As the name implies, the peculiarity of fissure caries is that it affects the so-called fissures - natural anatomical structures of the tooth, having the appearance of grooves and grooves on the chewing surface. According to statistics, this type of caries is the most common.
Most prone to fissure caries children with baby teethand adults with very deep or closed fissures. Such cavities even with very thorough cleaning can not be completely rid of plaque and food debris.
It is not always easy to diagnose pathology, therefore, to identify it, sometimes special caries diagnostic apparatus fissure At home, insignificant darkening of the grooves on the chewing surface is often neglected. As a result, too late appeal to the dentist may result in the need for depulpation and even loss of a tooth. Therefore, all darkening in the area of fissures should be treated very carefully.
Symptoms and appearance of teeth affected by fissure caries
The photo below shows an example of fissure caries. In the deepest places of the fissures dark areas of enamel are clearly visible, under which are the main areas of damage to the tooth:
Fissure caries may develop already after a short time after the eruption of a tooth, and the probability of the appearance of pathology depends on several factors, which include:
- large depth and specific form of fissures;
- low resistance of tooth enamel;
- the constant presence in the mouth easily digestible carbohydrates and cariogenic bacteria.
Fissure caries affects mainly the weakest areas on the chewing surface of the posterior teeth. Most often, the pathology develops in children on the first permanent molars (on the sixth teeth).
On a note
The development of fissure caries in the first permanent molars is due to the fact that these teeth erupt in a child as early as 6 years. Their eruption remains most often unnoticed by parents and is sometimes mistakenly regarded as the appearance of milk (temporary teeth), which will still fall out.
Most often, the lower sixth teeth erupt first, and the upper teeth - only after a while, so self-cleaning during chewing does not occur, since there are no contact areas. The child himself cannot ensure proper hygiene of such remote rear areas, as a result - a kind of “biological garbage dump” arises. Constantly contaminated with residues of carbohydrates, fissures begin to darken, since under the surface layers of the enamel, demineralization zones (reduced mineral content in the enamel crystal lattice) arise due to the action of organic acids.
The following photo clearly shows that fissure caries is localized mainly in the central part of the chewing surface of the tooth. If the disease is not started, the root and the neck are not affected:
The clinical picture of nosology is precisely in the coloring and further destruction of enamel in the area of fissures.
Depending on the depth of the carious cavity, fissure caries may be accompanied by the following symptoms:
- Short-term pain from chemical irritants (sweet, salty, sour) and temperature pain (cold, hot) with superficial, medium and deep caries.
- Short-term pain from mechanical irritants (when injected into the food cavity), mainly with deep damage to the fissures.
- It is important that when caries pains pass quickly, immediately after the removal of the stimulus.
In the early stages, fissure caries often develops asymptomatically (initial and superficial stages), which leads to late treatment of the patient: when the fissures are combined into a full-fledged carious cavity with softened infected tissues and bright symptoms appear.
At the terminal stage, the lesion reaches the pulp. At the same time, the pain acquires a completely different character: even after the irritant is eliminated, it lasts for a long time, spontaneous pains appear (for no apparent reason), nightly, radiating or shooting (giving to any area of the maxillofacial region), long-aching, pulsing, tearing, intolerable etc.
All of these are complications of caries, called pulpitis or periodontitis, depending on the stage of the “nerve” lesion in the canals of the tooth.At this stage, the patient is forced to consult a doctor for emergency care, and treatment is carried out according to the diagnosis. It is characterized by technically more complex manipulations than in the treatment of caries and more often takes place in several important stages before the filling itself. By time and financial component - this is a costly event.
The earlier diagnosed caries are diagnosed, the faster, cheaper and easier the treatment will be.
Diagnosis of the disease: tools, devices and methods
Diagnosis of fissure caries in many cases is quite simple, since the lesions of the enamel are clearly visible with the naked eye. But sometimes, especially in deep fissures, they are completely invisible, and they don’t even have a dental probe in this instrumental diagnosis.
On a note
Fissures themselves have a darker shade than the rest of the tooth enamel. This is due to the fact that they are filled with bloom, dental plaques that cannot be completely removed with a toothbrush, and are simply located in the recesses in the shadow of the tooth hillocks. All this often masks fissure caries and makes it difficult to identify.
In general, the diagnosis of the disease is carried out in the following ways:
- visual inspection;
- radiography;
- use of caries markers;
- laser diagnostics;
- fissurotomy.
Each method has its advantages and disadvantages, which are manifested in the diagnosis of caries at different stages.
Visual inspection
The simplest method for detecting fissure caries is a visual inspection.
A dental probe and a mirror are used to examine the oral cavity. But if the fissures are closed or the diameter of the lesion is smaller than the diameter of the tip of the probe, it is impossible to establish the presence of the disease in this way.
Radiography
X-ray can detect hidden caries fissure, even if there are no symptoms. The picture reveals well the lesion sites and their sizes, but the doctor will not prescribe it without suspicion, and often before the appearance of pain in the tooth X-ray is not appointed.
In addition, with the help of X-rays it is impossible to detect caries of fissures in the early stages, before the damage of the tissues under the surface of the enamel.
Laser diagnostics
Diagnostics, in which caries is “highlighted” by a laser beam, is practically a 100% method of detecting fissure caries (laser fluorescence method).Using this method, caries can be diagnosed at almost any stage of its development.
Although the price of the apparatus for the diagnosis of caries of fissures is quite high, it is in all good dental offices. This is explained by the fact that laser diagnostics reveals caries even at the initial stages. And with the "capsular" type fissures, this option is optimal.
Fissurotomy
When the fissure lesions are revealed, but their size is not known, an additional method for determining the degree and depth of carious zones is used - fissurotomy. For this procedure, a set of burs has been developed, with the help of which minimally invasive intervention is carried out in the tooth structure.
With the help of carbide boron, the darkened fissure reveals about 0.6-1.1 mm. According to the opened picture, the dentist decides which treatment of fissure caries will be the most effective.
Features of the treatment of fissure caries
Fissure caries treatment is carried out in several stages:
- removal of affected areas;
- installation of a seal or restoration tab.
Removal of the affected areas is carried out using a drill. With the help of modern filling materials, the treated cavities are filled.
If there is a complication of caries (pulpitis), then the “nerve” is removed. Next, the canals are sealed, and depending on the clinical situation (cavity size, area, position of the tooth, load on it, interaction in the bite, etc.), either a seal is placed or a set of measures is taken, which may include such options as:
- filling + crown;
- installation by a dentist-therapist pin (anchor, fiberglass, titanium, etc.) + seal (or even setting the crown on top);
- recovery tab;
- stump tab + crown.
The choice depends on the professionalism of the doctor, his tactics regarding the clinical situation in the oral cavity, since the tooth is not considered as a single organ with its inherent functions, but in the system of its interaction with other teeth and surrounding tissues.
An alternative to all well-known fillings is a restorative insert - a micro-prosthesis made according to the shape of the patient's tooth.It is created in a dental laboratory from polymeric materials, medical alloys, sometimes from silver, gold or platinum. To make a tab, pre-made tooth cast. Its fixation is carried out with the help of medical cement.
When fissure caries is diagnosed, treatment with a restorative tab is more promising than a seal, because its service life is longer. If it is made of polymers, it looks more aesthetic and looks like a healthy tooth.
How to prevent the development of caries on fissures?
Prevention of caries, including fissure, is the best way to maintain healthy teeth.
There are the following areas of prevention:
- oral hygiene;
- tooth fluoridation;
- timely sealing of fissures;
- regular dental examination.
Thorough cleaning of the teeth allows you to maintain a normal pH level in the oral cavity, removes plaque and bacteria, the waste products of which destroy the enamel.
But even with regular cleaning, if the mineralization of tooth tissues is reduced, the risk of the appearance of fissure caries increases.To strengthen the enamel, it is recommended to use toothpaste with fluoride or undergo a remineralization procedure in the dental office.
A good method of prevention is sealing fissures - they are poured with a liquid composite, which then hardens and prevents the access of bacteria to the tooth enamel. Active substances are added to the material, which additionally remineralize and strengthen enamel.
And, of course, it is important to regularly visit the dentist’s office. A planned visit to the doctor and timely reorganization will allow time to detect caries at the earliest stages of development and take effective measures to eliminate it.
From the practice of the dentist
As mentioned above, at the age of six, the first molars erupt - the teeth that are most susceptible to fissure caries, rapid destruction, up to serious complications, and removal. It is impossible to admit it in any way, since orthodontist dentists (doctors who correct the pathology of bite) are hoping for the sixth teeth, calling them the “key of occlusion”. It is the ratio of these teeth that directly affects the formation of the correct bite.The removal of the sixth tooth entails serious consequences for the development of the jaw and bite. Therefore, early detection of fissure caries by pediatric dentists and hygienists is important for the prevention of future complications.
Useful video: what is important to know about fissure caries - expert comments
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