Stages of dental caries and their treatment

Tooth decay is the most common disease in the world dental profile, which affects about 95% of the world population. Regardless of the stage of caries, the disease requires treatment in the shortest possible time. The disease is of long flowing process of demineralization and destruction of tooth caused by the change of its acid-alkaline environment, plaque, bacterial flora, excessive eating of carbohydrates. Despite its apparent simplicity and lack of seriousness of the disease, lesions of carious origin can lead to tooth destruction and loss, the opening of the dental canals, the development of severe purulent processes of the jaw. This is due to the need for annual preventive checkups and struggle with early stages of tooth decay.


Caries of the teeth occurs under the influence of acid cocci and lactobacilli. The speed of development of the disease depends on the frequency of exposure to a pathogenic factor on the enamel of the tooth. The higher the figure — the faster the decay reaches its final stages. At the maximum loss of the tooth and the formation of significant cavities in the area of soft tissue get the bacteria. The patient develops pulpitis, periodontitis and other pathological processes of infectious origin.
Modern dentistry allows you to reverse the effects of tooth decay on almost all stages of its development. However, with advanced forms of the disease, accompanied by inflammation of the periodontal soft tissues, the treatment can be long and painful. In some cases, the affected tooth must be removed, implanting in its place an artificial element. So, what are the stages of dental caries are distinguished experts? How is the diagnosis and what the patient is experiencing at each stage of the disease?

Stage № 1. The carious spot (initial caries)

The only manifestation of primary caries is a local discoloration of the tooth enamel. In small areas the tooth loses its Shine, becomes dull or slightly yellowish. Thus a smooth surface is maintained. With the development of demineralization spots are rough to the touch, as the tooth enamel becomes defective. Pain or change the sensitivity of the tooth patients not marked. Diagnostics of the initial caries is more often made by chance during examination of the patient for another reason or during routine medical examination.
Differential diagnosis of carious spot is in relation to diseases such as fluorosis and hypoplasia of the tooth. Distinctive signs of decay is:

  • The roughness of the spots;
  • Paintability stains methylene blue;
  • The asymmetry of the location of the spots.

This stage of development of caries allows for treatment without invasive manipulations. The affected tooth is disinfected, cleaned with hydrogen peroxide and dried. After the injury to apply special coatings, restoring the mineral composition of demineralized area. On contact surfaces of the teeth this method of treatment does not bring the expected result, so the treatment is performed in the traditional way. The decayed area is cut and sealed.

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Stage No. 2. Surface caries

The lack of adequate treatment leads to the transition of the primary carious spots to the stage surface caries. The distinctive symptoms of the disease, which at this stage are:

  • The increased roughness blemishes;
  • Change the spot color from white to gray or brown;
  • Cavities and chipped enamel in the outbreak of the disease;
  • Discomfort when a mechanical or thermal impact on the tooth;
  • Yellowish tinge on the crown of the tooth in kolodezniy region.

In the second stage of development of caries differential diagnosis is performed with the erosion of tooth enamel. As a rule, damage to the erosive nature are oval in shape, smooth bottom. Cavity such features do not possess.

Treatment of superficial caries can be carried out by cleaning and remineralization of the tooth, but this technique does not always prove to be effective. Innovative method of therapy is the use of the gel Icon, allowing to provide high-quality protection of the cleared area from the effects of metabolic products of bacteria. Primary treatment is the second stage of the disease is to clean the affected area, followed by sealing.

Are used in dentistry several types of fillings, which harden under the influence of a special light or chemical curing agents. However, massive damage is better to use inlays, produced in individual molds of the patient and fixed on a special glue. Of course, such methods are used in the later stages of the disease. However, caries rarely develop evenly. Most areas of surface damage are juxtaposed with the teeth affected to maximum extent.

Phase 3. Middle caries

At the stage of secondary caries pathological plot deepens, a cavity reaches the dentin. Damage, localized in the open areas, you can see with the naked eye. Hidden pockets of caries found in the study of the dental probe. Latest is delayed when passing through such areas.
The walls of carious cavity, usually hard. In some cases they may be partially covered dentin. This occurs in cases where the disease develops for a long time. When the average degree of caries cavity increases in depth, however the deep layers of dentin often does not reach. The distribution of the defect in the horizontal direction is usually negligible.

Subjectively, the patient may present the following complaints:

  • The sharp increase in sensitivity of the tooth;
  • Pain in the use of a thermally, chemically or mechanically irritating food;
  • Pain when brushing teeth or touching the outbreak of the disease.

Treatment of 3rd degree of caries requires the mechanical removal of damaged tissue using a special drill. Thereafter, the resulting cavity is cleaned and sealed. Save and restore the tooth in this, the penultimate stage could in almost all cases.

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Stage № 4. Deep caries

Deep caries is the final stage of the disease, which is often accompanied by inflammation of the paradontium, the almost complete destruction of the tooth, other concomitant pathology. Due to the low health literacy population disease most often is diagnosed at this stage. The patient seeks help when tooth decay starts to cause not only aesthetic discomfort but also physical pain. Deep caries is characterized by the following symptoms:

  • Detects deep cavities, and penetrating into the deep layers of dentine;
  • The patient complains of pain during eating, and spontaneous pain that occurs more often in the evening or night;
  • The sensing cavity provokes the appearance of a sharp nagging pain;
  • Pathological the plot has a black color;
  • The crown is sometimes destroyed in the subgingival region.

Treatment of deep caries begin with an assessment of the depth of damage. The patient is assigned a x-ray of the tooth, the nidus is investigated using a dental probe. Treatment is similar to that at the average caries. The destroyed tissue was removed, install the seal, and then restore the integrity of the tooth crown. The procedure can be performed under local infiltration or conduction anesthesia, and without it. In conjunction with the renovation and filling of the tooth, patients can be assigned to remineralizing therapy, recommended usage of therapeutic and antiseptic toothpastes. This is necessary in acute disease, when the process of decay is faster than the average in the age group of the patient.

Deep destruction of the tooth often make its recovery impossible or impractical. In such cases, the destroyed tooth removed. After partial healing of the hole in its place may be implanted the prosthesis (at the request of the patient).

Suspended cavities

In fact, this form does not apply to the stages of development of caries of a tooth. However, it requires special consideration, as it can leak for a long time. Suspended caries form of the disease in which the pathological process is fully or partially suspended under the influence of therapy.
The frozen form of the disease may acquire 2 or 3 stages. The first stage of caries (stain) in the provision of needed assistance to go unnoticed, after the doctor manages to restore the salinity affected area. Frozen caries cannot be considered complete healing. Sooner or later the tooth will require a re-intervention of a dentist.

Complications of dental caries


The third and fourth stages of tooth decay can lead to the development of purulent-septic complications. This happens when contact with pathogenic or conditionally pathogenic microflora contained in the mouth of the patient, the soft tissue of the jaw through the open dental channels. Most often, dentists have to deal with the following types of complications of the disease under consideration:

  • Pulpitis;
  • Periodontitis;
  • Periostitis;
  • Osteomyelitis;
  • Abscess.

Pulpitis is inflammation of dental pulp that contains the nerve endings and blood vessels. After drinking hot or cold foods causing pain, persisting for long periods of time.

When diffuse process, the pain becomes constant. Treatment of pulpitis is the cleaning and filling of root canals.
Periodontitis — inflammation of periodontal tissues, accompanied by pain aching. Pain is worse when pressing on the aching tooth or tapping on it. The disease diagnosis is carried out after the sensing of the cavity, radiography and visual inspection. Treatment — debridement and sealing of the tooth. Wobbly and badly damaged teeth should be removed.
Periostitis is a natural consequence of untreated periodontitis. The disease is characterized by inflammation of the periosteum of the jaw that leads to the development of this syndrome as:

  • Swelling of the soft tissues of the face;
  • Radiating pain in the damaged tooth;
  • Infiltration in the area of the tooth root;
  • General toxic syndrome.
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Treatment is carried out by removal of the tooth, drainage of the inflamed site with the goal of providing outflow of fluid, a common anti-inflammatory and antibacterial therapy.

Osteomyelitis is an inflammatory process of purulent-necrotic nature. Must lead to such symptoms as:

  • Swelling of the face;
  • Hyperemia of the projection of the affected area;
  • Swelling of the gums in the area, significantly larger than the pathological focus;
  • General toxic syndrome;
  • Infiltration, which is found on both sides of the jaw.

Treatment of osteomyelitis is surgical. After opening and debridement of the lesion the patient is prescribed antibiotic drugs, restorative therapy, physiotherapy restorative procedures.

An abscess is a limited area of inflammation accompanied by accumulation of pus. In addition to the dangers of septic (toxic syndrome, sepsis), abscesses of the big sizes can mechanically disturb the breath, the brain, to pinch a major blood vessel. Treatment of the abscess can only be surgical. The abscess is opened, washed with antiseptic solutions and drain, ensuring free discharge of pus and wound exudate from the wound. Patients are appointed Antibacterials.