caries
Introduction
Introduction to dental caries Rickets is a progressive lesion of the hard tissues of the teeth caused by a combination of various factors in the oral cavity. It is characterized by the demineralization of inorganic matter and the decomposition of organic matter. As the disease progresses, a color changes to form a substantial lesion. Evolution. It is characterized by high incidence and wide distribution. The average attack rate is about 50%, which is the main common disease in the oral cavity. It is also one of the most common diseases in humans. The World Health Organization has listed it as the three major human disease prevention and treatment diseases with cancer and cardiovascular diseases. basic knowledge Sickness ratio: 20-30% Susceptible people: no specific population Mode of infection: non-infectious Complications: endodontic disease
Cause
Dental caries
Bacteria ( 30% ):
It is a necessary condition for the occurrence of rickets. It is generally believed that there are two types of rickets, one is the genus Acidogenic genus, which is mainly Streptococcus mutans, actinomycetes and lactobacilli, which can decompose carbohydrates to produce acid, resulting in Inorganic demineralization of teeth; the other is Gram-positive cocci, which can destroy organic matter. After long-term action, teeth can form cavities. The currently recognized main cariogenic bacteria are Streptococcus mutans, and others include actinomycetes. Lactobacillus and the like.
Oral environment (30%):
The oral cavity is the external environment of the teeth and is closely related to the occurrence of rickets. The main factors that play a leading role are food and sputum.
(1) Foods are mainly carbohydrates, which are related to the formation of plaque matrix and the main energy source of bacteria in plaque. Bacteria can use carbohydrates (especially sucrose) to metabolize and produce acid, and synthesize extracellular polysaccharides and intracellular polysaccharides. The organic acid produced is beneficial to the growth of acid-producing and acid-resistant bacteria, and is also beneficial to the demineralization of hard tissues of the tooth. The polysaccharide can promote the adhesion and accumulation of bacteria on the tooth surface and provide energy when the exogenous sugar is deficient. Source, therefore, carbohydrates are the material basis for rickets.
(2) sputum under normal conditions, sputum has the following effects: 1. Mechanical cleaning: reduce the accumulation of bacteria. 2. Antibacterial effect: direct inhibition or inhibition of plaque adhesion on the tooth surface. 3. Anti-acid effect: neutralization by substances such as bicarbonate. 4. Anti-solvent: Enhance the acid resistance of the teeth and reduce the solubility by containing calcium, phosphorus and fluorine. When the amount and quality of sputum change, the attack rate can be affected. It can be seen clinically that the incidence of dry mouth or sputum secretion is significantly increased. Patients with maxillofacial radiation therapy may have multiple lesions due to destruction of the parotid gland. Gum; on the other hand, when the amount of lactic acid in the sputum increases, or the bicarbonate content decreases, it is also conducive to the occurrence of sputum.
Host (25%):
The tooth is the target organ in the process of rickets. The shape of the tooth, the degree of mineralization and the structure of the tooth are directly related to the occurrence of rickets. For example, the teeth of the teeth and the poorly mineralized teeth are more susceptible to sputum, and the degree of mineralization is more Well, the teeth with appropriate fluoride content in the tissue have strong anti-spasm; on the other hand, the structure of the teeth is closely related to the body, especially during development, which not only affects the development and structure of the teeth, but also the flow of sputum. The flow rate and its composition also have a great influence, and it is also an important link in the occurrence of rickets.
Time (5%):
The occurrence of rickets has a long process. From the initial sputum to the clinical formation of sputum, it usually takes 1.5-2 years. Therefore, even if the bacteria are caused, the suitable environment and the susceptible host exist at the same time, and the rickets will not happen immediately. Only when the above three factors exist for a long time at the same time can cause spasticity, so the time factor is of great significance in the occurrence of rickets.
Prevention
Dental caries prevention
Prevention of dental caries is a very important child health work. The basic principle is to take appropriate measures against the factors of the disease.
1. Reducing or eliminating pathogenic irritants to reduce or eliminate plaque, changing the oral environment, creating clean conditions is an important part of sputum prevention. The most practical and effective way is to brush your teeth and gargle. It is necessary to strengthen publicity and education so that children can develop oral cavity from an early age. Hygienic habits, learn how to brush your teeth properly, brush your teeth to remove most of the bacteria in the mouth, reduce the formation of plaque, children can use their soft towels or flannel to scrub the teeth, children can learn to brush their teeth after 3 years old, as soon as possible Brush once, gargle after a meal, brushing your teeth before saliva is more important, because the interval between the nights is long, the bacteria are easy to multiply, you have to brush, that is, "the upper teeth are brushed from top to bottom, the lower teeth are brushed from bottom to top", "Li Brush both inside and outside, and pay attention to the bite surface of the back teeth, so that the teeth and the food residue on each tooth surface can be cleaned. After brushing the teeth, rinse the mouth, do not cross the brush, and the horizontal brush is easy to damage the gums. Also, the residue in the teeth is not cleaned. Should pay attention to children's eating habits, increase all kinds of complementary foods on time, eat more coarse, hard and fibrous foods, have a frictional cleansing effect on the tooth surface, reduce the accumulation of food debris, hard food needs to be fully chewed, both enhanced Periodontal tissue, which can rub the teeth and bite the surface, may make the pits shallower, which is beneficial to reduce pit and sulcus.
2. Reduce or control the sugar in the diet. China is a country with cereals as the main food. It is difficult to control the carbohydrates in the diet. However, in recent years, the number of sugar foods and various beverages has increased significantly. Educate children to develop the habit of eating snacks and confectionery, do not eat sugar before going to bed, pay attention to the quality of children's three meals, from the young children to grow more vegetables, fruits and foods containing calcium, phosphorus, vitamins, etc. Try to eat whole grains as much as possible, pay attention to breast-fed babies, recently advocated the control of carbohydrates in the diet, and use sugar substitute to reduce dental caries, which is currently unrealistic and uneconomical in China. It is reported that some of the sugars (aspartame) commonly used in the United States contain toxicity and have attracted international attention.
3. Enhance the resistance of teeth Mainly through the fluoridation method to increase the fluoride in the teeth, especially to change the structure of the surface or surface of the enamel, enhance its resistance to cockroaches, the methods that are considered to be better in modern times are: Central water fluoridation, school water fluoridation, topical fluoridization, fluoride toothbrushing, fluorde mouthrinse, and the like.
Complication
Caries complications Complications, pulp disease, periapical periodontitis
Mild caries affect chewing function, severe caries, or caries can not be treated, continue to develop can cause dental pulp disease, apical periodontitis, jaw inflammation and other complications, and even become oral lesions, affecting general health, dental caries It is the main cause of tooth loss in children. The early loss of children's teeth not only hinders digestive function, but also affects the normal development of the maxillofacial region.
Symptom
Caries symptoms common symptoms toothache teeth hot and cold pain enamel corrosion molars teeth yellow teeth neck yellow spots tooth odor buried teeth teeth dark spots
[clinical manifestations]
1. rickets
The predilection site of rickets is closely related to whether the food is easy to stay. Some surfaces on the teeth are not easy to be cleaned. The bacteria and food debris are easy to stay. The plaque accumulates more and is easy to cause rickets. These parts are rickets. Good hair parts, including: pit and groove, abutment surface and tooth neck.
The pit and fissure of the tooth is a defect left in the process of tooth development and mineralization. It is also the primary pathological site of rickets. The abutment surface of the tooth is the most common site of rickets that is second only to the pit and fissure. Or the atrophy of the interdental nipple leads to food impaction. The neck of the tooth is the junction of enamel and dentin, which is good for retaining food and bacteria. It is also a weak link of the tooth tissue, especially the enamel is not in contact with the cementum. Dentin is more prone to spoilage when exposed directly.
2. rickets with good teeth
Due to the characteristics of different tooth anatomy and growth sites, there is a difference in the incidence of dental caries in each tooth. A large number of epidemiological survey data show that the tooth position distribution of caries is basically symmetrical on the left and right sides, and the mandible is more than the upper jaw. More teeth than the anterior teeth, the lowest rate of anterior teeth of the lower jaw.
3. degree of damage
Clinically, the color, shape and quality of caries can be seen, and the change of quality to main, color and shape is the result of qualitative change. With the development of the disease course, the lesion enters the dentin from the glaze, the tissue is continuously destroyed, and the disintegration gradually forms. The caverns are often divided into three stages: shallow, medium and deep, according to the degree of deterioration. The performances are as follows.
Shallow sputum: also known as enamel enamel, sputum is limited to enamel, the initial smooth surface is characterized by whitening plaques caused by demineralization, later yellowish brown due to coloration, dimples in the pits, generally no Obvious cavities, only rough feeling when visiting, late can be limited to enamel shallow holes, no symptoms, no response to probing.
Lieutenant: The sputum has reached the shallow layer of dentin. The clinical examination has obvious cavities. It can detect pain. It can cause pain response to external stimuli (such as cold, heat, sweetness, acid and food embedding, etc.). After the pain disappeared immediately, there was no spontaneous pain.
Squat: The sputum has reached the deep layer of dentin, generally showing a large and deep cavities, or the entrance is small and deep, with extensive damage. The response to external stimuli is heavier than that of the sputum, but after the stimuli are removed, it can still be Immediate pain relief, no spontaneous pain.
The smashing is a black transmission area on the X-ray film. For those who are difficult to diagnose (such as the adjacent enamel), X-ray film can be used to assist in diagnosis.
4. Defective lesion type
(1) chronic sputum
Rickets generally progress slowly, especially in adults, most of which are chronic. Due to the long course of disease, the texture is dry and the soft palate is less. These patients have a long repair process, usually with a hardened dentin layer at the bottom of the cavity.
(2) Acute sputum
More common in children, adolescents, pregnant women or poor health, short course of treatment, rapid progress, soft palate, soft texture, light coloration, pale yellow or white ochre, easy to be removed, lack of hardened dentin layer .
(3) Static
As the local cariogenic factors are eliminated, the progression of the caries is very slow or completely stopped, called static sputum.
(4) secondary paralysis
It is more common in the treatment of rickets. The damaged tissue is not cleaned or the edges of the prosthesis are not close together, and cracks are formed to cause recurrence.
Examine
Caries inspection
1. Oral examination
Rickets are prone to occur in stagnant areas where the teeth are not easily self-cleaning, especially in the gaps of the molars or in the crowded caulking of the dentition.
1) The superficial lesions are limited to enamel or cementum. White or grayish black ecchymoses can be seen locally. There are no symptoms. The tip of the probe can be caught during the probe. The probe slips through the lesion and has a rough feeling. No pain.
2) The lesions in the middle of the sputum are deep, involving the shallow layer of dentin, which is partially blackened. It may have temperature or chemical stimulation pain, and it is obvious that it has obvious cavities and is sensitive.
3) The deep lesions are deep and the dentin is deep and close to the pulp cavity. In the case of food impaction or hot and cold sweet and sour stimulation, pain is generated. Locally, black holes are found. Probes can be used to probe the deep bottom of the dentin. Sensitive or painful, no history of spontaneous pain.
2. Auxiliary inspection
If it is determined that there is difficulty in the damaged part, X-ray teeth can be taken, black shadows can be seen in the smashed area, and those with conditions can use optical fiber transillumination, electrical impedance, ultrasonic, elastic mold separation, dyeing and other techniques to improve the early diagnosis of rickets. Accuracy and sensitivity.
Diagnosis
Dental caries diagnosis
diagnosis
Diagnosis can be performed according to clinical manifestation and examination.
Differential diagnosis
Identification with tooth hypersensitivity
Teeth hypersensitivity is mainly caused by irritation. When brushing teeth, eating hard objects, eating acid, sweet, cold, hot, etc., it causes soreness, especially for mechanical stimulation. The most reliable diagnostic method is to use sharp probes. Sliding on the tooth surface, one or several allergic areas can be found. A mechanical stimulator is reported abroad. The pressure of the stainless steel needle is adjusted by screws to test the sensitivity of the teeth. It is also useful to test the electronically controlled thermometer. However, so far So far, the sensitivity of the teeth can only be expressed by the patient's subjective feelings.
