Chronic caries (including milk teeth in children)

There are two types of caries: acute and chronic caries. In addition, according to several researchers, this separation of caries in formation and development is only of scientific interest – about the processes in the tissues of the carious tooth about to examine a certain period of time. However, we will continue to interest this topic in relation to timely diagnosis of carious lesions, treatment, and prevention.

Overall, chronic tooth decay is a feature 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. It is only in the late stages of the caries process (with moderate or deep caries) that characteristic symptoms appear that lead a person to the doctor.

Without a full fight, including proper tooth care, diet and diet correction, and removal of other possible cariogenic factors, chronic tooth decay is incurable – it will appear on your teeth constantly until the causes of its occurrence are eliminated.

Chronic tooth decay is significantly more common than acute. On the whole, almost any tooth decay that has no signs of a generalized disease is chronic with one or another rate of development. Many patients do not even take this disease seriously and simply consider the damage to their teeth as an accidental misunderstanding or as a matter of course.

From the experience of the dentist:

It should be noted that the acute and chronic course of caries intertwines. In other words, they are so unstable for a number of reasons that they can change in the body. Acute caries can slow down, acquire a chronic course until temporary suspension. Conversely, chronic tooth decay, when exposed to both external and internal adverse factors (metabolic disorders, somatic diseases, stress, hypothermia, gross eating disorders, etc.), can become acute at lightning speed.

Therefore, in practice it is almost impossible to precisely determine the timing of caries development or to distinguish one current from the other depending on the patient’s complaints and the external signs of the carious process. Acute caries often has no symptoms in the oral cavity because the destroyed part of the tooth is in a place that is inaccessible to external irritant factors. That is, the tooth is quickly destroyed and no pain is observed, which additionally causes difficulties in determining the activity of the carious process.

Chronic tooth decay can be observed in milk teeth. This is one of the most common diseases in children, as it is difficult for parents to track the condition of their teeth at an early age. Sometimes the dentist is faced with the problems of the acute course of tooth decay if the caries child in the staining stage becomes deep injuries to the tooth tissue within a few months. In this case, it is necessary to stop its development immediately after extensive treatment of all herds.

There are indications that chronic caries in children can already be detected on the broken 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 pattern for chronic tooth decay can be seen in the photo below:

There are no extensive lesions of the teeth and the dark areas are very small in some places and often do not pay attention to the patient. The pain is usually absent.

In some cases, even chronic tooth decay is accompanied by small symptoms, not to mention those early stages of the carious process, if the disease can be treated without filling. This is due in part to the formation of replacement dentin – the adaptive response of a living tooth to the appearance of an infectious irritative focus when secondary tissue is formed that protects the nerve from external influences and irritants.

Chronic tooth decay almost never leads to a noticeable destruction of the tooth enamel, which is characteristic of acute tooth decay.

"I go to the dentist all my life if I can remember. There is nothing particularly terrible, only holes appear constantly in one tooth, now in another, they have to be filled. There are no nerves in two teeth. Only now, after 30 years, did I get a good dentist who explained everything well. I have chronic tooth decay that is slow to develop. The teeth themselves are strong, but I brush them incorrectly and irregularly so that tooth decay develops.

In general, I have started to solve this problem. I completely healed all teeth (a little over 20,000 cost me everything), bought a normal ROX paste, a special rinser, which the doctor prescribed. In the third month I use everything, brush my teeth after every meal, I don’t eat. We’ll see if there is a result. "

At various stages of development, the picture of chronic caries has its own characteristics:

  1. Chronic caries in the coloring stage is practically not shown. The tooth can react to cold food or air, but this is not perceived by the patient as a pathology. The demineralized enamel area looks like a whitish, dull spot on the tooth.
  2. Chronic superficial caries leads to the formation of cavities in the tooth enamel, but still without damaging the dentine. 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.
  3. Chronically moderate tooth decay is characterized by a large dentin cavity. With this flow, the cavity has no softened dentin, only pigmented is present here. carious dentin. The bottom is dense with slight protrusions and roughness, which indicates a sluggish process in the compensation stage due to substitution dentine.
  4. Chronic deep caries differentiate >

In all stages of caries development, tapping the affected area does not cause pain. Percussion only causes temporary pain in complications such as pulpitis or periodontitis.

From the practice of the dentist

Percussion does not cause pain in all types of caries. The pain of lightly tapping on the tooth is only associated with the complications of tooth decay, and this is the main diagnostic feature that affects the differential diagnosis of caries through protocols.

In practice, the patient can sometimes have a kind of deep cavities that are on the contact surfaces "Food containers" receive. Food sticks here and causes gum trauma. If the patient comes with an abundance of stuck foods and inflammation of the gingival papilla, then there will be sensitivity when tapping on the tooth (percussion). But we have to understand that it can only hurt the gums and not the tooth. Caries is only a mediated cause of pain during percussion. In these cases, you usually use additional diagnostic methods. But this is a rare clinical situation, officially percussion is painless for any tooth decay.

Causes of chronic tooth decay

In general, chronic tooth decay occurs for the same reasons that are characteristic of tooth decay in general – because of the activity of bacteria that process the rest of the carbohydrates in the mouth into organic acids. These acids regularly affect the enamel and lead to their destruction at one or the other speed. Then the dentin under the enamel is destroyed.

In most cases, the reason for the increased activity of cariogenic bacteria and the development of chronic tooth decay is insufficient dental care. The slow course of the disease indicates that the enamel of a healthy person is sufficiently resistant to the effects of cariogenic factors and that saliva successfully inhibits the activity of bacteria and restores the structure of the enamel (saliva contains all the necessary chemical elements for this). Nature has done everything possible to protect their teeth, and the development of the disease usually happens only through the fault of the patient.

Chronic caries of the deciduous teeth develops for the same reasons (one of the examples is the so-called bottle caries). Often, the parents’ delays in bringing up the child to oral cavity hygiene lead to the appearance of foci of disease that could have been avoided if the basic rules were followed – regular brushing of teeth and mouthwashing after eating.

In addition, chronic caries in children is often not perceived by parents as a disease. Separate carious lesions become infatuated with Children with Attributed to sweets, and many parents do not pay attention to prevention and treatment because they believe that if milk teeth fall out anyway, you should not torture your child at the dentist and spend money on treatment, so the necessary measures are not taken in time, causing individual lesions become chronic.

Diagnosis of chronic tooth decay

Chronic tooth decay is usually diagnosed with a simple visual inspection of the appearance of carious areas. Sometimes the doctor concludes that the patient has chronic tooth decay, with regular monitoring of the patient when he can assess the frequency of new tooth lesions and the rate of development of the disease.

X-rays, transillumination, and luminescence diagnostics can be used to diagnose medium and deep chronic caries, but they usually don’t need to be used due to the visibility of the lesions.

Fluorescence diagnostics are used to detect the initial caries. It can also be used as a diagnosis of tooth decay complications, as an element of differential diagnosis. A fluoroscopy is not necessary if the cavity is visible to the eye. X-rays are good for detecting hidden middle and deep voids.

treatment specificity

The treatment of chronic caries is practically no different from that of acute caries; in most cases, it is limited to removing the identified caries development foci without the use of long-term treatment methods.

Superficial and initial caries are treated with the method of remineralizing therapy using calcium and fluorine preparations (ie without using a drill). In some cases, however, 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 filler material. With large sizes of the cavity or with the destruction of one or more walls of the tooth plates or in some cases crowns.

In general, crowns are rarely installed with deep caries. Tabs – more common, as they were originally designed from the point of view of repeating the tooth anatomy and improving the functions in contrast to the usual patch seals. Often the tabs are placed and placed on the vital (living) teeth. With the modern development of aesthetic-therapeutic dentistry, fillings and inlays are more important than crowns on vital teeth.

"I seem to have chronic tooth decay. Constantly appears in different teeth, you need to go to the doctor regularly every six months. But there was nothing particularly terrible yet, always just seals. The nerves have never been removed and the crowns have not been put in place, although the doctor says an opportunity may appear soon because caries can develop well under the oldest fillings. "

The choice of treatment method depends not only on the stage of development of the disease, but also on the age of the patient, the location of the cavity, the requirements for the 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 to simply get such a light filling.

With proper treatment of uncomplicated tooth decay, there are never situations in which you need to remove a tooth, with a manifest lack of professionalism on the part of the doctor when his direct actions (creating a hole in the underside of the tooth, excessive preparation under the gums), or errors in diagnosis and treatment with the subsequent transfer of caries to pulpitis may lead to the tooth having to be removed. A good doctor can always save a carious tooth without pulpitis and periodontitis.

In theory, in the case of chronic caries, the doctor does not have to apply filling materials that emit fluoride into the tooth cavity for a long time, as well as deep fluoridation and constant monitoring of the patient’s teeth. Due to the slow development speed of the process, the removal of carious areas offers sufficient protection against tooth decay, and the fluoride and calcium of the patient already receive the tooth enamel in sufficient quantities. However, given the ability of caries to change drastically from a chronic to an acute form, doctors prefer to play it safe and use insulating seals or fillings made of glass ionomer cements that release fluorides into the surrounding tissue. This won’t be worse, but the benefits can be good.

Prevention of chronic tooth decay

The prevention of chronic caries aims to eliminate the causes of its development – removal of plaque from teeth and dental plaques. You need:

  1. Brush your teeth at least twice a day with toothpaste that removes plaque, and 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 caries prevention.
  2. Limit the amount of sweets in the diet, eat coarse vegetables and fruits regularly.
  3. To brush teeth after eating with threads, use sugar-free chewing gum.
  4. Regular checkups at the dentist to cure the emerging caries development spots.

Sometimes the doctor can prescribe the use of remineralizing gels and mouthwashes. These recommendations should not be neglected.

Chronic tooth decay in children is prevented by the same methods. For infants up to 2 years of age, the rules of prevention include correcting diet and canceling night-time feeding and meals before bedtime after brushing your teeth.

It is very important to teach children to brush their teeth on time: the smallest patients rarely have chronic tooth decay, and the disease is usually acute with rapid and extensive tooth damage.

And most importantly – milk teeth in children should be treated just as carefully as permanent teeth. A complete set of healthy milk teeth is the most important guarantee of normal jaw formation in children, and the dental skills imparted guarantee the child’s protection from chronic caries in adulthood.

Remember: Dental health begins in childhood and parents’ attention to it will give much more than even the most professional and high quality treatment.

Interesting video: why there is tooth decay and how you can protect yourself against it

And so there is actually a treatment for deep caries with a drill


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Christina Cherry
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