep carious cavity.

Cervical caries: diagnosis

Diagnosis of cervical caries is not difficult, since carious defects are located on clearly visible surfaces of the teeth. White chalky spots can also be seen in the mirror even on your own, especially if you dry the surface of the teeth.

In addition to visual inspection, special dye solutions are used. The patient is asked to rinse his mouth with this solution. At the same time, the dye from this solution cannot penetrate the enamel of healthy teeth saturated with calcium, but the dye perfectly penetrates into demineralized (deprived of calcium) areas of the enamel. Demineralized enamel is very porous. After the mouth is rinsed with running water, the dye is retained only in areas of the enamel that are subject to demineralization. A few hours after rinsing with this dye, the teeth gradually acquire their previous color.

Cervical caries: how to treat...

Depending on the stage of cervical caries, different treatment methods can be used. At a very early stage, when caries consists only of white chalky spots without destruction of the surface layer of enamel, it is advisable to try conservative treatment. If a carious defect has already formed, then it is definitely necessary to fill such defects.

1. Treatment of cervical caries in the white spot stage -

The essence of caries therapy in the white spot stage is that the enamel deprived of calcium must be saturated with calcium again. For this purpose, special remineralizing preparations containing highly active calcium and fluorine are used. One of the best preparations for remineralization of enamel is Tiefenfluorid Enamel-Sealing Liquid (made in Germany). Also, for the treatment of caries in the white spot stage, dentists widely advertise the drug ICON (developed by the German company DMG).

The disadvantage of this drug is that it does not actually heal, but rather preserves the enamel with a special polymer composition (like plastic). In any case, before applying and applying these drugs, soft dental plaque and hard dental deposits must be removed from the teeth. It is also necessary to teach the patient proper oral hygiene, since if hygiene remains at the same level, then the success of such therapy will not be expected.

Enamel-sealing liquid “Tiefenfluorid” –

2. Treatment of cervical caries with destruction of enamel -

Treatment of root caries consists of the following steps:

Cleaning teeth from plaque and tartar(Fig.7) –
Soft plaque and hard dental deposits must be removed. This is usually done using polishing brushes and abrasive paste.
Determining the color of the enamel of filling teeth(Fig.8) –
it is necessary to choose the right color of the filling material so that it matches the color of your own tooth enamel
Preparation of a carious defect –
those. At this stage, all dental tissue affected by caries is removed using a drill.
Isolating a tooth from saliva(Fig.9) –
Qualified dentists use a rubber dam for this, which allows you to completely isolate the tooth (being treated) from saliva and wet breath. This is important if you want the filling not to fall out in a few months to a year.
A rubber dam is a thin band of latex in which holes are made for a group of teeth and then pulled over those teeth. After tensioning the scarf, a special metal fixing clasp is installed. It is needed to hold the rubber dam close to the gums. You can see how teeth are isolated using the power of a rubber dam in Fig. 9.
Treatment of the cavity with adhesive –
enamel and dentin must be treated with adhesive before adding filling material.
Filling a defect –

Filling material is introduced into the treated carious cavity to fill the lost part of the tooth. The tooth is given its physiological shape. During the layer-by-layer application of filling material, each layer is illuminated with a special photo-polymerization lamp, which leads to hardening of the filling material (Fig. 10).
Sanding and polishing –
It is performed using special fine-grained discs and burs in order to give the tooth its final shape, as well as to create a smooth and shiny surface.

Stages of treatment of cervical caries using a specific example -

In Fig. 11 you can see the initial situation: with many carious defects, treatment of the upper central and lateral incisors is planned. In Fig. 12 we can see that all tissues affected by caries have already been removed, and a rubber dam has been applied to the teeth to isolate them from saliva. Figure 13 shows a view of the finished work.

Prevention: cervical caries

As follows from the causes of caries, methods for its prevention are as follows:

Regular oral hygiene –
with a toothbrush and toothpaste, and also (after each meal). If you can’t brush your teeth, the minimum you should do is floss and then chew gum for 5 minutes.
Avoid snacking between meals –
consumption of sweets, chips, flour, etc. without subsequent brushing of teeth for 5 minutes is one of the reasons for the development of caries. Having a snack means you need to brush your teeth. Laziness? - means continue to walk around with rotten teeth and bad breath.
Professional hygiene –
1-2 times a year (depending on the quality of oral hygiene), remove dental deposits and pigment plaque, and also treat teeth with special fluorine- and calcium-containing products to strengthen the enamel. We hope that our article was useful to you!

There are three parts to a tooth: the root, the neck and the crown. The anatomical crown is normally located above the gum, and the neck and root are covered by surrounding tissues. That is why caries, which is located at the border with the gum and near the neck of the tooth, is called cervical (otherwise known as cervical).

Below are several photographs with examples of cervical caries:

Many people begin to take cervical caries and the reasons that cause it seriously only when the problem is already clearly evident in the reflection in the mirror and causes natural aesthetic inconvenience. The smile zone is of particular value for people who need communication to accomplish certain tasks. And since cervical caries is often localized precisely on the front teeth, there is an urgent need to restore the aesthetic component.

The photo below shows a typical example of cervical caries on the front teeth:

At the same time, many questions arise regarding the reasons causing such problems and, of course, regarding possible methods for eliminating cervical caries, which we will talk about next.

The main causes of cervical caries

The main reasons for the development of cervical caries in general differ little from the reasons that cause other forms of dental caries. They are connected:

With the nature and diet: the amount and frequency of consumption of foods containing easily fermentable carbohydrates.
With a microbial factor: the activity under dental plaque and in its volume is predominantly of bacteria of the species Streptococcus mutans. In this case, bacteria ferment carbohydrates with the formation of organic acids, which affect the surface and subsurface layers of enamel with the formation of foci of demineralization. As a result, calcium, phosphorus, and fluorine are washed out, the mineral crystal lattice of the enamel is disrupted, with the gradual formation of a carious stain.
A very common cause of carious lesions is also the lack of adequate oral hygiene (correctly developed manual skills for cleaning tooth surfaces, the regime and frequency of this procedure).

Photo in the cervical area of the tooth:

From the experience of a dentist

I often get asked questions like: “Why then does my brother eat as much sweets as he wants and whenever he wants for many years now, and doesn’t even really brush his teeth, but they are still intact, and I have solid fillings?”

The fact is that although the causes of caries are the same for everyone, they affect everyone differently. A significant role in the prevention of caries is played by the composition and quantity of saliva, its remineralizing properties, the functional state of the body, environmental influences, caries susceptibility of the tooth surface, and the individual structure of dental tissues, determined by genetics and heredity.

However, the cervical area of the tooth also has a number of features that contribute to the fact that the carious process here can very quickly pass from the stage of initial caries to deep...

Diversity of clinical presentation

In its development, cervical caries goes through all the same stages as any other:

Caries in the spot stage;
Surface;
Average;
Deep.

A feature of cervical (cervical) caries is that it is often difficult to determine at what stage of destruction the enamel and (or) dentin are. It is especially difficult to establish the difference between caries in the spot stage and superficial caries, as well as between medium and deep.

This is due to the fact that at the border of the transition of the crown part of the tooth to its neck there is thin and often weakly mineralized enamel. As a result, the cervical area tends to become subject to excessive abrasion due to poor brushing techniques, excessive brushing, and the use of highly abrasive toothpastes (commonly called whitening toothpastes).

As a result, over the years, the thickness of the enamel in the cervical area becomes less and less. And as soon as this zone ceases to experience the cleansing factor, then, with a combination of several cariogenic mechanisms, cervical caries quickly develops.

On a note

Many patients mistakenly call cervical defects cervical dental caries. From the point of view of the classification of caries, such forms do not exist, but the doctor, when a patient asks to cure “cervical caries of the front tooth,” easily understands what kind of help is needed from him (and often we are not even talking about caries, but about wedge-shaped defects, which we are talking about We'll talk more below).

Gingival caries is a synonym for cervical caries. It is only important to distinguish perigingival from subgingival. The first develops directly above the gum, and the second - in those areas of the tooth that are below the gum.

Most people, when carious stains appear on teeth in the cervical area (initial stage), may already experience unpleasant sensations: a feeling of discomfort, a feeling of setbacks and even certain pains characteristic of hypersensitive teeth, but this is less common. Basically, caries in the spot stage is asymptomatic and is detected only visually in the form of a white or pigmented spot.

Below is a photo of cervical caries in the spot stage:

With superficial caries, pain often occurs from chemical irritants (salty, sweet) and temperature (cold). Outwardly, at this stage, the disease resembles caries in the spot stage, but when probing at the dentist with a special sharp instrument (probe), a roughness zone is revealed in the center of a large spot.

Medium and deep cervical caries are often characterized by a whole palette of pain symptoms from all types of irritants. Sometimes they may be accompanied by pain from mechanical influences when hard food gets in, but this is rare due to the shape of the teeth, which protects the cervical areas from food getting under the edge of the gum.

Cervical often causes pain when inhaling cold air.

A month ago I had to go to the dentist because my front teeth were falling out. First, the very front ones near the gums darkened slightly, and then the fangs also darkened. It didn't end there. Just a few days before visiting the dentist, I began to feel severe pain in my front teeth from cold water and sometimes from sweets. I tried to drink warm water and eat less, but this could not continue. I went to the clinic, where in 5 visits my front teeth were repaired first, and then my fangs. They said it was advanced cervical caries. True, the color choice was not quite perfect, but it saved money.

Maxim, Tolyatti

The following photo clearly shows deep caries in the cervical area:

Cervical caries and circular: similarities and differences

The following lesion zone is characteristic of cervical caries: the gingival areas of the vestibular (buccal) as well as the lingual (palatal) surfaces of the lateral and anterior teeth.

If the causes of the pathology are not eliminated, then the boundaries of the caries lesion in the cervical area increase to the contact surfaces covering the tooth in the form of a ring - in this case they already speak of circular caries. That is, circular caries can be conditionally called a “cervical complication.”

To a greater extent, circular caries affects baby teeth, especially in weakened children. It is also called “ring” or “anular”.

In the photo below you can see an example of circular caries on a child’s baby teeth:

It is not difficult to guess that circular caries, being more aggressive, more often occurs with pronounced clinical symptoms, and even sometimes leads to breaking or spalling of the crown part of the affected tooth. However, in some cases, even such serious defects may not cause significant pain, since they produce replacement dentin, which protects the pulp from irritation.

Possibilities of differential diagnosis of cervical caries

At home, it can be difficult to determine exactly what kind of formation on a tooth spoils the aesthetics or causes pain. Spots, streaks, defects, depressions in the cervical area - all this can characterize the following types of pathologies:

Actually cervical caries.
Dental diseases of non-carious origin (fluorosis, hypoplasia, erosion, wedge-shaped defect, etc.).
Various variants of pigmented (colored) dental plaque, up to the so-called “smoker’s plaque.”

The photo below shows stains on teeth due to fluorosis:

Of all these options, cervical caries ranks first in the number of people visiting the dentist. Other types of pathologies are less common.

Only a doctor can correctly make a final diagnosis, but you can correctly navigate yourself even before visiting the dentist. Most often, difficulties arise when comparing caries with fluorosis and enamel hypoplasia.

The length of time that a stain or stains have existed on the enamel, as well as their location on different parts of the tooth crown, may indicate hypoplasia (its cause is the underdevelopment of tooth enamel, which is caused at the stage of fetal development in the mother’s body). To confirm the diagnosis, the dentist stains the spot with a 2% solution of methylene blue. If the spot does not stain, it is enamel hypoplasia, and not cervical caries in the white spot stage.

Fluorosis is more difficult to distinguish from caries and other non-carious lesions. It is important here to know the level of fluoride in drinking water in a given area or area of early residence. If it is elevated, then the multiple nature of the stains located on the teeth of the same name at the same time indicates fluorosis. Cervical caries most often develops in the form of a single carious spot.

It is important to distinguish between a wedge-shaped defect and cervical caries: they differ in that the first has a wedge shape or a V-shape. With a wedge-shaped defect, the walls of the cavity are dense, smooth and shiny, which cannot be said about carious tooth destruction in the cervical area.

Despite the fact that the localization of these diseases is the same, the appearance of the cavity always tells the doctor the correct diagnosis. In addition, the initial forms of caries and wedge-shaped defects can be recognized by staining with special caries indicators.

There is no such thing as wedge-shaped dental caries. This is an erroneous common name for a wedge-shaped defect.

In the photo you can compare a wedge-shaped defect and cervical caries:

I went to the dentist about strange decay of the front and back teeth on the left. I am already over 50 years old, I have almost all my teeth, I have not suffered from caries, unlike my relatives, but recently I felt pain from cold water and began to look at my teeth in the mirror. I found some holes near the gums on the canine and on other teeth only on the left side.

The doctor said at the appointment that these were wedge-shaped defects on three teeth on the left, and not caries at all. A possible reason turned out to be that I am right-handed, and I always brushed my teeth hard and for a long time, so I erased the enamel on the left side, since it is more convenient to clean there. The dentist showed me that there are also beginning wedge-shaped defects on the right, but they are not expressed yet.

Sergey, Volokolamsk

Modern treatment methods and the specifics of choosing materials for fillings

Depending on the depth of the lesion, the appropriate treatment tactics are selected.

Home treatment of cervical caries can be carried out as an addition to the treatment of caries in the spot stage. The following applies:

toothpastes and gels containing high concentrations of fluorides, as well as calcium and phosphorus compounds;
dental floss (floss) impregnated with fluoride;
rinses, again, with fluorides (since it is this element that very effectively promotes the mineralization of tooth enamel).

Using fluoride-containing complexes on your own without first consulting a dentist can be hazardous to your health. Any prescription of drugs or additional funds is based on the diagnosis, the activity of the carious process, the area of the lesion, long-term results and possible risks.

Cervical caries in the spot stage most often responds to conservative treatment, that is, without the use of a drill. However, due to the close location to the gum tissue, the constant leakage of gingival fluid into the working area and the thin layer of enamel, certain difficulties are created for the use of some new techniques.

For example, the modern minimally invasive technology ICON (ICON), due to the close location of dentin in the cervical area, is limited in use, since the substances used cannot affect dentin. It can be difficult to determine how thin the enamel in the cervical area is in a particular person, so this technique is used relatively rarely for cervical caries.

Chemical preparations related to remineralization therapy and deep fluoridation of enamel have become widespread.

In adult and pediatric dentistry, the following drugs are currently actively used for the treatment of initial cervical caries:

Gluflutored;
Enamel-sealing liquid;
Belagel Ca/P, Belagel F.
Remodent.

Treatment of superficial, medium and deep cervical caries when conservative therapy is not possible is carried out in the following sequence:

Anesthesia (anesthesia) to ensure painless manipulation.
Cleansing a carious tooth from dental deposits to reduce the infectious load.
Preparation (mechanical processing) of a tooth to remove carious and pigmented tissues.
Medicinal treatment of the cavity with weak antiseptic solutions.
Formation of a cavity according to the selected material for a permanent filling.
Filling the formed cavity.

The difficulty of choosing a material for a filling is determined by the immediate location of the formed cavity near the edge of the gum. The closer the cavity is to the gum, the more difficult it is to properly install the material. The reason for this is the possibility of moisture, gingival fluid and blood getting onto the working surface.

Dentist's opinion

The most difficult ones for high-quality filling are not even the subgingival carious cavities, but their combination with subgingival ones. Combined forms are not so rare and are associated with the activity of the carious process in a particular tooth. Often, cervical caries of the anterior teeth is complicated by subgingival defects, which, as a result of preparation, can be difficult to isolate from fluid (blood) even with the use of a rubber dam. In this case, the doctor chooses a material that may be inferior in strength and aesthetics, but hardens reliably in a humid environment.

Due to the specific localization of carious cavities, the choice of dentists comes down to the use of glass ionomer cements (GIC), which are more resistant to moisture compared to aesthetic light-cured composite materials. Hybrid GICs are of particular interest.

On a note

One of the most widely used glass ionomer cements for filling cavities with cervical caries is VITREMER. This is one of the few GICs that has a wide range of colors, a triple curing mechanism and high strength. In the treatment of cervical caries, this material competes with aesthetic light-curing composite materials.

Modern methods and technologies make it possible to combine glass ionomer cements with composites to achieve maximum effect. Competently following the instructions for the materials used makes it possible to profitably use the positive properties of each subsequent material when introduced into the formed cavity, creating a filling with reliable fixation, increased retention time, strength and aesthetics.

An example of filled teeth after treatment of cervical caries is shown in the photo below:

Unfortunately, many budget organizations cannot boast of the ability to use modern technologies and materials. The equipment of hospitals and clinics is often limited only to materials for compulsory medical insurance, where there is no rubber dam, saliva ejector, modern and convenient for working with cervical defects GIC, light-curing composites - all that is required for high-quality work in the long term.

A week ago, standing in front of the mirror, I discovered a dark spot on my upper front tooth near the gum. There was no pain, but the fear of the prospect of walking with a black tooth seemed to me, as a physics teacher at school, stronger than the fear of the dentist since childhood. They recommended a good doctor in a small private office, where after examining the spot, the doctor said that it was cervical caries, which had already destroyed all the enamel and had gone a little under the gum. It turned out that fear has big eyes: they made a good imported injection, drilled a little, put a filling in one go, and even the color of the filling, one might say, is almost like the real one - you can’t even tell the difference from the outside.

Alexander, Omsk

Features of early diagnosis and prevention of cervical caries

Among the common methods for diagnosing cervical caries are the following:

Visual methods. They are actively used by both the doctor and the patient. When caries occurs on the front teeth, recognizing defects (especially in advanced form) is not so difficult. In this case, the doctor only needs a dental mirror and a probe.
Laser diagnostics. An equally popular technique, especially when it comes to hidden caries or zones. One of the devices, “Diagnodent,” uses the principle of changing the characteristics of a laser beam reflected from dental tissues affected by caries. As soon as cervical caries or root caries is found, the device emits a sound signal.
Method of vital staining of carious spots. Ideal if the doctor has doubts about the diagnosis of caries. The simplest and most reliable way is to stain the stain with a special caries marker (indicator), which is used, for example, a 2% solution of methylene blue dye. If staining has occurred, this is initial caries. Other well-known chemical dyes can also be used: 0.1% solution of methylene red, carmine, congorot, tropeolin, silver nitrate solution.
Transillumination. A technique that is used much less frequently, but makes it possible to identify the initial forms of cervical caries when teeth are illuminated with a bright beam of light. In this case, shadow formation is assessed as the beam passes through healthy and caries-affected tissues.

Modern prevention of caries is aimed at eliminating the causes of its development:

Firstly, it is necessary to break the chain “carbohydrates - microbial factor” (which will stop the development of not only cervical caries, but in general will significantly improve the cariogenic situation in the oral cavity).
Secondly, it is necessary to strengthen the mineral structures of the enamel.

To implement the first direction, you must perform the following actions:

Follow the diet and nature of your diet, focus on solid and moderately rough foods, increase the amount of fruits and vegetables (especially after the main meal), limit the consumption of easily fermentable carbohydrates in any form (cakes, cookies, sweets, sweet buns, etc. .).
Follow important hygiene rules: brush, toothpaste and floss all accessible surfaces of the teeth at least twice a day, and rinse your mouth immediately after each meal. It is important to understand that brushing your teeth before eating does not give a good result, since dental plaque, contaminated with microbes, forms within a few hours after a snack.

On a note

Floss (dental floss) is by no means a waste of time, but a complete cleaning of the most inaccessible contact surfaces, especially in the cervical area, where caries most often begins to form.

The photo shows an example of using dental floss:

To strengthen the mineral structure of enamel, it is enough to combine the above methods with various forms of preparations for remineralization and fluoridation at home. The range of products containing mineral components (fluorine, calcium, phosphorus) in various combinations is huge. Your dentist will help you figure out what is best for the health of your teeth and also has fewer risks when used independently.

The most popular for home prevention of cervical caries are: toothpastes with fluoride and calcium, rinses (with fluoride), dental floss impregnated with fluoride.

The correct and safe combination of methods and means of prevention is usually selected at an appointment with the dentist. Within 20-40 minutes, the doctor can talk about the pros and cons of each of them, and determine, taking into account individual parameters (dental caries susceptibility, level of hygiene and condition of the cervical area), the most suitable option for you.