How to cure cervical caries. The 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 such a pathology is that in the first stages of progression, symptoms may not appear at all. Cervical caries goes 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 can develop, and in most clinical situations it is not possible to save the tooth. Therefore, it is important to timely detect the progression of the pathological process and prevent its further development. As practice shows, cervical caries affects mainly people after 30 years.

Causes

The main cause 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. Also, heredity can be attributed to the causes of the disease.

Predisposing factors to the formation of cervical caries:

enamel demineralization. This happens as a result of the vital activity of bacteria that are in the mouth, as well as due to changes in the biochemical composition of saliva. As a result of the activity of bacteria, lactic acid is released, which leads to the destruction of enamel (one of the main causes of caries);
avitaminosis. If there are 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 spots 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 basal part of the tooth is not damaged and the tooth can be completely preserved.

stages

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

spot stage. A small whitish spot is formed 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 tissues and completely eliminate the pathological process;
carious process damages the surface of the tooth. It affects the upper part of the tooth - enamel. The tooth begins to react to stimuli;
average caries. The carious process penetrates deeper and affects both enamel and dentin at the same time. The patient has a strong sensitivity to various stimuli - chemical, mechanical, temperature. Pain, as a rule, passes rather 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, 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 pains (with deep cervical caries);
pain while brushing your teeth.

Treatment

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

Treatment of caries in the stain stage

The essence of the treatment of cervical caries at this stage is that the demineralized area of enamel must again be saturated with calcium. To this end, dentists use remineralizing agents, which contain active calcium and fluorine. Before applying such drugs, it is indicated to remove plaque and calculus from the surface of the affected tooth.

Treatment of caries in the formation of a carious cavity

It is possible to treat caries, in which the integrity of the tooth enamel is already broken, only with the help of a drill. Other methods in this case are not appropriate. The entire treatment process is divided into the following stages:

removal of plaque and tartar from the surface of the tooth;
The second stage is very important - the definition of color. It is important to choose the color of the composite material as accurately as possible so that it matches the color of the patient's enamel as much as possible;
preparation of an existing carious cavity. It is carried out only under local anesthesia;
tooth isolation;
covering the formed cavity with an 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 brushing of teeth;
for the purpose of prevention, it is recommended to visit a qualified dentist every six months;
after drinking drinks, coffee, sweets, juices, be sure to rinse your mouth;
Rational nutrition is also very important for the prevention of cervical caries. A person should consume a sufficient amount of vitamins and minerals;
strengthening the immune system.

Is everything correct in the article 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. 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 milk mixtures from a bottle at night. As a result, 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 you do not start treatment in a timely manner, then this pathological process can lead to complete loss of the tooth.

- a carious process with localization in the gingival region, that is, in the region of the neck of the tooth. Depending on the stage, cervical caries can be manifested by darkening of the tooth enamel in the perigingival region; increased sensitivity of the tooth to temperature, chemical and mechanical stimuli; the formation of a carious cavity of various depths, pain syndrome. Cervical caries is diagnosed during a dental examination and x-ray of the tooth. Treatment of cervical caries is carried out taking into account the stage of carious lesions of the tooth and does not differ from that in other types of caries.

General information

Cervical caries - a type of cariescharacterized by the destruction of hard tissues 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, lingual surfaces of the lateral and frontal teeth. Cervical caries 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 of the cervical region develops due to the same causes and mechanisms as carious processes of other localizations. At the same time, the occurrence of cervical caries is favored by the special conditions that exist in the gingival region. First of all, this is the inaccessibility of this area for high-quality hygienic care, and, consequently, an increased accumulation of plaque and the formation of tartar in the cervical area. There is a direct link between cervical caries and gingivitis.

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

Among other factors, the development of cervical caries can contribute to the frequent consumption of acidic foods and the use of drugs that increase the porosity of the enamel, pregnancy. If several teeth are affected by cervical caries at the same time, most likely, one should 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 spots, superficial, medium and deep caries. In the initial stage, the enamel in the neck of the tooth loses its luster and becomes matte; a light (chalky) or pigmented spot with a smooth surface appears on it; clinical manifestations are absent.

In the future, the surface of the spot 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 thermal stimuli. This indicates the transition of cervical caries to the next clinical and morphological stage - superficial.

The weakness of the enamel in the area of the neck of the tooth contributes to a fairly rapid progression of cervical caries to the stage of medium and deep caries, which are clinically manifested by the formation of a carious cavity, food jamming, pain reaction when talking, eating, brushing teeth. Deep caries can be accompanied by significant tooth decay and be 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 basal neck of the tooth in the form of circular caries.

Diagnosis of cervical caries

In the process of diagnosis, 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 a consultation with an endocrinologist to exclude the 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 conduct remineralizing therapy - a course of applications of fluorine-containing drugs, periodontitis, gingivitis. Advanced cervical caries can lead to tooth decay and loss, the restoration of which will require prosthetics or dental implantation.

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

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

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

Features of cervical caries and a characteristic clinical picture

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

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

On a note

Most dentists tend 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 tissues, 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 gums, and the entire area near the border of the neck is called "cervical". The selective defeat of this weak zone by caries often involves the active destruction of enamel and dentin, up 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 turn 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 cervical region, reaching the middle of the crown of the tooth, deepening 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 breaking off part or all of the crown.

The photo below shows an example of circular caries in milk teeth:

A feature of cervical caries is also the fact that often defects are located in the "smile zone". If the sites of destruction are located on the lateral group of teeth, or on surfaces that are inaccessible to the eye, then most often this does not cause serious aesthetic consequences and experiences, however, short-term pains from various irritants and the risk of caries turning into its complications without treatment are possible.

With the appearance of the cervical (especially in the “smile zone”), serious psychological problems often arise, up to a nervous breakdown. This is especially true for people whose work is associated with 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 pains are always of a short-term nature and quickly pass after the removal of the stimulus. It is this aspect that allows you to make a correct preliminary diagnosis and not to be confused with the complications of caries.

Cervical caries in the stain stage, as a rule, manifests itself only visually: a change in the color of the enamel in the cervical region: from a white spot to a pigmented one, depending on the activity of caries and the options for staining it with dyes from food. Sometimes there is a quickly passing feeling of soreness from chemical stimuli (especially sour). At this stage, conservative treatment is possible, without tooth preparation 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, although sometimes it also develops asymptomatically.

If you do not start treatment, then further cervical caries from a superficial form passes into a medium, and then a deep one. In this case, most often there are pains from chemical (sweet salty), temperature (cold and hot) and mechanical (when solid food is ingested) irritants. It is worth emphasizing once again that all pains are of a short-term nature and quickly disappear when the causative factor that causes them is eliminated.

When there was pain in the front tooth from cold water, at first I did not understand what was wrong. He 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. Went to a dentist friend 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 I like ...

Valery, Tambov

Treatment of cervical caries at home: reality or myth?

For many people, the very fact of the possibility of treating cervical caries at home allows them not to go to the dentist for professional help for a long time (for example, because of children's fears of terrible toothache during treatment with a drill). Well, the good news for these people is that certain home therapies do make a lot of sense.

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

However, there are a few important things to keep in mind when doing this:

Cervical caries and its characteristics are individual for each person: location, depth of the lesion, area, structure of enamel, etc. Moreover, the carious process in the cervical region (areas) often occurs against the background of various aggravating factors, which may include poor oral hygiene, age, other dental problems, general health. There are no guarantees that an 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 is no guarantee 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 stain stage in a short time, but also will not harm the general state of health and dental health with high concentrations of, for example, fluorides. (which can be dangerous if used incorrectly).

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

From the experience of a dentist

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

Often, defects in deep-lying tissues (deep layers of enamel and dentin), as well as common complications of caries - pulpitis and periodontitis, are masked under cervical caries in the stain stage. If pulpitis (or periodontitis) is detected, the treatment tactics is reduced to the therapy of the tooth canal with the elimination of the infectious process in it. Setting a seal in the cervical region without processing and filling the canal (canals) would soon lead to even more serious complications, up to 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 during meals, which is already characteristic of 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, there are:

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

Decoctions for rinsing the mouth: from the bark of oak, 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 in caries

One of the simplest folk remedies for getting rid of the pain of caries is an infusion of sage. It is necessary to pour 2 tablespoons of dry grass with half a liter of boiling water, then leave for about 30 minutes in a closed container. The resulting remedy must be filtered and rinsed 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 in 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 in the clinic for the treatment of carious lesions.

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

Gluftored;

Enamel-sealing liquid;

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

Belagel Ca/P, Belagel F;

Remodant;

"Fluorodent";

GC Tooth Mousse.

Treatment of cervical caries in the stain stage by the method of remineralizing therapy includes the following steps:

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

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

Home use of drugs 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 gingival 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 cavity of the cervical defect for filling (especially when combined with subgingival caries);

ingress of moisture on the working field;

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

We list the main principles of the treatment of cervical caries using the methods of mechanical cleaning of the carious cavity and subsequent filling:

Cleansing of tooth surfaces from dental deposits;

Isolation of the working field with a rubber dam (rubber dam) with good equipment of the clinic;

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 the filling technique;

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 ormoceres (organically modified ceramics) can be noted.

This is interesting

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

Currently, for sealing cervical caries, combined technologies are used 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 gingival or subgingival localization of cavities, but also allows you to restore the aesthetic and functional parameters of the tooth, in other words, to keep a beautiful tooth for many years.

The photo shows how the teeth look after the 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 elementary rules that allow you to protect your teeth from cervical caries, even for those who are prone to developing this pathology.

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

Limit the use of easily fermentable carbohydrates with high culinary processing (sweets, flour products). This will not only help to adjust the diet in a useful way, but also reduce the risk of caries.

It is not possible to observe the culture of carbohydrate intake if it is not possible to completely abandon them: in no case should they be eaten in the intervals between main meals, in large quantities, and even more so at night without oral hygiene.

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

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

Get your brushing skills corrected as quickly as possible, either by a dentist (hygienist) or by using an instructional video. The level of hygiene and protection of teeth from cervical and any other caries depends on the correct observance of the technique of cleaning the surfaces accessible to the brush.

Be sure 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 for a toothbrush.

Special toolsthat can be used at home:

Toothpastes for cervical caries with a fluoride concentration of 1000 to 1500 ppm;

Dental floss impregnated with fluoride;

Fluoride rinses.

Most of the hygiene products on the market for protecting teeth from cervical and other types of caries (for example, toothpastes) are safe for teeth and general human health, but there are always risks. Individual a set of products for professional and home strengthening of teeth and protection against cervical and other types of caries. It can be pastes, and gels, and solutions.

This is the competent systematic approach in relation to the dentist 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.

An interesting video about the features of cervical caries

Causes of caries and effective methods of protection against it

Cervical is called caries that develops at the base of the tooth. The affected area is located in the lowest part of the dental crown, and sometimes even goes under the gum. In the early stages of the disease, a white chalky spot appears on this part of the tooth; in the future, it is transformed into a carious cavity. In this case, 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 kind of caries is caused by pathogens found in plaque or tartar. Cervical caries is no exception, so poor oral hygiene should be called its main cause. The problem is exacerbated 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, thermal and chemical stimuli;
the appearance at the base of the tooth of a carious cavity, which can go under the gum.

What is the danger of cervical caries?

The focus of infection is located at the very base of the tooth, and since the thickness of the enamel and dentin is much less here than in other parts of the tooth crown, caries gets to the pulp much faster. Thus, it is very important to detect 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 cavity in the cervical area; pain from getting sweet, sour or salty food on the lower part of the tooth; sharp pain from cold or hot.

What is the treatment 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 by the method of remineralization (weakened enamel is saturated with calcium with the help of special preparations);
in the later stages, doctors apply filling (first, the tooth is cleaned of plaque and stone, then the affected tissues are removed, after which the anatomical shape returns to the tooth).

What are the features of filling with cervical caries?

Since the lesion is located close to the gum, and sometimes goes under it, good retraction of the gum is necessary. In other words, the gum must be carefully moved away from the carious cavity so as not to be damaged during processing and filling.
Due to the peculiarities of the loads in the area of the neck of the tooth, it is necessary to use liquid, plastic materials for filling, for example, Filtek flow.
Due to the nature of 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 reoccurrence of cervical caries is to brush your teeth regularly, making sure to thoroughly clean them down to the neck. In addition, visit the dentist regularly, because if caries is detected at an early stage, it will be quite possible to get by with a simple remineralization. Once every six months, it is recommended to do a professional cleaning of the teeth to remove deposits from them that contain cariogenic microorganisms.

What are the possible complications?

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

What are the criteria for the quality of treatment?

The quality of treatment of cervical caries is evaluated by several parameters:

absence of pain in the tooth;
high-quality marginal fit of the seal;
restoration of the anatomical shape and aesthetic appearance of the tooth;
low chance of relapse.

How much does cervical caries treatment cost?

The price for the treatment of cervical caries depends both on the stage of the disease and on the materials used. The approximate cost of this service at the DentaBravo clinic is indicated in the price list. An exact 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, buccal, palatine and others. Its main feature lies in the unusual location and the associated difficulties in the timely detection and treatment of this form of the disease.

At the stage of spots and superficial caries, when such a pathology does not yet cause severe pain, it is impossible to detect damage to the teeth, covered by the upper part of the periodontal tissues, with a simple examination of the oral cavity. For this reason, the treatment of a diseased tooth with caries localized under the gum usually has to be taken already at the stage of progressive pulpitis, which gives out the pathological process with pains 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 also 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 non-standard localization, even without obvious signs of its presence.

Localization of caries under the gum

Caries with localization under the gum can be located, generally speaking, on either side of the tooth. However, practice shows that more often it develops on the proximal surfaces, that is, in the interdental region (interdental caries, which initially began above the gum, tends to quickly go under the soft tissues, 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 the tooth looked healthy outwardly, but at the moment, after some time, one can observe a neglected carious process that led to such a radical decision by the dentist.

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

On a note

Subgingival caries should not be confused with what some patients call "gum caries". The second nosology is a typical cervical caries that develops exactly along the edge of the periodontium. At the same time, of course, it does not go to the gum itself, since it can only affect the tissues of the tooth. Caries that develops under the gum can sometimes spread to areas above the edge of the periodontium, but during its treatment and cleaning of 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 the surrounding areas of enamel.

The carious cavity under the gum is a kind of "food-collector" that provokes the gum to regular irritation with the development of traumatic or infectious inflammation like gingivitis or even periodontitis.

Dangers and consequences of caries under the gum

As with other forms of caries, subgingival caries may have minimal evidence on the outer surface of the enamel, but it can penetrate deep into the internal tissues, leading to imperceptible 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 (popularly called "nerves") to be involved in it.

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, the pain in the tooth becomes so acute that before the periodontal inflammation, the patient already consults a doctor and receives appropriate treatment.

Reasons for the development of pathology

Caries under the gum 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. Food residues and bacteria that produce cariogenic acids easily penetrate into such pockets. 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 gum drops or is mechanically retracted (flaked) from the tooth;
lack of normal oral hygiene;
some diseases, due to which the secretion of saliva decreases, or its composition changes and, as a result, bactericidal activity.

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 starchy foods) and hereditary factors - the susceptibility of teeth to caries, the thinness of enamel, and others.

Symptoms and diagnosis of caries localized under the gum

Caries, located under the gum, practically does not betray itself with the symptoms that are typical for cases of localization of pathology in open areas of the enamel. Since the affected areas of the outer walls of the tooth are protected by the periodontium, cold and hot products practically do not fall on them, and therefore even deep 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 remnants of rotting food, the patient may be a little disturbed by the tooth itself, and the gum injured or irritated by food remnants. With some experience, the patient will be able to distinguish between these types of painful sensations, and the doctor, in his words, will implement the correct diagnostic methods.

Thus, it is possible to suspect the development of caries under the gum only when pain occurs in the tooth or adjacent soft tissues, and before that, the lesion can only be detected by chance during a special diagnosis of adjacent teeth using x-rays, transillumination or laser devices.

The doctor will not specifically prescribe an x-ray 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 gum can be diagnosed at a stage when reaming and filling the tooth is not required to eliminate it.

The specifics of the treatment of caries under the gum

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

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

If a part of the dentin is covered by the disease, the doctor removes the area of defective enamel covering it, cleans the carious cavity and installs a filling. When the pathological process covers 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 they make it possible to treat a tooth with such a problem with high quality.

On a note

To create maximum dryness of the surgical field and to control gingival bleeding, dentists often use rubber dams in such cases. This is a piece of rubber (latex) whose function is to isolate individual teeth from the oral cavity 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 setting, since it will not be possible to completely eliminate the ingress 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 placed under the gum, but it is better than a composite filling that fell out a day later or immediately. At least the JIC can be guaranteed.

If a rubber dam is used in the clinic, 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 a 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 most durable and durable fillings, and in general, the treatment is of better quality.

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

With a small lesion, when the pulp is not involved in the pathological process, the carious cavity is cleaned with a drill and filled with filling material.
If more than 60% of the tooth tissues are damaged by caries or if 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, from 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 most of the crown, the latter is removed, the tooth is depulped, a stump tab and an artificial crown are installed.

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

It is possible to make a decision about one or another treatment option only after opening the carious area, cleaning it and determining the amount of tissue damage.

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

Prevention rules

The main opportunity to prevent the development of caries under the gum is to undergo examinations at the dentist on time. This is a universal measure that will protect both those who can boast of healthy and strong teeth, and the owners of teeth that are quite susceptible to caries.

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

For the prevention of caries under the gums, all the rules common to other types of caries are relevant: regular thorough brushing of teeth, correction of the diet with restriction of sweets and starchy foods, removal of food debris from the oral cavity, consumption of 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 toothache. This will guarantee timely and successful treatment.