Dental caries

Gingival or cervical caries of teeth is diagnosed when the destruction of hard dental tissue affects the part of the tooth near the neck - the slightly narrowed transition of the dental crown to the root, that is, near the very edge of the gum, and often even under it.

Causes dental caries

Although dental caries (from the Latin caries – decay) is a multifactorial disease, as in the case of damage to the occlusal surfaces of chewing teeth or crowns between contacting teeth, the key causes of the process of destruction of tooth enamel, dentin and cement in the neck of the tooth are associated with the impact on them of the waste products of strains of closely related bacteria Streptococcus mutans and Streptococcus sobrinus. [ 1 ]

For them, the oral cavity, or more specifically, dental plaque (an organic film that forms on their surface), is a natural habitat where they live in entire colonies.

Useful information in the article – Why does dental plaque occur and why is it dangerous?

In addition, etiological factors in the development of caries are considered to be metabolic disorders in dental tissues, in particular, insufficient mineralization of enamel that is incapable of self-healing (which consists of crystalline calcium phosphate - hydroxyapatite) or an excessively long maturation process due to a deficiency of calcium, phosphorus or fluorine.

Caries of this localization can affect any teeth of the upper and lower row, and its types include: cervical caries of the anterior teeth (incisors), premolars and molars, on the canine. Cervical caries of the wisdom tooth (third molar) can develop, especially with its dystopia or retention. [ 2 ]

Cervical caries of baby teeth has the same etiology, read - Caries of baby teeth.

Risk factors

Dentists believe that a natural factor predisposing to the occurrence of caries localized in the cervical zone is a thinner layer of enamel protecting the neck of the teeth.

And risk factors include:

• insufficient dental hygiene leading to plaque accumulation;
• tooth wear and enamel destruction;
• gum recession with exposure of the tooth neck;
• foods high in sugar and fermentable carbohydrates; relatively high sugar intake promotes bacterial growth and may cause cervical caries in young children; [ 3 ]
• celiac disease (since the autoimmune response to gluten can lead to demineralization of hydroxyapatite crystals in tooth enamel);
• genetic predisposition to decreased mineralization of tooth enamel, including hypocalcification in amelogenesis anomalies and enamel hypoplasia;
• xerotomy (dry mouth of various etiologies);
• acid reflux (gastroesophageal reflux disease).

Bruxism, as well as orthodontic treatment with braces, can cause cervical caries of the front teeth. Cervical caries can also be caused by veneers - pads on the front surfaces of the incisors (for the installation of which part of the tooth enamel is removed), and incorrect installation of crowns, and teeth whitening with low pH products. [ 4 ]

Pathogenesis

The specialized literature examines the pathogenesis of the carious process caused by bacterial etiology.

The above bacteria, using their enzymes (glucosyltransferases) from the glucose component of sucrose, synthesize a number of extracellular adhesive polysaccharides – glucans, which promote the constant colonization of hard surfaces with the formation of a polymer biofilm, which, in essence, is the matrix of dental plaque and serves as protection for bacteria.

S. mutans are acidogenic, that is, they metabolize carbohydrates into organic acids (lactic, formic, acetic and methylacetic), which destroy tooth enamel by dissolving hydroxyapatite with the release of free calcium and phosphates, and then damage the underlying tooth tissue. [ 5 ]

Symptoms dental caries

The symptoms that manifest gingival caries depend on the stage of the pathological process.

When this is the initial stage, its first signs are the appearance of a white (chalky) or brown spot on the tooth enamel, and dentists define cervical caries as a spot. Next comes the superficial stage, in which the spot deepens somewhat in the central part, and this can cause painful sensations when brushing teeth and increased sensitivity to chemical irritants and temperature – dental hyperesthesia. [ 6 ]

In case of moderate caries, a cavity with softened (demineralized) dental tissue – dentin – forms at the site of the stain and the depression on it; tooth sensitivity increases, and after exposure to irritants, a short-term toothache occurs.

If there is deep cervical caries, then the size and depth of the carious cavity in the neck of the tooth are significant, it can be black inside, and the affected enamel around the cavity has uneven blackened edges. Often there is intense pain in the tooth. [ 7 ]

Complications and consequences

A complication of cervical caries is its spread to almost the entire perigingival area of the tooth, defined as a circular carious lesion, which subsequently leads to a fracture of the dental crown.

Due to rapid progression, cervical caries leads to the development of an inflammatory process in the dental pulp (pulpitis) or its periradicular tissues (periodontitis), provoked by the activation of fusobacteria and other opportunistic microorganisms present in dental plaque.

Also possible consequences include the formation of a granuloma with tissue necrosis or a dental cyst. [ 8 ]

Diagnostics dental caries

In addition to recording patient complaints and standard dental examination, cervical caries can be diagnosed using special markers that color only that part of the hard dental tissues that are affected by caries.

Most often, instrumental diagnostics is limited to stomatoscopy,

Diaphanoscopy or X-ray examination of teeth, and in case of complications in the form of pulpitis, electroodontodiagnostics are performed.

Differential diagnosis

Differential diagnostics is carried out to distinguish between non-carious pathologies of dental tissues, [ 9 ] primarily cervical caries and wedge-shaped defect [ 10 ] (non-caries-related abfraction of the cervical zone), for more details see – Wedge-shaped defect of hard dental tissues.

Treatment dental caries

What kind of doctor treats cervical caries? Both diagnostics and treatment of caries of any localization are performed by a dentist-therapist.

Is it painful to treat cervical caries? Currently, treatment using a drill to sanitize the carious cavity is carried out under local anesthesia; if the caries is deep, painless removal of the nerve is performed. When the carious cavity is partially covered by the edge of the gum, as well as in the presence of suppuration of the gingival pocket, its preliminary dissection may be necessary - gingivotomy for the treatment of cervical caries. [ 11 ]

At the final stage, a filling is placed. Cervical caries is filled with photo-hardening polymer composites, glass ionomer cements and other modern filling materials. But when carious lesions are not in the “smile zone”, dental amalgam is used. [ 12 ]

More information in the materials:

• Treatment of dental caries
• Treatment of deep dental caries: basic methods

How to restore cervical caries, or more precisely, the carious cavity that forms with it, read in the publication - Restoration of teeth.

The answer to the question of why cervical caries hurts after filling is in the article - Toothache after filling

Treatment of cervical caries at home

There is an opinion that it is possible to treat cervical caries at home. And it is connected with the fact that damage to tooth enamel at the stage of a spot - after cleaning teeth from plaque - is treated by its dosed fluoridation, which promotes remineralization.

To do this, you should use various remedies for cervical caries recommended by dentists.

These are medicinal toothpastes and gels such as:

• toothpastes ROCS, WhiteWash, Fluorodent;
• Elmex Gelee medical toothpaste in gel form;
• paste with aminofluoride and sodium fluoride Lacalut Extra sensitive - Lacalut sensitive for cervical caries;
• Topical APF gel (with sodium fluoride).

Fluoride-containing mouthwashes such as Listerine Expert or Lacalut sensitive are also recommended.

Prevention

Prevention of any caries, including cervical caries, includes:

• twice daily brushing of teeth;
• to clean the spaces between teeth, use dental floss;
• limiting sweets and flour products in the diet;
• Regular visits to the dentist – for preventive examination of teeth and professional cleaning of plaque.

Dentists advise strengthening tooth enamel, for more details see – Strengthening tooth enamel, and also eating healthy foods for teeth. [ 13 ]

Forecast

At the initial stage of cervical carious enamel lesion - if therapeutic measures are taken in time - the prognosis is most favorable. But if cervical caries is not treated, then you can lose a tooth.