Caries in children
The content of the article:
- Causes of caries in children and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Caries treatment in children
- Possible complications and consequences
- Forecast
- Prevention of caries in children
Caries in children is a disease often encountered in pediatric practice, characterized by demineralization and destruction of hard tooth tissues with the subsequent formation of a cavity defect.
According to various sources, in economically developed countries, caries of milk teeth in children under 7 years old occurs in 80-90% of cases.
Caries in children is the most common reason to visit a pediatric dentist
Causes of caries in children and risk factors
The main causes of dental caries in children include:
- hereditary predisposition;
- non-observance of the rules of oral hygiene;
- poor nutrition;
- congenital pathologies of tooth enamel (hypoplasia, aplasia);
- diseases of the gastrointestinal tract;
- decrease in general and local immunity;
- unfavorable environmental conditions.
Children of the first years of life sometimes develop the so-called bottle caries (caries of a milk bottle, nursery, kefir, circular caries, caries of feeding), in which the cervical areas of the upper incisors and canines are affected.
The reasons contributing to the occurrence of bottle caries in children are:
- infectious diseases;
- general somatic pathology;
- insufficient production of saliva;
- chronic diseases in parents;
- long-term (longer than one year) breastfeeding or bottle-feeding, especially at night;
- sleep of a child with a pacifier in his mouth;
- lack of hygienic care for the oral cavity, especially after feeding before bedtime.
Forms of the disease
Depending on the depth of the lesion:
- uncomplicated caries;
- complicated caries (pulpitis, periodontitis).
According to the histological classification:
- carious damage to the tooth enamel;
- carious damage to the dentin of the tooth;
- carious damage to the cement of the tooth;
- interrupted tooth decay.
According to the Black classification of carious cavities, 6 classes of caries are distinguished, depending on the location:
- Area of fissures, blind pits of all teeth.
- Contact surfaces of molars and premolars.
- The contact surfaces of the canines and incisors, the integrity of the incisal edge is not compromised.
- The contact surfaces of the canines and incisors, the integrity of the incisal edge is broken.
- Vestibular surfaces of all groups of teeth.
- The cutting edges of the canines and incisors, as well as the cusps of the molars.
Depending on the rate of progress, caries can be chronic or acute. The latter form is often found precisely in childhood.
Disease stages
Depending on the degree of damage, 4 stages of caries are distinguished:
- The initial stage, or the stage of the chalk spot, is the appearance of a focus of enamel demineralization in the form of a chalk spot (in the cervical region of the tooth - a whitish line), pain and other manifestations of inflammation are absent.
- Superficial caries - a defect forms in the tooth enamel with exposed dentin, lesions are yellowish or brown in color, there is an increased sensitivity of hard tooth tissues to sweets.
- Medium caries is a defect in the tooth enamel, which partially affects the dentin of the tooth, pain is noted when eating cold, hot, sweet foods, which disappear after the temperature or chemical stimulus stops.
- Deep caries - significant damage to enamel and dentin, painful reaction of the tooth to thermal and chemical stimuli, lasting for some time and after the cessation of the thermal and / or chemical stimulus.
4 stages of caries in children
Symptoms
The difference between the carious process in children and what develops in adults is in a faster course - acute caries is more common in children, and the chronic process leads to the destruction of tooth tissues faster. In addition, multiple caries is more common in children, which is associated with age-related imperfection of the immune system.
At the initial stage of caries, there is no visible destruction of the hard tissues of the tooth, for this reason, examination with a probe is not very informative. The disease manifests itself only in the form of a chalky spot - an area with a slightly altered structure, a matte surface, in contrast to shiny healthy enamel. The chalk spot may regress in some cases.
At the stage of superficial caries in children, a zone of dark pigmentation (a brown or grayish spot with a rough bottom) appears on the surface of the tooth, in which enamel softening is found during instrumental examination.
At the stage of middle caries, the defect affects all layers of enamel and part of the dentin. Caries in the visible areas of the tooth appears as a tissue defect with a dark colored bottom and edges (the so-called hollow).
At the middle stage of caries, a hollow appears on the visible area of the tooth (a spot with a dark colored bottom and beveled edges)
At a deep stage, the defect in the tooth tissues affects the dentin layer almost to the entire depth, only a thin wall remains between the cavity and the pulp. In this case, as a rule, complete or partial destruction of the crown occurs. Subjective sensations vary depending on the depth of the tooth damage and the severity of the disease. Acute pain is usually noted if irritating food (cold, hot, sweet, sour, etc.) gets on the affected surface. In some cases, in the chronic course of the disease, subjective sensations are absent even with deep caries.
For bottle caries in children, the defeat of the upper incisors and canines is characteristic, the defect extends around the circumference of the crown, especially in the neck of the tooth, since these areas have the lowest mineralization. As in other cases, white spots appear at the initial stage. As the carious process progresses, the spots acquire a brownish or brownish-black color, and sensitivity to cold, hot, sweet foods appears. The pathological process can spread both to adjacent teeth and deep into the tooth tissues with the subsequent development of pulpitis and periodontitis. In the absence of timely treatment, bottle caries can lead to premature loss of milk teeth.
Bottle caries in children affects the upper incisors and canines
Diagnostics
Caries in children is diagnosed during a visual and instrumental (using a mirror and a probe) examination by a dentist. The patient's subjective feelings may indicate the depth of the tooth lesion, but are not the main criteria for making a diagnosis.
To clarify the diagnosis, it may be necessary to dry the tooth surface, vital staining of the hard tissues of the teeth to detect initial caries (in this case, chalk spots become more noticeable), stomatoscopy in ultraviolet light. If complications are suspected, radiography is indicated.
Caries diagnosis in a child begins with a dental examination
Differential diagnosis of caries in children is carried out with enamel hypoplasia, fluorosis, pulpitis.
Caries treatment in children
Caries treatment in children consists of two main stages:
- Dissection of a carious cavity, during which destroyed tooth tissues are removed to intact;
- Filling the cavity formed as a result of the carious process and subsequent preparation of the cavity, the task of which is to close the cavity so that the tooth does not decay further and restores its functions.
Dissection of a carious cavity in children is usually carried out using a drill, less often by a laser method, which is characterized by painlessness, noiselessness, and also demonstrates a number of differences in the quality of preparation of the tooth for further manipulations. After removing the destroyed tissues from the carious cavity, the sawdust is removed with a stream of water, then the cavity is dried with a stream of air, disinfected, and dried again. A gasket is placed on the bottom of the cavity, then a filling, which reproduces the normal anatomical shape of the crown. After hardening, the filling is ground and polished.
Depending on the stage, the treatment of caries in children has some differences.
Caries at the superficial stage does not always require preparation. A chalky spot is destruction within the enamel, therefore, laser treatment of the defect with subsequent surface filling with modern composite materials that have high adhesive properties may be sufficient. Another method consists in superficial grinding of the carious area (without creating a cavity), followed by remineralization of the enamel by means of applications or electrophoresis with solutions of remineralizing drugs.
Treatment of caries in children in the middle stage of caries consists in the preparation of hard tissues with filling of the carious cavity.
The method of treating caries in a child depends on the stage of the disease
In the treatment of deep caries, the bottom of the cavity is located close to the tooth chamber containing the neurovascular bundle (pulp). To protect it, a medical pad is installed - a filling material with antiseptic and anti-inflammatory properties. On top of the medical pad is covered with a regular one, then a filling is placed. Deep caries cannot always be differentiated from the initial stages of pulpitis, therefore, if in doubt, filling is performed in two stages - first, a temporary filling is placed, and only a few days later, in the absence of signs of inflammation, it is replaced with a permanent one.
Treatment of bottle caries at the initial stage is carried out by the following methods:
- the method of teeth impregnation with silver solutions, which allows you to stop the progression of the pathological process. The disadvantage of this method is the staining of the teeth in black;
- treatment of a carious cavity with ozone - the method is similar to silvering, but does not cause the tooth to become black;
- remineralizing therapy (through the application of remineralizing drugs) with the preliminary implementation of professional dental hygiene.
Bottle caries at the superficial, middle and deep stages requires complex treatment. With significant tooth decay, it may be necessary to remove or restore them using special children's crowns in order to properly form the jaw and bite.
Possible complications and consequences
A complication of caries in children may be the development of pulpitis (inflammation of the neurovascular bundle of the tooth) and periodontitis (inflammation of the ligamentous apparatus of the tooth). Periodontitis, which has developed due to the lack of adequate treatment for caries in milk teeth in children, in turn, can cause damage and even death of the rudiment of a permanent tooth. Advanced caries in children can lead to tooth loss. The formed defect in the dentition leads to a violation of the correct position of the dentition (bite) and the growth of jaw bones, speech defects.
In addition, unsanded carious cavities are foci of persistent infection in the child's body, which can cause other diseases, including allergies.
Forecast
With timely diagnosis and properly selected treatment, the prognosis is favorable.
Prevention of caries in children
Prevention of caries in children should begin already in the prenatal period - a balanced diet of a woman during pregnancy with sufficient intake of necessary trace elements reduces the likelihood of dental pathologies in a child in the future.
Good dental and oral hygiene is very important for the prevention of dental caries in children.
One of the main methods of caries prevention in children is careful hygienic dental care. From the moment the first teeth appear, children need to be taught how to use a toothbrush, and when the child is able to rinse out his mouth on his own - and hygienic toothpaste. With weakened tooth enamel and a tendency to develop caries, medicinal pastes are used containing drugs that help to strengthen the enamel of the teeth.
In addition, recommended:
- limited use of the pacifier, refusal to lubricate the pacifier with sweetened solutions;
- preventing the baby from falling asleep with a bottle of milk or other sweet formula for feeding;
- balanced nutrition, complete in the composition of macro- and micronutrients;
- regular (2 times a year) preventive examinations at the dentist from the time the child's first teeth erupt;
- when a child has permanent teeth, it is advisable to carry out a fissure sealing procedure;
- limiting the child's consumption of sweets;
- if necessary - covering teeth with fluoride varnish.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
