What is the pathogenesis of dental caries? What causes caries? You will find answers to these and other questions in the article. The etiology and pathogenesis of caries are still not fully understood. Let's consider them in detail in the article.
Theories
Few people know what the pathogenesis of caries is. For a long period of time, localistic (microbial and chemical) theories of the appearance and development of caries dominated (and have not lost their significance today). In accordance with them, acids are formed in the oral cavity during bacterial fermentation of carbohydrates (including lactic acid). They dissolve the enamel cuticle, destroy the enamel itself and open bacteria to the dentinal tubules.
Bacteria penetrate dentin and lime salts are selected from it. They crush and digest dentin, as a result of which dense tooth tissues are destroyed. It was found that microbial associations (enterococci, streptococci, staphylococci and others) that reside in the surface layers of a carious tooth have an increased hyaluronidase activity.
What is installed?
Everyone who cares about the health of their teeth should be aware of the pathogenesis of caries. Scientists have found a direct relationship between the level of development of caries and the hyaluronidase activity of bacterial flora and saliva.
It was also found that a lack of mumps (the hormone of the salivary glands) and hypersecretion of saliva accelerate the progress of caries, while excessive amounts of mumps favor the regulation of mineral and protein metabolism of the teeth and have anti-caries effects.
Researchers Opinion
What do researchers say about the pathogenesis of caries? They believe that in the process of nucleation and development of caries, not only local microbial and chemical factors play a role, but also the general condition of the human body, hereditary tendency, age (stages of puberty), the process of eruption and change of milk teeth (it is at these moments that caries occurs most often).
Of great importance are disorders in the body of protein, mineral and carbohydrate metabolism, an incorrect ratio of phosphorus, calcium salts in the teeth, a lack of vitamins, trace elements, hormones.
Due to the lack of these substances, it is likely that the work of pulmonary odontoblasts with their neurovascular device, which acts as trophic intradental centers in relation to the hard tissues of the tooth — cement, enamel and dentin — is upset. In the appearance of caries, it is necessary to take into account the conditions of life, nutrition, geographical factors and other parameters of the influence of the external environment on a person.
Food
How does caries pathogenesis depend on nutrition? The role of food, in particular carbohydrates, is proved experimentally. So, if rats are kept on a cariogenic diet (containing 54% sucrose), it is possible to recreate the primary manifestations of dental caries within a month and track all stages of its evolution, very similar to those observed in humans.
In experimental dental caries in rats, dystrophic transformations in the liver, the insular device of the pancreas and other endocrine glands were noticed. This allows us to regard caries as an illness accompanied by metabolic disorders of the whole organism.
Clinical Observations
Many are interested in the pathogenesis and etiology of dental caries. Clinical observations confirm the influence of human well-being on the development of this anomaly. So, for example, in babies born from mothers who suffered during pregnancy endocrine, metabolic, allergic ailments, caries occurs immediately after teething, and then permanent teeth are damaged.
At the same time, to this day, the mechanisms of demineralization of enamel, the most important pathogenetic element of caries, from which the pathological process actually begins, remain unrevealed. All further stages of the development of the defect are apparently associated with the bacterial flora, which plays a significant role in the dissolution of apatite in the destroyed areas of enamel, dentin and the entire chain of future harmful processes.
Enamel fluorosis
What is enamel fluorosis? This is one of the manifestations of prolonged fluoride poisoning during meals and water containing too much of it. The disease is found in isolated epidemic foci of our planet, where more than 2 mg of fluorine falls on 1 liter of water.
It is manifested by the appearance in the enamel of fangs and incisors of small or large spots in the area of destruction and loosening of enamel (sometimes up to the dentin). These segments are initially whitish, then slowly turn yellow and, expanding, turn black.
Most likely, pigmentation occurs due to the substances of provisions. Experts believe that fluorine in toxic doses destroys ameloblasts, reduces the activity of phosphatase and breaks down the mineralization of enamel.
Classification
The etiology and pathogenesis of caries has not yet been fully studied, but the clinical symptoms of caries have been studied perfectly. Several typologies of caries have been developed, which are based on various signs:
- The classification is anatomical. Depending on which tissue is destroyed, there are: dentin caries; enamel caries; caries of cement.
- By localization of the site of destruction: cervical (cervical); occlusal (fissure); anular (circular, circular); caries of contact surfaces.
- Topographic or clinical classification (best known). Primary caries is damage to the enamel, in which the surface layer is not damaged. It happens in two phases: the phase of the pigmented spot - suspended demineralization; white spot phase - progressive demineralization. Surface caries - an anomaly within the enamel. Medium decay - anomaly extends beyond the dentinal-enamel compound. Deep caries - the destruction of most of the dentin with the formation of a cavity, the bottom of which is separated from the cavity by a thin layer.
- With the flow: acute (fleeting); sharpest; sluggish (chronic); flowering.
- According to the sequence of occurrence: primary; recurrent or secondary.
- By the degree of activity (according to T. F. Vinogradova, 1978): compensated caries - KPU index at the age of 15-18 years is not more than 6; caries subcompensated - at the age of 15-8 years, the KPU index is 7-9; decompensated caries - at the age of 15-18 years, the CPU index is 9.
- According to the intensity of destruction: multiple; single; systemic - caries, in which there is a total lesion of almost all teeth with a concentration of the process near the neck of the tooth.
- By the presence of complications: complicated caries (so-called periodontitis and pulpitis, which are inflammatory ailments that occur due to the progression of the carious process); simple caries (due to the lack of clinically identified transformations in the pulp). All 4 phases of topographic classification are in this group.
Black classification
Considering the pathogenesis and etiology of dental caries, Black classifications should also be given attention. The classification was developed more than 100 years ago, and despite the fact that today it is considered incomplete, it is still widely used in dental practice.
- 1st class - carious cavities in the area of natural fissures of premolar and molars, as well as in blind cavities of molars and incisors;
- 2nd class - carious cavities located on the contact surfaces of premolars and molars;
- 3rd class - cavities located on the contact surfaces of the fangs and incisors without destroying the cutting edge;
- 4th class - cavities located on the contact surfaces of the fangs and incisors with damage to the cutting edge and crown angle;
- 5th grade - cavities located in the cervical zone of all groups of teeth.
Diagnostics
So, we examined the pathogenesis and etiology of dental caries. Diagnosis of caries is a very serious matter, as caries can not always be determined during a routine examination. If the patient came to the reception and he has no obvious signs of a carious cavity, the doctor identifies the ailment based on complaints, if any.
Then the teeth are examined using a special mirror. At this stage, color, plaque on enamel and so on is set. Sometimes sounding is performed, with which you can determine the external condition of the teeth - sensitivity, shade, and more. If there is a suspicion of the presence of a medium or deep type of caries, percussion (tapping) is performed.
The manipulation depends on the classification of the ailment - superficial, deep or medium.
If no signs of a cavity are found, then staining with a vital agent - blue methylene solution is performed. With this tool, you can see spots on the surface, determine the state of dentin, how soft or hard it is.
If the caries is medium or deep, take an x-ray of the teeth. Using this procedure, the depth of the cavity is found out and how much damage has affected the pulp chamber.
Diagnostics using electric current is used only if there is a suspicion of damage or irritation of the pulp chamber. This method is also used when it is necessary to identify foci of the disease.
Routine inspection
If the method is prophylactic, then the risk of a cavity is established. Check the condition of the enamel, oral cavity and saliva. The strength of the surface of the teeth and its ability to recreate is also determined.
Plaque
What is the role of plaque in the pathogenesis of caries? If a person often consumes carbohydrates and poorly cares for the oral cavity, cariogenic microbes are tightly fixed on the pellicle, creating plaque. The remnants of sticky food get stuck in the retention zones of the teeth (pits, fissures, fillings, contact surfaces, prostheses), begin to rot and wander. The occurrence of plaque is affected by:
- tooth surface structure;
- oral hygiene;
- the anatomical structure of the tooth and its relationship with nearby tissues;
- chewing intensity and diet;
- dentition defects;
- gum fluid and saliva;
- the presence of prostheses and fillings in the oral cavity.
Dental plaque has a porous structure, which ensures its connection with the liquid components of food and saliva. This is an amorphous soft substance that adheres tightly to the tooth surface. In the plaque, microbial waste products and mineral salts accumulate. As a result, diffusion slows down as porosity disappears.
A new substance appears - dental plaque, which can only be removed by force and not completely. Under this plaque, organic acids accumulate, which are products of sugar fermentation and the life of microbes. It is these acids that influence the appearance of a demineralized zone on a small area of enamel.
By the way, the process of demineralization does not always end with the appearance of superficial caries, since in parallel with it there is a process of remineralization or restoration of tooth enamel due to the constant flow of mineral components from the oral fluid. With a balance of de- and remineralization, a carious process in tooth enamel does not occur.
Caries in babies
What is the pathogenesis of caries in children? In addition to the health of the mother, the mineralization of the permanent teeth in babies is also significantly affected by the state of health of the child. After all, this process occurs mainly in its first years of life.
The functional state of the gastrointestinal tract, the usefulness and nature of nutrition, the concomitant ailments, the fluorine content in drinking water, and other factors can play a decisive role in the formation of caries-resistant or tooth-sensitive hard tissues of teeth.