DISEASES OF THE TEETH AND ALVEOLAR PROCESS : TOOTH DECAY (CARIES) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
The etiology is not yet well understood. Violation of lime metabolism, vitamin deficiency, lack of vitamin D, ultraviolet starvation - etiological points put forward by the proponents of the endogenous theories. Fermentation of food residues, leading to the formation of lactic acid, the effects of acid-forming microbes, "denaturation" of saliva,expressed violations of its physico-chemical structure - etiological points put forward by supporters of exogenous theories of the origin of caries.
The pathogenesis. The essence of the caries process is expressed in the violation of the relation between organic and inorganic components of dental hard tissues formed complex compounds of calcium protein. At the same time developing processes of desalinatio and hypercalcinuria, and ultimately calcification leads to the destruction of enamel and dentin, as the growing phenomena of decalcification violates biological and mechanical resistance of dental hard tissues.
Symptoms. The occurrence of turbidity, chalky or brown pigmentation of the enamel. Then follows the formation of the cavity, gradually increasing in size. Pain occur only under the influence of the direct action of physical and chemical stimuli (cold, sweet, sour, salty). Characterized by the absence of so-called spontaneous pain.
The course and complication. The decay may be slow chronic form, or dry cariesthat develops over many months or even years. Acute and peracute forms of decay are accompanied by a very rapid (within weeks, days) deepening of carious destruction. In cases where from cavity infection penetrates into the pulp and the periodontium, talk about complicated caries.
Recognition is based mainly on the detection of a defect of enamel and dentin with a rough or softened down, and the presence of carry-over in pain from the action of cold, sweet, sour, salty. From pulpitis caries is characterized by the absence of spontaneous pain.
The prediction is quite favorable if the disease is detected in uncomplicated stage. Less favorably under systematic and recurrent caries, burdened by a common nutritional disorder, lime exchange (a severe form of rickets, tuberculosis intoxication, pregnancy). In these cases, despite treatment, the teeth continue to decay.
Rich in vitamins and mineral salts food. To prevent the development of complicated forms of caries must be at least two times a year to expose the teeth to the inspection and immediately eliminate detected carious lesions.
Removal of necrotic and infected parts of enamel and dentinal tissue and isolation of naked parts of the tooth from the direct influence of the external environment. The first is achieved by drilling or excalibre carious dentin (enamel) and processing the prepared cavity disinfection agents (clove oil, alcohol, thymol). Painless drilling is achieved using fluoride toothpaste Lukomsky "Notestein 75" (Natrii fluorati 10,0 Glycerini, q. s. ut fiat pasta) or 30% paste Lukomsky (sodium fluoride and white clay in equal parts and glycerin to form a paste). Technique of anesthesia excavator to remove necrotic dentin, to isolate the cavity from the access of saliva to dry heated air to enter the pasta. When the sensitivity of the whole procedure is repeated. After preparation of the cavity is filled with plastic, fast-hardening mass, i.e., they apply a filling of cement or amalgam. For temporary fillings used gutta-percha, zinc oxide, so-called artificial dentin.