Why do teeth crumble and what to do?

Every year dentistry rises one step higher, expanding the range and scale of treatment of dental pathologies. New drugs are discovered, more effective methods of treatment and prevention of dental diseases are introduced. However, due to total urbanization, an increase in the rhythm of life, a decrease in environmental indicators, dental diseases are still a serious problem in the life of every person. One of such conditions is the destruction of hard dental tissues.

Why do teeth crumble?

Quite often, at a certain period of their life, a person, noticing problems with their teeth, begins to wonder why their teeth are crumbling. This can happen against the background of systemic pathologies, pregnancy, after moving to an industrial city, taking up a responsible position in a large institution. Also serious factors are: low stress resistance of a person, excessively slow adaptation to new circumstances, difficult family circumstances. Given the versatility of the concept of "crumbling teeth", let's consider the most common causes of this problem.

Caries, pulpitis and depulpation of teeth

One of the most common causes of tooth decay is caries. The carious process is the demineralization of hard dental tissues. The causative agents of this disease are considered to be streptococci of the cariogenic group (Str. Mitis, Str. Sanguis, Str. Mutans and Str. Salivarus). After the appearance of plaque, the above-mentioned microorganisms begin to multiply in it. As a result of active life, streptococci secrete various metabolic products, enzymes, toxic substances. As a result, the mineral components of the tooth "dissolve", which leads to the appearance of a demineralization spot, then a defect, a cavity and, finally, total destruction of the tooth. Risk factors for the development of the carious process are poor oral hygiene, reduced intake of micro- and macroelements (especially phosphorus and calcium), diseases of the gastrointestinal tract, endocrine and nervous systems, salivary glands, etc.

Clinically, caries may be unnoticeable, or, on the contrary, attract all the attention of a sick person. Everything depends on the stage and type of pathological process. The first signs of caries are the appearance of a chalky spot on the tooth. Since tooth enamel normally has a natural glossy shine, caries at the spot stage will be visually determined, since it has a matte surface. Of course, we are talking only about those cases when the pathological process is on the visible parts of the tooth. Most often, this is the labial surface of incisors, canines and small molars. In other cases, patients rarely notice focal changes in the color of the tooth. This is also due to the fact that the initial form of caries is not accompanied by pain.

Superficial caries implies the presence of a defect in the tooth tissues. This stage of the carious process is accompanied by painful sensations, but massive destruction of the tooth tissues is not determined. Therefore, a visit to the dentist, careful removal of the affected tissues and the installation of a high-quality filling can stop the progression of the pathological process in this tooth for many years.

Medium and deep caries are stages of the carious process, in which demineralization of hard tooth tissues with noticeable loss of tissues of the crown of the tooth most often occurs. In some cases, caries begins in the distal (back) areas of the tooth crown, after which it spreads deep into the dentin. It is worth noting that in dentin, caries expands its boundaries faster than in enamel. Due to this, in enamel, the carious cavity can be narrow, and in dentin, it can be several times larger than the first. As a result of such imperceptible destruction, a person will at some point come to the doctor and say that his tooth hurts and crumbles for no apparent reason.

A special form is flourishing (generalized, multiple) caries - it occurs more often in children under 6 years of age. This is explained by the fact that during this period children have temporary teeth. As is known, the enamel of baby teeth is thin and porous. This allows cariogenic microorganisms to easily penetrate into the tissues of the tooth, multiply there and provoke the occurrence of the carious process. The low content of protective immunoglobulins in the saliva of the child's body also contributes to the successful vital activity of streptococci. Children with pathologies of immunity, mineral metabolism, salivary glands and genetic diseases are at risk. The clinical picture of multiple caries never goes unnoticed. The child begins to complain of pain that appears in several teeth. Parents most often bring their child to the dentist with complaints that his baby teeth are crumbling. During the examination, a large number of teeth affected by caries are determined.

Treatment of caries involves removing the affected tissues and performing direct restoration. Most often, composite materials are used for this purpose, which allow achieving an aesthetic result and reliable restoration of the anatomical and functional integrity of the tooth. When blooming caries or caries in pregnant women occurs, a special approach is required, which will take into account and correct the general condition of the body.

Prevention of caries is the most important principle of maintaining healthy teeth. Since the main condition for the appearance of streptococci accumulations is dental plaque, prevention of caries should begin with regular oral hygiene. If you do not create comfortable conditions for the vital activity of streptococci, the risk of their appearance is reduced to a minimum. It is also worth considering how to strengthen the teeth so that they do not crumble. For this, there are special pastes that contain the necessary elements (calcium, phosphorus, magnesium, zinc, etc.). Examples of toothpastes with similar compositions are: Colgate "Enamel Health", Blend-a-med "Anti-caries", etc. It is also worth noting the oral B "Biorepair" paste, which contains substances that suppress the vital activity of cariogenic bacteria (in particular Str. Mutans). An excellent means of preventing caries is the procedure of remineralization of teeth. For this purpose, there is a special gel ROCS "Medical minerals" (ROCS gel "Medical Minerals"). It is applied to the teeth every day after brushing the teeth for 30-40 minutes. There are many varieties of this gel on the market, taking into account age and taste preferences. As the manufacturer states, this product is a source of essential mineral components that form the structure of the tooth.

Destructive and erosive forms of fluorosis

Fluorosis is a dental disease of endemic nature. This pathology occurs in people who live in areas with fluoride content in drinking water of about 1.6 - 2.0 mmol / l. It should be noted that due to individual characteristics of the body, not all people experience this disease. However, if this disease occurs, serious aesthetic and functional disorders are noted. The pathogenesis of fluorosis, like most non-carious lesions of the teeth, has not been fully studied. At the moment, it is believed that at the stage of development of tooth rudiments, excess fluoride in the body leads to the formation of a specific compound - fluorapatite. Compared to hydroxyapatite, which normally forms tooth enamel, fluorapatite is a more fragile substance, which leads to increased tooth wear and defects. The clinical picture of erosive and destructive forms of fluorosis is quite specific. In children, when permanent teeth erupt, brown defects are determined on the enamel. It is worth noting that the lesions are located symmetrically, for example, on the canines on the right and on the canines on the left. Another feature of fluorosis is the fact that several spots can be located on one tooth. The presence of fluorosis is most often noticed by parents in their child. They complain that the child has teeth with dark spots. The child himself most often feels the consequences of the destruction of dental tissue, which manifests itself in the form of defects, chips, abrasion, etc. Diagnosis of fluorosis is not difficult. Living in an endemic zone and the nature of the lesions clearly indicate the presence of the disease in question. Treatment of fluorosis consists of restoring the affected teeth with the help of restorative materials or fixed structures (crowns, veneers, etc.). To prevent this pathology, it is necessary to control the intake of fluoride into the body. To do this, you should drink defluoridated water and use toothpaste without fluoride.

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Dental erosion

Dental erosion is a non-carious lesion that manifests itself as defects in the enamel and dentin on the outer (vestibular) surface of the tooth. The cause of this disease has not yet been fully clarified. Like some other non-carious lesions, erosion has "surrounded" itself with a set of etiological theories. Interestingly, some theories even contradict the term "erosion". For example, the chemical theory suggests that various chemicals, such as acids, affect the hard tissues of the tooth. They are contained in citrus fruits, confectionery, soda and other products. However, in physics, the effect of chemicals on the body is usually called corrosion. But, due to the uncertainty of the true cause of the disease, even its name cannot be formulated clearly. The mechanical theory is that various abrasive substances (toothbrushes, pastes, hard food, foreign objects) affect the tooth. When considering this theory, the term "erosion" sounds more logical, since it consists of the mechanical action of liquid or air on the surface of a physical body. However, this version of the origin of erosions, like the previous one, has not received the necessary scientific justification. The third theory states that the cause of erosions is hyperfunction of the thyroid gland. It has been scientifically proven that people with hyperthyroidism develop dental erosions 2 times more often than healthy people.

The clinical picture of this disease is that a person, without any obvious reason, first develops matte spots, and then defects on the vestibular surface of the teeth. The lesions narrow as they deepen, which is why the defects are called cup-shaped. Subjectively, erosions appear only after the transition from the spot stage to the defect stage. A person develops increased sensitivity to cold and sour foods. Without a clinical examination, erosion is difficult to distinguish from caries, wedge-shaped defects and other lesions of hard dental tissues. Therefore, a person who is not professionally associated with dentistry will complain that his teeth are crumbling.

The question: "How to treat erosions?" cannot be answered clearly, since the etiology of the disease remains unclear. Therefore, therapy consists of eliminating the symptoms of the disease, risk factors and strengthening the hard tissues of the teeth.

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Parafunctions of the masticatory muscles

The work of the human masticatory muscles is closely related to the condition of his teeth. When various parafunctions occur, the muscles contract with excessive force, which leads to increased load on the teeth. Moreover, with some types of parafunctional activity, the jaw performs lateral and anterior-posterior movements, which provokes pathological abrasion of teeth. There are two most common types of parafunctions of the masticatory muscles - bruxism and klench.

Bruxism is a parafunction of the masticatory muscles of central genesis. Throughout the development of dentistry, many risk factors for bruxism have been identified, but the main cause has not yet been established. Scientists who study sleep and the associated limbic system of the brain claim that bruxism is caused by a sleep disorder. Some dentists who study gnathology and the study of occlusal relationships (contacts between teeth) suggest that the cause is obstacles from the teeth. The most logical theory is that bruxism is a protective reaction of the body aimed at combating stress. Since the modern world is developing very dynamically, the pace of life is constantly accelerating, and the amount of new information is increasing. This leads to the fact that a person has many problems that they do not have enough time and energy to solve. Moreover, highly paid professions require a high level of responsibility, which adds to the stressful state. If we add to this such factors as the lack of sports, love relationships, new pleasant experiences and rest, then a person begins to experience chronic stress. As is known, stress is the most “universal” risk factor for diseases. Diabetes, cancer, cardiovascular diseases - all this can be provoked by chronic emotional stress. If the stress load is reduced, then the risk of these diseases also decreases. Therefore, with bruxism, the body reduces emotional stress through muscle activity. This raises the question: “What should be treated? Bruxism or mental state?”

The mechanism of bruxism can be described as follows. An impulse is sent from the central nervous system to the muscles. The chewing muscles contract with a force that is 6 times stronger than the normal contraction force during chewing. At the same time, the lower jaw can move forward and deviate to the sides, performing these movements throughout the entire bruxism cycle. The duration of the attack is from 5 seconds to several minutes.

The clinical picture of bruxism is characterized by tooth wear, enamel cracks, abfractions and chips. Some patients, observing the above-mentioned signs, complain that their teeth are crumbling and hurting. However, all this is not due to weakened teeth, but due to increased load on them.

Clenching is a type of muscle parafunctional activity in which teeth are clenched without lateral and anteroposterior jaw movements. That is, the lower jaw moves only in the vertical direction. Complaints with clenching are approximately the same as with bruxism, the only difference is that tooth wear is expressed to a lesser extent.

Bruxism is diagnosed only in clinical settings. A full anamnesis is collected, the tone of the masticatory muscles is examined, and they are palpated. During the examination, attention is paid to the abrasion of the teeth and the presence of gum recessions. Diagnostic plaster models are also analyzed in the articulator. This allows us to determine the occlusal relationships and identify points on the teeth that create obstacles to the movement of the lower jaw. One of the diagnostic techniques is to compare the abrasion facets. The method consists of setting the lower jaw in such a position that the upper and lower incisors are in contact with each other. From this point, the position of the lower jaw is deflected to the left or right and the maximum correspondence between the planes of the upper and lower teeth is found. Most often, this position is 1-3 cm to the left or right from the central position of the lower jaw.

A more accurate method of diagnosing bruxism is Bruxcheckers. They are special mouthguards that a person puts on at night. The thin colored coating of the mouthguard allows the opposite teeth to leave imprints on it, which will allow the doctor to see "unwanted contacts." Clench diagnostics is also based on the study of the chewing muscles and occlusal relationships.

Treatment of parafunctional activity is currently carried out in a rather abstract manner. Until the cause of the disease is established, it is considered polyetiological. And if it is polyetiological, then the effect on its cause is initially impossible. Therefore, therapy is aimed at reducing symptoms and eliminating tooth wear. In the presence of chronic stress, a course of psychotherapy is prescribed. Special mouth guards are used to protect teeth and periodontium. In the presence of unwanted tooth contacts, selective grinding of teeth is performed. If the patient has incorrectly positioned teeth or defects in the dental arches, then orthodontic treatment and rational prosthetics are necessary.

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Abfractions

Abfractions (wedge-shaped defect) are non-carious lesions of teeth, in which V-shaped foci of destruction of hard tissues appear in the cervical area. Many researchers believe that the nature of wedge-shaped defects is polyetiological. Some scientists build their hypotheses that are associated with mechanical and chemical irritants. However, the most logical at the moment is the theory of lateral load on teeth. It so happened that the anatomical shape of teeth is thought out by nature very carefully. Human teeth easily withstand chewing load. Powerful roots, correct inclination of teeth, optimal shape of tubercles on chewing surfaces - all this contributes to the ideal distribution of load on teeth. However, if its direction is incorrect, the force and time of exposure are exceeded, then the hard tissues of the tooth begin to experience stress. Such a situation can be observed in bite pathologies, periodontal diseases (tooth mobility), defects of the dentition (when the chewing load is distributed to the remaining teeth), parafunctions of the masticatory muscles (bruxism), etc. All of the above conditions can lead to the appearance of a wedge-shaped defect. For a clearer understanding of the pathogenesis, you can imagine how a dry tree branch breaks. When you try to bend it, a stretch zone appears on the outer side of the bend, and a compression zone on the inner side. If we talk about a tooth, then the compression zone for it will be the vestibular surface, and the stretch zone is the oral surface. Since there is no shortage of space for cells in the stretch zone, the distance between them first increases and then decreases without a visible effect on the condition of the tooth tissue. In the compression zone, the situation is different: as a result of external influence, the cells squeeze each other, leading to a V-shaped destruction of enamel and dentin. The clinical picture of this lesion remains unnoticed for a long time. This is due to the slow progression of the disease and the absence of acute symptoms. However, at a certain point, a person begins to complain that the tooth enamel is crumbling. The diagnosis of a wedge-shaped defect is also quite simple: a V-shaped defect is observed, the surface of which is covered with unchanged hard tissues (enamel or dentin). Treatment of this condition should begin with the exclusion of predisposing factors of the disease, which were indicated earlier. Only under this condition can restorative treatment of the affected teeth begin. Restoration of the function and aesthetics of teeth is performed using filling materials, ceramic veneers and crowns.

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Pregnancy

The period of pregnancy for a woman is one of the most important stages in her life. However, it should be noted that this condition sometimes causes significant damage to the health of the expectant mother. This is primarily due to the restructuring of the hormonal background and the preferential direction of nutrients through the placenta to the fetus. Considering the fact that the bone structures of the fetus are formed in the first trimester of pregnancy, mineral components enter through the placenta in fairly large quantities. Thus, already in the first trimester of pregnancy, a woman may experience a deficiency of mineral components. Most often, pregnant women complain of hair loss, crumbling teeth and nails. In addition to calcium deficiency, the body becomes more sensitive to external irritants and vulnerable to pathogens of various diseases. Activation of saprophytic flora leads to the fact that even relatively harmless diseases proceed in a rather aggressive form. The same caries, for example, in an ordinary person can be a single phenomenon, in which one tooth is affected, and in a pregnant woman, caries can acquire the character of multiple and rapidly progressing. Fear of medical intervention during pregnancy can force a woman to endure pain and postpone a visit to the postpartum period. However, with this approach, by the end of the third trimester, you can lose several teeth due to their total destruction and loss. The clinical picture is different in each individual case. If caries progresses not too aggressively, then a pregnant woman can complain about the loss of old fillings and the ingress of cold, hot and sweet food into the tooth. In the case when caries progresses quite quickly, people complain that their teeth crumble one after another. Carious spots appear in several teeth at once, and then cavities. Very often, these problems are complicated by pulpitis and periodontitis, which requires anesthesia and endodontic treatment. To prevent these complications, it is necessary to contact a dentist in time for diagnostics. It consists of an instrumental examination of teeth, which reveals areas of demineralization (caries). Caries detectors are often used to detect the carious process. These are special pigment solutions that color only the affected hard tissues of the tooth. Treatment of caries involves, first of all, the removal of all softened tissues. This can be done using rotating instruments (drills) or by manually extracting soft tissues using an excavator. Then the cavity is filled with one of the materials (composite, cement, compomer, etc.). The choice of material depends on the depth and location of the lesion, as well as the economic and aesthetic preferences of the patient.

Conclusion

If you notice that your teeth are starting to crumble, try to find the main reason for this condition (poor hygiene, stress, diseases of other organs, pregnancy, change of job or parallel existence of these factors). Analyze the latest events that have happened in your life and try to note the most difficult for you psychologically and physically. Perhaps the fact that your teeth are crumbling is one of the symptoms of a completely different disease. Unfortunately, there is a tendency in society that people do not consider it necessary to involve a dentist in their life and their general health. However, this will only make things worse for the patient. The dentist will do his job: remove plaque, perform dental restoration. But the further prognosis remains in the hands of the patient. If he continues to work in a hazardous industry, his teeth will continue to crumble quickly. If a person cannot get out of a state of depression, he may develop other, more serious diseases. As a result, the next time this patient will go to the dentist with a more aggravated condition of the dental system. Therefore, do not postpone dental problems for an indefinite future. You should look at your body comprehensively, as a single fragile mechanism, where the psychological and physical components are closely interconnected and require a reverent attitude towards yourself.

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