Absolutely every person has heard that caries needs to be treated on time. But despite the warnings of dentists, there is a large amount of information on the Internet on the complications of advanced caries - people come to the clinic when the caries has become deep or has turned into pulpitis or periodontitis.
How deep caries will be treated - we will tell you about this below and will definitely tell you in the article:
- About what deep caries is;
- Consider the symptoms of deep caries;
- Let's look at the stages of treatment for deep caries;
- We’ll tell you whether it’s painful to treat deep caries;
- We will indicate the prices for the service in Moscow
Calculate the cost of treatment by taking a short test in 20 seconds!
Do not delay your treatment, because in this matter time plays against us.
Deep caries: what is it and how does this stage of the disease manifest itself?
Caries is a disease that goes through several successive stages in its development. A carious tooth lesion begins with a small spot on the enamel and, if measures are not taken and you do not contact a specialist, the destructive process will progress, affect the internal tissues of the tooth, and eventually the disease will reach the stage of deep caries.
When caries is advanced, a deep carious cavity forms in the tooth, reaching almost to the pulp (nerve of the tooth). Between the pulp and destroyed dental tissues there remains a thin layer of healthy dentin, which is not sufficient protection of the tooth nerve from infection. If deep caries is not treated urgently, it will turn into pulpitis or periodontitis - complications that can lead to tooth loss.
Deep caries is clearly visible visually (if not hidden by a poorly installed filling) and has clear symptoms:
- With deep caries, the tooth hurts. Painful sensations occur when a tooth with caries comes into contact with external irritants - hot/cold, sour/sweet foods;
- You can see a deep, dark-colored cavity in the tooth (as people say, there is a big hole in the tooth);
- Since the carious cavity with deep caries becomes clogged with food debris, a strong and unpleasant odor may appear from the mouth.
WORTH LEARNING AND REMEMBERING: How do you understand that a tooth hurts because of deep caries, and not because of pulpitis? Pain during deep caries can be quite severe, but it quickly disappears if the external irritant that provoked the pain syndrome is eliminated. With pulpitis, the tooth hurts for a long time and in attacks. In any case, pain in a tooth is already a reason to visit a dentist. Remember that the longer you delay dental treatment, the higher the risk of losing a tooth!
Diagnostics
To make a diagnosis, diagnostics are carried out, which include:
- external inspection using a mirror;
- instrumental examination using a probe;
- voicing symptoms (complaints) by the patient;
- thermal diagnostics (checking the reaction to cold and hot);
- electroodontic diagnostics (testing the reaction to exposure to current);
- radiography (performed if the presence of secondary deep caries is suspected or to exclude it).
If upon examination significant damage (destruction) of the tooth crown is detected, expressed by the presence of a deep carious cavity and accompanied by pain during probing, then this confirms the presence of deep caries in the patient.
In the acute form, the carious cavity is filled with light, softened dentin. In chronic deep caries, the walls and bottom of the cavity are filled with a layer of dense pigmented dentin (from brown to black). Percussion of the tooth is not accompanied by pain.
Diagnosis of deep caries
Treatment of deep caries begins with diagnosis, which includes the following measures:
- Visual inspection;
- X-ray of the tooth.
Why do you need a dental x-ray before treating deep caries? A photograph of the tooth must be taken in order to:
1. To identify deep caries under a filling. If the tooth was treated poorly in the past, during its treatment the doctor did not remove all the tissue damaged by caries - the tooth will continue to decay under the filling. In this case, caries may well develop into a deep form, that is, it can reach almost to the nerve of the tooth.
2. To see the degree of development of the inflammatory process and understand whether deep caries has had time to develop into pulpitis, the treatment of which follows a slightly different scheme.
Probing of the tooth to assess the degree of softening of internal tissues in deep caries is not carried out. Since the destruction has reached almost to the nerve, this diagnostic procedure can cause severe pain to the patient.
First stage of caries
The initial stage of caries is the white spot stage; it is an area of enamel demineralization. The internal tissues of the tooth are still protected from bacteria. The person does not feel discomfort and does not even know about the development of pathology. It can only be identified at this stage during a preventive examination. However, not all people visit the dentist every six months, so caries is rarely detected at the first stage.
The disease progresses, the enamel softens and becomes loose. The pathological process can be stopped with the help of special fluoride-containing drugs. This treatment of caries is called remineralization of enamel; it is saturated with minerals and strengthened. The application of protective compounds that restore the structure of the enamel surface is carried out in a doctor’s office.
For home use, he prescribes toothpastes, gels and rinses that have antibacterial properties and contain calcium, fluorine, magnesium and other minerals. Examples of such products are ROCS Active Calcium toothpaste, DRC ROCS (ROCS) Medical Minerals gel and Vivax Remineralization balm.
How to treat deep caries: an overview of the main stages of the treatment process
After the diagnosis of “deep caries” is made, a decision is made on how treatment will be carried out - in one or two stages. The correct approach to quality treatment of deep caries will involve two stages, not one. Why? Let's explain in detail.
Through the thin layer of dentin, which is preserved in the tooth when caries develops to a deep form, carious bacteria can easily penetrate into the pulp. The initial stage of pulp infection may not be visible on the image, but it is extremely important to exclude it so that the tooth does not begin to hurt under the filling.
Therefore, at the first stage of treatment of deep caries, all destroyed tissue is removed, a cavity is formed for a filling, into which the medicine is placed, and the tooth is closed with a temporary filling. In the treatment of deep caries, a break is taken for 2-3 days: if during this time the tooth does not begin to hurt, then at the next visit to the doctor’s office, a permanent filling will be placed on it.
Below we provide a detailed treatment plan for deep caries:
1. Treatment of deep caries begins with mandatory anesthesia of the manipulation area. Local anesthetics are used for this purpose.
WORTH LEARNING AND REMEMBERING: Is it painful to treat deep caries? People often ask this question on the Internet, in various forums. You can answer it this way: modern anesthetics used in the treatment of deep caries make it possible to carry out all the necessary medical procedures without pain and discomfort for the patient. Therefore, do not be afraid to treat your teeth because of vain and unfounded fears that dental treatment is painful.
2. The treatment area is isolated with a rubber dam - a special latex scarf. Isolation of teeth during treatment is important: it protects the treated tooth from contact with oral microflora, which may contain harmful bacteria. In addition, the latex lining prevents moisture from entering the already formed cavity for installation of the filling. Moisture during filling installation affects the strength, reliability and durability of the restoration.
3. After the anesthetic takes effect, the dentist will begin working with the tooth - you need to remove all tissue damaged and destroyed by caries, and also form a cavity for installing a filling. Removal of destroyed tooth tissue is done using a drill.
4. A special therapeutic lining based on calcium is placed into the prepared tooth cavity. This gasket will help destroy pathogenic microflora and prevent the risks of developing pulpitis.development of pulpitis. After the treatment pad, an insulating pad is installed in the tooth, which helps secure the treatment pad and isolates it from the filling - temporary or permanent.
Next, a temporary filling is placed on the tooth and the next time the person should come to the clinic in a couple of days. During the second visit, the dentist will ask the patient about possible pain in the tooth, conduct an examination, and if there are no complaints of pain or signs of inflammation, a permanent filling will be placed on the tooth. At this point, the process of treating deep caries can be considered complete.
WORTH LEARNING AND REMEMBERING: If a tooth is destroyed by deep caries, then restoring it with a filling is impractical. Large fillings simply do not hold strong enough and can fall out or break, damaging the root of the tooth. Therefore, teeth with tissue destruction of more than 50% are restored with inlays or filling, and then covered with a crown.
What are the differences from other forms of the disease?
Deep caries is very similar to some forms of the disease, but there are still visible and invisible differences.
Difference from pulpitis
Pulpitis is a complication of advanced caries. The forms of the disease can be distinguished from each other by their characteristic symptoms:
- Defeat. With pulpitis, the nerve is affected; with caries, the nerve remains unharmed.
- Feelings of pain. With pulpitis, pain can occur spontaneously, even without exposure to irritants on the tooth. With caries, pain disappears along with the disappearance of irritants.
- Night sleep. With pulpitis, sleep can be disturbed due to severe pain; with caries, the tooth does not hurt at night.
Difference from average caries
The similarity between the two forms of the disease is that the patient in both forms feels pain from cold, sour or sweet foods. However, with average caries they go away within 1-2 minutes, with deep caries they last longer.
Medium caries is characterized by the fact that in this form the carious lesion does not affect the tooth pulp and does not cause inflammation of the nerve, as in deep caries.
Is it possible to treat deep caries in one stage?
A one-stage approach to the treatment of deep caries is extremely undesirable, since it does not eliminate 100% the risks of developing pulpitis under an already installed permanent filling. But sometimes deep caries is treated in one stage. To decide whether such a decision is appropriate, the dentist must evaluate a number of factors:
- The thickness of the remaining healthy dentin;
- The severity and nature of pain in the tooth that the patient complains of.
When working with a tooth affected by deep caries, it is not always possible to remove damaged tissue without affecting the pulp chamber. If this happens, treatment of deep caries cannot be carried out in one stage!
Deep caries of the front teeth. What are the differences in treatment?
Deep caries of the front teeth should be treated as carefully as possible so as not to burn the pulp. The main difficulty in treatment is:
- minimum thickness of all tooth tissues;
- inconvenient location of the cavity, if we are talking about caries located in the interdental space.
When infection penetrates into the pulp, pulpitis develops rapidly. A few hours is enough. The disease is accompanied by increasing pain. It needs to be treated immediately.
Complications of deep caries
If the treatment of deep caries is not carried out in a timely manner or it is of poor quality, complications may develop, the treatment of which will be more complex and more expensive. Complications of deep caries include pulpitis and periodontitis - inflammatory processes that affect the nerve and root of the tooth and may well lead to the need for tooth extraction.
Pulpitis and periodontitis are treated according to a different scheme, which involves removing the nerve of the tooth and treating the dental canals. Naturally, the cost of treating complications will be higher than the cost of treating deep caries.
Second stage of caries
The second stage of carious lesion is called superficial. The carious process continues to destroy enamel, but has not yet transferred to hard tissues. The white spot darkens, becomes brown or yellow. It can be seen with the naked eye, especially if it is on the outside of the front tooth. The first subjective signs of the disease also appear: discomfort is felt after eating sweet foods.
Cariogenic microbes live off carbohydrates. The more sweets a person eats, the more bacteria multiply in the mouth. Because of this, caries continues to progress. However, even at this stage, people often ignore the symptoms of the disease, explaining discomfort while eating by increased sensitivity of the teeth, which is not associated with pathologies. Immediately after eliminating the irritant, the unpleasant sensations disappear.
Superficial caries can still be cured with therapeutic methods, that is, by remineralizing the enamel. If treatment is not started and the pathology develops to the third stage, a filling must be placed.
Is it possible to cure deep caries with folk remedies or at home?
Some people are so afraid of dentists that even when a tooth starts to hurt badly, they do not go to the clinic, but start looking for traditional medicine recipes against caries or take antibiotics, hoping that these drugs will get rid of caries.
Let us write right away that such amateur activity is useless and dangerous. Caries cannot be cured at home either with decoctions or tablets from the pharmacy. To stop the process of tooth decay, you need to remove damaged tissue and destroy bacteria. And all these procedures are feasible only in a clinical setting.
Stages of caries treatment
The main stages include:
- Plaque is removed from the enamel. This is done with ultrasonic attachments, pastes with an abrasive composition, and dental brushes. A special color scale is used when the dentist determines the color of the teeth and selects the appropriate shade of the filling material so that the filling is as invisible as possible on the teeth.
- Opening of the cavity of a tooth affected by inflammation. The edges of the enamel are drilled and the affected dentin is removed. This treatment procedure must be carried out efficiently and professionally. Due to poorly removed areas affected by inflammation, secondary caries may appear;
- Removal of affected tissue. To do this, special devices are used or done manually;
- A cavity is created, which is subsequently filled;
- Treated with antiseptic agents;
- The filling is installed in the place that was prepared for it. Using filling materials, the natural shape of the crown is restored. The filling is fixed with a polymerization lamp. When the filling hardens, the dentist polishes the surface to eliminate irregularities and create anatomical shapes.
If the tooth continues to hurt
Mild pain immediately after treatment of deep caries is not a cause for concern. They are recognized by dentists as the norm and do not require special treatment. Mild pain in the tooth after treatment of deep caries can be explained by the fact that the gums were affected during the treatment procedures. After 1-2 days, the discomfort will go away on its own.
But if, after treatment of deep caries, the tooth hurts severely and for a long time (more than 2-3 days) and, against the background of the pain syndrome, a high temperature and swelling of the gums appear - all this may indicate a poor quality of treatment and the development of an inflammatory process under the filling. With such symptoms, you cannot do nothing: you need to urgently contact the dentist.
To eliminate the risk that your tooth will hurt after treatment, you need to carefully choose the clinic where you will have your teeth treated. You should not choose dentistry based on the most beautiful advertising that promises the lowest prices - you should find out all the details about the level of equipment of the clinic, the technologies that are used in it, the level of qualifications, and the doctors working in it.
All conditions for high-quality treatment of deep dental caries have been created in our clinic in Moscow - VENSTOM.
Calculate the cost of treatment by taking a short test in 20 seconds!
Do not delay your treatment, because in this matter time plays against us.
Definition of the concept in dentistry
Deep caries is the last stage of the carious process occurring in the tooth, which is characterized by extensive damage not only to hard tissues, but also to the deep layers of dentin. In general, the concept of “deep caries” reflects the depth of the lesion.
Caries can be:
- primary - a consequence of untreated secondary caries;
- secondary (recurrent) - the occurrence of a carious process under a filling in a previously treated tooth.
Based on the sensation of pain and clinical examination, the disease is divided into 3 forms:
- Acute form. It is determined by the narrow entrance opening of the carious cavity and the wide base (during examination), as well as by descriptions of the patient’s sensations - reaction to food temperature and chemical irritants.
- Chronic form. It is characterized by a wide (funnel-shaped) inlet and a narrow base. The patient feels pain when the “hollow” is clogged with food and during examination with a probe by the dentist.
- Deep cervical caries. It is characterized by the development of demineralization of enamel tissue and the carious process in the cervical area of the tooth (near the gums).
According to the clinical course, caries is also divided into several forms:
- compensated,
- subcompensated,
- decompensated.
Cost of the service in Moscow
Of course, the cost of treating deep caries will be higher than the cost of treating initial caries, because the treatment process will be more complex, including various manipulations and carried out in two stages.
On average, the cost of treating deep caries of one tooth can amount to 5-6 thousand rubles, and this is if there is no need for treatment of the tooth canals. If you want to find out for yourself the exact cost of caries treatment in your case, you definitely need to visit the dentist’s office. The doctor will examine the clinical picture, conduct a diagnosis and, before starting treatment, announce its full cost.
Types of filling materials
Filling is the most important stage of anti-caries therapy. Fillings are used to restore tissues destroyed by the carious process in order to achieve maximum aesthetic effect. Different materials are used for filling:
- amalgams;
- zinc phosphate compounds;
- composites;
- glass ionomer and silicate cements;
- metal alloys;
- plastics;
- ceramics.
In some clinical cases, doctors use several compounds with different properties at once. Permanent fillings have high biological compatibility, sufficient adhesion, and resistance to various types of influences. The fillings are easily ground and polished, which allows you to adjust the shape of the tooth. In cases where pathology has led to significant destruction of dental tissue, instead of filling cement it is better to use dental inlays, which are attached with an adhesive composition.
How is a therapeutic napkin installed for deep caries?
Depending on the form and complexity of the disease, as well as the chosen method of caries treatment, the dentist can install the lining by direct or indirect application. The first option assumes that it is applied directly to the pulp area, ensuring direct contact between the gasket and the dental nerve. The method is used for tooth injuries with exposure of the nerve, for fibrous pulpitis. The second method is to apply a lining using dentinal tubules without direct contact with the pulp. It is often chosen for the treatment of deep stage caries and acute pulpitis.
Pros and cons of using medicinal pads in dentistry
The use of medicinal pads in dental practice has a number of advantages:
- They relieve inflammation, promote tissue regeneration, and help prepare the tooth for filling.
- Many drugs contain anesthetics that provide an analgesic effect, which is important when treating tissues near the sensitive dental nerve.
- Most materials are highly plastic, harden quickly and prevent the formation of microscopic cracks in the tooth.
In addition to the advantages, therapeutic pads have a number of disadvantages:
- They impair the adhesion of the filling to the walls and bottom of the cavity, which can shorten the service life of the restored tooth.
- If the technology for installing a medical pad is violated, the risk of tissue infection increases.
- Most materials dissolve when exposed to liquids, so they must be replaced frequently.
Despite the disadvantages, medicinal pads are still widely used in dentistry, as they have a wide spectrum of action and help solve many therapeutic problems.
How do combined pastes work?
The composition of combined pastes includes oils, fillers (zinc oxide or white clay), as well as medications. The therapeutic effect of a particular pad directly depends on the latter:
- Stimulating dentin growth and promoting enamel remineralization. These drugs are called odontotropic, they are based on fluorides, collagen, calcium glycerophosphate and other substances. They are used when it is necessary to increase the layer of bone tissue between the pulp and a deep carious cavity.
- Possessing anti-edematous and anti-inflammatory effects. They help stop the inflammatory process in the dental pulp; they are based on prednisolone and hydrocortisone. Typically, such preparations are temporarily placed at the bottom of the cavity and covered with a bandage on top. If the dentin layer next to the neurovascular bundle grows too slowly, then a spacer with an odontotropic effect is applied.
- Pads with an antiseptic effect based on metronidazole or chlorhexidine disinfect and prevent the growth of bacteria.
- Proteolytic enzymes contained in the drug are needed in the treatment of acute focal pulpitis, as well as in the treatment of deep caries.
Most combined pastes harden poorly and have low strength, so they are used as a temporary therapeutic material. After their removal, a different type of therapeutic pad is usually used.
