Details about caries and the causes of its development

In the tooth there are three parts: the root, neck and crown. The anatomical crown is normally located above the gum, and the neck and root are covered with surrounding tissues. That is why caries, which is located on the border with the gum and near the neck of the tooth, is called cervical (otherwise - cervical).

Below are some photos with examples of cervical caries:

Many people begin to take seriously the cervical caries and its causes, only when the problem is clearly evident in the reflection in the mirror and causes natural aesthetic inconvenience. Smile area for people who need to communicate for the implementation of certain tasks, is of particular value. And since the cervical caries is often localized on the front teeth, there is an urgent need to return the aesthetic component.

The photo below shows a typical example of cervical caries on the front teeth:

In this case, a lot of questions arise regarding the causes of such problems and, of course, regarding possible methods of eliminating cervical caries, which we will talk about later.

 

The main reasons for the appearance of cervical caries

The main causes of the development of cervical caries in general differ little from the causes of other forms of carious lesions of the teeth. They are related:

1. With the nature and diet: the number and frequency of consumption of foods containing easily fermentable carbohydrates.
2. With microbial factor: activity under the dental plaque and in its volume mainly of bacteria of the species Streptococcus mutans. At the same time, bacteria ferment carbohydrates with the formation of organic acids, which affect the surface and subsurface enamel layers with the formation of demineralization foci. As a result, calcium, phosphorus, fluorine are washed out, the mineral crystal lattice of the enamel is broken, with a gradual formation of a carious stain.
3. A very frequent cause of carious lesions is also the lack of adequate oral hygiene (well-formed manual skills for cleaning the surfaces of the teeth, the mode and frequency of this procedure).

The photo initial caries in the cervical area of ​​the tooth:

From the experience of the dentist

Often people ask me questions like: “Why, then, does my brother eat as much sweet as he wants and when he wants for many years now, and even doesn’t even clean his teeth, but they are still intact, but I have solid fillings?”.

The fact is that although the causes of caries are the same for everyone, they affect everyone differently. A significant role in preventing caries is played by the composition and amount of saliva, its remineralizing properties, the functional state of the body, the influence of the environment, the caries susceptibility of the tooth surface, the individual structure of dental tissues, determined by genetics and heredity.

However, there is a number of features in the cervical area of ​​the tooth, which contribute to the fact that the carious process here can very quickly go from the initial caries stage to the deep ...

 

A variety of clinical picture

In its development, cervical caries goes through all the same stages as any other:

• Caries in stains;
• Surface;
• Average;
• Deep.

The peculiarity of cervical caries is that it is often difficult to determine at what stage of destruction enamel and (or) dentine are located.It is especially difficult to establish the difference between caries in the staining stage and surface caries, as well as between medium and deep.

This is due to the fact that on the border of the transition of the crown part of the tooth in its neck is thin and often poorly mineralized enamel. As a result, the cervical area tends to excessive abrasion with improper brushing techniques, excessive strain on the brush and the use of highly abrasive toothpastes (usually called bleaching).

As a result, over the years, the thickness of the enamel in the cervical area becomes less and less. And as soon as this zone ceases to experience the cleansing factor, the combination of several cariogenic mechanisms quickly develop cervical caries.

 

On a note

Many patients mistakenly call cervical defects cervical tooth caries. From the point of view of caries classification, such forms do not exist, but when a patient requests to cure “cervical front tooth caries,” the doctor easily understands what help is needed from him (and often it is not even caries, but about wedge-shaped defects about which we still talk below).

Pre-gingival caries is a synonym for cervical. It is only important to distinguish the gingival from the subgingival. The first develops directly above the gum, and the second - on those parts of the tooth that are below the gum.

Most people with the appearance of carious spots on the teeth in the cervical area (initial stage) may already experience unpleasant sensations: discomfort, harsh feelings and even certain pains characteristic of hypersensitive teeth, but this is less common. Basically, caries in the stain stage is asymptomatic and is only visually determined as a white or pigmented spot.

Below is a photo of the cervical caries in the stain stage:

In case of surface caries, pain often occurs from chemical irritants (salty, sweet) and from temperature (cold). Externally at this stage, the disease resembles caries in the staining stage, but when probing at the dentist with a special sharp instrument (probe), a roughness zone is revealed in the center of the extensive spot.

Medium and deep cervical caries are often characterized by a whole range of pain symptoms from all types of stimuli.Sometimes they can be joined by pain from mechanical effects, when hard food is ingested, but this is rarely due to the shape of the teeth, which protects the cervical areas from food getting under the gum edge.

Cervical caries of the front teeth often causes pain when inhaled cold air.

Feedback

A month ago, I was forced to go to a dentist, as the front teeth fell out. First, the most anterior parts slightly darkened near the gums, and then the canines. This was not the end. Just a few days before a visit to the dentist, I began to feel severe pain in the front teeth from cold water and sometimes from sweets. I tried to drink warm water and eat less, but this could not continue. I turned to the clinic, where in 5 visits I first repaired my front teeth, and then fangs. They said it was a running cervical caries. Color, however, picked up is not quite perfect, but saved money.

Maxim, Togliatti

The following photo clearly shows deep caries in the cervical area:

 

Cervical caries and circular: similarities and differences

For the cervical caries the following lesion zone is characteristic: the gingival areas of the vestibular (buccal) and lingual (palatal) surfaces of the lateral and front teeth.

If the causes of the pathology are not eliminated, then there is an increase in the boundaries of caries lesions in the cervical area to the contact surfaces with a tooth enveloping in the form of a ring - in this case they already speak about circular caries. That is, circular caries can be conventionally called the "complication of the cervical".

Mostly circular caries affects the milk teeth, especially in debilitated children. It is also called "ring" or "anular."

In the photo below you can see an example of circular caries on the baby’s baby teeth:

It is not difficult to guess that circular caries, as more aggressive, often proceeds with severe clinical symptoms, and even sometimes leads to breaking off or spalling of the crown part of the affected tooth. However, in some cases, even such serious defects may not cause pronounced pain, as they produce replacement dentin, which protects the pulp from irritation.

 

Possibilities of differential diagnosis of cervical caries

At home, it is difficult to determine exactly what kind of education on the tooth spoils the aesthetics or causes painful sensations. Spots, strokes, defects, indentations in the cervical area - all this can characterize the following types of pathologies:

1. Actually cervical caries.
2. Diseases of non-carious teeth (fluorosis, hypoplasia, erosion, wedge-shaped defect, etc.).
3. Various variants of pigmented (stained) plaque, up to the so-called “smoker raid”.

The photo below shows the stains on the teeth during fluorosis:

Of all these options, cervical caries ranks first in terms of the number of people visiting a dentist. Other types of pathologies are less common.

Only the doctor can correctly make the final diagnosis, but you can correctly navigate even before visiting the dentist yourself. Most often, difficulties arise when comparing caries with fluorosis and enamel hypoplasia.

The age of a stain or stains on the enamel, as well as their location on different parts of the tooth crown, may indicate hypoplasia (its cause is underdevelopment of the tooth enamel, caused even at the stage of fetal development in the mother's body).In confirmation of the diagnosis, the dentist conducts staining stains with a 2% solution of methylene blue. If the stain is not stained, this is enamel hypoplasia, and not cervical caries in the stage of white spot.

Fluorosis is more difficult to distinguish from caries and other non-carious lesions. Here it is important to know the level of fluoride in drinking water in the area or in the area of ​​early residence. If it is elevated, then the multiple character of the spots located on the teeth of the same name at the same time indicates fluorosis. Cervical caries often develops as a single carious stain.

It is important to distinguish between a wedge-shaped defect and cervical caries: they differ in that the former is wedge-shaped or V-shaped. With a wedge-shaped defect, the walls of the cavity are dense, smooth and shiny, which is not the case with carious destruction of the tooth in the cervical area.

Despite the fact that the localization of these diseases is the same, the appearance of the cavity always prompts the doctor the correct diagnosis. In addition, the initial forms of caries and wedge-shaped defect can be recognized by staining with special caries indicators.

There is no such thing as a wedge-shaped tooth caries. This is the erroneous everyday name of the wedge-shaped defect.

In the photo you can compare the wedge-shaped defect and cervical caries:

Feedback

I turned to the dentist about the strange destruction of the front and rear teeth on the left. I am already 50 years old, almost all of my teeth, did not suffer from caries, unlike my relatives, but recently I felt the pain of cold water and began to look at my teeth in front of a mirror. I found some holes near the gums on the canine and on the other teeth only on the left side.

The doctor said at the reception that these are wedge-shaped defects on the three teeth on the left, and not at all caries. The possible reason turned out to be that I was right-handed, and I always brushed my teeth strongly and for a long time, so I erased the enamel on the left side, since it is more convenient to clean it. The dentist showed me that on the right, too, there are beginning wedge-shaped defects, but they are not pronounced yet.

Sergey, Volokolamsk

 

Modern methods of treatment and the specificity of the choice of materials for fillings

Depending on the depth of the lesion, an appropriate treatment strategy is chosen.

Home treatment of cervical caries can be carried out as an adjunct to the treatment of caries in the stain stage. In this case, apply:

• toothpastes and gels containing fluoride in high concentrations, as well as calcium and phosphorus compounds;
• dental floss (floss), impregnated with fluoride;
• rinse again with fluoride (since this element is very effectively contributes to the mineralization of tooth enamel).

It is dangerous for health to use independently complexes containing fluoride without prior consultation with a dentist. Any prescription of drugs or additional means is repelled by the diagnosis, activity of the carious process, the area of ​​the lesion, long-term results and possible risks.

Cervical caries in the staining stage are most often amenable to conservative treatment, that is, without using a dental drill. However, due to the proximity to the gingival tissues, the constant flow of gingival fluid into the working area and a thin layer of enamel, certain difficulties are created for applying some new techniques.

For example, modern minimally invasive ICON technology (Aikon) due to the proximity of the dentin in the cervical area is limited to use, since the substances used can not affect dentin.It is difficult to determine how thin the enamel in the cervical area of ​​a particular person is, therefore this technique is rarely used for cervical caries.

Chemicals related to remineralizing therapy and deep fluoridation of enamel have become widespread.

The following drugs are being actively used in adult and pediatric dentistry for the treatment of primary cervical caries:

• Gluftored;
• Enamel-sealing liquid;
• Belagel Ca / P, Belagel F.
• Remodent.

Treatment of superficial, medium and deep cervical caries in case of impossibility of conservative therapy is carried out in the following sequence:

1. Anesthesia (anesthesia) to ensure painless manipulations.
2. Cleansing of carious tooth from dental plaque to reduce infectious load.
3. Dissection (mechanical treatment) of the tooth to remove carious and pigmented tissues.
4. Drug treatment of the cavity with weak solutions of antiseptics.
5. The formation of the cavity according to the selected material for permanent fillings.
6. Filling the formed cavity.

The complexity of the choice of material for the filling is determined by the direct location of the formed cavity near the edge of the gums. The closer the cavity is to the gum, the more difficult it is to properly install the material. The reason for this is the possibility of moisture, gingival fluid and blood on the working surface.

Opinion dentist

The most difficult for high-quality filling is not even the gingival cavities, but their combination with subgingival cavities. Combined forms are not so rare and are associated with the activity of the carious process in a particular tooth. Often, cervical caries of the front teeth is complicated by subgingival defects, which as a result of preparation can be difficult to isolate from the fluid (blood) even with the use of cofferdam. In this case, the doctor chooses a material that may be inferior in strength and aesthetics, but reliably hardens in a wet environment.

Due to the specificity of the localization of carious cavities, the choice of dentists comes down to the use of glass ionomer cements (JRC), which are more resistant to moisture than aesthetic light-cured composite materials. Of particular interest are hybrid JRCs.

On a note

One of the most widely used glass ionomer cements for sealing cavities in case of cervical caries is VITREMER (Vitremer). This is one of the few JRCs with a wide range of colors, a triple curing mechanism and high strength. In the treatment of cervical caries, this material competes with aesthetic light-cured composite materials.

Modern techniques and technologies allow combining glass ionomer cements with composites to achieve maximum effect. Proper execution of the instructions for the materials used makes it possible to profitably use the positive properties of each subsequent material when introduced into the formed cavity, creating a seal with reliable fixation, increased retention time, strength and aesthetics.

An example of sealed teeth after treatment of cervical caries is shown below in the photo:

Unfortunately, many budget organizations cannot boast the possibility of using modern technologies and materials.The equipment of hospitals and clinics is often limited only by the compulsory medical insurance materials, where there is no cofferdam, saliva ejector, modern and convenient for working with cervical defects of the JRC, light-cured composites - all that is required for quality work in the long term.

Feedback

A week ago, standing in front of a mirror, I found a dark spot near my gum on my front upper tooth. There was no pain, but the fear of the prospect of going with a black tooth to me, as a teacher of physics at school, seemed stronger than the fear of the dentist since childhood. They advised a good doctor in a small private office, where, after examining the stain, the doctor said that it was a cervical caries, which had already destroyed all the enamel and had gone a little under the gum. It turned out that fear has large eyes: they made a good import injection, drilled a little, put a seal at a time, and even the color of the seal, it can be said, is almost like a real one — not even distinguished from the outside.

Alexander, Omsk

 

Features of early diagnosis and prevention of cervical caries

Among the common methods of diagnosis of cervical caries are the following:

1. Visual methods.They are actively used by both the doctor and the patient. When caries occurs on the front teeth, it is not so difficult to recognize defects (especially in neglected form). The doctor in this case requires only a dental mirror and probe.
2. Laser diagnosis. No less popular method, especially when it comes to hidden caries or caries in the root zone. One of the devices, Diagnodent, uses the principle of changing the characteristics of a laser beam reflected from tooth tissues affected by caries. As soon as cervical caries or root caries is found, the device beeps.
3. The method of vital staining carious spots. It is ideal when a doctor doubts the diagnosis of caries. The easiest and most reliable way is to stain the stain with a special caries marker (indicator), which is used, for example, with a 2% solution of the dye methylene blue. If staining has occurred - this is the initial caries. Other well-known chemical dye preparations can also be used: 0.1% methylene red solution, carmine, congot, tropeolin, silver nitrate solution.
4. Transillumination.The technique, which is used much less frequently, but allows you to identify the initial forms of cervical caries when the teeth are illuminated with a bright beam of light. At the same time, shadow formation is estimated when the beam passes through healthy and caries-affected tissues.

Modern prevention of caries is aimed at eliminating the causes of its development:

• First, it is necessary to break the chain “carbohydrates - the microbial factor” (which will stop the development of not only cervical caries, but in general will significantly improve the cariogenic situation in the oral cavity).
• Secondly, it is necessary to strengthen the mineral structure of enamel.

To realize the first direction it is necessary to perform the following actions:

1. Observe the mode and nature of food, focus on solid and moderately coarse food, increase the amount of fruits and vegetables (especially after the main meal), limit the consumption of easily fermentable carbohydrates in any form (cakes, cookies, sweets, sweet buns, etc.) .).
2. Adhere to the important rules of hygiene: clean with a brush, toothpaste and floss all available tooth surfaces at least twice a day, and rinse your mouth immediately after each meal.It is important to understand that brushing the teeth before eating does not give a good result, since the dental plaque, which is seeded with microbes, is formed in a matter of hours after a snack.

On a note

Floss (dental floss) is by no means a waste of time, but a thorough cleaning of the most difficult to reach contact surfaces, especially in the cervical area, where caries begins to form most often.

The photo shows an example of the use of dental floss:

To strengthen the mineral structure of enamel, it is sufficient to combine the above methods with various forms of preparations for remineralization and fluoridation at home. The range of products containing mineral components (fluorine, calcium, phosphorus) in their various combinations is huge. The dentist will help you to understand what is best for the health of your teeth, and also has less risks when you apply yourself.

The most popular for home prevention of cervical caries are: toothpastes with fluorine and calcium, rinses (with fluorine), dental floss soaked with fluoride.

The correct and safe combination of methods and means of prevention is usually selected at the dentist’s appointment.Within 20-40 minutes, the doctor can tell about the pros and cons of each of them, determine the most appropriate option for you, taking into account individual parameters (tooth caries, teeth hygiene and condition of the cervical area).

 

An interesting video about the features of caries

 

An example of the treatment of deep cervical caries using a drill