Cervical tooth decay

Pre-gingival or cervical caries of teeth is diagnosed when the destruction of hard dental tissues affects a part of the tooth near the neck - a 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 of the cervical caries

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

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

Useful information in the article -  Why does dental plaque arise and why is it dangerous?

In addition, the etiological factors in the development of caries are considered to be a violation of metabolic processes in dental tissues, in particular, insufficient mineralization of enamel incapable of self-healing (which consists of crystalline calcium phosphate - hydroxyapatite) or a too long process of its maturation 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) may develop, especially with its dystopia or retention. [2]

The cervical caries of milk teeth has the same etiology, read -  Caries of milk teeth .

Risk factors

Dentists consider a thinner layer of enamel that protects the neck of the teeth to be a natural factor predisposing to the occurrence of caries with localization in the cervical area.

And risk factors include:

• insufficient hygienic dental care, leading to the accumulation of plaque;
• 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 can cause cervical caries in young children; [3]
• celiac disease  (since the autoimmune response to gluten can lead to demineralization of crystals of hydroxyapatite of tooth enamel);
• a genetic predisposition to a decrease in the mineralization of tooth enamel, including hypocalcification with anomalies of amelogenesis and  enamel hypoplasia ;
• xerotomy (dry mouth of various etiologies);
• acid reflux (gastroesophageal reflux disease).

Bruxism and orthodontic treatment with braces can cause cervical caries in anterior teeth. They can provoke cervical caries and veneers - onlays on the front surfaces of the incisors (for the installation of which part of the tooth enamel is removed), and improper installation of crowns, and teeth whitening with low pH products. [4]

Pathogenesis

In the special literature, the pathogenesis of the carious process due to bacterial etiology is considered.

The above bacteria from the glucose component of sucrose with the help of their enzymes (glucosyltransferases) synthesize a number of extracellular adhesive polysaccharides - glucans, which contribute to the constant colonization of hard surfaces with the formation of a polymer biofilm, which, in fact, is a matrix of dental plaque and serves as a 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 tissues of the tooth. [5]

Symptoms of the cervical 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 determine the cervical caries in the spot stage. This is followed by the superficial stage, in which the stain deepens somewhat in the central part, and this can cause painful sensations when brushing teeth and increased sensitivity to chemical irritants and temperature -  tooth hyperesthesia . [6]

With medium caries, a cavity with softened (demineralized) dental tissue - dentin is formed on the spot and a depression on it; the sensitivity of the tooth increases, after exposure to irritating agents, a short toothache occurs.

If there is deep cervical caries, then the size and depth of the carious cavity in the area of the tooth neck is significant, inside it can be black, and the affected enamel around the cavity has uneven blackened edges. Intense tooth pains often occur. [7]

Complications and consequences

A complication of cervical caries is its spread to almost the entire part of the peri-gingival region of the tooth, defined as a circular carious lesion, which subsequently leads to a fracture of the dental crown.

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

Also, possible consequences are the formation of granulomas with tissue necrosis or dental cysts. [8]

Diagnostics of the cervical caries

In addition to recording patient complaints and a standard examination of the teeth, the diagnosis of cervical caries can be carried out using special markers that stain only that part of the hard dental tissues that are affected by caries.

Most often, instrumental diagnostics is limited to stomatoscopy,

Diaphanoscopy or fluoroscopy of the teeth, and in case of complications in the form of pulpitis, electroodontodiagnostics is performed.

Differential diagnosis

Differential diagnosis is carried out to distinguish between non-carious pathologies of dental tissues,  [9]first of all, cervical caries and wedge-shaped defect  [10] (abfraction of the cervical zone not associated with caries), for more details see - Wedge -  shaped defect of hard dental tissues . 

Treatment of the cervical caries

Which doctor treats cervical caries? Both diagnostics and treatment of caries of any localization are dealt with by a  dentist-therapist .

Is it painful to treat cervical caries? Now treatment with the use of a drill for the rehabilitation of the carious cavity is carried out under local anesthesia; if the caries is deep, a painless removal of the nerve is performed. When the carious cavity is partially closed 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 seal is placed. Filling of cervical caries is carried out with photo-hardening polymer composites, glass ionomer cements and other modern filling materials. But when carious lesions are not in the "smile zone" use dental amalgam. [12]

More information in the materials:

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

How is the restoration of cervical caries, more precisely, the carious cavity formed with it, read in the publication -  Restoration of teeth .

The answer to the question why cervical caries hurts after filling, 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 the defeat of the tooth enamel at the stage of stains - after cleaning the teeth from plaque - is treated by its dosed fluoridation, which promotes remineralization.

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

These are medicinal toothpastes and gels such as:

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

Mouthwashes containing fluoride are also recommended, such as Listerine Expert or Lacalut sensitive. 

Prevention

Prevention of any caries, including cervical caries, includes:

• two times daily brushing of teeth;
• to clean the interdental spaces using dental floss;
• restriction of sweet and starchy foods in the diet;
• periodic visits to the dentist - for a preventive examination of the teeth and carrying out their professional cleaning from dental plaque.

Dentists advise to strengthen the enamel of the teeth, for more details see -  Strengthening the tooth enamel , as well as to use healthy  products for the teeth . [13]

Forecast

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