What is important to know if caries has destroyed deep-lying internal tissues of the tooth ...

The term "internal caries" ordinary patient dental clinic usually understands the disease, affecting tissue deep under the tooth enamel. At the same time, doctors know that by and large, any caries affects exactly the internal tissues of the tooth, which are softer and more easily damaged than enamel. Therefore, the phrase "inner caries" can be applied to almost any case of the disease and by and large is a tautology.

In some cases, internal caries is said to mean the pathological process under a crown or a poorly fixed filling. Here the caries inside the tooth develops completely unnoticed both for the doctor and the patient, and only shows itself when the enamel is covered by a pathological process around the filling (crowns) or when pain occurs. But again, this is all the same ordinary caries, just with non-standard localization.

However, the reasons diagnosis and treatment of caries inside the tooth have their own specifics.

 

Signs and appearance of teeth with deep caries

In the photo below - internal caries on the tissue under the destroyed enamel. This is a typical type of disease developing inside a tooth. Dark areas of the affected dentin are clearly visible:

It is the changed color of tissues damaged by caries that is the main diagnostic sign of the disease. In the overwhelming majority of cases, the doctor unequivocally makes the diagnosis "caries" precisely by the black points on the enamel or on the fissures.

From the practice of the dentist

Black dots on the teeth may indicate either congenital or acquired (most often) pigmentation (“smoker’s bloom”, etc.), but more often - on hidden caries. When you begin to drill such points, they go so deep that 70-80% of the points within the enamel are completely removed, and 20-30% reach the dentin, and sensitivity appears (if the patient, due to the refusal of anesthesia, asked to manipulate the conditions until it becomes painful). Since the patient is always right, we act according to the situation: it becomes painful - we will coordinate and administer anesthesia according to the protocol to the brave client.

Sometimes even seriously damaged teeth with internal caries can seem perfectly healthy. So, if the surface from which the damage began, fits snugly to the other tooth, caries can develop deep in the internal tissues, and even with a close examination of the oral cavity with the naked eye goes unnoticed. The situation is similar when the caries inside the tooth develops from damage in the enamel located below the soft tissues of the gums (root caries).

In most cases, at the first inspection of the teeth, their walls (surfaces) affected by caries are striking. These are often not carious cavities, but simply gray, dull enamel, which has lost its healthy appearance due to demineralization.

Often, the dentist sees a certain “tunnel” in the gap between the teeth, but the probe may, due to the density of the interdental gap, not pass into the hidden internal carious cavity. Usually, the doctor shows the patient the grayish shades of enamel against the background of the developed internal caries in the mirror and, after anesthesia, starts the treatment of the tooth.

When boron touches gray enamel, in almost 90% of cases, after a couple of seconds, it breaks off and boron falls into the innercavity with an abundance of carious, pigmented, infected and softened dentin. If the anesthesia is performed by the doctor correctly, there is absolutely no pain.

The doctor performs cleaning and filling of the tooth strictly according to the caries treatment protocol. If there is already a message in the tooth with the pulp chamber (the cavity where the nerve is located), then the doctor will depulpate and fill the canals with the subsequent production of permanent fillings in one or two visits.

The photo below shows a tooth in which deep internal carious cavities are visible under bright light:

The following photo shows fissure caries, that is, localized in the area of ​​the natural relief of the teeth. Under such darkening inside are also often hiding significantly destroyed tissue, which is not immediately detectable during a routine inspection:

At home, such an "internal caries" is almost impossible to detect. He will present himself only in case of extensive damage to the dentin and pain in the tooth when the pulp is turned on in the pathological process. That is why preventive visits to the dentist are so important,which by special methods can detect caries at any of its localization and cure a tooth before its depulpation (nerve removal) is required.

 

Causes of deep caries

The causes of caries in deeply located tooth tissues are similar to those for caries with any other types of its localization. The disease develops due to the following factors:

1. The constant presence in the oral cavity of acids, as trapped here with food (fruits, vegetables), and produced by bacteria that consume the remnants of almost any carbohydrate food - flour, sweets, cereals.
2. Reduced secretion of saliva or its low bactericidal activity. This may be caused by other diseases or metabolic disorders.
3. Mechanical and thermal damage to tooth enamel.
4. Hereditary factors.

Caries usually develops under the influence of a complex of several such factors.

In any case, it is in the deep, under the enamel parts of the tooth that caries develops most quickly due to the greater susceptibility of the tissues to the action of acids. Therefore, there are often situations where a barely visible (and even generally invisible to the naked eye) opening is an extensive cavity destroyed by the carious process.

On a note:

That is why the enamel is almost always broken off (coming off in a piece) when a large carious cavity has already formed that affects the layers of softened infected dentin. That is, the enamel can hold the load for a long time, hanging over the hidden carious cavity, often without giving it away.

 

Features of diagnosis of caries inside the tooth

It is much more difficult to diagnose caries inside a tooth than usual ones, which have manifestations on the enamel surface. Definitely it can be noticed when using the following diagnostic methods:

1. Visual examination, in which the doctor may notice cavities darkening under the enamel.
2. The use of caries markers - special brightly colored liquids that linger on surfaces damaged by caries. When internal caries with their help determine the boundaries of damaged tissue after the opening of the enamel. In dental practice, 2% methylene blue or fuchsin-based preparations are usually used.
3. X-rays, at which deep cavities affected by caries, have a significantly darker color.
4. Transillumination (transmission of a tooth with a bright light) and luminescent diagnostics (the same, but with the use of ultraviolet light).With such screening, the internal lesions of the tooth become clearly visible.
5. Laser diagnostics is a method by which a laser beam is sent to a tooth, which initiates its own luminescence of a tooth. The tissues affected by caries emit light in a range that is different from that in healthy areas. This is recorded by the device, which beeps and displays the results graphically on a computer screen.

In addition, neglected internal caries causes pains in the patient, at first not strong and occurring mainly when chewing hard food and contact with the tooth of very cold products, and aggravated as the disease progresses. If a tooth starts to regularly hurt without visible damage, you should definitely come to the dentist for a checkup.

The following methods can be used as auxiliary for diagnosing and confirming caries inside the tooth:

1. Fissurotomy - minimal opening of the enamel over the (presumably) carious cavity with the help of special thin burs. It is usually not carried out to confirm the diagnosis, and to clarify the boundaries of the carious area.
2. EOM - electroplating.When it is, a tooth is affected by weak currents to determine the threshold of its sensitivity. This allows us to distinguish internal caries from pulpitis.

 

Disease Treatment Rules

In all cases of caries development inside the tooth, its treatment requires the opening of enamel, the removal of the affected dentin and the filling of the cleaned cavities. In its advanced form, internal caries leads to the need to remove the nerve and fill the canals.

Even more difficult are situations when a very large amount of tissue is damaged by caries from inside the tooth, and it either splits after its removal or simply due to softening. In this situation, according to indications, it is often necessary to remove a tooth with the subsequent installation of an implant at the request of the patient, or to manage with modern prosthetic techniques.

On a note

A split split is different, so tooth-preserving techniques may include, for example, restoration of a tooth on a titanium (anchor, fiberglass) pin after its thorough intracanal treatment + installation of a crown (metal ceramics, stamped, solid-molded, etc.) may involve preparing the tooth under the tab, setting tabs + crowns.There may be many options.

Sometimes the damage is quite extensive, but they manage to preserve the roots of the tooth, removing the pulp from them. In such cases, it is possible to manage installation of the crown.

In any case, after the detection of the carious cavity, the doctor carries out its cleaning with boron. If such tissues come close to the pulp, their removal can be painful and is most often performed using local anesthesia.

From dental practice

There are ambiguous situations when the pulp area is not opened yet during the cleaning of the carious cavity, but the patient begins to feel pain when the doctor is working. Definitely it is not possible to say whether it is necessary to carry out a depulpation here or not. Without depulpation after installing the seal, it can start to disturb the nerve endings when chewing and cause pain. Some doctors tend to depulp such a tooth so that it does not have to perform repeated work if the patient begins to experience pain after installing the seal. Other dentists explain the situation to the patient in detail and make a decision with him. It should be borne in mind that many patients are very sensitive to the preservation of their teeth in a "live" form and are willing to take a chance,in order to walk a few more years with a tooth with preserved pulp, if after a simple filling the pain will not arise.

In general, even with deep caries, it is necessary to remove the nerve, according to statistics, in less than a third of the cases, and the removal of the tooth itself due to deeply penetrated caries is generally a rather rare situation.

 

Prevention of deep caries

To avoid the development of caries deep inside the tooth can, if you regularly undergo preventive examinations at the dentist and detect the appearance of the disease at the stage of the stain. With this approach, with a high degree of probability it will be possible to avoid depulpation, and in the absence of hidden caries, it will even be possible to do without opening a tooth and filling it.

To prevent the appearance of even the earliest signs of caries, the following preventive measures should be observed:

• brush your teeth thoroughly at least twice a day - after breakfast and before bedtime;
• after eating, rinse your mouth;
• do not get involved in sweets and sweets;
• remove leftover food stuck between teeth;
• Avoid getting too hot or too cold foods and drinks on the teeth.

If you are susceptible to carious damage to your teeth, you should consult with your doctor and, according to his recommendation, take calcium and fluoride preparations in the form of tablets or special solutions.

Chewing gum containing xylitol instead of sugar can be an additional preventive measure. They should be chewed for 10–15 minutes after a meal to enhance the production of saliva and clean the gaps between the teeth.

In combination with systematic use, such preventive measures will provide reliable protection against damage to the teeth, and even when the first signs of caries appear, the doctor can manage to eliminate the pathology before it spreads to the deep tissues under the enamel.

 

Interesting video: preparation and restoration of the tooth with deep caries

 

An example of a two-step treatment for deep caries