Caries on the front teeth: what to do and how to treat?

What to do if tooth decay 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 for career, success and good dating. The appearance of caries on the front teeth can not only spoil future plans, but can also cause serious problems in the dental system with a number of possible complications (which many don’t even realize until they come over themselves).

When enlarging and deepening the caries cavity on the front tooth or between them, part of the enamel or even the entire coronal part of the tooth often breaks off, caries complications with severe pain (pulpitis, periodontitis), tooth disorder (shift in relation to the natural arrangement), diction disorder (Lisping )) and serious violations of aesthetics. There are often cases of mental disorders in the case of multiple caries of the front teeth when the problem is very painful, constant for a person and takes up a significant part of his free time and thoughts.

How early the early signs of caries development on the front teeth will be recognized, which restoration options are available today and what should be preferred and how much everything will cost – we will pursue all these and some other interesting questions in more detail.

Characteristic signs of destruction of the front teeth

The front teeth are characterized by a "thinner" Organization of the tooth tissue from: In the cervical area (near the gingiva), the tooth enamel is of negligible thickness, so that it is easier for bacteria causing caries to destroy this particular zone with the formation of cervical caries. Often, cervical caries extends here to the area 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 fractures and fractures are possible in almost the entire visible part of the affected tooth.

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

Because the front incisors are necessary for a person to bite while writing, food residue, when close together, clogs 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 shell of the enamel above it disappears, forming a deep carious cavity.

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

But all of these are examples of distant carious destruction. At first glance, the process can start out pretty harmless – only a white spot appears on the teeth or in the zone between them. This is often not important, but in vain: the whitening of the tooth enamel clearly indicates the beginning of the demineralization process, and measures should be taken urgently at this moment to protect the tooth from further destruction. We’ll talk about it below.

Note: "Why did the anterior tooth filling change color so quickly?"

The fact is that the color stability of light-curing composites depends on both the doctor and the patient. The most common causes of a rapid change in the color of a filling due to medical fault are: Anomalies in the preparation techniques Cavities (carious tissue on the left) and the restoration itself, the use of low-level materials, haste, inadequate knowledge of working with the material, did not inform the patient about the recommendations after the restoration.

Causes of color changes due to the patient’s fault: Do not follow the doctor’s recommendations (do not take staining products for 1-2 hours), do not check the quality of the restoration and polish the sealant after 5-6 months.

The variety of forms and possible carious manifestations

Caries on the anterior teeth can look very different depending on the clinical shape, type and type of course. For example, the following types of caries are differentiated depending on the depth of tissue destruction:

  • Initial (in the phase of the spot);
  • superficial (tooth enamel);
  • Average;
  • deep

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

In addition, depending on the course of the disease (active or inactive), acute and chronic caries are emitted. If a large number of carious lesions appear on several teeth, a diagnosis of "multiple caries" made and localized on the front teeth (their complication is circular) and approximal caries.

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

In caries of the front teeth we speak of the following classes:

  • III class. Caries affects the lateral (contact) surfaces of the incisors and canines without, however, violating the integrity of the angle of the crown and the incisal.
  • IV class. Caries, in which in addition to the side surfaces of the incisors and canines, the incisor and the angle of the crown are also recorded.
  • V-class caries, which occupies the cervical (gingival) region in all tooth groups, but more strongly – from the front on the vestibular (outer) surface.

In the classification of carious caries according to Black used by tens of thousands of dentists, the VI class was added after the author’s death, which shows carious damage only to the cutting edges of incisors and canines as well as posterior teeth. This innovation caused a storm of ambiguous feelings, and a number of dentists protested the unauthorized decision to introduce an additional section because Black himself could no longer influence this decision, and, in medical practice, practically neither the caries of the incisal edges of the front teeth nor that carious lesion of the mound of the teeth.

Features of the restoration of the anterior teeth

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

So The cheapest choice for your front teeth is the initial tooth decay or other tooth decay, that is, when the pathology hardly touches the enamel and has not penetrated deeply into hard tissue. The first stage of the carious process, in which a person can see the process of caries independently, is a focal demineralization of the tooth enamel or, more simply, the appearance of a matt or pigmented (yellow, brown) stain on the surface of the anterior tooth shows that, as a rule, thoughts arise in such cases in future patients: is it possible to somehow lighten, grind or even treat this stain on the front teeth of the house?

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

Icon technology (Ikon) is the modern approach to treating tooth decay without a drill. This microinvasive treatment is indicated for the initial caries of the anterior teeth with localization on the anterior and contact surface of the incisors (i.e. between the teeth). This technique is particularly relevant after removing braces, when stains are found on one or all anterior teeth in almost 60-80% of cases. The treatment usually lasts no more than 20 minutes and does not require anesthesia. Consistent use of medication in the icon set enables curious spot heal for a visit.

Photo of the anterior tooth before and after caries treatment with Icon technology:

Superficial caries. When treating superficial caries on the front teeth, simple grinding with disks and polishers is often used if the process does not touch the deep enamel layers, and if it is not possible to achieve the desired result, the classic technology of caries treatment is used.

Medium and deep caries. When the carious process crosses the boundaries of the enamel and reaches the dentin, we speak of the average caries. In the case of deep caries, a cavity is formed that is adjacent to the pulp chamber. In all of these cases, caries cavity treatment is required.

Photo of deep caries on the front tooth:

The most popular method for treating caries on the front teeth in modern dentistry is mechanical, using drills and hand tools. Dissection (cavity treatment) using a drill allows carious tissue to be maximally incised in order to prevent the recurrence of caries and to create an aesthetic filling.

The air-removing sandblasting method of the cavity enables the gentle use of an aerosol with an abrasive substance to treat small carious areas on the front teeth.

The laser method of dental treatment is still not widely used because not all clinics can afford expensive equipment, and for some researchers the effectiveness of laser treatment in certain clinical cases of tooth decay is questionable.

Note: "What to do if part of the front tooth has broken off from a stroke?"

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. It is therefore important to identify a root fracture in good time in order to implement a comprehensive treatment approach. If the root is in order and the "nerve" If the soft tissue in the tooth is damaged, the canal is treated, and only then is a seal applied, the anterior tooth is restored.

The mechanical treatment of the caries on the front teeth with the help of a drill enables the maximum removal of not only softened carious tissues but also pigmented ones. This is due to the basic position regarding future aesthetics. If there is even a small area of ​​pigmented dentin or a dark spot on the enamel, at least the appearance of the restoration next to the filling will be disturbed, and caries will soon appear again under the filling.

In the following video you can follow the most important steps in the treatment of deep caries on the front tooth with a dental drill:

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

An important part of the treatment when machining the cavity is the expulsion of water onto the tooth, since the front teeth in particular have thin layers of tissue (enamel, dentin) and the proximity of the pulp chamber have the serious risks of overheating, even necrosis. In such cases, the tooth under the filling will start to hurt, and in the future you will need the tooth- "nerve" remove.

From the practice of the dentist

Often, patients come to the dentist with complaints of severe front tooth pain and think that this tooth decay "pained", although the infection already has the tooth- "nerve" had reached and the pulpitis began. Symptoms that occur in this case with a diseased tooth can sometimes be very similar to the caries clinic: the pain can be slight or not at all, external stimuli do not cause a painful reaction in the tooth or are mild. If the doctor still finds out that it is pulpitis, you cannot get rid of a filling here .

First the anesthesia is carried out without errors, then the carious cavity is removed from infected tissues, amputation and extirpation of the "nerve" performed (extracted from the root canal). The canal is washed with various antiseptics (hydrogen peroxide, sodium hypochlorite, etc.) and sealed with hardening filling material with or without gutta-percha points, ie for the physiological narrowing of the root. The complete treatment of pulpitis can be carried out in one or more visits, depending on the scope of the technical equipment of the clinic, the properties of the tooth, the professionalism of the doctor and the procedure that he practices during such procedures.

After anesthesia, cleaning of the caries cavity, 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 for the restoration of the anterior teeth in caries are in most cases light-curing composites. Each set manufactured by a company has its own color properties (syringe sets with a specific color).

Before the restoration, the dentist assesses:

  • Transparency, tooth color and color spectrum;
  • Tooth shades by zones: in the cervical area, in the area of ​​the tooth body and on the cutting edge;
  • individual peculiarities of the tooth (hypoplasia, cracks).

Ideally, after restoration, its surface should not be like one in the Soviet era "patch" resemble. The finished work should have a number of such individual properties, so that at the end of the polishing of the fillings, a natural gloss property of the enamel appears, each tooth zone has its own shade, the tooth has the same characteristic lines, micro-cracks, translucent congenital stains. Anterior tooth art restoration often takes up to 2 hours or more.

There are different approaches to assessing the final result: It is assumed that the ideal restoration should harmonize with the symmetrical anterior tooth after completion of the filling. In other words, if there are natural dimples, spots, lines, etc. on the symmetrical central incisor, they will also be restored on the tooth restored for caries.

A number of specialists believe that the final restoration of the anterior tooth in shape and color should be adapted to the tooth to be restored and to the neighboring tooth, but not more. In this case, the errors that nature caused on a symmetrical incisor and that look natural are not repeated with a seal during the restoration. It cannot be said that such a restoration technique is not considered popular.

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

The role of prevention in preserving anterior teeth

Preventing tooth decay on the front teeth is currently paramount for maintaining a nice smile area. The complex of such activities can be divided into systemic and local applications.

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 raids accumulate;
  • Large quantities of calcium-containing foods (milk and milk products);
  • Fluorine prophylaxis under the supervision of the dentist using fluorinated water, salt or milk, as well as taking fluoride tablets.

Local preventive measures:

  • Cleaning the anterior and posterior teeth with fluor />
  • remineralizing therapy and deep fluoridation of the anterior teeth during tooth admission and further domestic use of special mineralizing gels or solutions.

How much does the treatment cost??

Compared to the treatment of caries of the posterior teeth, restoring the anterior teeth is an expensive pleasure. The clinic’s pricing depends on the type of caries (initial, medium, deep), its location (cervical, approximate) and the destruction zone. This determines the complexity and duration of the treatment.

The level of the technical equipment of the clinic, the materials used to restore the anterior teeth (economy class, business class, etc.), the professionalism of the dentist, as well as the chosen approach to treating tooth decay and the technique of the work are important.

For example, if the treatment of caries on the front incisor in the clinic takes no longer than 20-30 minutes, if the best light-cured composite is not selected, then the usual result of such treatment may be the usual patch of a seal, often from others is hit. I don’t have to say about a nice smile in this case.

Art restoration usually has an increased price, but the edition is an individual work that others can only recognize after a close look at the emphasis, and not always.

There is also a restoration of the author. This is the same artistic restoration, but it involves the dentist’s personal accomplishments, original techniques, unique techniques during work, combination of materials, and some other techniques. The price of this problem is sometimes too high for a simple resident, but beautiful teeth can really be worth it.

Interesting video: An example of the restoration of the anterior tooth with deep caries

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Christina Cherry
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