There are two types of caries process: acute and chronic caries. Moreover, according to a number of researchers, this separation of caries in terms of formation and development is only of scientific interest - to study the processes occurring in the tissues of the carious tooth over a given period of time. We, however, this topic will be further interesting in terms of timely diagnosis of carious lesion, treatment and prevention.
By and large, chronic caries is a characteristic of the general condition of the patient’s teeth. It can be described as the constant appearance of new lesions, their slow and imperceptible development. Only in the late stages of the carious process (with medium or deep caries) characteristic symptoms appear that cause a person to see a doctor.
Without a comprehensive fight, including the proper care of teeth, correction of diet and diet, as well as eliminating other possible cariogenic factors,chronic caries is incurable - it will appear on the teeth constantly until the causes of its occurrence are eliminated.
Chronic caries is significantly more common than acute. By and large, almost any caries that has no signs of a generalized disease is chronic with one or another speed of development. Many patients do not even take this disease seriously, considering the damage to the teeth simply as some random misunderstanding, or as something taken for granted.
From the experience of the dentist:
It should be noted that the acute and chronic course of caries are mutually intertwining processes. In other words, they are so unstable that with changes in the body for a number of reasons acute caries may slow down, acquiring a chronic course, up to a temporary suspension. Conversely, when exposure to the body of adverse factors, both external and internal (metabolic disturbances, somatic diseases, stress, hypothermia, gross eating disorders, etc.), chronic caries can turn into acute with lightning speed.
That is why in practice it is almost impossible to establish precisely the specific time of the development of caries, or to distinguish one current from another according to the patient's complaints and the external signs of the carious process. Often in the oral cavity, acute caries has no symptoms, since the destroyed part of the tooth is located in a place inaccessible to external irritating factors. That is, the tooth is destroyed quickly, and no pain is observed, which additionally causes difficulties in determining the activity of the carious process.
Chronic caries can be observed in milk teeth. This is one of the most common diseases in children, as it is difficult for parents to keep track of the state of their teeth at an early age. Sometimes the dentist is faced with the problems of the acute course of caries, when in a matter of months the child has caries in the staining stage turns into deep violations of the tooth tissues. In this case, it is necessary to immediately stop its development, after conducting a comprehensive treatment of all foci.
There is evidence that chronic caries in children can be determined already on the erupted permanent teeth. The principle of its development is the same as in the milk bite.
The clinical picture and symptoms of the disease
A typical tooth appearance for chronic caries is shown in the photo below:
There are no extensive lesions of the teeth, and the dark areas in some places are very small in size and often do not pay attention to the patient. Usually pain is absent.
In some cases, even deep caries, with a chronic course, passes with little symptoms, not to mention those initial stages of the carious process, when the disease can be treated without filling. This is partly due to the formation of replacement dentin - the adaptive response of a living tooth to the appearance of an infectious irritant focus, when secondary tissue is formed that protects the nerve from external agents and irritants.
Almost never chronic caries does not lead to noticeable destruction of enamel, which is very characteristic of acute caries.
Feedback
“I go to the dentist all my life as I can remember. There is nothing especially terrible, just constantly, in one tooth, now in another, holes appear, they have to be filled. There are no nerves in two teeth.Only now, after 30 years, I got a good dentist who explained everything well. I have chronic caries, only slowly developing. The teeth themselves are strong, but I brush them incorrectly and irregularly, so tooth decay develops.
In general, I began to solve this problem. Fully healed all the teeth (a little more than 20,000 I was all worth it), bought a normal ROX paste, a special rinse that the doctor prescribed. For the third month I have been using it all, brushing my teeth after every meal, I do not snack. We'll see if it gives a result. ”
Ilya, Moscow
At different stages of development, the picture of chronic caries has its own characteristics:
- Chronic caries at the staining stage practically does not manifest itself. The tooth may react to cold foods or air, but this is not perceived by the patient as pathology. The area of demineralized enamel looks like a whitish dull stain on the tooth.
- Chronic superficial caries leads to the formation of cavities in the tooth enamel, but still without damage to the dentin. Such a cavity has no overhanging edges, is wide, well opened, the enamel itself usually darkens due to pigmentation, but retains a relatively high hardness.
- Chronic moderate caries is characterized by a wide cavity affecting dentin. With this flow, the cavity does not have softened dentin, only pigmented is present here. carious dentin. The bottom is dense with slight ledges and roughness, which indicates a sluggish process in the compensation stage due to substitution dentin.
- Chronic deep caries differs from the average only in the depth of the cavity. It also does not have overhanging edges of the enamel, usually well polished.
At all stages of caries development, tapping on the affected area does not lead to pain. Percussion causes fast-passing pain only in case of complications such as pulpitis or periodontitis.
From the practice of the dentist
For all types of caries, percussion does not cause pain. The pain of light tapping on the tooth is associated only with the complications of caries, and this is the main diagnostic sign that concerns the official differential diagnosis of caries by protocols.
In practice, sometimes with deep cavities located on the contact surfaces, the patient may receive a kind of “food bag”. Food gets stuck here and causes gum trauma. If the patient comes with an abundance of stuck food and inflammation of the gingival papilla, then when tapping the tooth (percussion) there will be sensitivity. But we must understand that it can only hurt the gums, and not the tooth. Caries here is only a mediated cause of pain during percussion. Usually in these cases use additional methods of diagnostics. But this is a rare clinical situation; officially, for any caries, percussion is painless.
Causes of chronic caries
Generally speaking, chronic caries occurs for the same reasons that are characteristic of caries in general - because of the activity of bacteria that process the rest of carbohydrates in the mouth into organic acids. These acids regularly affect the enamel of the teeth and with one speed or another lead to its destruction. Then the dentin lying under the enamel is destroyed.
In most cases, the reason for the increased activity of cariogenic bacteria and contributing to the development of chronic caries is insufficient tooth care. The slow course of the disease indicates that the tooth enamel of a healthy person is sufficiently resistant to the action of cariogenic factors, and saliva successfully inhibits the activity of bacteria and restores the structure of enamel (saliva contains all the necessary chemical elements for this). Nature has already done everything possible to protect her teeth, and the development of the disease usually occurs only through the fault of the patient.
Chronic caries of milk teeth develops for the same reasons (one of the examples is the so-called bottle caries). Often, parents' delay in teaching the child to hygiene of the oral cavity leads to the appearance of foci of the disease, which could have been avoided if the basic rules were followed - regular brushing and rinsing the mouth after eating.
In addition, chronic caries in children is often not perceived by parents as a disease in general. Separate carious lesions are attributed to the infatuation of children with sweets, and many parents do not pay attention to prevention and treatment, because they believe that if baby teeth fall out anyway, then you should not torment your child at the dentist and spend money on treatment.Accordingly, the necessary measures are not taken on time, and as a result, single lesions become chronic.
Diagnosis of chronic caries
Chronic caries is usually diagnosed with a simple visual examination of the appearance of carious areas. Sometimes the doctor concludes that the patient has a chronic caries, on a regular check-up of the patient, when he can assess the frequency of occurrence of new lesions of the teeth and the speed of the disease.
X-ray, transillumination and luminescent diagnostics can be used to diagnose medium and deep chronic caries, but usually they do not need to be used because of the visibility of the lesions.
On a note
Fluorescent diagnostics is used to recognize the initial caries. It can also be used as a diagnosis of caries complications, as an element of differential diagnosis. Transillumination will be unnecessary when the cavity is visible to the eye. X-rays will be good for detecting hidden medium and deep cavities.
Treatment specificity
The treatment of chronic caries practically does not differ from that in acute caries.In most cases, it is limited to removing the identified foci of caries development without the use of long-term treatment methods.
Superficial and initial caries are treated by the method of remineralizing therapy with the use of calcium and fluorine preparations (that is, without using a drill). However, in some cases, grinding of the lesions with subsequent mineralization or even preparation of the tooth with subsequent filling is required.
With medium and deep caries, necrotic dentin and pigmented enamel are removed. If the resulting cleaned cavity is relatively small, it is disinfected, and then filled with filling material. For large sizes of the cavity or the destruction of one or more walls of the tooth set tabs or, in some cases, crowns.
In general, crowns are seldom installed with deep caries. Tabs - more often, since they were originally conceived from the point of view of repetition of the tooth anatomy and improvement of functions as opposed to the usual patches-seals.Often the tabs are set and put on the vital (living) teeth. With the modern development of aesthetic therapeutic dentistry, fillings and inlays are more important than crowns on vital teeth.
Feedback
“I, apparently, have chronic caries. Constantly appears in different teeth, every six months, you regularly have to go to the doctor. But there was nothing especially terrible yet, all the time only seals are put. The nerves have never been removed and the crowns have not been put, although the doctor says that an occasion may appear soon, because under the oldest fillings caries may well develop. ”
Oksana, Kiev
The choice of treatment method depends not only on the stage of development of the disease, but also on the patient's age, localization of the cavity, requirements for aesthetics of the filling material. For example, practice has shown that children who know what color fillings are and compete with each other in their brightness, very calmly and patiently endure manipulations with their teeth in order to simply get such a bright filling.
On a note
With the correct treatment of uncomplicated caries, there is never a situation when you need to remove a tooth.With a blatant lack of professionalism of the doctor, when his direct actions (creating a hole in the bottom of the tooth, excessive preparation under the gum), or errors in diagnosis and treatment with the subsequent transfer of caries into the pulpitis can lead to the need to remove the tooth. A good doctor can always save a carious tooth without pulpitis and periodontitis.
Theoretically, in chronic caries, the doctor does not need to apply filling materials, which for a long time emit fluoride into the cavity of the tooth, as well as engage in deep fluoridation and constant monitoring of the patient's teeth. Due to the low rate of development of the process, the removal of carious areas provides protection against caries for a sufficiently long period, and the patient's fluoride and calcium already receive the enamel in sufficient quantities. Nevertheless, given the ability of caries to drastically change from a chronic to an acute form, doctors sometimes prefer to play it safe, and put insulating gaskets or fillings from glass ionomer cements that emit fluorides into the surrounding tissues. Worse from this will not be, but the benefits may well be.
Prevention of chronic caries
Prevention of chronic caries is aimed at eliminating the causes of its development - removal of plaque on teeth and dental plaques. For this you need:
- Brush your teeth at least twice a day with toothpaste that removes plaque, preferably with an average degree of abrasiveness. Good for this paste Elmex protection against caries, R.O.C.S. Caribbean summer and some other pastes for the prevention of caries.
- Limit the amount of sweet in the diet, eat regularly coarse vegetables and fruits.
- To brush teeth after eating with the help of threads, use sugarless chewing gums.
- Regularly undergo examinations at the dentist, in time to heal the emerging foci of caries development.
Sometimes the doctor may prescribe the use of remineralizing gels and mouth rinses. These recommendations should not be neglected.
In children, chronic caries is prevented by the same methods. In babies up to 2 years, the rules of prevention also include the correction of the diet and the cancellation of night feedings and meals before bedtime after brushing.
It is very important to teach children to brush their teeth on time: the smallest patients rarely have chronic caries, and usually the disease is acute with rapid and large-scale damage to the teeth.
And most importantly - baby teeth in children should be treated as diligently as permanent ones. A complete set of healthy primary teeth is the main guarantee of the normal formation of jaws in a child, and imparted dental care skills guarantee protection for the child against chronic caries in adulthood.
Remember: dental health begins in childhood, and the attention of parents to it will give much more than even the most professional and high-quality treatment.
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