In most cases, tooth decay occurs in elderly patients over 60 years of age. This category takes about 60-90% of all cases of detection of the disease at a dentist’s appointment.
According to the widely used classification, depending on the affected part of the tooth, the following types of caries are distinguished:
- tooth caries;
- cervical caries;
- tooth decay;
- radical caries.
What is the difference between caries of the tooth root from the cervical and root? Caries of the root of the tooth is located deep under the gum, disrupting the integrity of the tissues of the unhealed and invisible by visual inspection of the root.
Cervical carious cavities develop only around the edge of the gum on the buccal and on the labial surfaces of the enamel. That is, it is visible to the eye areas.
The photo below shows a comparison of carpal caries with root caries:
As for the radical caries - it is formed along the exposed roots of the teeth on the pagan, contact and cheek surfaces.This means that in this case we can also see with the eye areas of tooth decay.
Let's summarize the preliminary results. Tooth decay caries is tooth decay that is not visible to the eye, but can lead to serious problems. Now consider the important nuances in more detail.
The main reasons for the formation of caries of the tooth root
Tooth decay under the gum most often develops in humans due to serious gum disease: atrophy, dystrophic processes in tissues or as a complication after their treatment. Otherwise, tooth decay is called “cement caries”. Usually, destruction begins with the cervical area on the open surface of the root (see photo).
It is interesting
Microorganisms and their metabolic products penetrate the root cement and wash out mineral components from it. At the same time organic components (collagen) are preserved. Over time, the activity of the microflora under the gum leads to the destruction of the thinned layer of cement that does not have a reliable mineral base. Develops hidden caries process on the tooth root.
Let us consider in more detail the main causes of root caries:
- Often, root caries develops when a gum pocket is formed and food debris accumulates in it. The gingival pocket is a consequence of a violation of the normal attachment of the gums to the cervical part of the tooth, when the gum can literally “move away” from the root zone. In this case, it is most often possible to detect tartar and plaque. The activity of microorganisms that feed on carbohydrate residues of dental plaque makes it easy to form a carious process on the uncoated root enamel with the subsequent formation of a cavity.
- In addition, root caries can be a consequence of complications of cervical caries. That is, the destruction of enamel visible by the eye gradually deepens inward: from the neck of the tooth to its root.
- Also, the delay in the caries of the tooth root can be the delayed treatment of large caries, when not only the crown of the tooth and the cervical gland are destroyed, but it comes to the root itself.
- And, finally, caries of the root can occur if the crown is not set on a tooth badly or after its expiration date. At the same time, a gap is formed between the edge of the crown and the gum, from which the tooth peeps out.It is in this area that a raid actively accumulates and a stone is formed over time. The destruction of a tooth in a given place can even lead to a fracture of the crown part of the tooth.
Characteristic clinical manifestations
The main feature of tooth decay is the absence of complaints in most cases in the early stages of the appearance of destruction. Hidden carious lesion under the gum for a long time, it may not detect itself in any way, but the following symptoms appear after the “gum exposure” or the formation of a large carious cavity:
- Painful sensations from thermal irritants (cold, hot), chemical irritants (mainly from sweets) and mechanical (if solid food gets under the gum).
- Aesthetic disturbances visible to the eye. This is due to an increase in the area of damage and the unification of caries at the base of the root with cervical defects. The photo below shows an example:
- A feeling of discomfort when eating. This is most often caused by the extension of the tooth and violations of its support by the ligamentous apparatus, which holds it in the hole. At the same time, mobility develops with the appearance of unpleasant sensations associated with chewing food and getting it into the cavity of the root caries.
On a note
Since it is practically impossible to feel caries at the base of the root in the early stages of destruction, you should contact your dentist to diagnose 1 time in 6 months, especially if there are serious age-related changes in the gums, as well as with painful symptoms in them already described above symptomatology.
Features of detection of hidden caries
For successful detection of root caries, the dentist uses a number of techniques.
For example, sensing using a sharp probe is widely used. A mandatory requirement for this technique is to preliminarily remove stone and plaque from all surfaces of the teeth, since hidden foci are found just beneath a layer of dental plaque.
The sharp probe is a dental instrument, safe for healthy tooth tissues, for examining and diagnosing hidden foci of tooth decay. In the study of the probe, the doctor gently inserts it into hidden foci to identify the roughness of enamel, chips, medium and large defects.
In addition, x-ray methods are often used to diagnose root caries. They are ideally suited for the initial forms of root caries, even when there is no carious cavity. The most commonly used are:
- Bite-wing roentgenogram;
- Parallel radiography method;
- Orthopantomogram.
The photo shows an example of an x-ray with a clearly visible pathology at the root of the tooth:
It is important to know
It is necessary to follow all the recommendations of the dentist to diagnose hidden lesions, since the time spent on a long search for root destruction will pay off in time for the treatment of the tooth and the prevention of serious complications that often lead to its loss.
Modern methods of root caries treatment
Depending on the location of caries, its area, depth, severity of the process, the general situation in the oral cavity, etc., the dentist chooses the optimal tactics, which consists of the general principles of treatment of caries of the tooth root. These include:
- Professional oral hygiene. This is an important step in achieving the necessary results, since most often only the removal of dental plaque allows you to gain access to the carious cavity, to process it in the most clean conditions without additional infected lesion.
- Elimination of delayed factors on artificial crowns and bare roots: correction of fillings hanging above the gum edges, replacement of bad dentures, elimination of dental-anomalies (for example, crowding of the teeth, which prevents normal oral hygiene with brushes and toothpastes).
- Treatment of initial and superficial caries of the root base without filling. Most dentists have a wide Arsenal of fluoride-containing preparations (varnishes and gels) with or without the addition of an antiseptic.
It is interesting
Preparations that contain 0.05-2% sodium fluoride, aminofluoride, 4% titanium fluoride with 1-5% chlorhexidine or triclosan, 0.4% tin fluoride have proven themselves well. Deep fluoridation involves the use of dentin-sealing liquid in the diagnosis of “caries of the tooth root”, which contains fluoride crystals and copper ions. It is advisable to use fluorides in combination with calcium preparations (10% calcium gluconate solution and 0.5-1% sodium fluoride solution for applications to the root lesion site).
Also noteworthy is the treatment of superficial and deep caries with a filling technique.When treating subgingival cavities, a difficult situation often arises: the inability to isolate well the place for future fillings from saliva, gingival fluid, blood, etc.
As a result, the doctor carefully protects the gum from unnecessary damage: it can conduct its diathermocoagulation (removing excess gums that have been heated to high temperatures with a tip), retraction (correction of overhanging edges) of the gums with special threads soaked with hemostatic solution. The whole procedure is carried out, of course, with good anesthesia to achieve optimal end results in the treatment of root caries.
Treatment of the cavity is carried out under water cooling of the tooth, an oval cavity, which is free from caries and infection, is formed more often with additional platforms for better fixation of the future filling. It is treated with antiseptics and sealed.
Currently, the complexity of the choice of material for filling is associated with different types of cavity location, its shape, the presence of various interfering factors: saliva, blood, gingival fluid, etc.It is difficult to put the material "dry", and modern composite ("light") fillings are very sensitive to a moist environment.
Acceptable materials for seals at present:
- Amalgam Unfortunately, dentists, this material is increasingly used because of the complexity of the organization of kneading material. These are the most durable fillings that are mixed with mercury, therefore, they require the creation of conditions for the protection of personnel.
- Compomers. These are materials that combine the positive properties of composites and glass ionomer cements. However, there are moments when the properties of the composites in them prevent the seal from the compomer from successfully “catching on” for guaranteed fixation on the tooth.
- Glass ionomer cements. This is the best option for sealing deep subgingival defects, as this material is best glued in a wet environment. Fluorides are also introduced in it to restore the normal mineral structure of the tooth over a long period of time.
Deep defect prosthetics
In addition to treatment with traditional methods of filling, methods of prosthetics of cavities with inlays and crowns are also used.The tab is, in fact, an artificial filling made of metal or ceramics, which is made by a dental technician, and the orthopedic dentist on cements or special glues fixes the prepared and cleaned carious cavity.
Convenience is that the tab replaces large cavities with messages with the subgingival part, and the risks of fixing difficulties are minimal. Since the tab has a stump - “tail”, which is fixed in the root of the tooth, it reliably remains cemented and performs its functions in full.
A crown is an artificial cap made of metal or a combination of metal and ceramics, which is securely fixed to the tooth and covers all its surfaces from the effect of infection from the oral cavity.
The picture below shows an example of restoration of a destroyed tooth using a tab and crown:
A correctly inserted tab or crown provides excellent protection of the tooth against possible complications of root caries: fracture, crown breaking, “rotting”, various gum abnormalities. However, it is worth remembering that before staging the crown, the tooth is either sealed using conventional technology, or a tab is fixed onto it, and then a crown.Only this gives a positive result for the long term.
Pricing policy clinics
Based on the criteria of the modern pricing policy of most clinics, it is useful to keep in mind the following points.
- For any material there are certain indications. A good doctor will never do the work with a tooth that is contraindicated in a given clinical situation. If it is enough to put an inexpensive filling out of glass ionomer cement - the doctor fixes it, and if the tooth is destroyed so that a tab or filling + crown is needed, the dentist will draw up a treatment plan, explain the cost and save the tooth in full.
- Filling materials are always cheaper than materials for dental prosthetics. Seals are much cheaper than aesthetic and functional crowns or tabs. However, there are exceptions.
Timely treatment of tooth decay is an important stage in the preservation of the tooth, the prevention of serious complications from the tissues surrounding the tooth, the adjacent teeth, and the bite as a whole. If there are any signs of abnormalities in the gums or suspicion of a carious cavity hidden under the gum, you should immediately contact a professional dentist for help.
Under normal conditions of the oral cavity, it is enough to visit the dentist's office once every 6 months for the purpose of routine inspection for early detection of caries. Take care of your teeth and be healthy!
Interesting video: complications in the treatment of the tooth root
An example of the treatment of deep caries
Root apex resection
Generally speaking, such nosologies as hidden caries are not in medical reference books and encyclopedias. Although the dentists themselves and their patients by this term ...
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 visible to the eye ...
Most people more than once thought about what the word "caries" itself means, even despite a more or less clear understanding of the processes, ...
In my upper teeth, as I understand from your article, cervical caries, how is it treated? And is it possible to do something without tearing out? (so far there is no discomfort, but I am afraid of the consequences).
There is a complex of treatment: special grinding of caries and the installation of photo seal. Visit the doctor 2 times a year. Undergo prophylaxis: polishing, applying a cleansing gel and fluoridation. Brush your teeth after eating. Healthy teeth!
In my lower front teeth, the gums move away from the teeth, the deposits are removed, but the gums also move away. What can be done to strengthen? I'm afraid I'll lose my teeth. FRONT, it's a disaster. And I'm afraid that caries will appear on the roots.
Hello Olga! I think you should go to a periodontist dentist. This is a specialist in the treatment of diseases of the gums and mucous membranes of the oral cavity. The treatment plan will be drawn up on the basis of a careful clinical examination. Almost always the process is a set of measures aimed at restoring the periodontal attachment. For example, you may need plastic gums, periodontal dressings on the gums, curettage of periodontal pockets, etc. The choice of treatment tactics belongs to the doctor after an internal examination. Health to you!
I have four front lower teeth stoked ... Can I restore them? Hike to the dental technician did nothing.
Hello! It seems to me that you are confusing a dental technician with an orthopedic dentist ("prosthetist"). I think that you went to an orthopedist who did not offer you anything suitable. If we are talking about the abrasion of teeth, then it is extremely difficult to restore such teeth. The fact is that the bite you, most likely, is exactly that convenient, therefore, increasing the data of the teeth in height will be a traumatic option for the bite. It seems to me that the reasons for the orthopedic dentist were quite to refuse you. I am sure that you should turn to another orthopedist, who has the ability to gradually “lift” the bite with the help of special caps, which will have to be worn for medical purposes. So the bite will gradually form to such an extent that something can be done with an increase in the height of the front lower teeth. Most often this is already done with crowns in the last stage of treatment. However, this approach takes on average about 6-12 months: it all depends on the required millimeters of height.
Hello, I have caries of the front tooth, with the edge of the two, which are bigger ... In general, the gum over this tooth is darker and slightly swollen. I think caries is also under the gum. Will I delete it, or can I save it?
Hello! The final verdict for your description will be made only by a dentist, putting you in a chair. It all depends on the depth, area of the lesion, the mobility of the tooth, its position, bite and other nuances determining the future. Immediately I can say that most often the front tooth can be saved. Often, the preservation is complicated by technical nuances: root canal treatment, root inflammation, subsequent tooth restoration with or without a pin, etc. Creating an insert for it + crowns can be an alternative or more reliable method for preserving a tooth. Before this, the doctor reliably occludes the canal and prepares the tooth for orthopedic work. In general, each doctor may have his own opinion on the possibility of preserving one or another tooth with its peculiarities of carious lesions, etc. For my part, I advise you: after receiving the verdict of “tooth extraction,” I recommend having another 1-2 consultations in other clinics in order to have some objectivity in your clinical situation.Successful diagnosis and treatment!
Hello! I have stones on my four lower teeth. Half of the root of one of the teeth fell out, root decay began at the same tooth, and after that the cervical caries began. This tooth has become very weak, even when a soft dough hits, it starts to hurt badly. I am very afraid of losing it. Tell me, please, can the doctors help this tooth, if it starts to cause pain when it gets very soft food? What then will be in contact with a dental instrument? A tooth can fall out at all.
Hello! In fact, the pain of irritation when eating is not a problem. The tooth can always be depulped and the sensitivity will disappear. However, if you have periodontitis, it is unlikely that the doctor will undertake not for the most “strong” lower front tooth, although all this is decided individually. The least information at the moment about the mobility of the tooth: I can not assess either his "reel" or the degree of "exposure" of his cervical area and the extension of the clinical crown. All this is evaluated by the dentist and as a result the verdict is rendered.They save such teeth according to the situation (it is generally necessary when it is correlated with bite, other teeth, etc.). The approach in this case is complex: it begins with the treatment of the canal and its filling and ends with the work with adjacent teeth and their splinting between them. Neighboring teeth often also have to be treated.
Hello. I was diagnosed with caries of the tooth root. No treatment was offered. The tooth did not hurt itself. Only when the doctor pounded on it with an instrument. It was suggested to remove in order to avoid complications. Tooth removed, but I do not see at the root of caries, as in the photo. I see that gutta percha sticks out of the root. Could it be that the tooth was removed in vain? Or perhaps caries inside the temporary fillings?
Hello! I think that your suspicions are not in vain about the removal of a tooth that does not have a root caries, but a complication after the treatment - the removal of gutta-percha over the top of the root, and possibly, perforation of the bottom of the tooth.
It seems to me that the situation was as follows: the dentist decided to retrain this tooth, but he encountered some obstacles.To overcome them, he could not with the help of further conservative tactics, and the only correct way out in this situation, in order to prevent your future suffering, was tooth extraction.
You write about a temporary filling and gutta-percha, which indicates that the tooth was treated intrachanally. I think that there was definitely no talk about root caries, but there was something serious. Maybe the colleagues did not want to expose their own colleagues, or there was something else, but what difference does it make now if the removal fact itself is completed, and it will be difficult to prove something now. The tooth that you have in your hands could be sent for examination, because the extracted gutta percha beyond the root is already a complication that the first doctor who treated you for channels allowed. For the rest, it is only after the extraction of the temporary dressing and the assessment of the condition of the bottom of the extracted tooth. Well, the picture would not hurt at the time when the tooth was still in its place in the dentition - as a justification for the fact that there were clear indications for removal.
Hello, I took an x-ray of a 6 tooth (3-6), on which root caries was found.The doctor drilled the tooth and laid the medicine to kill the nerve. The tooth ached, the gum became gray and moved away from the tooth. After 2 days (since it was a weekend) I went to the dentist again. She said that this medicine had passed through the cavity in the tooth, and because part of the root was bare, she healed him (I did not see the cavity, the information from her words). After that, she cut off part of the gums, saying that she would recover better, and laid the medicine. On the next visit, she tried to clean the roots, but after spending 5-7 minutes for one minute (she didn’t even watch the others), said that the roots are thin and she doesn’t see them, and it’s not necessary to open them at all. She put in a “mummifying” ointment (according to her, she dries out the nerves left in the roots) and put a seal, saying that if she gets sick, she should be removed.
Last week, the tooth hurts when biting. I do not want to delete it. Can you comment on the failure of root treatment? Maybe because of them the tooth continues to hurt? And can this lead to inflammation at the roots?
Hello! I think that this is a routine treatment method. Most likely, there are certain problems in this institution.The mummifying method is not the best way to save a tooth. In the course of treatment, there was also a serious mistake that led to a complication. I will not blame the doctor - I do not know under what conditions he has to work.
The tooth hurts when biting with a high degree of probability due to the aggression of the unmounted channels of the mummifying paste introduced at the beginning. There is also a risk that the tooth hurts due to an infectious process.
It is difficult for me to comment on the refusal of treatment of the channels, I cannot know whether the channels are objectively so complex, or all of this is the result of the routine treatment approach available in the clinic. This treatment may well lead to inflammation. In some cases, these teeth can become seriously ill after 1-3-5-10 years. It all depends on how well they are mummified. Yes, this old method also has rules, without violating which it is quite possible to get some success with all those minuses that made many countries abandon this drug and the way of preserving such teeth.
My advice is this: to re-over modern methods, it’s not too late, the tooth of a highly qualified doctor is in the clinic, where there is good equipment and time to work normally, perhaps on your complex canal systems.In principle, this is quite realistic, and the issue of price is purely individual, and is discussed with the dentist in advance.
I have caries of the front tooth root on the top row of teeth. The doctor of municipal dentistry refused to treat - he said, delete. And I feel sorry for the tooth, what to do, help!
Hello! In a public institution, they often refuse complex teeth for various reasons: there is no funding, motivation, desire, materials, skills, experience in this area, etc. That is why I recommend to go to a private clinic, or to several clinics in order to have a more complete picture of the possibilities of saving a tooth, as well as the prices of various options. Often, in case of caries, the root is depulped and a crown is placed for reliability. There is also another way of preserving: retraction of the gums and treatment of caries with glass ionomer cements or (less often) with composites. It all depends on what your clinical situation and the state of adjacent teeth, taking into account the bite. In general, a lot of things affect, so you need an inspection by an experienced specialist.So I recommend to get advice in different clinics, since in more than 50% of cases, consultations are positioned as free or are inexpensive.
Hello! I was sealed channels in the bottom seven for insurance LCA. The picture clearly shows that the filling material came out in a thin stream below the root itself in 2 channels. The jaw bottom whines not much and gives in the ear. Above now is a temporary seal. On the neck of this tooth is an open hole for cleaning caries. The temporary seal does not hold.
What to do if the tooth is not calmed down, and how will the seal on the neck of the tooth hold?
Hello! The fact that the material is brought out of the root is a complication. Whether it will result in something serious for the future, even if the symptoms disappear in a few weeks, is unknown (in order to at least roughly predict, you need to know what material is derived). Reputable dentists oppose the removal of materials for the top of the root.
As to the possibility of holding a seal in the cervical area, there are, of course, some nuances, but usually the material of choice is glass ionomer cement or a light-cured seal.When performing technology work with this area, the seal is kept for years without problems.
Hello! After CT, I was diagnosed with caries of the root of 7 teeth. Four months before that, I had an 8th tooth removed (difficult, traumatic removal), and then I also did a CT scan and with the 7th tooth everything was all right. Does the fact that there is a caries root, the fault of the doctor? I have to remove other teeth, I don’t know whether to look for another, as the doctor himself really liked.
Hello! For 4 months, root caries would hardly have formed, but not the fact that at present it takes place at all. I could comment in more detail if I had pictures in my hands. If you trust the doctor - trust completely, otherwise check according to the data of the images. At the same time, keep in mind that it is much easier to understand the clinical situation in the dentist’s chair than in absentia (that is, you need to contact another doctor for face-to-face consultation, and it’s better to go to another clinic).
If you, by the doctor’s fault, mean some complication during the extraction of an 8th tooth, resulting in caries of the root on 7th tooth, then this is excluded.If this gap between the teeth in the presence of a wisdom tooth was constantly “blocked” by food, then root caries on the 7th tooth developed over the years, and after removing the end tooth, it simply became visible (especially if the cavity is deep). The image can reveal even a small in depth carious process in the gum zone. Maybe this is your case.
So here either trust the doctor, or - to check it. Choose you.
Hello, turned the other day in a free clinic, removed the carious root, and the crown itself has long been destroyed. And this root began to disturb at night. And now I understand that it might have been possible to keep him in a paid clinic. They also plan to remove a wisdom tooth and send it to an x-ray. You know, I really do not want to lose my teeth in my 26 years. What do you advise to do? And what should I put in place of a living gum? I read about bridges and about implantation, it seemed to me a better way. I don’t want to lose two more teeth because of the bridge. So scary is all ...
Hello! Implantation would be the best option so as not to process the adjacent teeth under the crown of the bridge.However, there are also contraindications for implantation, which can be a serious obstacle to the implant engraftment in the bone, so that the optimal options for prosthetics in each case are selected individually.
Regarding the need to remove a wisdom tooth - without additional information this question cannot be answered, because a lot depends on the condition of the tooth (whether it is impacted or polyurethinized, as it is located in the jaw bone, whether the cheek mucosa is injured, there are inflammatory processes on the roots .d.) I recommend to find a good doctor in a paid clinic (ask around with friends, for example) and make a joint decision with him.