initial caries. Clinic, diagnostics, differential diagnostics, treatment

Or they make mistakes when choosing them.

Damage to the tooth surface can manifest itself in different ways. Often found, acid necrosis,. But the most common dental disease is a carious lesion.

In the case when the disease was not detected at the stain stage, tooth decay continues at a rapid pace, as a result of which superficial caries develops.

Features of the superficial form of the disease

As a result, damage occurs, which leads to its deformation and destruction. Superficial caries chooses tooth enamel as its place of localization, where it is usually clearly visible. But if you do not give due attention to its appearance, this will lead to the progress of the destructive process, and the teeth will react sharply to any chemical or mechanical impact.

The pain in such cases is of a short-term nature, but at the same time it should be a serious wake-up call for a visit to the dentist. The sooner you seek medical help, the more likely you are to avoid serious problems.

When caries appears on the tooth enamel, a cavity defect is formed, but this does not occur. Clinical and morphological classification divides the course of the disease into several stages.

First, the stain stage develops (initial caries), after which there is a superficial lesion of the enamel, then it develops and only then affects the tooth.

Initial forms are more characteristic in childhood and adolescence. But the more moderate and deep forms of the disease most often affect the teeth in the adult population.

In Russia, dental caries is the most common problem in the field of therapeutic dentistry and occurs in 65-95% of the population according to various sources.

What provokes the development of the destructive process?

Enamel caries in the initial stage looks like a chalky spot with a characteristic unnatural shade. This is the main indicator of the flowing. Externally, the tooth looks without damage, due to the preservation of a flat surface.

Absence can provoke the formation of a superficial enamel lesion.

Irregular brushing of teeth contributes to the accumulation of microorganisms on the teeth, which leads to the formation of. Bacterial deposits on the teeth are the main cause of the development of superficial caries and provoke a further exacerbation of the disease.

In the photo, the primary manifestations of superficial caries of milk teeth

There is a decrease in the level of natural acidity in the oral cavity, which contributes to the leaching of beneficial minerals and calcium from the enamel.

As a result, the gradual destruction of the teeth begins. The stain stage flows into a superficial enamel lesion. The destruction of the tooth begins, on which one can notice a defect in the form of a pyramid, the top of which is located on the border of dentin and enamel.

In some cases, a person may have a hereditary predisposition to thinning of the enamel. This can be facilitated by the consumption of poor-quality water with insufficient fluorine content.

Damage to tooth enamel can occur due to chemical exposure factors:

features of the composition of human saliva;
insufficient amount of minerals and vitamins in the diet.

It can lead to dental health problems that have not been subject to the necessary adjustment in time.

Experts say that use can also harm the surface of the teeth. Even a poorly installed seal carries a great danger. Food particles can get into the cavity under the filling, and it is simply impossible to clean them out with a brush.

Manifestations and complaints

Superficial caries has a number of rather striking symptoms. Of course, at the initial stage of the disease, it is impossible to notice anything other than the stain that has appeared, but as soon as the lesion moves further into the tooth cavity, the person begins to experience a feeling of discomfort, pain when drinking and eating.

The most obvious sign of caries formation is the deformation of the enamel surface, which gradually leads to the destruction of the entire tooth.

Superficial caries originates in the area where there is already a spot stage. The enamel in this place is thinned, subject to further destruction due to increased sensitivity. In the area of the defect that has appeared, various microorganisms and food debris accumulate.

Plaque formations quickly mineralize, representing a dental plaque. It is in this place that the pathological production of acids that destroy the tooth begins.

Diagnostic criteria and methods

In the early stages, the patient cannot independently recognize the disease. Most people think that this is a simple one that needs to be cleaned off. Therein lies the greatest danger.

Damaged enamel may have a different color. This is influenced by the food taken with the presence of certain dyes in it.

Only a visit to the dentist can reveal superficial caries at the stage of its inception; for this, various diagnostic measures are carried out. Already at the first examination, you can establish the nature and severity of the lesion:

The first examination - examination reveals the presence of white spots with a chalky tint. But it's too early to talk about caries.
If dips occur when the probe is passed over the area with the stain, this makes it clear that there is thinned enamel.
The next step is staining suspicious areas. For this, special dyes are used.

In the area of fissures, hidden lesions can often be observed. In the resulting grooves, it is very convenient for bacterial plaque to accumulate, since these places are considered difficult to access for high-quality cleansing.

Probing these areas, as a rule, immediately makes it clear that there is a roughness or defect. The examination may be accompanied by a short-term manifestation of pain.

Provision of dental care

Treatment of superficial caries is possible using several methods:

help yourself

Before you begin to treat the defect yourself, you need to consult with your doctor. An erroneous approach to treatment and prevention significantly moves away from professional help, and this threatens with further serious tooth decay.

You can do it at home. For this, special preparations are used, which can be bought at pharmacies. This approach will prevent the development of the initial form of the disease, leaving no chance for further progression of the disease. Enamel is quickly restored and acquires sufficient density.

High-quality timely treatment guarantees a favorable prognosis. Modern materials for installing seals are very reliable and of high quality.

Consequences can develop if you do not seek professional help in time. This threatens with serious destruction, formation, and as a result, inflammation of the nerve -.

Preventive measures

The basis of prevention is proper care of the oral cavity and timely treatment of the primary forms of the disease. If you find doubtful areas on the tooth surface, you should immediately consult a doctor.

Then the chances of preventing further development of the lesion are doubled. It is possible to preserve the aesthetic appearance and functionality of the tooth.

Necessary, use, intake of calcium-containing vitamins.

You need to visit the dentist every six months for a preventive examination. Carry out as needed. Stick to a balanced diet, limit carbohydrates, drink less sugary soda.

Spot stage(macula cariosa), or carious demineralization. Enamel demineralization on examination is manifested by a change in its normal color in a limited area and the appearance of matte, white, light brown, dark brown spots and even spots with a black tint.

The process begins with the loss of the natural luster of the enamel in a limited area. This usually occurs at the neck of the tooth, next to the gum. The area of the lesion is initially insignificant, but gradually increases and can capture a significant area of the cervical region. Then the entire stain or part of it may acquire a different shade. It is believed that the change in the color of the focus of demineralization occurs due to an increase in the size of microspaces and the penetration of coloring substances of an organic nature.

Clinical observations show that a white carious spot (progressive demineralization) turns into superficial caries due to a violation of the integrity of the surface layer or into a pigmented spot due to a slowdown in the demineralization process. This is the stabilization process. It should be understood that stabilization is temporary and sooner or later a tissue defect occurs at the site of the pigmented spot.

A clinical fact of great practical importance has been established. Children who do not have foci of demineralization have a low intensity of caries in terms of KPU of teeth and KPU of surfaces. In the presence of pigmented carious spots (slowly ongoing demineralization), the intensity of caries is higher. But the highest intensity of caries is found in children with white carious spots (a rapidly ongoing form of demineralization).

Thus, the appearance of foci of demineralization (white and pigmented spots) can serve as a prognostic test.

G. N. Pakhomov found that the indices of the hygienic state of the oral cavity and PMI are the highest in children with foci of active demineralization (white spot), moderate in children with foci of suspended demineralization (pigmented spot) and low in the control group. He pointed to the age dependence of focal demineralization, which was detected at the age of 7 and reached a maximum at the age of 10–11 years, and decreased at the age of 14. There is a difference in the occurrence of foci of demineralization and depending on the group of the tooth. Most often, slow and fast current demineralization is observed on the incisors of the upper jaw, in the second place in terms of the frequency of damage - the incisors of the lower jaw. On all other teeth, the frequency of demineralization is approximately the same. It should be noted that in all cases we are talking about the frequency of damage to the vestibular surfaces available for inspection. The frequency of damage to contact and chewing surfaces was not taken into account.

Noteworthy are two more indicators influencing the appearance of foci of demineralization. In children with a rapidly ongoing form of demineralization, 2.5 times more past and concomitant diseases were noted than in children without foci of demineralization. It was also established that with frequent consumption of sweets, the damage to the teeth by focal demineralization of the enamel in children increased by 2–3 times compared to the damage to the teeth in children who did not abuse sweets.

To determine the depth of damage to the tissues of the tooth, the choice of method and the prognosis of the treatment, the size of the carious spot is important. The larger the area of the lesion (spot), the more intense the course of the pathological process and the sooner it will end with the formation of a visible lesion. If a brown carious spot occupies 1/3 or more of the proximal surface of the tooth, then regardless of the data of the clinical examination (anamnesis, probing), under such a stain there is damage to hard tissues of the type of medium caries.

Caries in white spot stages It is asymptomatic and is detected only on close examination. The stain becomes clearly visible after drying the surface of the tooth with a jet of air. The tooth responds to temperature stimuli with the usual reaction - the appearance of sensitivity, which quickly passes. The dental pulp responds to a current of 2–6 μA. Due to the fact that demineralization occurs with a white spot, it is stained with a 2% solution of methylene blue when it is applied to a previously cleaned and dried surface of the tooth enamel.

Caries in stages of pigmentation is also asymptomatic.

Carious spot should be differentiated from spots with hypoplasia and fluorosis. Hypoplasia is characterized by the symmetry of the defeat of the teeth of the same name, which is due to the simultaneity of their laying, development and mineralization. With fluorosis, there are multiple, both white and brown, spots that do not have clear boundaries, located on the surfaces of all groups of teeth. With a high content of fluoride in drinking water, the size of the spots increases, and the nature of the changes is more pronounced: the enamel of the entire crown of the tooth may be brown. Fluorosis is characterized by endemicity of the lesion - a manifestation in all or most of the inhabitants of a region.

For treatment special remineralizing mixtures are used, which include calcium, phosphates, strontium, zinc and necessarily fluorides in ionized form. It is these elements that contribute to the restoration and strengthening of enamel, increase its resistance (resistance to harmful acids)

Enamel remineralization can be done in two ways. Remineralizing mixtures are administered by applications, as well as with the help of physiotherapeutic methods - electro and phonophoresis.

For remineralizing therapy, 10% calcium gluconate solution and 0.2% sodium fluoride solution, the Remodent complex preparation, are most often used. These preparations, as a rule, alternate with each other.

Before the remineralization procedure by the application method, the teeth are cleaned of plaque and thoroughly dried, and then tampons soaked in 10% calcium gluconate solution are placed on the areas of chalky spots for 15-20 minutes, replacing them every 4-5 minutes with fresh ones.

After every third application with a mineralizing solution, a cotton swab moistened with 0.2% sodium fluoride solution is applied to the treated tooth surface for 2-3 minutes. After completion of the entire procedure, it is not recommended to eat for 2 hours. The course of remineralizing therapy consists of 15-20 applications daily or every other day. After completion of the course, the surface of the teeth is covered with fluorine varnish, which additionally provides the enamel with fluorine ions. After 5-6 months. conduct a second course of treatment.

Remineralizing therapy is most effective when combined with a general body treatment and good oral hygiene.

Be sure to carry out general strengthening measures - prescribe an anti-carious diet with a restriction of sweets, vitamins C and group B or multivitamins, as well as calcium, phosphorus and fluoride preparations. It can be, for example, calcium glycerophosphate, calcium gluconate, etc.

Of the hygiene products, the most effective in the complex treatment of the initial stage of caries are anti-caries pastes containing fluorine and calcium and fluoride rinses.

As a result of properly performed remineralizing therapy, the chalky spot either completely disappears or significantly decreases in size.

Light and dark spots on the teeth are one of the signs of enamel caries. This is a superficial carious lesion that does not affect the internal tissues - dentin and pulp. There is no pain yet, but the smile is already ruined.

Further, a carious cavity is formed, the tooth begins to react to cold and hot, sour and sweet. A good reason to rush to the dentist is the ability to eliminate caries in the stain stage without drilling and filling.

The reasons

Among the versions of the origin of caries, Miller's theory, presented in 1898, is generally accepted. Miller even then stated that the disease is caused by cariogenic microorganisms living in the microflora of the oral cavity of each person - Streptococcus mutans and Lactobacillus. They begin to harm only under certain conditions. Consuming the remains of carbohydrate foods, bacteria produce organic acids.

With prolonged contact of acids with the surface of the tooth, demineralization occurs - the loss of trace elements that ensure the strength of the crown part. Acids destroy apatite crystals - compounds of phosphorus with calcium, carbon, chlorine and fluorine.

Together with four dozen other trace elements, apatites make up 99% of enamel. Without them, it becomes porous, vulnerable, fragile, loses its luster and gradually collapses. This happens so quickly that it does not have time to make up for mineral losses from food entering the human body.

The two most important causes of enamel caries

the use of excessive amounts of carbohydrate foods - in particular sweet and starchy foods;
poor oral hygiene: if you do not brush your teeth every time after eating, carbohydrate residues will become food for microbes.

An indirect factor leading to the appearance of enamel caries is the buffer capacity and the volume of saliva secreted. Buffer capacity refers to the ability of saliva to neutralize acids and alkalis, thereby raising the pH level and creating an unfavorable environment for bacteria. If there is not enough saliva, then there will not be enough buffer capacity to cope with this task.

Learn more about caries theories.

Classification and clinical picture

Taking into account the stage of development, there are 2 types of enamel caries:

In the stain stage - the integrity of the coronal part is not broken, there is no cavity;
- the lesion has spread in the thickness of the enamel, but the cavity does not reach the dentin.

The earliest sign is matte white spots on the enamel. At first, they are visible only on the dried surface of the tooth. Such defects are single, located in the cervical zone (near the gingival edge), on chewing surfaces - fissures or between crowns.

Over time, the surface of the spots becomes rough, they change color - from white to yellowish, light brown.

With superficial caries, a cavity with a depth of no more than 3 mm is formed in the enamel. The enamel thickness itself ranges from 2.8-3.0 mm. With the appearance of a “hole”, a pathological reaction to chemical, thermal and mechanical stimuli occurs. It becomes unpleasant from the contact of the tooth with sour and sweet, hot and cold. Unpleasant sensations often develop into pain. The same reactions appear when pressing and biting on the tooth.

Examination and diagnostics

To identify the problem, methods of extraoral and intraoral examination of the oral cavity are used - extraoral and intraoral. Diagnosis is painless, but there may be discomfort when the teeth come into contact with the probe.

Matte chalky and brown spots, for the surface of which the probe “does not cling” - a sign of an inactive form of caries in the stain stage. Softened areas of light brown color, in which the probe “gets stuck”, indicate a pathological process.

To determine the extent of the lesion, the vital staining method is used - the Borovsky-Aksamit test. Teeth with a healthy surface are immune to dyes, and pigments – silver nitrate, methylene blue and red, ninhydrin – easily penetrate thinned, porous enamel.

The most commonly used is methylene blue. A swab soaked in it is applied to the dried and thoroughly cleaned of plaque surface of the teeth for 3 minutes. Damaged areas are painted. After 20-40 minutes, the paint is washed out.

Laser diagnostics

Enamel caries can also be diagnosed with the DiangoDENT installation. Demineralized tissues reflect laser wavelengths of 680 nm or more. When this happens, the device notifies you with a signal.

Ultraviolet diagnostics

Affected areas in ultraviolet rays become dark, they contrast with healthy tissues, illuminated in blue. For the study, the Pluraflex apparatus is used.

Differential Diagnosis

When diagnosing caries in the spot stage, it is necessary to exclude non-carious lesions with similar manifestations - early stage hypoplasia and fluorosis, as well as age-related pigmentation.

With hypoplasia, spots appear on the outside of the incisors and canines closer to the cutting edge of the crown. They remain as shiny as healthy enamel. There are many fluorescent spots, they are located randomly and are not pigmented from contact with methylene blue. Age pigmentation (organic film on the teeth) is easily removed with soft plaque removers.

Superficial carious lesion is important to differentiate from erosion of hard dental tissues and wedge-shaped defect. In both cases, there are defects of clearly defined forms on the crowns. Their walls are dense, the probe does not cling to them.

In different regions, 15-40% of the total child population has this problem, most often at the age of 9-11 years. Defects are localized both in the cervical area and on the fissures. Since the enamel in children has not yet fully mineralized, it has a lower thickness and density than in adults. Children's caries progresses faster and delaying treatment is dangerous.

Treatment Methods

If in the first 2-3 years after teething, their enamel tends to self-repair, then mature, fully mineralized, it no longer regenerates.

The following treatment will help restore her strength.

Spot stage

The only reversible form that can do without drilling and filling. Shown remineralizing therapy aimed at restoring the structure of the enamel. The best results are obtained by the author's method of Professor Knappvost - deep fluoridation. The procedure is painless, designed for 10 sessions lasting an average of 30-40 minutes, takes place in stages:

Teeth cleaning. Ultrasonic if there is tartar. Brush and paste, if there is no stone.
Drying of crown surfaces.
Direct fluoridation. Using a brush or mouth guard, the teeth are treated with Tiefenfluorid enamel-sealing liquid from Humanchemie.

The composition of the sealing liquid includes highly active calcium hydroxide and fluorine. From the impact of the liquid, the pores of damaged enamel are filled with crystals - fluorine compounds with calcium, copper and magnesium, as well as silicate acid gel. Crystals remain in the pores from six months to two years. During this time, they produce ionized fluoride, which strengthens the tooth surface and increases its resistance to acids.

Surface defects

Softened tissues from damage are removed with a drill. The cavity is sealed, as in the treatment of other forms of caries. As a rule, photopolymer filling materials are used for this, which are easily matched by color and hold tenaciously even in small drilled holes.

An alternative to traditional drilling is the infiltration technique. The damaged area is treated with the German polymer preparation Icon. It "seals" the affected pores, thereby making it impossible for further progression of caries. Icon restores the density and brilliance of a healthy smile to the surfaces of teeth.

Microscopic carious defects can be treated with a biological method under the influence of ozone. Ozone kills 99.99% of cariogenic bacteria.

Prevention

brush your teeth with a brush and paste after each meal; use pastes containing fluorine - Lacalut Fluor, Arktikum Splat, Biorepair Total Protection Plus, President Classic, Silca Herbal Complete;
alternate calcium fluoride pastes - "New Pearl" with calcium", President Unique, Splat "Biocalcium", Splat "Maximum", R.O.C.S .;
use floss to clean the interdental spaces - this is where food residues usually accumulate;
do not abuse sweets;
include in the diet foods rich in calcium, fluorine, vitamin D - sour-milk products, fatty fish, legumes, etc.

Fissure sealing also has a good preventive effect - filling the grooves on the chewing surface of crowns with liquid sealants that protect against bacteria.

You can find more detailed information about fissure sealing on our website.

clinical picture. With initial caries, there may be complaints of a feeling of soreness. The affected tooth does not respond to a cold stimulus, as well as to the action of chemical agents (sour, sweet). Enamel demineralization on examination is manifested by a change in its normal color in a limited area and the appearance of matte, white, light brown, dark brown spots with a black tint. The process begins with the loss of enamel gloss in a limited area. It usually occurs at the neck of the tooth near the gum. The surface of the spot is smooth, the tip of the probe glides over it. The spot is stained with methylene blue solution. The tooth pulp responds to a current of 2-6 μA. During transillumination, it is detected regardless of location, size and pigmentation. Under the influence of ultraviolet rays in the area of the carious spot, quenching of luminescence is observed, which is characteristic of the hard tissues of the tooth.

Differential diagnosis of initial caries. Obvious differences have spots in caries and endemic fluorosis. This applies to both chalky and pigmented carious spots. Carious spot is usually single, fluorous spots are multiple. With fluorosis, the spots are pearly white, against the background of dense enamel - milky in color, localized in the so-called "immune areas" - on the labial, lingual surfaces, closer to the tubercles and cutting edges of the teeth, strictly symmetrically on the teeth of the same name on the right and left sides and have the same shape and coloration. Carious spots are usually located on the proximal surfaces of the crown of the tooth, in the area of fissures and necks of the teeth. Even if they formed on symmetrical teeth, they differ both in shape and location on the tooth. Carious spots are usually detected in people prone to caries. Such stains are combined with other stages of dental caries, and for fluorosis, a pronounced resistance to caries is typical. Unlike caries, fluorotic spots are especially often found on incisors and canines, teeth that are resistant to caries. Diagnosis is helped by staining the teeth with a solution of methylene blue: only the carious stain is stained. It is necessary to carry out differential diagnosis of initial caries and enamel hypoplasia. With hypoplasia, vitreous white spots are visible against the background of thinned enamel. The spots are located in the form of "chains" encircling the crown of the tooth. Such chains are single, but can be located several at different levels of the tooth crown. Identical in shape, spotted lesions are localized on symmetrical teeth. Unlike carious spots, hypoplastic ones do not stain with methylene blue and other dyes. Hypoplasia is formed even before the eruption of the tooth, its size and color do not change during the development of the tooth.

Treatment of caries in the stain stage. A white or light brown spot is a manifestation of progressive enamel demineralization. As experimental and clinical observations have shown, such changes can disappear due to the entry of mineral components from the oral fluid into the focus of demineralization. This process is called enamel remineralization. The ability of dental tissues to restore in the initial stages of caries has been proven, which is provided by the main mineral substance of the tooth - a hydroxyapatite crystal that changes its chemical structure. With the loss of part of the calcium and phosphorus ions, under favorable conditions, hydroxyapatite can be restored to its original state by diffusion and adsorption of these elements from saliva. At the same time, new formation of hydroxyapatite crystals from calcium and phosphate ions adsorbed by dental tissues can also occur. Remineralization is possible only with a certain degree of damage to dental tissues. The damage limit is determined by the preservation of the protein matrix. If the protein matrix is preserved, then, due to its inherent properties, it is able to combine with calcium and phosphate ions. Subsequently, hydroxyapatite crystals form on it. With initial caries (white spot stage), with partial loss of mineral substances by enamel (demineralization), free microspaces are formed, but the protein matrix capable of remineralization is preserved. The increased permeability of the enamel in the white spot stage causes the penetration of calcium ions, phosphates, fluorides from saliva or artificial remineralizing solutions into the demineralization area with the formation of hydroxyapatite crystals in it and filling the microspaces of the carious focus in the enamel. However, it should be noted that the permeability of different parts of the tooth enamel is not the same due to its heterogeneous structure. The cervical region, fissures, pits and, of course, defects in tooth enamel have the highest permeability. The least permeable is the surface layer of enamel, the middle layers are much larger. The permeability is greatly influenced by the concentration and temperature of the remineralizing solution, as well as the ability of the hydroxyapatite crystal to ion exchange and adsorb other substances. The penetration of substances into the enamel occurs in 3 stages:

movement of ions from the solution to the hydrated layer of the crystal;
from the hydrate layer to the crystal surface;
from the surface of the hydroxyapatite crystal to different layers of the crystal lattice - intracrystalline exchange.

If the first stage lasts minutes, then the third - tens of days. Pellicle, soft plaque and dental plaque prevent the entry of essential macro- and microelements into the enamel, impede the remineralization of tooth enamel. All patients, regardless of age, need to conduct a thorough professional oral hygiene before application remineralizing therapy: remove plaque, grind and polish all surfaces of teeth, fillings, orthopedic structures with brushes with abrasive pastes, rubber bands, strips until the patient feels smooth teeth ( language test). The quality of professional hygiene is determined by the dentist using a dental angle probe, a cotton swab or flagellum, which should slide over the surface of the teeth. Only professional oral hygiene will make it possible to achieve a dynamic balance of de- and remineralization processes, to activate the process of remineralization and mineralization. The dynamic balance of the processes of re- and demineralization in the oral cavity ensures the homeostasis of dental tissues. Violation of this balance towards the prevalence of the demineralization process and a decrease in the intensity of remineralization processes are considered as an important link in the chain of pathogenetic mechanisms of caries development. It is known that fluorine, when directly exposed to tooth enamel, helps to restore its structure. It has been proven that not only during the period of enamelogenesis, but also after tooth eruption, fluorapatite resistant to the action of aggressive factors of the oral cavity is formed in the surface layers of the enamel. It has been established that fluorine contributes to the acceleration of calcium deposition in enamel in the form of fluorapatite, which is characterized by a very high stability. Remineralizing therapy of dental caries is carried out by various methods, as a result of which the surface layer of the affected enamel is restored. Currently, a number of preparations have been created, which include calcium, phosphorus, fluorine ions, which cause remineralization of tooth enamel. The most widespread are 10% calcium glucanate solution, 2% sodium fluoride solution, 3% remodent, fluorine-containing varnishes and gels. To this day, the Leus-Borovsky enamel restoration technique remains popular: The surfaces of the teeth are thoroughly mechanically cleaned of plaque with a brush and toothpaste. Then it is treated with a 0.5-1% hydrogen peroxide solution and dried with an air stream. Next, cotton swabs moistened with a 10% solution of calcium gluconate are applied to the site of the changed enamel for 20 minutes; Swabs are changed every 5 minutes. This is followed by application of 2-4% sodium fluoride solution for 5 minutes. After the procedure is completed, it is not recommended to eat for 2 hours.

Well remineralizing therapy consists of 15-20 applications, which are carried out daily or every other day. The effectiveness of treatment is determined by the disappearance or reduction in the size of the focus of demineralization. For a more objective assessment of treatment, the method of staining the area with a 2% solution of methylene blue can be used. At the same time, as the surface layer of the affected enamel remineralizes, the intensity of its staining will decrease. At the end of the course of treatment, it is recommended to use fluoride varnish, which is applied to thoroughly dried surfaces of the teeth with a brush, a single dose of not more than 1 ml, always in a heated form. As a result of the treatment, the white spot can completely disappear, and the natural luster of the enamel is restored. The nature of the restoration of the focus depends entirely on the depth of changes in the area of the pathological process. With the initial changes, the effect of the treatment is immediately noticeable. With more pronounced changes, which are clinically characterized by a significant area of damage, and morphologically - by the destruction of the organic matrix, complete remineralization cannot be achieved. VC. Leontiev suggested using 1-2% sodium fluoride gel on 3% agar for applications. After professional cleaning of the teeth, the gel heated on the spirit lamp is applied with a brush to the dried teeth. After 1-2 minutes, it solidifies in the form of a thin film. The course of treatment - 5-7 applications. The effectiveness of this method is significant. After one course of treatment, the spots are reduced by 2-4 times. A year later, they may increase slightly again, but after a second course of treatment they decrease by 4-5 times compared to the initial state.

In recent years, Remodent has been proposed for remineralizing therapy. The dry preparation of Remodent contains calcium 4.35%; magnesium 0.15%: potassium 0.2%; sodium 16%; chlorine 30%; organic matter 44.5%, etc.; is produced in the form of a white powder, from which 1-2-3% solutions are prepared. A feature of the remodent used in the treatment of initial caries is that there is practically no fluorine in its composition, and the anti-caries effect is primarily associated with the replacement of calcium and phosphate vacant sites in hydroxyapatite crystals and the formation of new crystals. R.P. Rastinya successfully applied 3% Remodent solution for applications. In acute forms of caries, the complete disappearance of spots was noted in 63%, the stabilization of the process - in 24% of cases. Remodent treatment is carried out as follows: the surfaces of the teeth are thoroughly mechanically cleaned of plaque with a brush, then treated with a 0.5% hydrogen peroxide solution, dried with an air stream. Next, cotton swabs moistened with a remineralizing solution for 20-25 minutes are applied to the areas of the changed enamel, the swabs are changed every 4-5 minutes. The course of treatment is 15-20 applications. VK Leontiev and VG Suntsov developed a method for treating initial caries with calcium phosphate-containing gel with pH=6.5-7.5 and 5.5. Prepare gels based on calcium chloride and sodium hydrogen phosphate. Neutral gel is intended for the treatment of initial caries. The exceptions are large spots with sharply disturbed permeability and a softening area in the center. Such spots are treated with an acidic (pH=5.5) gel. The acidic environment of the gel leads to the elimination of the affected tissues in the center of the stain, which are no longer capable of remineralization, while the other part of the stain, which can still be mineralized, being sufficiently exposed to the mineral components of the gel, is restored. The specified gel contains calcium and phosphate ions in the same ratio as these elements are in saliva (1:4). At the same time, the amount of calcium and phosphate in the gel is 100 times higher than that in saliva. The state of the gel prevents the interaction of calcium with phosphate and precipitation. The treatment is carried out as follows: the surfaces of the teeth are mechanically cleaned of plaque with a brush or professional oral hygiene is carried out, then the teeth are treated with a 0.5% hydrogen peroxide solution, dried with a stream of air. The gel is applied with a brush to all surfaces of the teeth, dried for 1-2 minutes. The course of treatment is 10 procedures.

Gels can be used as toothpastes for the third evening brushing of teeth for 20-30 days (Fluodent, Elmex, Fluo-Kal) or as applications, the course of treatment is 15-20 procedures. The treatment is carried out as follows: the surfaces of the teeth are mechanically cleaned of plaque with a brush with toothpaste or professional oral hygiene is carried out, then all surfaces of the teeth are dried with a warm air jet or cotton swabs. The teeth are isolated from the oral fluid with dry cotton rollers, then a gel is applied to all surfaces with a brush, which is held for 15-20 minutes. The course of treatment is 15-20 procedures. It is convenient to apply the gel using a disposable polyurethane or wax template, when the gel is applied in a thin layer to the bottom of the template, which is carefully placed on the teeth and held for 15-20 minutes. This method of treatment even with hypersalivation allows the patient to feel comfortable. To optimize and intensify remineralizing therapy, it is advisable to educate the patient on rational oral hygiene with subsequent control in order to consolidate the skills of proper brushing. For self-control, the feeling of smoothness of the teeth, which the patient receives after professional oral hygiene, can serve. It is the feeling of smoothness of teeth at home that determines the time, technique and quality of brushing for the patient, and most importantly, it is an effective motivation to perform a hygiene ritual. At home, as a rule, it is advisable for children and pregnant women with decompensated and subcompensated forms of caries to use a magnetic toothbrush, 2 times a day, in the morning after breakfast and in the evening before bedtime, for 3-4 minutes. A magnetic toothbrush speeds up the process of cleaning the teeth, gives a high quality of hygiene and a long-lasting feeling of smoothness of the teeth due to the detachment of microorganisms from the surface of the enamel, helps to reduce swelling, redness and bleeding of the gums. A magnetic toothbrush can be used for therapeutic and prophylactic purposes by patients with inflammatory periodontal diseases, dental caries (at the stages of oral cavity sanitation), with chronic and acute diseases of the oral mucosa. A high remineralizing effect is given by a 12-day course of products consistently used in the form of applications:

calcium gluconate gruel - 7 days,
fluorine-containing gel - 5 days (zlgifluor, elugel, sensigel, elgydium, elmex, fluodent, fluocal). The last visit to the dentist ends with the coating of all surfaces of the teeth with fluorine-containing varnish (fluorine varnish, bifluoride-12). Yu.M. Maksimovsky proposed a ten-day course of remineralizing therapy, consistently using various remineralizing agents in the form of applications:
3% remodent solution - 2 days,
slurries of calcium glycerophosphate - 4 days,
1% sodium fluoride solution - 3 days,
fluoride varnish - 1 time, at the end of the course of treatment.

An important component of the treatment of the focus of demineralization is strict adherence to the rules of oral care, the purpose of which is to prevent the formation and long-term existence of plaque in the place of the former demineralization site. In addition, it is necessary to convince the patient to follow the nature of the diet: reduce the intake of carbohydrates and eliminate them in between meals. Brown and black spots characterize the stage of stabilization of the carious process. Pigmented spots are asymptomatic. In addition to a cosmetic defect and the patient's suspicion of the presence of a carious cavity, there are no complaints. Of interest are the data of R.G. Sinitsin, explaining the cause of pigmentation of the carious cavity. He established the possibility of accumulation of tyrosine in enamel and dentine and its transformation into a pigment - melanin. This process occurs with an apparently intact outer layer of enamel, although it is noted that in the center of the stain there is a decrease in microhardness and an increase in permeability, in particular, for radioactive calcium. Clinical and experimental studies have shown that remineralizing therapy with such changes is ineffective. As a rule, such lesions proceed for a long time and can turn into carious cavities with a violation of the dentin-enamel connection after a few years. With minor foci of pigmentation of the tooth enamel, a dynamic observation is carried out. In the presence of an extensive area of pigmentation, it is possible to prepare the hard tissues of the tooth and seal without waiting for the formation of a cavity. In most cases, grinding of the pigmented area is indicated, followed by remineralizing therapy. General etiopathogenetic therapy of dental caries is prescribed individually, based on the intensity of the lesion and the nature of the course of the pathological process.

Teeth are prone to various diseases, one of which is caries.

The latter is a process of demineralization of hard tissues of teeth, which develops as a result of exposure to acids formed by microorganisms.

First, caries affects the enamel, manifesting itself as a white spot on the surface. This type (or) of the disease does not apply to the main part of the tooth.

Provoking factors

The appearance of enamel caries is promoted by the formation of plaque, the presence of which leads to increased reproduction in the oral cavity of various microorganisms.

As a result of the processing of carbohydrates, they form acids, the effect of which reduces the amount of minerals contained in the enamel, namely calcium, phosphorus and fluorine. Their deficiency gradually destroys the enamel, which is manifested in the appearance of pigmented or white spots on the teeth.

This is facilitated by a number of conditions that are commonly called cariogenic factors. They are divided into general and local. The first ones include:

Wrong nutrition. The demineralization process is more intense when processing fast carbohydrates such as fructose, glucose or sucrose. Their source is sweets and flour products, the excess of which negatively affects tooth enamel. In addition, the poor quality of drinking water has a bad effect on the tissues of the teeth.
Hereditary predisposition to carious phenomena.
The presence of immune and cardiovascular diseases.
General weakened state of the body.

In turn, local factors are unfavorable environmental conditions, inadequate oral hygiene, general condition, features of the teeth and jaw in general, as well as professional affiliation. Working in conditions of hazardous production significantly worsens the condition of the teeth, and this is especially true for processes using alkaline and acidic compounds.

In the presence of one or more factors, it is recommended to strengthen the measures taken in order to carry out prevention or to restore tooth enamel.

Important: Streptococcus, which is the main cause of the disease.

Elements of early diagnosis

Regular visits to the dentist are the best way to detect enamel caries and prevent its development.

Symptoms of the disease are mild. The appearance of a white spot on the surface of the tooth is usually due to the formation of plaque or calculus. However, this fact may indicate the onset of carious processes, which only a dentist can recognize at this stage.

By examining and probing the teeth, the specialist can identify signs of the disease. One of these methods is the surface roughness detected using a dental probe in the area that aroused suspicion.

Probing in fissures (grooves of the teeth) is considered indicative, since the greatest accumulation of plaque occurs precisely there.

The presence of a white spot is considered quite important, but not quite a sufficient sign for diagnosing enamel caries. To identify the disease in certain areas, it is necessary to stain the problem areas with special dyes.

Diagnosis of enamel caries using dyes

The appearance of a white spot is possible with various non-carious lesions of the dental tissue, such as pigmentation or hypoplasia. For the purpose of diagnosis, various dyes are applied, which are used in dentistry specifically to identify enamel caries or other diseases.

The principle of their action is simple. In the presence of a carious stain, the dye easily penetrates the porous enamel and stains the affected area.

The most widely used solutions are:

Methylene blue 2%.
Methylene red 0.1%;

The solution is also used:

Kongoroth;
Carmine;
Tropeolin.

There is also a method called luminescent diagnostics. It is based on the action of ultraviolet rays emitted by a special lamp. Healthy enamel, when exposed to ultraviolet radiation, acquires a greenish tint, and affected by caries, it remains the same.

Important: The use of dyes is the simplest and most effective method for detecting enamel caries at an early stage.

The relevance of the treatment of enamel caries without a drill

Enamel caries, as a rule, does not require the use of a drill as a necessary method of treatment. An exception is the preparation of a tooth for the subsequent installation of a filling. In other cases, surgical intervention is not practiced.

Treatment is carried out through the mineralization of the affected areas, which is used in conjunction with the observance of the diet. The latter is important, since an unbalanced diet is one of the causes of caries.

If possible, reduce the amount of consumed foods that serve as sources of active carbohydrates, that is, all kinds of sweets, confectionery, flour products and soda.

You also need to refrain from certain types of food, for example, sticky or viscous, as their residues have an increased ability to linger in the oral cavity. The presence of excessively spicy or salty foods in the diet is undesirable. It is worth increasing the intake of foods containing calcium and phosphorus (cheese, seafood, fresh herbs).

Each baby begins over time, find out how to prevent this and what can be used as a preventive measure.

Read about the prevention of tartar and folk methods of dealing with it, as well as the main causes of deposits.

Treatment of caries in the stain stage

Treatment of the disease at this stage is carried out by a conservative method. It is based on measures to saturate the demineralized areas of the enamel with essential substances.

Before and after caries treatment

According to the results of the diagnostics, the doctor prescribes the necessary treatment, which includes the elimination of plaque and tartar. After cleaning the surface of the teeth, remineralizing therapy is prescribed. The microhardness of the enamel decreases, therefore, during therapy, the affected areas of the enamel are treated with dental compounds, including fluorine and calcium compounds. The usual course includes 10 sessions. These measures are carried out in a dental clinic.

Treatment involves the use of various means and allows. The effectiveness of their use is monitored by a doctor. As a rule, the next visit to a specialist occurs 2.5-3 months after the start of treatment.

During home therapy, apply:

remineralizing gels;
fluoride pastes.

The first are designed to restore the balance of minerals in the enamel. The most effective include:

Tooth Mousse - a gel made on the basis of milk casein and contains a large amount of calcium and phosphorus;
O.C.S.;
Medical Minerals;
Amazing White Munerals.

They are similar both in action and in saturation with minerals.

In turn, many fluoride-containing pastes not only restore tooth enamel due to the content of fluorides in their composition, but also eliminate bleeding gums and serve to prevent caries.

The most common are:

President Classic;
ElceMed TOTAL CARE.

These measures are the most effective. Their use seems to be preferable, especially in combination.

Important: Do not try to scrape off or otherwise mechanically remove the stain that has appeared, as this is impossible and will cause additional damage to the enamel.

Prevention

Prevention of caries means following simple rules. It is necessary to perform simple actions, the purpose of which is to remove accumulated food debris, prevent the formation of plaque, stones and create a healthy oral microflora.

First of all, you need to brush your teeth regularly and thoroughly, at least in the morning and evening, and preferably after each meal. In this case, you should use a toothbrush and dental floss (floss). The procedure should last at least 7-10 minutes and include the use of fluoride-containing pastes. The use of remineralizing gels is also recommended.
It is necessary to limit, and it is better to completely eliminate the use of food in between meals.
Visit the dentist regularly to check the condition of the teeth, remove plaque and tartar.

Fixing material

Useful video about the prevention of enamel caries from the “School of Health”:

Simple preventive measures can reduce the potential of cariogenic factors and significantly reduce the risk of enamel caries.