Caries (lat. Caries "decay") is a slowly proceeding process of depolarization and destruction of hard tooth tissue with the formation of a carious cavity in the dentin. Scientists still can not give an accurate conclusion about the causes of dental caries.
Prevalence
Traces of dental pathology are deep in the past. In the course of archaeological research, it was proved that such a disease occurred in people who lived about 5,000 years ago. This pathology is the most common today (affects more than 93% of people). In children, it is the leader among chronic diseases and occurs 6-8 times more often than bronchial asthma, which takes 2nd place. By the time school graduates, 80% of teenagers already have caries, and 98% of people have fillings. According to statistics, tooth decay is less in Africa and Asia.
Etiology of the phenomenon
Currently, the occurrence of dental caries is associated with the fact that the pH of saliva changes on its surface, plaque with bacteria is present, carbohydrate fermentation (glycolysis) occurs. To this is added the activity of acid-forming microflora. And already under the influence of organic acids, tooth damage occurs in the future.
Acid-forming bacteria of the mouth include acid-forming streptococci (Streptococcusmutans, Str. Sanguis, Str. Mitis, Str. Salivarius) and some lactobacilli.
Although tooth enamel is considered the hardest tissue in the body, like feldspar, its hydroxypatites are very sensitive to acids and begin to crumble even at pH 4.5. After each exposure of these substances to the protective coating, its inorganic components dissolve and remain in this state for 2 hours. If this happens regularly during the day, then the pH will remain in the acid zone for a long time, in such an environment, the buffer properties of saliva do not have time to restore it, and the enamel begins to irreversibly collapse.
The carious cavity is formed on average over 4 years. And since the root of the tooth is softer, here the process occurs 3 times faster. With a passion for sweet tooth decay can form in a few months.
Caries Factors
The main causes of caries are 4 starting points:
- caries on the surface of the tooth;
- glycolysis;
- cariogenic bacteria;
- time.
Counteraction to these negative factors is:
- Daily brushing with plaque removal.
- Saturation and fluorination of enamel - due to changes in the composition of water by adding this substance, as well as with its presence in toothpaste. Especially important is the adoption of such measures for babies. According to WHO recommendations, fluoridation of drinking water leads to a decrease in the frequency of caries by 30-50%.
Theories of Caries Origins
Currently, there are more than 400 theories of caries. In each of them there is some truth, but they cannot affect all aspects of the pathogenesis of the disease.
The authors consider only a few reasons, so all theories of caries can be divided into two groups. The creators of localistic concepts explain the origin of the destruction by the action of exogenous factors (saliva, plaque and stone, bacteria, exposure to acids, etc.). The authors of biological theories talk about the influence of endogenous disorders.
The cause of caries was tried to be established by doctors of ancient times - Hippocrates and Galen.
In the XVII-XVIII centuries. Vital theory was popular, according to which dental pathology occurs as a result of internal tooth decay.
In the XVIII century. chemical theories of caries appeared. So, Berdmar (1771) spoke about the effect on the tooth of inorganic acids from food. The discovery of the microscope allowed A. Levenguk (1681) to detect the "smallest animals" in the tissues of a decayed tooth.
Two centuries later, Leber and Rottenstein (1867) described a special type of microbes, which they considered to be the culprits of caries.
They also did not deny the influence of acids. On their basis, Miller's very progressive chemical-parasitic concept was formed in 1881. According to this theory of caries, the destructive process goes through 2 stages.
In the beginning, the inorganic part of tooth enamel dissolves under the influence of lactic acid, which is formed in the mouth as a result of sugar fermentation with the participation of acid-forming microorganisms.
Further, this compound lowers the pH of saliva, and hard tissue demineralizes. And at the 2nd stage, dentin is already destroyed under the influence of enzymes produced by bacteria.
The acid itself cannot act on dentin, because it consists of complex protein molecules.
Miller’s mistake was later revealed - bacteria are involved already from the 1st stage of destruction. To confirm his assumptions, the scientist conducted a very interesting experiment: in 1884 he managed to create tooth decay artificially - he took healthy teeth and left them in a mixture of carefully chewed bread, meat and a small percentage of sugars (2-4%) for 3 months at temperature 37 º. And dental pathology showed up.
Caries really often develops on chewing and proximal surfaces, that is, where bacteria linger more and food remains roam. But the theory does not explain many points: it was established that the saliva reaction is neutral or slightly alkaline (pH - 6.8-7.0), and it cannot cause enamel demineralization.
Miller's theory does not explain facts such as the development of caries in people who do not eat sweets and, conversely, its absence in those who eat such foods in large quantities. Otherwise: conditions in the oral cavity are not identical to experience.
The causes of cervical caries are that the selective lesion at certain points on the surfaces of the teeth is explained by demineralization, which occurs as a result of local formation of acid in areas covered with soft plaque (the so-called "dental plaques"). And they just arise more often in the cervical region. According to studies by Soviet authors (V.F. Kuskova et al.), The ability to ferment polysaccharides is present not only in streptococci, but also in other bacteria. In addition, “dental plaques” create conditions for exposure to tooth tissues not only acids, but also numerous enzymes from microbes.
The causes of cervical caries and treatment determine each other, and in the subsequent therapy begins with a deep cleaning of the tooth surfaces.
In a work in 1928, D. A. Entin revealed a close dependence of tooth and enamel on the physicochemical composition of saliva (an external factor affecting the condition of teeth) and blood (an internal factor). This is the basis of his theory of caries.
Saliva and blood are inconsistent, they change during various dysfunctional processes in the body. With diseases, the naturally optimal nutrition of the dental tissue is disrupted, and it becomes vulnerable to cariogenic bacteria.
The scientist considered the tooth as a semi-permeable biological membrane at the boundary of 2 environments:
- external - saliva;
- internal - blood and lymph pulp of the tooth.
Depending on the composition and properties of saliva, the state of enamel colloids changes (they swell or wrinkle), and their permeability also changes.
The protective coating in this case changes its charge and electroosmotic currents, which normally move centrifugally from the tooth pulp to the enamel and provide normal tissue nutrition, here the reverse movement begins - centripetal - from saliva to pulp.
When the potential changes, bacteria are attracted to enamel, and its increased permeability facilitates their penetration into.
It was proved that these processes actually arise, but without local factors of caries they do not exist. The progressiveness of the theory is in the description of the relationship between the state of the body and destruction, minus is in the consideration of the bioprocess only as a physicochemical reaction.
Biological theory
In 1948, the Russian scientist I.G. Lukomsky put forward his theory of tooth decay, in which he argued that the disease begins with a deficiency of vitamins D and B1. The nutrition of tooth cells (odontoblasts) is thus impaired, and caries occurs.
Its essence is that the enamel remains intact with the correct operation of the odontoblast. Theory is only of historical interest.
There is also the concept of A.E. Sharpenak (1949) - he argued that the primary link in the development of caries is the destruction of the protein matrix of tooth hard tissues. It occurs with a deficiency of amino acids lysine and arginine, as well as B vitamins.
But it was proved that in the spot stage such changes in the tooth do not occur. Destruction of dentin proteins is not a primary process, but has a significant role in the progression of caries. The anticariogenic effect of vitamin B is also clinically confirmed.
TsNIISom on the basis of many different materials created a working concept of the pathogenesis of dental caries (A. I. Rybakov, 1967). It is based on data on the uneven development of the process in different life periods of development. The interdependence of internal and external factors is noted here.
The formation of the dentofacial system begins in embryogenesis, and from then on, the study of caries should be considered.
There are 4 main periods:
- intrauterine (from 5 weeks to 5 months);
- the time of childhood and adolescence, the largest restructuring of the body (from 6 months to 6 years and then until the age of twenty);
- optimal physiological balance in adulthood (from 20 to 40 years);
- a period of time, accompanied by a lack of certain functions of the body (after 40).
The carious process is considered as a polyetiological pathological.
In the first phase (from 6 months to 6 years), the background for caries can be transferred diseases with lack of oral care, malocclusion, and trauma.
At 6-7 years, there is an increase in carbohydrate intake and there is a deficiency of fluoride in the body. There are violations of salivation and changes in the pH of the oral cavity.
In the period from 12 to 14 years, dental plaques, quite frequent at this time, acquire more importance. The trigger mechanism in this is hormonal adjustment.
At the age of 17-20, large loads on the liver, insulin apparatus begin.
At the age of 20-40, somatic diseases, pathologies of the dentition can occur (teething wisdom is usually difficult, tissue injuries, broken bite can occur).
The period of withering of the body (40 years or more) is characterized by a decrease in the activity of the genital and other endocrine glands, and diseases of the oral cavity.
The trigger mechanism in this case is malnutrition and local changes in the oral cavity.
Conclusion: both general and local provocative causes play an important role in the origin of caries.
Common caries factors:
- functional state of the nervous system;
- the presence of common diseases that cause a change in metabolic processes;
- poor quality diet;
- hereditary predisposition;
- hormonal disorders.
Local factors:
- enzymes;
- cariogenic microorganisms;
- excess carbohydrate food;
- the presence of plaque or plaque;
- violation of diet;
- broken teeth arrangement with crowding;
- changes in the quality and quantity of saliva;
- inferiority of dental structures.
For the appearance of pathology, these risk factors for caries should be summed up to a certain threshold level, then the enamel begins to collapse. The lack of the concept of A. I. Rybakov becomes an abundance of the etiological reasons called, but they are only contributing, and not the root cause.
Current interpretations
The modern theory of caries, founded by E.V. Borovsky and other co-authors (1979, 1982), notes pathology as a consequence of the influence and interaction of several groups of factors - general and local.
What does it mean? For destructive processes, a trigger for tooth decay is needed. This is the obligatory participation of microflora in the mouth together with glycolysis.
Treatment principles
Remineralizing therapy is carried out in the spot stage. The course of treatment consists of 10 procedures, during which the teeth are fed with calcium applications, Remodent solutions (a natural remedy) and fluorine-containing preparations (sodium fluoride 2-4%). It is better to be treated by a dentist in a polyclinic, which will first clean the tooth, then etch the surface with citric acid, rinse with water and apply a solution of 10% gluconate or calcium hydrochloride for 15 minutes.
Cavity filling
It is carried out at various degrees of negative processes: superficial, medium and deep caries. The affected tissue is removed, and the cavity itself is sealed.
Stages:
- Cleaning from plaque of the patient and adjacent contact teeth. The methods are different: ultrasound for hard coating, with soft - abrasive pastes or brushes.
- The color of the tooth is determined on a special scale - this is necessary for accurate selection of the shade of the filling material.
- Anesthesia - local anesthesia.
- Drilling carious tissues - cavities give the right shape with drilling overhanging edges of enamel.
- Then all carious dentin is removed. If at least a particle remains, pulpitis or periodontitis will develop under the seal.
- Distinguishing a tooth from saliva is an important stage! Previously, this was done with ineffective cotton rollers, the last 10 years by "Cofferdam". It is a latex film with a hole for teeth.
- Then, the existing cavity is treated with antiseptics.
- Then enamel etching with phosphoric acid gel - then the adhesive (something like glue) can diffuse into the dental tissue. After absorption, it is illuminated by a photopolymerization lamp.
- Laying a gasket under the seal - it is placed at the bottom and serves as an insulating one. This is necessary to establish a seal.
- Filling - it restores the shape of the tooth and its chewing surface. The composition is made of photopolymer composite materials. Each layer is applied sequentially and illuminated by a photopolymerization lamp for hardening.
- Grinding and polishing a tooth filling completes the treatment process.
Laser treatment
The main plus is complete painlessness and the fact that there are no enamel microtraumas. In parallel, sterilization occurs, so the germs do not fall under the seal.
Ozone treatment
Ozone completely destroys bacteria. Healthy tissues are not affected. The method is applicable for initial caries.
Infiltration
A special gel is applied to the affected tooth, the components of which enter into a chemical reaction with enamel. They simply dissolve the affected areas. After that, the surface is cleaned and dried with alcohol. There is no pain, and the whole process lasts no more than 15 minutes.
Air abrasive treatment
If caries is not yet in advanced form, small cavities can be cleaned by air-abrasive enamel. A strong stream of aluminum oxide particles with a directed jet presses out damaged tissues under pressure, and healthy parts remain. Such strokes are more effective than a drill.
Now you know about the causes of caries and the treatment of dental pathology. Caries is a polyetiological disease. Today, drill treatment prevails everywhere. Modern methods are used only for prevention.