Caries

Кариес

Caries is a tooth disease that develops because of aggressive influence of the microbes, to be more precise, because of the secretions of their vital activity. In other words the microbes extract acids that cause diminerilizaton of hard tissue of tooth.  First the enamel is decayed then it comes the dentine's (tooth bone) turn.

By enamel is enclosed the part of the tooth that is above the gingiva. The enamel is the strongest material that is contained in the human organism: it consists of 95% of minerals; it is a hard tissue and is compared with the diamond by its firmity.
The tissue under enamel is called dentine, in the dentine the amount of minerals is only 2/3, thus it can be said that the dentine is softer than enamel, t. e. it is more friable and is infected quicker.  Inside the dentine there is the pulpal cavity where the pulp is.  It is a complex tissue and consists of many blood vassels and bundle of nerves. The pulp provides the tooth with minerals, vitamines, t.e. nourishes the tooth. The nerve extrmities are responsible for perception of pain, as well as of different kinds of external provocatives
Кариес
The term caries means 'rotting'. The caries is developed gradually: first a pigmental stain appeares on the tooth surface (white, then yellow) that turns brown soon. Then the enamel is decayed and then it comes the dentine's turn. The hollow appeared first on the enamel, then on dentine gradually enlargenes and deepens. The food remnants gathered in the cavity and create a nutrisious environment for the microbes. 
If no medical procedures are performed the pathological process is developed and the tooth is decayed totaly and complications rise.  To the number of main complications belong the pulpitis and periodontitis.

The dentists differenciate between two stages of caries:

-early, when the caries stain appeares (white and pigmental).
-late, when a hollow appeares in the hard tissue (superficial, middle and deep caries). Caries becomes the reason of anatomic, functional and aesthetic defects of the tooth.  

Causes

The caries is developed as a result of vital activities of microbes in the dental deposite. The dental deposit in its turn is developed from cooked food, which contains great number of carbonhydrates. So, a soft dental deposit is gathered on the surface of the enamel and in those parts of teeth from where it is not cleaned while chewing, it clings frimly and becomes a 'place' for the accumulation of microbes. If the dental deposit is not cleaned on time, the microbes multiply quickly. The more the amount of microbes rises, the more they produce acids which clean calcium and flourine from the surface of enamel. The enamel softens gradually and the microbs penetrate deeper in the tooth damaging it.

Does caries develop to everybody?
Кариес
To some perople the resistance is weak to other it is rather high. The stability of teeth towards the caries depends on the protective system of the organism, concomitent diseases. The factor of heridety is also very important. It is determined that to the people with low imune system caries develops more actively. Important roles play the composition and the properties of saliva. To the people having dental caries the saliva is more viscous and in its composition the ratio of minerals is changed.    
The external factors (food, oral hygiene), heredity, as well as the total health state of the organism (immune, digestive systems) also have an important role in the development of the caries. Besides poor cleaning another cause of dental caries may be improper feeding (insufficiency of carbohydrates, vitamins, minerals, fluorine), the abuse of candy, as well as the stress.

What happens?

The soft deposit forms immediately during the eating process. It contains small remnants of food and generally consists of carbohydrate. If the tooth is not cleaned, the soft deposit hardens and sticks to the tooth firmly. And the microbes ‘inhabiting’ there transform the carbohydrates into acids. The tooth enamel softens under the influence of the acids.
This is the first stage of the development of the dental caries-the caries stain. In this stage it is still possible to stop the morbid process.
In the second stage of caries the process is aggravated and reaches to dentine-to the main tissue immediately under the enamel. The dentine is less stabile towards the caries than the enamel and thus the tooth destruction becomes more rapid and severe.

That is the middle stage of caries. If in this stage the caries is not treated the destruction of dentine leads to a hollowing.

That is already the deep caries.

To recognize the caries is rather easy, the symptoms are:
-on the teeth surface (especially on the chewing surface) dark pigments appear
-the surface of the tooth roughens
-there is a feeling of light pain while eating, the tooth is supersensible towards sweet and acid, hot and cold
-there may be fetid odor in the mouth
-with toothpick or tongue it is possible to grope for the hollow in the tooth

The caries may deeply injure the tooth and reach to the most delicate part of the tooth-pulp, where the nerves and vessels are. The lesion to this degree may be accompanied by strong pain and is called pulpit.

The Diagnosis and the treatmentДиагностика и лечение

If the caries is developed anyway, it is important to turn to dentist possibly early to start the treatment. To treat the deep caries is difficult and lasts comparatively long. This can cause serious complications.
The dentists in the ‘Aregak’ dental clinic treat patients of any age with the newest and painless methods, with new materials and with anesthetics of the last generation. Besides, the patients of the clinic are explained the ways of caries prevention, the correct oral hygiene, the right choice of hygienic means that would help to prevent caries.

Today the caries treatment is not painful at all and is done with anesthesia. The destructed dental tissues are removed and then the cavity is filled with newest inlay materials. It is necessary to turn to the dentist in case of first symptoms of dental caries as the later the treatment is, the greater the surface of the tissue destruction is.  

It is recommended to do a regular professional oral cleaning which would allow cleaning efficiently dental deposits and dental plaque from the difficult-to-reach zones which will prevent the caries development.  

Superficial caries: the dental enamel is damaged or not a big dental inlay has fallen or there is a small hollow in the tooth. The tooth treatment supposes elimination of enamel defect and restoration of its anatomical form, color and chewing function.   
Middle caries: in this case the ½ of hard tissue is damaged (enamel and dentine). It might be detected after the dental inlay has fallen or when the doctor is handling the tooth and a mid-depth caries zone is uncovered behind a small hollow. The tooth treatment supposes the elimination of enamel defect and the restoration of its anatomical form, color and chewing function.   
Deep caries: more than the ½ of the hard tissue of the tooth is damaged, but the nerve is not infected.  The treatment is done by elimination of the defect on enamel and dentine with the help of dental inlays (dentine forming medicine is used), the form of tooth, color and the chewing function are restored.   
If during caries treatment considerable destruction of inner tissues of tooth is detected and the restoration is not possible, then there rises need for prosthetics by placing an inlay or crown, or (exceptional cases) tooth extraction.

Secondary caries

As far as the tooth tissues do not regenerate, the caries treatment is realized by extraction of the injured tissues; the generated defect is eliminated by special filling or by placing a so called ceramic inlay. The goal of all artificial materials is not only to hide the defect but also to replace the lost volume of the tissue, as well as to restore the anatomic form of the tooth for full restoration of the functional problem. If the defect of the tissue is rather remarkable then it is advised not to use filling, but to place a ceramic inlay for it is more reliable and firm because of equal distribution of chewing load.
Secondary caries means repetition of caries lesion after a therapeutic treatment. The reasons for it may be different. If the infected tissues are not removed completely then the process may develop under the inlay. The wrong usage of this or that material, as well as not keeping the rules while placing the inlay may cause the development of secondary caries. Another reason may be the usage of the material of low quality that can’t sustain the pressurization and secondary caries is developed. The third reason is the insufficient personal oral hygiene that may provoke a secondary caries of healthy tooth tissues.
Many people think that in the teeth undergone depulpation can’t develop caries and they get surprised knowing that especially in those teeth caries is developed. As far as caries (primary and secondary) is a necrotic process that decays the hard tissue of the tooth, the presence of nerve in that process does not play any role.  

The caries prevention

Caries is a rather widespread dental disease. Today nearly everybody has problems with caries and its complications. As it has been mentioned, caries is necrosis of hard tissue of the teeth. The worst thing is that the process irreversible.  In other words it may be prevented but it is not possible to restore the lost tooth tissues. So it would be better not to wait until the caries is developed, but to prevent it. The caries is prevented productively to children, especially the pressurization of dental fissures.  

To prevent caries it is important Профилактика кариеса

-    to feed correctly. Fresh fruits and vegetables should dominate in the food. The confectionery and sweets should be limited.   
-    To clean teeth in the morning and evening not less than 2-3 minutes with correctly chosen toothpaste and toothbrush.
-    To perform professional oral cleaning regularly  
-    To visit the dentist twice a year for preventive dental examination.

There exist preventive measures that should be started yet in the intrauterine development period of the fetus, as far as in that period the basis of the teeth formation is put. The lifestyle of the future mother, her detrimental habits immediately affect the teeth quality of her child.  
After kid’s birth it is very important his nutrition-breast feeding, giving vitamins and minerals sufficiently and on time (one should be careful not to exceed the quantity), the elimination of bad habits of the kid (to suck the finger, mouth breading, biting pens and pencils, etc.). Pulling all this together we may say that the first point of caries prevention should be explanations given to future parents about the reasons of caries development and its dangerous consequences.
The second point is already the private oral hygiene that should be kept immediately after the first milk teeth appeared. Naturally, at the beginning it does mother and later she teaches the kid to do that on his own, of course, controlling his actions.
Cleaning the dental deposit mechanically we exclude the risk of caries generation. But if there is already a process then only teeth cleaning would not help.
That’s why the third point of caries prevention is the professional oral hygiene and the dentist’s preventive examination.