Treatment of caries of primary teeth in young children. Treatment of caries in children Dental treatment in children under anesthesia

Caries affects children's teeth from the moment they erupt. And before the age of 7, the disease is diagnosed in 80% of cases. However, most parents still do not pay attention to this problem.

Both baby and permanent teeth of a child must be treated! Otherwise, you will encounter pulpitis, purulent infection or other complications. To cure caries, it is not necessary to drill teeth; there are minimally invasive techniques for children - silvering, fluoridation, infiltration.

Features of treatment of caries of primary teeth

Treatment of baby teeth should be gentle and painless.

5 rules of child therapy

Two-stage anesthesia - first, the gum area is numbed with a gel or spray with lidocaine, and only then an injection is given. For children, the finest (carpule) needles are used.
The safe concentration of anesthetic in injection is 2% lidocaine or 4% articaine, administered from 1/6 to 1/2 of the “adult” dose, depending on the baby’s weight. Anesthetics with adrenaline are contraindicated under 4 years of age.
Removal of carious tissues using hand tools - excavators, curettes, scalers.
The use of filling materials that are applied in one go and also contain fluorides and other beneficial minerals.
The duration of the session is no more than 30 minutes, otherwise the child will get tired and begin to be capricious.

Diagnosis of caries

Caries in children develops faster and more aggressively than in adults. This is due to the fact that the enamel of baby teeth is weak and riddled with micropores, where bacteria easily penetrate. Once the carious process begins, the tooth is destroyed in just a few months. This is why it is so important to visit a pediatric dentist every 3-4 months.

Symptoms of caries at different stages:

Initial caries

First, white (chalky) spots appear on the enamel. Then they acquire a yellowish tint, and the surface of the tooth becomes rough. The baby does not feel pain yet, but a reaction to hot and cold food is possible. Initial caries is treated without drilling with a drill. This is the only stage at which it is still possible to restore the enamel and do without a filling.

Average caries

The enamel layer is destroyed and a carious “hole” is formed. Sharp pain appears when exposed to mechanical or chemical stimuli. Softened dentin and food debris accumulate at the bottom of the cavity. Gentle methods and prevention will no longer help - you need to put a filling. The dental cavity is open and needs to be sealed hermetically with a filling material.

Deep caries

The carious “hole” increases and becomes very noticeable. The enamel and a significant part of the dentin (bone dental tissue) are affected. When probing the bottom of the cavity, a large amount of softened dead tissue is discovered. Deep caries in children is treated with filling. But sometimes the enamel is so destroyed that there is no point in putting a filling; the baby tooth has to be removed.

Visual examination and probing are enough to determine the stage of caries in a child. But sometimes the carious lesion is located in a place that is difficult to access. In this case, an x-ray is prescribed or an intraoral camera is used.

If it is difficult to recognize initial caries, the doctor uses a caries detector. This is a liquid that turns infected tissue blue or pink. Don't worry, the drug is safe for your child's health.

Methods for treating caries in young children

Treatment of caries of primary teeth without a drill at an early stage

Silvering

An outdated technology that is still used in most dentistry. The doctor applies a solution of silver nitrate (30%) to the carious area of enamel. Silver has bactericidal properties and destroys cariogenic microflora. Everything goes quickly and painlessly, no anesthesia is needed. But after treatment with silver, baby teeth acquire a persistent black color, this is fraught with psychological complexes in the child. The method is indicated for children under 3 years of age.

Fluoridation

Fluoridation, or remineralization, is the strengthening and restoration of enamel, saturation of weakened areas with useful minerals. The dentist treats the surface of the teeth with a special solution containing calcium, fluorine, phosphorus and other microelements. The method stops the development of caries at the spot stage and is an excellent prevention of the disease. The effect lasts for six months. Recommended for children over 6 years old.

Ozone therapy

A non-contact and painless method that is indicated for children of all ages. Ozone is a powerful oxidizing agent that destroys pathogenic microflora on teeth. The procedure takes only 10-20 seconds. Ozone gas is supplied under high pressure through a special thin tip, which is directed to the affected area. After treating the enamel, the carious process stops.

Icon (infiltration method)

The doctor treats the carious area with a special etching gel, after which the infected tissues soften. They are delicately washed with a stream of abrasive mixture. Then the surface is dried with warm air and an infiltrant is applied - Icon liquid filling. The material hardens under the influence of light from a curing lamp.

The infiltrant “seals” all the pores on the enamel surface, smoothes out irregularities and roughness, and prevents the development of caries. The procedure for treating caries of primary teeth lasts 15-20 minutes and is used for children over 3 years old.

After silvering of a child's teeth

Sealing

Filling of baby teeth is carried out according to a standard template. The dentist carefully cleans out carious, dead tissue using hand instruments or a drill at low speeds. Then he rinses the cavity with a disinfectant solution and fills it with filling material. At the end of the session, the surface is ground and polished.

The filling material should not be harder than the enamel of a baby tooth, since it wears off quickly. Don't worry, this is a natural process. But if the filling is too hard, it will start to protrude around the edges.

Glass ionomer cements are best suited for the treatment of primary teeth. They are applied at a time, and not layer by layer, unlike photo composites. In addition, cement contains calcium and fluoride compounds, which helps strengthen dental tissues. The material wears off evenly with tooth enamel.

Modern clinics also use Twinky Star colored fillings for children. They look colorful, so children like them. The child can choose the color he likes. The filling consists of a compomer - it combines the properties of glass ionomer cement and photopolymer. The material is safe for health and contains beneficial fluoride ions.

Treatment of caries of permanent teeth

Treatment of permanent teeth in children is carried out in the same way as in adults. The main method of therapy remains filling. Photopolymer composite is considered the ideal filling material. Durable, perfectly conveys the shade and aesthetics of natural enamel.

Stages of filling

Injection of local anesthesia.
Preparation of carious tissues with a drill, cleaning of softened dentin.
Rinsing the cavity with an antiseptic solution - furatsilin, etonium, etc.
Air drying.
Application of a phosphate cement insulating gasket.
Layer-by-layer filling with a composite - each layer is illuminated with a photopolymer lamp.

In the early stages of caries, the Icon method, ozone therapy and enamel remineralization are also used. But silvering is contraindicated for permanent teeth. After all, no one wants to walk around with a black smile all their life.

Dental treatment for children under anesthesia

Local anesthesia

Treatment is usually carried out under local anesthesia, which comes in two types: application (without an injection) and infiltration (with an injection). The first option is used for superficial anesthesia and the danger is that the child may swallow a solution with a high concentration of lidocaine. Injection anesthesia is more reliable; it completely blocks pain in the receptor area.

Anesthesia

Some children are too restless and hyperactive, while others are afraid of dentists and refuse to open their mouths. How to treat teeth in this case? The problem is solved with the help of general anesthesia.

Do not be afraid of this method; it has long been used in Western countries to treat children from one year old. Some parents worry that anesthesia affects the child's memory or disrupts speech development. This is theoretically possible, but in practice this happens extremely rarely. But the cause of complications is not the anesthesia itself, but the child’s severe stress in dentistry or the presence of a chronic disease in combination with general anesthesia.

In the case of multiple bottle caries, anesthesia is the only way to carry out the necessary manipulations in one appointment. After all, it is unlikely that your child will be able to withstand 2 hours while the doctor fills all the teeth.

Tests before dental treatment in children under anesthesia

general blood and urine analysis;
biochemical blood tests;
blood for sugar;
electrocardiography.

6 hours before anesthesia you should not eat food, and 4 hours before you should not take any liquid, including water. The child gradually falls into a state of sleep after several breaths of a gaseous sedative based on sevoflurane. You can wake up the baby at any time, you just need to increase the dose of oxygen. Within 15 minutes all reflexes return to normal.

Complications and consequences of caries in children

Some parents believe that baby teeth do not need to be treated because they will soon fall out. It is not right! The formation of a normal bite depends on the condition of the primary teeth. If the carious infection progresses, it will penetrate into the deep tissues and damage the rudiments of the permanent dentition.

Premature removal of a baby tooth destroyed by caries also leads to disastrous consequences. Jaw growth is disrupted, new (permanent) teeth grow out of place, crowding and other problems appear. The child will have to wear braces.

In addition, advanced caries is complicated by pulpitis (inflammation of the dental nerve), periodontitis, or the formation of a cyst on the gum in the root area. It is very difficult to treat such consequences; it is necessary to fill the root canals.

In turn, periodontitis turns into osteomyelitis or an abscess, which not only reduces general immunity, but also threatens the child’s life!

Prices for treatment of caries of primary teeth

Caries can be cured in a public children's clinic or private dentistry.

Average prices in paid clinics:

installation of a cement filling on a temporary tooth - 1,700 rubles;
photopolymer filling - 3500-4000 rubles;
silvering of one baby tooth - 500 rubles;
remineralizing therapy session - 2400 rubles;
Twinky Star color filling - RUB 2,300;
use of general anesthesia - about 10,000 rubles. in 1 hour.

Remember to have regular checkups with your pediatric dentist. Most institutions provide consultation free of charge.

According to statistics, today only 20% of children do not know what caries and the dental chair are. Parents do not take this disease too seriously due to its high prevalence. And really, why worry if all children equally have bad teeth? In fact, early caries is a complex problem that requires a comprehensive solution. Today we will talk about the causes and prevention measures, as well as the available treatment options. This information will be extremely important for all parents, as it will allow them to avoid a number of troubles.

What is caries

This is the process of destruction of hard tooth tissues. There are quite a few reasons for this; today we will analyze them in detail. These can be both external and internal reasons, that is, the general condition of the body and immunity are affected in the first place.

However, the main reason why early caries develops is dental plaque, or more precisely, bacteria that live in the oral cavity. How do they get there? Everything is very simple, the mother becomes their carrier. They licked the pacifier, let the baby eat from his spoon, and so the teeth began to deteriorate, before they had time to really grow. But that's not all. If the mother did not treat her teeth before pregnancy, then the baby is guaranteed early caries, because he will initially be infected.

How does the process of tooth decay proceed?

We have already learned that there are bacteria in the oral cavity that are responsible for the development of this disease. But early caries is caused by their waste products. This results in a classic power circuit. Bacteria eat sugars and produce acids. As a result, the acid-base balance in the oral cavity is disrupted.

This is the answer to the main question about why early caries develops so quickly. The enamel of baby teeth is very weakly mineralized, this is especially noticeable in the first 2 years and 5 months of life. It is because of this that dentists recommend giving up sweets at least during this period of a child’s life and not giving him too cold or hot food.

So, the resulting acid washes away minerals from the enamel, which means that the destruction process proceeds very quickly. In just a few months, early caries turns into complicated forms, in which dentists remove teeth. Imagine that the child at this moment may still be only a year old. At the age of 2 to 3 years, these processes slow down, but most often by this time it is too late, and most of the teeth are in poor condition.

Causes of early childhood caries

Let us now discuss in detail why such a disease develops. Many parents think that if they do not give their baby sweets, then they are completely protected from the development of caries. In fact, it’s too early to relax. The list of reasons is much wider:

Improper oral hygiene. Even if teeth are just emerging, they immediately need proper care. This is wiping the gums with a damp cloth, and later brushing with a wet brush without toothpaste. When a child has 6-7 teeth, you can start using the first fluoride-free toothpaste.
Infection with pathogenic microorganisms. We've already talked about this, but it's worth repeating. It is impossible to eat with a child from one spoon, especially if you have carious teeth in your mouth.
Genetic predisposition. This is a violation of the development of enamel, which begins during intrauterine formation, due to maternal smoking or taking certain medications.
Lack of vitamins and minerals, in particular fluoride and calcium, in the child’s diet.
Long-term breastfeeding, no matter how strange it may be. By the time baby teeth form, the baby should be fed five times a day. But if a child continues to breastfeed without restrictions, at any time of the day or night, without performing oral hygiene after this, then plaque and carious cavities will form.
Mixtures and juices, milk, sweet compotes - all this contributes to the development of caries. This factor is especially serious if the child does not part with the bottle day and night. After a year, he should only receive water at night. During the day, after each feeding, it is necessary to perform oral hygiene.
Cookies and buns, sweets and marshmallows that are given to a child are also an important factor, since food for bacteria is constantly present in the mouth. It is not necessary to completely deprive your child of sweets, but convey to him that after sweets he needs to chew gum, rinse his mouth, or at least drink water.

Important for everyone to know

Once again, to summarize, I would like to note that early caries in children occurs largely due to fractional and frequent feedings on demand, as well as unlimited access to snacks during the day and, most importantly, at night. Replace all sweets with fruits. The fructose they contain does not pose any danger. In addition, the diet should have enough calcium, the main source of which is cottage cheese and cheese. No less important is vitamin D, which we get from fish. In addition, the body can produce it independently when exposed to sunlight. The third required component is fluorine. You can buy special water filters enriched with this element.

Preventive actions

Early caries of primary teeth is much easier to prevent than to treat. And first of all, maintaining hygiene will help you. All the measures described above (rinsing the mouth, wiping the first teeth and their subsequent brushing) are also aimed at reducing the risk of developing the disease. If you notice bright white stripes on your child's teeth, you should contact your dentist as soon as possible. Soon enough they will turn into dark spots.

Early childhood caries can be stopped in the first stages if you use drugs that increase the mineral composition of tooth enamel. From birth to six years, doctors prescribe special gels, for example, ROX Mineral. Mom will rub it into her gums, and the minerals will effectively strengthen tooth enamel. After six years, Remars Gel is prescribed, which also gives very good results.

Consequences of advanced forms of the disease

Often parents believe that nothing bad is happening. These are baby teeth, they will fall out and that’s it. Photos of early caries in advanced stages present a rather unpleasant picture, but you need to think not only about the aesthetic side of the issue. If the disease is not treated, then a general decrease in immunity occurs. How could it be otherwise when a breeding ground for bacteria grows in the tooth cavity and tends to invade other organs. As long as the immune system is strong, it will keep the number of bacteria in check, but as soon as it fails, hostile microorganisms take over.

The child is often sick

What does uncontrolled bacterial growth lead to? First of all, these are constant problems of the ENT organs. The closest are the tonsils, followed by the bronchi and lungs. In this case, parents are faced with endless sore throats, coughs and other manifestations of acute respiratory infections.

Gastrointestinal diseases are rarely associated with caries, but there is also a direct relationship here. The child ingests a large number of bacteria of the streptococcal flora along with waste products. It is clear that this does not have the best effect on the digestion process.

Moreover, all this along the chain leads to orthodontic problems. Since the teeth hurt and the respiratory organs are constantly in an inflamed state, a malocclusion and the habit of breathing through the mouth gradually develop. This is even reflected in the formation of specific facial features. You see how much an untreated tooth means.

What can you do

In fact, parents can, if not completely cure, then significantly stop early caries. We’ll talk to you now about how to get rid of a rapidly progressing disease at home. The first thing to remember is that only in the early stages can home treatments be effective.

You can determine it yourself. If the damaged tooth still does not hurt, even when too cold or hot water gets in, there are no black spots, and the caries itself looks like a whitish strip, then it is worth taking a number of measures to prevent further development of the clinical picture. In principle, this is the prevention that was described above. If you realize it at this stage of the development of the disease, then a photo of early caries in children will be practically no different from a healthy smile, with the exception of bright white spots. So:

Urgently choose a special paste and use it twice a day.
Additionally, treat your teeth with gels and compounds to strengthen the enamel.
Use rinse aids.
Follow your diet. That is, replace sweets with vegetables and fruits and enrich your diet with fermented milk products.

Folk recipes

First of all, this is the use of medicinal herbs and decoctions from them:

For these purposes, dentists recommend using sage. It destroys microorganisms and normalizes the acid-base environment in the oral cavity. To do this, pour 100 g of dry grass with the same amount of vodka. After two weeks, the product can be used in the form of applications.
An infusion of finely chopped roots is often used for rinsing. To do this you will need a glass of raw materials, cut into pieces. They are poured with a liter of vodka and left for 7 days. After this, the tincture is used for evening rinsing, diluted with water.
Mint strengthens tooth enamel. To do this, the leaves are cut and placed in a water bath for several minutes. You can add a little wine vinegar to them for better preservation. Used for rinsing.
A decoction of onion peels effectively kills bacteria.
Simple soda and salt perfectly inhibit the development of caries. To do this, add 40 g of one or another substance to a glass of water. Every time after eating you need to rinse your mouth with this solution.

Further development of the disease

Until now we have only talked about early caries. It will not be possible to get rid of deeper lesions at home. In this case, you should definitely consult a doctor. Even the superficial stage is characterized by the appearance of defects in the enamel, which creates a favorable environment for the development of microorganisms. The middle stage is associated with the destruction of not only enamel, but also dentin. Painful sensations already arise here when in contact with cold and hot, when eating sour and sweet. The deep stage of caries is damage to the internal cavities of the tooth. Now the disease is approaching the nerve endings. Accordingly, the pain becomes more and more pronounced.

Instead of a conclusion

As you can see, taking care of the oral cavity is largely the task of parents. It is you who can create all the conditions to make trips to the dentist rare and enjoyable. In our article we provide photos of early caries of baby teeth so that you have a good idea of where it all begins. There is no need to wait until black spots or holes appear on your teeth. If you start acting now, your chances of stopping the disease are much higher. And of course, you can’t do without consulting a professional doctor, at least once every 6 months.

Caries of primary teeth at an early age is one of the most difficult problems in pediatric dentistry. At the age of 6 months to 3 years, it is characterized by a rapid course and multiplicity of lesions. Baby teeth can become damaged immediately after they emerge.

According to the survey results, 50–57% of children aged two years have dental caries. By three years, this figure increases sharply to 80%. The main misconception of parents is the belief that baby teeth “will still be replaced by permanent ones.” For this reason, a visit to the dentist often occurs when the crown part of the tooth is completely destroyed, when deep inflammation of the internal tissues develops (pulpitis, periodontitis), or in case of acute pain.

Different terms have been used to refer to caries of primary teeth:

blooming caries,
multiple caries,
bottle caries,
nursing caries,
carob caries,
creeping caries.

Since 2002, the term “early childhood caries” has been adopted to designate severe caries of primary teeth and its complications in children from one to four years of age.

Causes of caries development in primary teeth

Caries of primary teeth develops not only under the influence of cariogenic bacteria in the child’s mouth. The following factors contribute to susceptibility to the disease:

defective enamel maturation;
nutrition with a deficiency in proteins, macro- and microelements, with an excess of carbohydrates;
water with insufficient fluoride is one of the leading factors;
absence of pellicle - a film that appears on the surface of the teeth after they erupt; it is a structural element of the surface layer of enamel, protects the hard tissues of the tooth from the effects of acids;
composition of saliva, its concentration, viscosity, quantity and rate of production;
the biochemical composition of the hard tissues of the tooth, which determines the course of caries (a dense structure with minimal spaces in the crystal lattice slows down the course of caries and vice versa);
condition of the neurovascular bundle of the tooth;
the state of the body during the formation and maturation of dental tissues;
abnormal tooth development due to general physical diseases.

The risk of developing an infectious process is also associated with the immaturity of local immunity: secretory immunoglobulin A1 contained in saliva is destroyed by pathogenic bacteria. The concentration of this immunoglobulin in early childhood is significantly lower than in an adult. Therefore, the child is more susceptible to the development of infectious inflammation, including diseases of the hard tissues of the tooth of an infectious nature - caries.
The development of caries at an early age (up to three years) is influenced by:

violations of the structure of the teeth that occur during intrauterine development are associated with maternal diseases (mineral metabolism disorders) and toxicosis;
artificial feeding, night or long-term breastfeeding;
severe debilitating illnesses of the child in the first months after birth;
treatment with antibiotics in the first months of a child’s life.

After three years, other reasons also appear: genetic predisposition (imperfect mineralization of teeth), poor oral hygiene, which allows plaque to accumulate on the teeth.

Features of the development of caries in childhood

In childhood, caries occurs more intensely. This is due to the structural features of enamel and dentin (the hard base of the tooth):

hard tissues are poorly mineralized;
there are micropores and microcracks on the enamel surface;
the layer of enamel and dentin is relatively small;
dentinal tubules are shorter and wider;
a significant volume of the tooth cavity, the horns of the pulp (loose fibrous connective tissue that fills the tooth cavity, containing a large number of nerve endings) are located close to the enamel-dentin junction;
immature pulp at the stage of formation of a temporary tooth is almost incapable of forming replacement dentin.

Dentin is quickly damaged due to its low salt content and the lack of protective reactions from the immature pulp.
Immaturity is expressed not only in the structural features of the enamel. The roots of the tooth form within 2–3 years after eruption. Their structure is varied. At the stage of root formation, the pathology is acute.

First of all, caries affects the upper front incisors. Wet dentin is removed in layers. Characterized by a rapid transition of the disease to a complicated stage. This leads to rapid destruction of the temporary tooth.

Single dental caries lesions in early childhood are rare. As a rule, 8 or more (up to 20) teeth are involved in the process. There are several carious cavities in one tooth. Such caries develops after acute infectious diseases (measles, scarlet fever, tonsillitis and others), which were severe. It is also called sharp, acute, blooming. Sometimes a large number of new cavities form after a disease.

Multiple caries develops with some chronic diseases (tonsillitis, diseases of the bronchopulmonary system), with rickets, Down's disease.

Forms of caries in milk teeth

Caries in children is classified in the same way as in adults:

elementary,
surface,
average,
deep.

Caries of primary teeth is often deep.
Special forms, characteristic only of milk teeth, are:

circular caries;
planar caries.

With circular caries, lesions spread in the cervical area and encircle the tooth in a circle. This is due to the later mineralization of the part of the tooth located in the cervical part.

Circular caries appears after the eruption of the front incisors under unfavorable environmental conditions, when the mineralizing potential of the biological fluid in the oral cavity decreases. Most often, this form of pathology is found in a premature or weakened child. With late teething, the circular form of pathology practically does not occur.

The cause of planar caries is underdevelopment of enamel due to a violation of the mineral and protein metabolism of the tooth in its infancy. This form of caries of primary teeth is localized on the chewing part of the posterior lateral teeth (molars), covering the entire surface. A peculiarity of the course of the pathology is the rapid transition to medium and deep caries.
The classification of carious defects differs according to their type and stage of the process. There are 6 stages of formation of carious defects from d0 to d4. They are presented in Table 1.
Table 1

*Stage name*	*External signs*	*Course of the pathological process*
Stage d0	No symptoms. The surface is not damaged	When examined under a microscope, expansion of the intercrystalline space is observed
Stage d1.1	A white spot on the surface of the enamel, visible after drying; when wet, the tooth looks intact	Subsurface demineralization
Stage d1.2	The defect is visible against the background of surrounding healthy tissue and may have a brown color. The tooth surface remains intact, but loses its shine and appears dull	Porosity, transparent dentin appears
Stage d2	Destruction at the enamel-dentin interface results in a microcavity, which is determined visually.	The course of the disease can no longer be slowed down or stopped by stimulating remineralization processes. It is necessary to eliminate existing cavities by smoothing the surface (odontoplasty) or appropriate microinvasive techniques.
Stage d3	Destruction of the entire enamel layer down to dentin	Bacteria have penetrated into the initial segments of the dentinal tubules (infected dentin) and demineralized dentin.
Stage d4	The defect extends to the entire dentin, right down to the pulp.	Hyperemia - inflammation - pulp necrosis

When making a diagnosis, the pediatric dentist most often uses a classification of the activity of the carious process (acute, acute, chronic) and the level of caries intensity - low or high.

Symptoms of early childhood caries

An early diagnostic sign of caries is a large amount of plaque. It is practically not removed from the surface of the tooth. Subsequently, chalky spots appear - the first carious lesions. Within 2–3 months, the spots become light yellow. Further, in place of the spots, hard tissue defects form in the form of carious cavities.
At the middle stage of caries, the child experiences pain when food with a sweet and sour taste enters the carious cavity. With medium and deep caries, due to the small thickness of the bottom of the carious cavity, separating it from the space in the coronal part of the tooth, infection can be transmitted to the pulp, the development of the inflammatory process and its death.

Clarified fruit juices, juices from citrus fruits, and bananas increase the cariogenic situation in the child’s oral cavity. Sweet night drinking is not acceptable. When studying drinks for baby food, it was found that all fruit drinks have a higher cariogenic potential index than sucrose.

Bottle caries affects the upper front teeth. Fangs suffer less often due to later periods of eruption. The incisors on the lower jaw remain healthy, since they are protected by the tongue, which tightly covers the pacifier from below when sucking.

Bottle-type caries of the upper front teeth also develops when a child is breastfed after one year. Breast milk contains β-lactose. This sugar has low cariogenic potential. However, frequent and prolonged presence of breast milk in the mouth, especially at night, also helps to reduce the pH of dental plaque and demineralize the hard tissues of teeth.

Plaque formation begins with the attachment of aerobic bacteria Streptococcus mutans to the smooth surfaces of teeth. It is important that caring for your child’s teeth begins from the moment the first tooth erupts. At the first stage (when the first teeth appear), this can be wiping with a gauze cloth moistened with boiled water, special wipes with xylitol (“Spiffies”), brushing with a silicone finger brush or a traditional brush.

With the appearance of the first temporary molars, brushing is carried out only with a toothbrush twice a day. This involves using a small amount of toothpaste (“traces”).
It is believed that the first paste should not contain fluoride compounds due to the possibility of ingestion, and excessive intake of fluoride ions during this period increases the risk of developing fluorosis of permanent teeth. – a chronic disease that occurs in areas with excess fluoride in drinking water. Develops before teething.

To maintain the best balance between caries prevention and the development of fluorosis, the use of pastes with a fluoride concentration of 500 ppm is recommended. The use of toothpastes with lower or no fluoride concentrations is ineffective. In children at high risk of developing caries, it is necessary to use a more concentrated fluoride paste (900 - 1100 ppm). As a safety precaution, it is recommended that you do not leave your child unattended while brushing their teeth. At a younger age, use only a “smear, trace” of toothpaste.

When licking a pacifier, tasting food from a spoon, chewing food, or kissing on the lips, the baby’s oral cavity is quickly contaminated with cariogenic microorganisms. It is recommended to avoid “saliva contact” with the child.

The high intensity of caries entails serious consequences for the developing child’s body:

intoxication and bacterial allergization from foci of chronic infection;
dysfunction of biting and chewing food and resulting disruption of digestive processes;
changes in patency and disarticulation;
aesthetic defects;
perhaps psychological complexes.

In young children, it is one of the factors for early tooth loss and malocclusion. The disease aggravates the course of many diseases and creates serious problems with the child’s health.

The period of physiological maturation (mineralization) of enamel can take from 2 to 5 years. Throughout the entire period of mineral maturation, especially during the first year after eruption, a child’s teeth need careful and effective care. Compliance with the rules of oral hygiene will improve health and prevent the development of caries in baby teeth.

The word “caries” is translated from Latin as “rotting” - this complex destructive process occurs over a long period of time, passing through several stages. Due to the action of various external and internal factors, there is a process of gradual and consistent tooth destruction, while the stages of caries differ in their characteristics, have characteristic signs and can be amenable to various treatment methods.

Important! According to statistics, more than 90 percent of the world's population suffers from this insidious disease, to one degree or another. The trend in the development of caries is so rapid that it makes dentists all over the world sound the alarm: even young children, whose age is barely 3 years old, are susceptible to the disease and seriously risk not only losing their primary bite faster than expected, but also getting problems with a permanent one.

What is the essence of the problem

The peculiarity of dental caries is that this disease affects the hardest of all tissues of the human body - enamel, and the scale of its spread is such that 9 out of 10 inhabitants of our planet suffer from this disease to one degree or another. But don’t be upset, because currently there are various ways to restore enamel - read more about them.

On a note! The development of caries can occur at a fairly high speed, leading not only to problems of an aesthetic nature, but also to physical pain, from which a person cannot find relief.

We should not forget that harmful bacteria, the activity of which causes the development of the disease, can also negatively affect the digestive processes. And tooth decay can lead to difficulties with nutrition, the appearance of complexes regarding being in society, the desire to hide your smile from others, to serious inflammation in the oral cavity, in periodontal tissues, and so on. That is why it is important to begin the fight against the disease as quickly as possible, so as not to lead to serious health problems.

Stages of problem development

The most understandable classification of the development of the disease is one that is based on several successive stages associated with the degree of tissue damage:

: a characteristic sign is a change in the color of the enamel. It still remains hard, but the process of destruction, disruption of its structure and integrity, its demineralization is already beginning, therefore, it is so important to start treatment as early as possible so that the disease does not spread further. At this stage of the disease, the enamel becomes pale whitish, matte (rather than transparent). It can be quite problematic to notice it with the naked eye, especially on the chewing elements of a smile. This is why dentists insist on annual preventive examinations, because for professionals, noticing pathology is not a problem,
: the process of demineralization of the enamel begins and a person experiences discomfort, manifested by painful sensations, from cold, hot, sweet or sour foods,
(medium caries): pain not only increases, but also becomes longer and more intense. The damage penetrates deeper, the damage becomes more noticeable, and the carious area increases. Here we are talking about the appearance of a fairly large “hole” in which pieces of food begin to get stuck. What is typical is that this stage can develop rapidly and, in the absence of proper measures, lead to pulpitis,
(deep caries): the result is . The peripulpal dentinal area is affected by the disease, and this stage is dangerous even with the complete loss of a tooth or removal of its nerve.

Features of the initial stage of the disease

The main symptom of the initial stage of the disease is clearly presented in the photo. As you can see, it is the stains that “report” in this case about problems with the tooth. They can be matte, barely visible, brown, dark and even almost black. But most often, white demineralized pigmented areas appear on the enamel. The main reason for their occurrence is a lack of calcium salts, leading to a weakening of the protective functions of the enamel.

But we should not forget that among the classical causes of any caries, the palm still belongs to the accumulation in the oral cavity of a large number of harmful microorganisms that settle on different types of plaque and deposits (hard stone and soft plaque). This state of affairs is often accompanied by insufficient oral hygiene, neglect of professional hygiene procedures, long-term treatment (taking antibiotics and potent drugs) and weakened immunity after illness.

What’s interesting is that this stage occurs unnoticed and painlessly for a person; sometimes increased sensitivity can manifest itself, but this happens rarely.

Important! Cure caries with such symptoms will not be particularly difficult. Moreover, here it will be possible to do without boron and anesthesia. Enamel remineralization procedures, fluoridation, and fissure sealing will help effectively solve the problem. Naturally, you need to strengthen the body from the inside; for this it is important to adjust your diet, including vitamins and foods containing calcium and fluoride.

Over time, if no action is taken, the stain begins to darken, which is a sign of tissue damage and gradual decay; if this is not responded to in any way, this can lead to damage to the upper layer of the tooth and the development of superficial caries.

The second stage of tooth damage

Here, due to demineralization processes, painful sensations begin to manifest themselves as a consequence of various types of influences, primarily hot and cold, as well as sour and sweet. Discomfort also occurs when there is mechanical pressure on the tooth (during the process of cleaning it with a brush and paste, or when pressing). This is already superficial caries and there is no way to delay treatment any longer.

Middle stage of the disease

The stage of intermediate caries is manifested by the formation of a hollow in the tooth, as the moment of destruction of dentin comes, and the painful sensations are characterized by increasing intensity. It may, however, turn out that symptoms will not appear if the dentin layer is thick enough, but this is not common.

Interesting! Those with naturally yellow teeth can boast of unusually strong dentin – this is confirmed by recent studies. A yellow tint to a smile from birth is not always a reason to be upset. This may mean that your dentin has a rich mineral composition and is less susceptible to decay. However, in this case there is one drawback - it will not be possible to whiten the yellowness using traditional methods; the problem will have to be solved with the help of veneers, lumineers or crowns.

If a cavity forms in the affected area, then food debris begins to get into it, which provokes the appearance of a strong unpleasant odor due to its rotting and accelerates the development of the inflammatory process. At the stage of average caries, the disease can behave unpredictably. It can develop for a long time or rapidly (it all depends on the provoking factors), after which it will develop into deep damage to dentin.

Deep tooth damage

At this final stage, the pathology process provokes severe pain, which, however, does not last a very long time and usually manifests itself after food, drinks or other irritants enter the cavity. If food remains remain in the cavity for a long time, then the pain may become longer.

A companion to this stage of the development of the disease will be halitosis, that is, an unpleasant and rather strong odor from the mouth that occurs as a result of rotting and disintegration of tissues. If treatment is ignored here too, the patient risks getting additional problems as a result of one or another.

When choosing a treatment method, the dentist, first of all, relies on diagnostic measures, how quickly the disease develops, and the depth and speed of spread of carious tissue damage.

Features of pathology in children

Children's teeth are also susceptible to caries, and by no means to a lesser extent than adults. The main reasons for its occurrence in children are:

insufficient attention to oral hygiene,
features of the composition of children's saliva: it does not yet contain the necessary enzymes that provide the oral cavity with a balance of harmful and beneficial microflora,
frequency of consumption of carbohydrates, which become the main breeding ground for pathogenic bacteria in the mouth: naturally, we are talking about sweets, and the lack of rinsing after eating them. This also includes the so-called development of bottle caries, when the risk of getting a problem occurs even in children under one year old – parents give their kids snacks with sweet mixtures and juices at night,
lack of adequate amounts of essential minerals and vitamins.

The symptoms, as well as the stages, are no different from permanent ones; moreover, the disease can affect several teeth at the same time. Today, many methods of combating the disease are used, of which the most widespread are:

: This is only relevant when we are talking about the middle and deep stages of the disease. The previously affected area is drilled with a bur and thoroughly cleaned,
silvering: the procedure stops the development of initial caries, but these days it is performed less and less due to the aesthetic component. The fact is that during the treatment process, the doctor applies a special composition enriched with silver ions to the baby’s teeth - it prevents the development of the disease - but in this case the child’s smile darkens, which causes a lot of concern in older age,
remineralization: enrichment of enamel with minerals, calcium and fluoride is indicated for those children who are prone to the constant appearance of carious formations. The procedure will be useful to carry out not only as a treatment for caries in the spot stage (and, by the way, not only for children, but also for adults), but also as a preventive measure (several times a year on an ongoing basis).

Read more about caries treatment methods in the corresponding article.

Possible complications

Of all the possible complications of caries, the greatest danger is pulpitis, periodontitis and granuloma:

: Sharp and sharp pain is a classic sign of this disease. It occurs unsystematically and does not depend on the time of day (it often bothers patients at night) or on food intake. It is often not easy to determine which tooth is affected, since it can radiate into the jaw or ear,
: if pulpitis is not treated, then advanced deep caries turns into periodontitis, most often localized at the root apex. Symptoms include halitosis, a reaction to temperature changes, the appearance of an abscess on the gums and swelling of the periodontal tissues, enlarged lymph nodes, increased body temperature, and general weakness. Treatment depends on the type and classification of periodontitis: it can be therapeutic or surgical. In some cases, it is necessary to remove a tooth,
granuloma: the symptoms of granuloma may not manifest themselves for quite a long time, but if the disease worsens, then severe pain appears. The main danger of granuloma is the development of various pathological processes. After all, an infection with blood can spread throughout the body, leading to cardiac and neurological disorders, as well as the appearance of flux, cysts or phlegmon, osteomyelitis, and blood poisoning.

Do not forget that these are not all the complications that a person may encounter as a result of an advanced form of the disease. He may lose a tooth, and then he will have to restore it using prosthetic bridges or implantation. Here we will talk about significant costs. And if the problem is ignored, it will result not only in various complexes against the backdrop of impaired smile aesthetics, but also in difficulties with chewing food and health: the gastrointestinal tract and spine will suffer, headaches will appear, articulation and facial symmetry will be disrupted.

Principles of prevention

Preventing caries is much easier than treating it later. For effective prevention, the following actions should be followed:

Take good care of your oral cavity: it is important to purchase yourself, in addition to a brush with medium-hard bristles and toothpaste, additional accessories. These include floss, irrigator, rinses,
reduce the amount of sweets you consume: try to end your meal with a piece of solid vegetables or fruits, rather than carbohydrates. This will help naturally clean the enamel surface from plaque, bacteria and deposits,
use fluoride-containing pastes: you should be careful here and use these compounds only after consulting your doctor. In some regions of Russia, the water contains a high content of fluoride, which is fraught with the development of fluorosis for people. The use of prophylactic pastes in this case can only worsen the situation,
brush your teeth correctly: no horizontal or sudden movements with the brush - this will harm the integrity of the enamel, cracks will appear on it, where bacteria will happily penetrate
use rinse aids,
undergo regular dental examinations: adults – several times a year, children 3-4 times a year.

Full information on caries prevention is also posted in a separate article, click and get ready to have healthy teeth!

A late visit to the doctor means that the danger of tooth extraction is very high, so it is necessary to start treatment at the earliest stages, when the first stains appear on the surface of the teeth.

Diagnosis and treatment

As for diagnostic measures, this can be a visual examination of the patient using a special mirror, identifying an area of demineralized enamel using dyes, radiography, palpation.

Treatment is based on the removal of those areas of tissue that are “captured” by the disease. This is done in most cases (except for the stain stage) using a drill. Naturally, this procedure violates the shape of the tooth, its aesthetics and anatomical features. Accordingly, after such removal it is necessary to restore it using filling material.

The easiest stage to treat is the spot stage, when demineralization can be stopped with the help of drugs that have a high calcium and fluorine content. Subsequent stages require more serious dental intervention, the use of anesthetics, drills and other treatments.

Video on the topic

A mother brought her 18-month-old son to the clinic for a regular check-up. The child is practically no longer fed from a bottle, but he still receives it before bed. During the day, the child uses a special drinking cup from which he drinks everything from milk to soda. His mother started giving him bottled apple juice instead of milk because the child tends to be constipated. When examining the oral cavity, the doctor noticed “white spots” on some of the child’s teeth (Fig.). The doctor talked about the child’s dental hygiene and prescribed a local fluoridated gel.

EPIDEMIOLOGY

DRAWING. Demineralization at the gum margin, which manifests itself as a characteristic whitish color .

Early childhood caries is the most common chronic disease childhood. In children in age It's 5-7 years old meets at five times more common than asthma and seven times more common than hay fever.
Caries strikes more 25% of children in the United States are between the ages of 2 and 5, and nearly half of children are between the ages of 12 and 15.
Untreated primary dental caries occurs in 32% of Mexican American and 27% of black African American children aged 2 to 11 years, compared with 18% of non-Hispanic white children.
Early childhood caries is defined as “the presence of one or more carious (superficial or cavitary) lesions, removed (due to caries) teeth, or filled dental surfaces of any primary tooth in a child aged 71 months or older.
The consequences of early childhood caries include: low self-esteem, delayed physical development, reduced learning ability, a higher risk of new caries and additional costs.

DRAWING. Severe damage to the central incisors of the maxilla and bilateral lateral incisors of the maxilla with an area of demineralization at the gum line (yellowish-brown color). The upper incisors are often the first teeth to become affected by tooth decay due to bottle feeding. .

ETIOLOGY AND PATHOPHYSIOLOGY

Dental caries is a multifactorial infectious disease that is caused by demineralization of tooth enamel in the presence of a substrate of sugar and acid-forming cariogenic bacteria, Streptococcusmutatis(also known as mutatisstreptococci), which are considered to be the primary strain causing destruction and are found in a soft gelatinous biofilm.
Tooth decay can develop any time after teeth erupt. Early teeth are in principle susceptible to caries, which is caused by transmission Streptococcusmutatis from the mouth of the person caring for the child or other children in the family into the mouth of the baby. This type of tooth decay is called formula-fed tooth decay or early childhood caries.
Risk factors for caries include: o Frequent consumption of liquids.
Frequently sipping liquids containing sugar (juice, milk, medicine, soda).
Eating sticky food.
Feeding for pleasure, sleeping with a bottle, tooth decay in the caregiver.
Drinking non-fluoridated tap water or bottled water, which often lacks fluoride.
Low socio-economic status.
Taking medications that contain sugar or cause dryness, poor oral hygiene.

DIAGNOSIS and CLINICAL SIGNS

Areas of demineralization develop on the surfaces of teeth between teeth and in crevices and cracks. These areas are painless and clinically appear as dull or brown spots.
As the infection progresses, a cavity develops that can spread into the dentin and through the dentin (the component of the tooth located under the enamel) to the pulp (consisting of nerves and blood vessels; pulp infection is called pulpitis), causing pain, necrosis and sometimes abscess.

DRAWING. Severe form of early childhood caries in a four-year-old child with intensive destruction of all four incisors of the upper jaw .

DRAWING. Severe early childhood caries in a three-year-old child with multiple areas of cavity carious lesions on the lower jaw incisors and loss of the upper jaw incisors due to carious destruction .

TYPICAL LOCATION

Areas of demineralization (white or brown spots) and carious lesions are usually observed at the gingival margins of the upper incisors, and then the first and second molars.

LABORATORY STUDIES AND RADIATION DIAGNOSTICS

Foci of demineralization are invisible on a radiograph, but radiography can reveal progressive carious lesions on and between the occlusal surfaces.

DIFFERENTIAL DIAGNOSIS

Depressions or defects in embryonic development. There are defects on the surface of the teeth (for example, the thickness of the enamel varies noticeably) or noticeable grooves.

TREATMENT

Patients are explained the importance of maintaining oral hygiene and during a preventive examination of the child, the risk of developing caries is assessed.
They refer you to a dentist for a consultation on possible sealing of cavities and cracks.
Before prescribing a fluoride supplement, the doctor should determine the fluoride concentration in the child's drinking water source. If your public water supply is not fluoridated, well water exposed to fluoride minerals and some fruits and vegetables grown in soil irrigated with fluoridated water may be sources of fluoridation. Fluoride supplements are not recommended for individuals living in areas with optimal public water fluoridation (0.7-1.2 ppm or >0.6 mg/L).
It is recommended to show your child to the dentist when the baby is one year old.
The use of fluoridated varnish twice a year in children at moderate and high risk prevents the development of caries on demineralized enamel.

The mother or caregiver should be told how the child's teeth are developing and what level of dental development should roughly correspond to the child's age. Before teething, it is necessary to clean the baby's mouth with a napkin or gauze swab to prepare the transition to using a toothbrush. A child's teeth should be brushed by an adult until the child can do it himself (usually by the age of seven). Fluoridated products are not recommended for children under three years of age, as the child may swallow the toothpaste while brushing their teeth. To brush your teeth, it is recommended to apply a pea-sized amount of toothpaste to your brush. Parents should be aware of the benefits of fluoride, as well as fluoride and the side effects of too much fluoride. You should teach your child to drink from a cup as early as possible and avoid giving your baby milk, juice or soda from a bottle or cup before putting the child to bed.

Advise the mother not to breastfeed her baby close to bedtime, as this creates an ideal environment for the growth of cavity-causing bacteria and tooth decay.

OBSERVATION

Ensure that a child with white spots on teeth or visible decay is taken to the dentist for monitoring and treatment, so that the teeth can be saved from decay or treated.