What to do if caries appeared on the front teeth

For most people, a beautiful smile is not only an indicator of good dental health and general health, but also an important element of career, success, and good dating. The appearance of caries on the front teeth can not only spoil plans for the future, but also cause serious problems in the dental system with a number of possible complications (which many do not even realize until they themselves come across).

With the increase and deepening of the carious cavity on the front tooth or between them, part of the enamel or even the entire coronal part of the tooth often breaks off, complications of caries with the development of severe pain (pulpitis, periodontitis), dentition disorder (shift relative to the natural arrangement), diction disorder (lisping ) and serious violations of aesthetics. Often there are even cases of mental disorders in case of multiple caries of the front teeth, when the problem for a person becomes very painful, constant and occupies a significant part of his free time and thoughts.

On how to recognize the earliest signs of caries development on the front teeth in time, what restoration options are available today and what should be preferred, as well as how much it all costs for money - all these and some other interesting questions we will continue with in more detail.

 

Characteristic signs of destruction of the front teeth

The front teeth are characterized by a more “thin” organization of the tooth tissues: in the cervical area (near-gingival), the enamel is of negligible thickness, so for bacteria that cause caries, it is easier to destroy this particular zone with the formation of cervical caries. Often, cervical caries here extends to the region of the side walls of the tooth and even to the inner surface with the formation of the so-called circular caries - This is a severe carious form, in which splits and breaks are possible in almost the entire visible part of the affected tooth.

The photo below shows examples of circular caries on the front milk teeth child:

Since the front incisors are necessary for a person to bite off writing, then when they are close to each other, food debris clogs up in the gaps between the teeth,often causing approximal (contact) caries or, more simply, caries between the front teeth. At the same time, the wall of the incisor damaged by caries becomes dark, almost black, and sooner or later the envelope of the enamel over it disappears with the formation of deep carious cavity.

Photo of caries on the contact surfaces of the front teeth:

However, all these are examples of quite far gone carious destructions. At first glance, the process can begin quite harmlessly - just a whitish spot appears on the teeth or in the zone between them. Often, this is not attached any importance, but in vain: whitening of enamel already quite clearly indicates the beginning of the process of its demineralization, and it is at this moment that urgent measures should be taken to save the tooth from further destruction. We will talk about this below.

To the note: “Why did the front tooth filling change color so quickly?”

The fact is that the color stability of light-cured composites depends on both the physician and the patient. The most common causes of a rapid change in color of a filling due to a doctor’s fault are: violations of the preparation techniquecavities (carious tissues left) and the restoration itself, the use of low-level materials, haste, insufficient knowledge of working with the material, not informing the patient about the recommendations after the restoration.

Causes of color change due to the patient's fault: not following the recommendations of the doctor (not to take coloring products for 1-2 hours), not showing up after 5-6 months for quality control of the restoration and polishing of the seal, etc.

 

The variety of forms and possible carious manifestations

Caries on the front teeth may look very different, depending on the clinical form, type and nature of the course. For example, the following types of caries are distinguished depending on the depth of tissue destruction:

• initial (in the stage of the spot);
• superficial (caries of enamel);
• average;
• deep.

The photo below shows an example of caries in the stain stage:

In addition, depending on the course of the disease (active or inactive) emit acute and chronic caries. When a large number of carious lesions appear on several teeth, a diagnosis of “multiple caries” is made, and localized on the front teeth (its complication iscircular) and approximal caries.

There is a classification of carious cavities according to Black, depending on their location. At the same time, there are 5 classes, the first two describing caries of the posterior teeth, and the last three characterize carious cavities on the front teeth.

In the case of caries of the front teeth, we are talking about the following classes:

• III class. Caries affecting the lateral (contact) surfaces of the incisors and canines, but without violating the integrity of the angle of the crown and the cutting edge.
• IV class. Caries, in which, in addition to the side surfaces of the incisors and canines, the cutting edge and angle of the crown are also captured.
• V class Caries, which occupies the cervical (gingival) region of all groups of teeth, but to a greater extent - from the front on the vestibular (outer) surface.

It is interesting

In the working classification of carious cavities according to Black, which is used by tens of thousands of dentists, after the death of the author himself, VI class was added, which includes carious damage only to the cutting edges of incisors and canines, as well as hillocks of posterior teeth. This innovation caused a storm of ambiguous emotions, and a number of dentists protested against the unauthorized decision to introduce an additional section, since Black himself could no longer influence this decision.In addition, neither the caries of the cutting edges of the front teeth, nor the carious lesion of the hillocks of the chewing teeth is practically encountered in medical practice.

 

Features of the restoration of the front teeth

The features of the carious process on the front teeth, in particular, its localization and degree of neglect, largely determine the approaches to treatment: the stages of cavity treatment, the equipment used and the materials used. If you are already setting up on a trip to the dental clinic for treatment, then you will probably be interested to know what you can expect there ...

So, the most favorable option for your front teeth is the initial caries or, otherwise, caries in the staining stage, that is, when the pathology barely touched the enamel and has not gone deep into hard tissues. The first stage of the carious process, when a person can independently see the process of tooth decay, is focal demineralization of enamel or, more simply, the appearance of a matte or pigmented (yellow, brown) spot on the surface of the front tooth.Practice shows that usually in future patients, in such cases, thoughts arise: is it possible to somehow whiten, sand or even somehow treat this stain on the front teeth of the house.

Well, caries in the staining stage can really be treated at home, but it is much faster, more efficient and safer to do this under the guidance of a dentist.

It is interesting

The modern approach to the treatment of caries in the stage of a stain without a drill is the Icon technology (Ikon). This microinvasive treatment is indicated for the initial caries of the front teeth with localization on the front and contact surfaces of the incisors (that is, between the teeth). This technique is especially relevant after removing braces, when in almost 60-80% of cases spots on one or all front teeth are detected. The treatment procedure usually takes no more than 20 minutes, does not require anesthesia. Consistent use of drugs included in the Icon set allows cure carious spot for one visit.

Photograph of the front tooth before and after caries treatment using Icon technology:

Superficial caries. For the treatment of surface caries on the front teeth, simple grinding with discs and polishers is often used, if the process does not touch the deep layers of enamel.If it is not possible to achieve the desired result, then the classical technology of caries treatment is applied.

Medium and deep caries. If the carious process crosses the boundaries of the enamel and reaches the dentin, then we are talking about the average caries. With deep caries, a cavity is formed, bordering the pulp chamber. In all these cases, treatment of the carious cavity is required.

Photo of deep caries on the front tooth:

The most popular method of treatment of caries on the front teeth in modern dentistry is mechanical, using burs and hand tools. Dissection (cavity treatment) with the use of a drill allows maximum carving of carious tissues to prevent the recurrence of caries and create an aesthetic filling.

The air-abrasive sandblasting method of the cavity allows using an aerosol with an abrasive substance in a gentle way to treat small carious areas on the front teeth.

The laser method of dental treatment is still not widely used due to the fact that not all clinics can afford expensive equipment.In addition, for some researchers, the effectiveness of laser treatment in certain clinical cases of caries is in doubt.

To the note: “What to do if a part of the front tooth broke off from a blow?”

An urgent need to contact your dentist for an x-ray of the tooth root. The fact is that as a result of an impact, not only the coronal part, but also the root part can be damaged, so it is important to identify a root fracture in time to implement a comprehensive approach to treatment. If the root is in order and the “nerve” is not touched, one-stage restoration of the front tooth is done, if there is damage to the soft tissues inside the tooth, the canal is treated and only then a seal is applied.

The mechanical method for the treatment of caries on the front teeth with the help of a drill provides for the maximum excision of not only softened carious tissues, but also pigmented ones. This is due to the principled position regarding future aesthetics. After all, if even a small area of ​​pigmented dentin or a dark spot on the enamel is left, then at least the appearance of the restoration will be disturbed next to the filling, and as a maximum, a repeated caries will soon appear under the filling.

In the video below, you can follow the main steps in the treatment of deep caries on the front tooth using a dental drill:

Interesting video: an example of the treatment of deep caries on the front tooth

During the machining of the cavity, an important component of the treatment is the jetting of water to the tooth, since, first of all, the front teeth have thin layers of tissue (enamels, dentin) and the proximity of the pulp chamber determine the serious risks of overheating, even necrosis. In such cases, the tooth begins to ache under the filling, and in the future you will need to remove the dental “nerve”.

From the practice of the dentist

Often, patients come to the dentist with complaints of severe pain in the front tooth and think that this caries "ached", although in fact the infection had already reached the dental "nerve" and pulpitis began. Symptoms that arise in this case in a diseased tooth can sometimes be quite similar to the caries clinic: the pain may be minor or not at all, external stimuli do not provoke a painful reaction in the tooth or it is mild. If the doctor nevertheless finds out that this is pulpitis, then one can’t get rid of one filling here ...

First, anesthesia is done without fail, then the carious cavity is cleared from infected tissues, amputation and extirpation of the “nerve” is performed (extracted from the root canal). The canal is washed with various antiseptics (hydrogen peroxide, sodium hypochlorite, etc.) and sealed to the top, that is, to the physiological narrowing of the root, with hardening filling material with or without gutta-percha pins. Work on the full treatment of pulpitis can be carried out in one visit or in several, depending on the level of technical equipment of the clinic, the characteristics of the tooth itself, the professionalism of the doctor and the approach he practices in such procedures.

After anesthesia, cleansing the carious cavity, its medical treatment with antiseptic solutions and the formation of a cavity under the material used, the color of the future restoration is determined. The materials used for the restoration of the front teeth during caries are in most cases light-cured composites. Each set produced by a company has its own color characteristics (sets of syringes with a specific color).

Before restoration the dentist evaluates:

• transparency, tooth tone and color range;
• tooth shades by zones: in the cervical part, in the area of ​​the tooth body and at the cutting edge;
• individual peculiarities of the tooth (spots of hypoplasia, the presence of cracks).

Ideally, after restoration, its surface should not resemble a “patch”, as it was in Soviet times. The finished work should have a set of such individual characteristics so that at the end of polishing the fillings a natural luster characteristic of enamel appears, each tooth zone has its own shade of color, the tooth has the same characteristic lines, microcracks, translucent congenital spots. Art restoration of the front tooth often takes up to 2 hours or more.

On a note

There are various approaches to the assessment of the final result: it is believed that the perfect restoration after the completion of the filling should be in harmony with the front tooth symmetrical to it. In other words, if there are natural pits, specks, lines, etc. on the symmetric central incisor, then they are also recreated on the tooth restored for caries.

A number of specialists are of the opinion that the final restoration of the front tooth should be matched in shape and color to the tooth being restored and to the adjacent tooth, but no more. In this case, the errors that nature created on a symmetrical incisor and which look naturally, are not repeated during restoration with a seal. It cannot be said that such a restoration technique is considered not popular.

It is advisable in advance (before treatment) to agree with the doctor what result you like more and to build on the individual characteristics of the tooth.

 

The role of prevention in the preservation of the front teeth

Prevention of caries on the front teeth is currently of paramount importance for maintaining a beautiful smile area. The complex of such activities can be divided into systemic and local application.

Systemic preventive measures include:

• restriction of carbohydrate intake and priority for fruits and vegetables for self-cleaning of the gaps between the front teeth, where food and raid accumulates;
• consumption of foods containing calcium in large quantities (milk and dairy products);
• fluoroprophylaxis under the supervision of the dentist with the use of fluorinated water, salt or milk, as well as taking fluoride tablets.

Local preventive measures:

• cleaning the front and side teeth with fluoride and calcium-containing pastes after each meal;
• the use of mouthwash for mouth with fluorine (see below for a photo example);
• remineralizing therapy and deep fluoridation of the front teeth at the dental admission and further home use of special mineralizing gels or solutions.

 

How much can the treatment cost

Compared with the treatment of caries of the posterior teeth, the restoration of the front teeth is an expensive pleasure. The pricing of the clinic depends on the type of caries (initial, medium, deep), its location (cervical, approximate) and the area of ​​destruction. This determines the complexity and duration of treatment.

The level of technical equipment of the clinic, the materials used for the restoration of the front teeth (economy class, business class, etc.), the professionalism of the dentist, as well as the chosen approach to the treatment of caries and the technique of the work are important.

For example, if the treatment of caries on the front incisor in the clinic takes no more than 20-30 minutes, not the best light-cured composite is selected, then the usual result of such treatment may be the usual patch from a seal that is often struck by others. About a beautiful smile in this case do not have to say.

Art restoration usually has an increased cost, but the output is an individual work that others will be able to detect only after a close look at the emphasis, and even then not always.

There is also an author's restoration. This is the same artistic restoration, but it includes personal achievements of the dentist, original techniques, unique techniques used during the work, combination of materials and some other techniques. The price of the issue here is sometimes prohibitively high for a simple inhabitant, but beautiful teeth can really be worth it.

 

Interesting video: an example of the restoration of the front tooth with deep caries

 

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