Therapy

Caries

Dental caries (Caries dentis) is a pathological process that manifests itself after the eruption of teeth, in which demineralization and softening of the hard tissues of the tooth occurs, followed by the formation of a defect in the form of a cavity.

Dental caries is currently the most common disease in mankind.

Modern methods and diagnostic tools used in dentistry make it possible to detect caries even in the “spot stage”, when a lighter colored area appears on the tooth surface – the first sign of demineralization (calcification) of tooth enamel. In our clinic, we use a device for the diagnosis of early and latent caries. With initial caries, treatment is reduced to the restoration of the lost mineral components of the enamel by remineralization and deep fluoridation with various gels, varnishes, which are a large selection in modern dentistry, but the essence of their application is the same – to prevent further spread of the carious process.

With the spread of caries in depth, the treatment of dental caries is based on the method of removing the affected tissues by preparation and restoration of the tooth with the help of filling materials (glass ionomer cements and photocomposites).

In case of untimely treatment, caries is complicated in the form of pulpitis or periodontitis.

Pulpitis

As a result of a number of reasons, an infection can enter the pulp. In this case, inflammation develops – pulpitis; the pulp increases in volume and the tooth begins to ache. With pulpitis, the pathological process extends not only to the deep areas of dentin, but also to the neurovascular bundle – the pulp. Pulpitis is manifested by acute throbbing pain in the affected tooth, often without clear localization, capable of irradiating into the teeth of the opposite jaw, ear, temple, eyes, which intensifies in the evening and at night.

Thermal stimuli cause a slowly passing pain attack. It is possible to cure this condition by removing the pulp, instrumental and medical treatment of the root canal system, followed by their filling. In order to remove a “nerve” from a tooth, it will take from an hour to several hours. In this case, the removal process itself takes a few seconds, and the rest of the time is spent on cleaning, shaping and filling the root canals. After their filling, not a single empty area should remain, since the void in the canal is ideal conditions for the propagation of infection. Endodontic root canal treatment is possible using an operating microscope.

Periodontitis

With delayed treatment of caries and pulpitis, periodontitis (periodontal inflammation) develops. In this case, the tooth can cause pain from mildly aching to very strong, aggravated by biting.

Periodontitis is also treated endodontically, since the cause is in the tooth. However, the treatment of periodontitis is usually more laborious, time-consuming and costly in comparison with the treatment of pulpitis and, moreover, caries.

Endodontic root canal treatment is possible using an operating microscope.

Erosion of enamel

Erosion is a progressive loss of hard dental tissues (enamel or enamel and dentin) of insufficiently clarified etiology. Some foreign authors believed that tooth erosion, like a wedge-shaped defect, arises exclusively from the mechanical action of a toothbrush and powder. Others believe that the occurrence of erosion is associated with the consumption of large quantities of citrus fruits and their juices. The implication was the adverse effect of various diseases – gout, neuropsychiatric disorders, etc.

Unfavorable factors of the working environment (acids, metal and mineral dust, etc.), as well as surfactants both in the field of their production and in the composition of hygiene products, are important.

Erosions often occur on the vestibular surface of the central and lateral incisors of the upper jaw, they are found on the canines and premolars. Sometimes the lesion is symmetrical. Their occurrence may be associated with a violation of mineral metabolism due to endocrine or other disorders in the body and, accordingly, in the dental pulp.

Endocrine disorders and, above all, thyroid hyperfunction play an important role in the formation of dental erosions. Erosion of teeth in patients with thyrotoxicosis is detected on average 2 times more often than in people with normal thyroid function.

The developed erosion is a round-shaped enamel defect located in the oblique or transverse direction of the most convex part of the vestibular surface of the tooth enamel. Usually the bottom of the erosion is smooth, shiny, and hard. Its gradual expansion and deepening can lead to complete loss of enamel and exposure of dentin on the vestibular surface of the tooth. Erosion is often combined with the abrasion of the cutting edges of crowns, incisors and molar cusps.

Painful sensations are often absent or mild, however, there is a fairly strong dentin hyperesthesia.

Erosion treatment should be comprehensive. An important element of the comprehensive treatment of erosion is considered to be the strengthening of hygienic dental care and the exclusion from the diet or at least limiting the use of acidic foods (lemons and other citrus fruits). Based on the assumption that the mechanical factor may also play a role in the pathogenesis of this disease, it should be recommended to use a softer toothbrush when brushing your teeth and use therapeutic and prophylactic toothpastes containing calcium glycerophosphate, fluorine and other trace elements and salts.

At the same time, it is necessary not only to organize local treatment, but also to conduct a thorough examination of the patient using general diagnostic methods, clinical and paraclinical methods, including consultations of related specialists. The main method of local treatment is filling the defects with photocomposites.

Enamel hyposia

Enamel hypoplasia is regarded as a defect in its development that occurs as a result of metabolic disturbances in developing teeth and manifests itself in a quantitative and qualitative violation of tooth enamel. Some researchers believe that during hypoplasia, the formation of dental tissues is disrupted due to changes in the cells that form enamel – enameloblasts.

Other authors consider enamel hypoplasia as a defect in its mineralization during the normal formation of dental tissues.

Depending on the cause, hypoplasia of hard tissues of a group of teeth occurs, which are formed in the same period of time (systemic hypoplasia), or several adjacent teeth of one, and more often different periods of development (focal odontodysplasia). Hypoplasia of a single tooth (local hypoplasia) is also observed.

Clinically, enamel hypoplasia is manifested in the form of spots, cup-shaped depressions (single or multiple) of various sizes and shapes, or linear grooves of varying depth and width, encircling the tooth and located parallel to the cutting edge or chewing surface. Taking into account the number of hypoplastic areas, it is sometimes possible to clarify how many times a similar metabolic disorder has occurred. Sometimes there is a combination of grooves with rounded depressions. In some cases, there is no enamel at the bottom of the depressions or on the tubercles of the premolars and molars.

If hypoplasia occurs with the formation of defects in the enamel, then the treatment consists in preparation and filling.

Fluorosis

Fluorosis (Latin Fluorum – fluoride + osis) is systemic enamel hypoplasia with a clearly established etiological factor (cause). This is a disease that develops before teething with prolonged ingestion of water or products with a high content of fluoride compounds. The disease is endemic.

Fluorosis manifests itself mainly on permanent teeth shortly after eruption. The teeth of children living in an endemic focus from birth or moving there at the age of 3-4 years are affected.

The enamel of teeth affected by fluorosis loses its transparency, becomes dull, yellow-brown spots appear on it.

Depending on the severity of the manifestation of dental fluorosis, there are dashed, spotted, chalk-speckled, erosive and destructive forms of the disease. The first three forms occur without loss of tooth tissue, and erosive and destructive – with loss.

One form or another of fluorosis persists for life and one form of spotting does not pass into another, regardless of the saturation of fluorine in the new water source.

Prevention. In order to prevent tooth damage by fluorosis in settlements where the fluoride content in water exceeds the concentration allowed by GOST (from 0.8 to 1.5 mg / l), it is necessary to carry out a set of preventive measures, both public and individual.

Public measures are reduced to: 1) replacement of water sources with a high fluorine content by others with a lower (optimal) concentration; 2) mixing of waters (by looping) several water sources rich and poor in fluorine, bringing the concentration to the required level; 3) construction of water treatment plants capable of defluorination of drinking water.

Individual prevention methods include:

natural feeding;
refusal of early introduction of complementary foods;
additional introduction to food of vitamins C and D, calcium preparations;
exclusion or limitation of products containing fluoride (sea fish, spinach);
taking children out of the endemic area on vacation.

Treatment of fluorosis is challenging and is done by a dentist. Sometimes the enamel defects are ground, with significant damage to the tooth tissues, filling of the defects, prosthetics with non-removable orthopedic structures (veneers, crowns) are indicated.

Wedge-shaped defects

A wedge-shaped defect is a progressive (at different rates) loss of hard tooth tissues (enamel and dentin) on the vestibular surface (buccal and labial) in the area of the tooth neck, in the shape of a wedge.

Factors causing the disease:

Diseases of internal organs – for example, wedge-shaped defects are found in 23% of people with chronic diseases of the gastrointestinal tract.
Periodontal disease, in particular periodontal disease – for example, neurodystrophic changes in the maxillofacial area lead to gum atrophy and exposure of the tooth neck and root.
Anomalies of the bite – so, with an incorrect load on the tooth, in one of its points there is a center of tension (the neck of the tooth). In the area of stress, enamel micro-chips occur, which later turn into a defect (abfraction defect). Of course, this will be facilitated by the increased load on the periodontium, for example, bruxism (a disease in which people grind their teeth in their sleep), abuse of chewing gum, etc.
Incorrect brushing technique (horizontal movements). Also, the use of brushes with very stiff bristles and the use of very abrasive hygiene products will provoke the development of wedge-shaped defects.

Most of the complaints are cosmetic in nature. Defects deepen very slowly and, as a rule, the lesion covers a group of teeth. Sometimes defects reach a considerable depth, while short-term pains from chemical and temperature stimuli may appear.

Treatment: In the presence of severe defects in hard tissues, filling is recommended. In aesthetically significant areas, composite filling materials are optimal, which can be used to close wedge-shaped defects without preparation. With deep defects, opening of the pulp of the tooth and even a fracture of the crown is possible. With such lesions, it is necessary to make artificial crowns.

Tooth hypersensitivity

Hypersensitivity or hyperesthesia of the teeth is a symptom complex characterized by short acute pain, which is a reaction of the tooth to external stimuli.

Irritants can be factors such as:

high or low temperature of food, drinks, as well as air inhaled through the oral cavity;
the chemical effect of food – the reaction of teeth to sweet, salty, sour;
mechanical irritants – hard toothbrushes, electric toothbrushes, various toothpicks and dental floss.
brushing your teeth too hard or improperly;

Causes of hyperesthesia:

periodontal disease (as a result of exposing the roots of the teeth, their sensitivity may increase);
dietary features, in particular: frequent consumption of sour foods, carbonated sweet drinks;
harmful production factors (for example, workers in the chemical industry);
excessive chewing load on the teeth, for example, due to the habit of clenching the teeth or missing one or more teeth.
violation of the integrity of the crown part of the tooth (enamel chips, microcracks, pathological abrasion).

Treatment of hyperesthesia of dental hard tissues is aimed at normalizing the hydrodynamic mechanism of enamel and dentin sensitivity by reducing the response of dental fluid to external stimuli:

– sealing microspaces of enamel and dentin with special varnishes, desensitizers;

– remineralizing therapy (restoration of tooth enamel) reduces the volume of micropores due to increased mineralization of tooth tissues and normalization of phosphorus-calcium metabolism in the body.

– in the presence of defects – filling with composite materials, and in case of pathological abrasion, covering teeth with artificial crowns.

Dental Jewelry

Skyces (SKYCE) are small pebbles that are glued to the teeth.

The simplest and cheapest skyces are made of ordinary glass, it is more correct to call them rhinestones. The base of the dental skyces has a special rough surface, which allows them to firmly adhere to the teeth and not come off. Due to the low cost, this type of dental jewelry (rhinestones) is available to absolutely everyone.

More expensive skyces are made of rock crystal, Swarovski crystals, precious stones and metals, special medical alloys.

Skies also differ in color, shape, size, and manufacturer.

Skyces can be from 1 to 5 mm in diameter, depending on the type and shape. Their shape can be different: hearts, stars, dolphins, droplets, rhombuses, squares.

Most often, dental jewelry is placed on the upper teeth. On the medial edge (near the center) of the canines or first premolars, on the distal (far from the center) or medial edge of the second incisors. Which one is better to decorate the tooth is decided individually with the dentist, while the shape and size of the teeth, the bite, the smile zone, into which the teeth fall, are assessed.

In addition to a healthy tooth, skies can be attached to a filling.

Only a professional dentist can glue and remove skies. There are two ways to inlay teeth with skyces: with and without preparation (drilling) of the tooth. In the first case, a cavity is drilled in the tooth corresponding to the size of the jewelry. Further, the pebble in the hole is fixed with filling materials.

Without preparation, that is, without harm to the teeth and without damaging the enamel, rhinestones, skyces and gold onlays are glued.

Dental jewelry does not require special care; a standard method of brushing your teeth 2 times a day is sufficient.

If you are tired of the jewelry, removing it is not a problem. But removal should be done by a professional dentist.

The main condition under which dental decoration is possible and acceptable is dental health. Therefore, you should first put all your teeth in order, remove dental deposits, i.e. sanitize the oral cavity.

Artistic tooth restoration

Artistic restoration of teeth is not only the restoration of the appearance of the tooth, but also the preservation of its function. Thanks to the possibilities of modern dentistry, today it is possible to eliminate such flaws as cracks, chips and gaps between teeth, discoloration of the enamel (stains and darkening) or an ugly shape. Before starting the process of dental restoration, a comprehensive diagnosis is performed and, if necessary, treatment of caries, gum disease and the elimination of other dental problems is carried out. The adhesive technique used today and modern composite filling materials have significantly expanded the indications for direct restoration of teeth without the use of artificial crowns with the most sparing attitude to the remaining tooth tissue.

These conservative methods of treatment allow us to achieve aesthetic results that are comparable to those of prosthetics or are several times superior.

Types of artistic dental restoration

There is a direct and indirect artistic restoration of teeth. In the first case, direct work is carried out with the surface of the teeth: grinding, building up with filling material, correction in shape and occlusion, and other procedures. Thanks to complex therapy and aesthetic restoration of teeth, the natural appearance is preserved without loss of function. That is, the teeth become not only beautiful, but also healthy.

The direct method of tooth restoration is the best option for eliminating minor defects in the anterior teeth. Direct restoration is performed in one step (except for those procedures when it is necessary to restore a large number of teeth).

To restore teeth with direct restoration, photopolymers are used, thanks to which it is possible to: restore color and shape, level the surface of teeth, correct their position in the dentition, and also eliminate interdental spaces.

Advantages of direct restoration in dentistry:

It’s fast – all procedures are done in one visit
Provide a minimally invasive approach to restoration and the most sparing attitude to hard dental tissues
It is relatively inexpensive (specialists do not use a dental laboratory).

The indirect method of restoration of a tooth is a method of restoration of teeth that uses prosthetics. Today there are several options for restoring teeth using indirect restoration: the installation of veneers, dental inlays, crowns, and dental implants.

Read more about these methods on our website in the section ORTHOPEDICS