Superficial caries microbial caries. Caries - classifications. V. general questions

Due to the characteristics of the development of caries, several classifications have been identified. We present the main classifications of caries

In accordance with changes in hard tissues and clinical manifestations Several types of classification of dental caries have been created, they are based on various signs.

According to the WHO classification, caries is classified as a separate category.

Classification of caries ICD-10

  • K02.0 enamel chalk stain stage ( initial caries)
  • K02.1 Dentin caries
  • K02.2 Cement caries
  • K02.3 Suspended dental caries
  • K.02.3 Odontoclasia
    Pediatric melanodentia
    Melanodontoclasia
  • K02.8 Other dental caries
  • K02.9 Dental caries, unspecified

The advantages of this classification include the introduction of the subcategories “arrested caries” and “cement caries”.

Topographic classification of dental caries

In our country, this classification is most widely used. It takes into account the depth of the lesion, which is very convenient for the practice of the dentist.

  1. – focal demineralization of the hard tissues of the tooth is observed, and it can proceed intensively ( White spot) or slowly (brown spot).
  2. – at this stage a carious cavity appears within the enamel.
  3. – at this stage, the carious defect is located within the surface layer of dentin (mantle dentin).
  4. – in this case, the pathological process reaches the deep layers of dentin (peripulpal dentin).

IN clinical practice The terms “secondary caries” and “recurrent caries” are also used; let’s take a closer look at what they are:

1)Secondary caries– these are all new carious lesions that develop next to the filling in a previously treated tooth. Secondary caries has all the histological characteristics of a carious lesion. The reason for its occurrence is a violation of the marginal seal between the filling and the hard tissues of the tooth; microorganisms from the oral cavity penetrate into the resulting gap and create optimal conditions for the formation of a carious defect along the edge of a filling in enamel or dentin.

2) Relapse of caries is the resumption or progression of the pathological process if the carious lesion was not completely removed during previous treatment. Recurrence of caries is more often found under a filling when x-ray examination or along the edge of the filling.

Clinical classification of dental caries

  1. Acute caries. It is characterized by the rapid development of destructive changes in the hard tissues of the tooth, the rapid transition of uncomplicated caries to complicated ones. The affected tissues are soft, slightly pigmented (light yellow, grayish-white), moist, and can be easily removed with an excavator.
  2. Chronic caries is characterized as a slow process (several years). The spread of the carious process (cavity) is mainly in the planar direction. The altered tissues are hard, pigmented, brown or dark brown in color.
  3. There are also other forms of caries, for example, “acute”, “blooming caries”.

Classification of carious cavities according to Black

Class 1 – cavities located in the area of ​​fissures and natural recesses (for example, the blind fossa of the lateral incisors);

Class 2 – cavities located on the contact surfaces of small and large molars;

Class 3 – cavities located on the contact surfaces of the incisors and canines while maintaining the cutting edge;

Class 4 – cavities located on the contact surfaces of the incisors and canines with violation of the angles and cutting edge of the crown;

Class 5 – cavities on the labial, buccal and lingual surfaces located in the gingival part of the crown.

IN Lately class 6 is distinguished, which Black did not describe; these are cavities located on the tubercles of the molars and on the cutting edge of the incisors and canines.

The caries classification system is designed to categorize the degree of damage. It helps to choose a technique for further treatment.

Caries is one of the most famous and common dental diseases throughout the world. If tissue damage is detected, mandatory dental treatment to prevent further destruction of dental elements.

General information

Doctors have repeatedly made attempts to create a single, universal system of classifications of human diseases.

As a result, in the 20th century the “International Classification - ICD” was developed. Since creation unified system(in 1948), it was constantly revised and supplemented with new information.

The final, 10th revision was carried out in 1989 (hence the name ICD-10). Already in 1994 International Classification began to be used in countries that are members of the World Health Organization.

In the system, all diseases are divided into sections and marked with a special code. Oral diseases, salivary glands and jaws K00-K14 belong to the section of diseases digestive system K00-K93. It describes all dental pathologies, not just caries.

K00-K14 includes next list pathologies related to dental lesions:

  • Item K00. Problems with development and teething. Edentia, the presence of extra teeth, abnormalities in the appearance of teeth, mottling (fluorosis and other darkening of the enamel), disturbances in the formation of teeth, hereditary underdevelopment of teeth, problems with teething.
  • Item K01. Impacted (sunk) teeth, i.e. changed position during eruption, in the presence or absence of an obstacle.
  • Item K02. All types of caries. Enamel, dentin, cement. Suspended caries. Pulp exposure. Odontoclasia. Other types.
  • Item K03. Various lesions of hard dental tissues. Abrasion, enamel grinding, erosion, granuloma, cement hyperplasia.
  • Item K04. Damage to the pulp and periapical tissues. Pulpitis, pulp degeneration and gangrene, secondary dentin, periodontitis (acute and chronic apical), periapical abscess with and without cavity, various cysts.
  • Item K06. Pathologies of the gums and the edge of the alveolar ridge. Recession and hypertrophy, trauma to the alveolar margin and gums, epulis, atrophic ridge, various granulomas.

    • Item K07. Changes in bite and various jaw anomalies. Hyperplasia and hypopalsia, macrognathia and micrognathia of the upper and mandible, asymmetry, prognathia, retrognathia, all types of malocclusion, torsion, diastema, trema, displacement and rotation of teeth, transposition.

    Incorrect jaw closure and acquired malocclusions. Diseases of the temporomandibular joint: looseness, clicking when opening the mouth, painful dysfunction of the TMJ.

  • Item K08. Functional problems with the supporting apparatus and changes in the number of teeth due to exposure external factors. Loss of teeth due to injury, extraction or disease. Alveolar ridge atrophy due to long absence tooth Pathologies of the alveolar ridge.

Let's take a closer look at section K02 Dental caries. If a patient wants to find out what entry the dentist made in the chart after treating a tooth, he needs to find the code among the subsections and study the description.

K02.0 Enamels

Initial caries or chalk stain – primary form diseases. At this stage, there is still no damage to hard tissues, but demineralization and high susceptibility of the enamel to irritation are already diagnosed.

In dentistry, 2 forms of initial caries are defined:

  • Active(White spot);
  • Stable(brown spot).

During treatment, caries in an active form can either become stable or disappear completely.

The brown spot is irreversible; the only way to get rid of the problem is by preparation and filling.

Symptoms:

  1. Pain- For initial stage not typical toothache. However, due to the fact that demineralization of the enamel occurs (its protective function), the affected area may feel highly susceptible to the effects.
  2. External disturbances– visible when caries is located on one of the teeth in the outer row. It looks like an inconspicuous white or brown spot.

Treatment directly depends on the specific stage of the disease.

When the stain is chalky, remineralizing treatment and fluoridation are prescribed. When the caries is pigmented, preparation and filling are performed. At timely treatment and good oral hygiene, a positive prognosis is expected.

K02.1 Dentine

Lives in the mouth great amount bacteria. As a result of their vital activity, organic acids are released. They are the ones responsible for the destruction of the basic mineral components that make up the crystal lattice of the enamel.

Dentin caries is the second stage of the disease. It is accompanied by a violation of the structure of the tooth with the appearance of a cavity.

However, the hole is not always noticeable. It is often possible to notice irregularities only at a dentist’s appointment when a diagnostic probe is inserted. Sometimes it is possible to notice caries on your own.

Symptoms:

  • the patient is uncomfortable chewing;
  • pain from temperatures (cold or hot food, sweet foods);
  • external disturbances, which are especially visible on the front teeth.

Painful sensations can be provoked by one or several foci of the disease, but quickly disappear after the problem is eliminated.

There are only a few types of dentin diagnostics - instrumental, subjective, objective. Sometimes it is difficult to detect a disease solely based on the symptoms described by the patient.

At this stage, you can no longer do without a drill. The doctor drills the diseased teeth and installs a filling. During the treatment process, the specialist not only tries to preserve the tissue, but also the nerve.

K02.2 Cement

Compared to damage to enamel (initial stage) and dentine, cementum (root) caries is diagnosed much less frequently, but is considered aggressive and harmful to the tooth.

The root is characterized by relatively thin walls, which means that the disease does not take much time to completely destroy the tissue. All this can develop into pulpitis or periodontitis, which sometimes leads to tooth extraction.

Clinical symptoms depend on the location of the disease focus. For example, when the cause is located in the periodontal area, when the swollen gum protects the root from other influences, we can talk about a closed form.

With this outcome, no obvious symptoms are observed. Usually, with a closed location of cement caries, there is no pain or it is not expressed.

Photo of an extracted tooth with cement caries

At open form In addition to the root, the cervical area can also be destroyed. The patient may be accompanied by:

  • External disorders (especially pronounced in the front);
  • Inconvenience while eating;
  • Painful sensations from irritants (sweets, temperature, when food gets under the gum).

Modern medicine makes it possible to get rid of caries in several, and sometimes even in one, dentist appointment. Everything will depend on the form of the disease. If the gum covers the lesion, bleeds, or greatly interferes with the filling, then gum correction is performed first.

After getting rid of the soft tissue, the affected area (with or without exposure) is temporarily filled with cement and oil dentin. After the tissue has healed, the patient comes back for a second filling.

K02.3 Suspended

Suspended caries is a stable form of the initial stage of the disease. It appears as a dense pigment spot.

Typically, such caries is asymptomatic, patients do not complain about anything. The stain can be detected during a dental examination.

Caries is dark brown, sometimes black. The surface of tissues is studied by probing.

Most often, the focus of suspended caries is located in the cervical part and natural depressions (pits, etc.).

The treatment method depends on various factors:

  • Spot size– formations that are too large are prepared and filled;
  • From the wishes of the patient– if the stain is on external teeth, then the damage is eliminated with photopolymer fillings so that the color matches the enamel.

Small dense foci of demineralization usually occur over a period of time with a periodicity of several months.

If the teeth are properly cleaned and the amount of carbohydrates consumed by the patient is reduced, then the future progressive development of the disease may be stopped.

When the spot grows and becomes soft, it is prepared and filled.

K02.4 Odontoclasia

Odontoclasia is a severe form of dental tissue damage. The disease affects the enamel, thinning it and leading to the formation of caries. No one is immune from odontoclasia.

The appearance and development of damage is influenced by a huge number of factors. Such prerequisites even include poor heredity, regular oral hygiene, chronic disease, metabolic rate, bad habits.

Main visible symptom Odontoclasia – toothache. In some cases, due to non-standard clinical form or increased pain threshold the patient does not feel this either.

Then only the dentist will be able to make the correct diagnosis during the examination. The main visual sign indicating problems with enamel is tooth damage.

This form of the disease, like other forms of caries, is treatable. The doctor first cleans the affected area, then fills the painful area.

Only high-quality oral cavity prevention and regular dental examinations will help to avoid the development of odontoclasia.

K02.5 With pulp exposure

All tooth tissues are destroyed, including the pulp chamber - the partition separating dentin from the pulp (nerve). If the wall of the pulp chamber is rotten, then the infection penetrates into soft fabrics tooth and causes inflammation.

The patient feels severe pain when food and water enter the carious cavity. After cleansing it, the pain subsides. In addition, in advanced cases, a specific smell from the mouth appears.

This condition is considered deep caries and requires long, expensive treatment: mandatory removal of the “nerve”, cleaning of the canals, filling with gutta-percha. Several visits to the dentist are required.

Details of the treatment of all types of deep caries are described in the article.

Item added in January 2013.

K02.8 Another view

Other caries – average or deep form diseases developing in a previously treated tooth (relapse or re-development next to the filling).

Average caries– this is the destruction of the enamel elements on the teeth, accompanied by attacks or permanent painful sensations in the area of ​​the outbreak. They are explained by the fact that the disease has already spread to the upper layers of dentin.

The form is required dental care, in which the doctor removes the affected areas, followed by their restoration and filling.

Deep caries– a form that is characterized by extensive damage to the internal dental tissues. It affects a large area of ​​dentin.

The disease cannot be ignored at this stage, and refusal of treatment can lead to nerve (pulp) damage. In the future, if you do not use medical care pulpitis or periodontitis develops.

The affected area is completely removed, followed by restorative filling.

K02.9 Unspecified

Unspecified caries is a disease that develops not on living, but on pulpless teeth (those from which the nerve has been removed). The reasons for the formation of this form do not differ from standard factors. Typically, unspecified caries occurs at the junction of a filling and an infected tooth. Its appearance in other places of the oral cavity is observed much less frequently.

The fact that a tooth is dead does not protect it from developing caries. Teeth depend on the presence of sugar penetrating into oral cavity along with food and bacteria. After the bacteria are saturated with glucose, acid begins to form, leading to the formation of plaque.

Caries of a pulpless tooth is treated according to the standard scheme. However, in this case there is no need to use anesthesia. The nerve that is responsible for pain is no longer in the tooth.

Prevention

The condition of dental tissue is greatly influenced by a person’s diet. To prevent caries, you need to follow some recommendations:

  • eat less sweets and starchy foods;
  • balance the diet;
  • monitor vitamins;
  • chew food well;
  • rinse your mouth after eating;
  • brush your teeth regularly and correctly;
  • avoid simultaneous administration cold and hot food;
  • periodically inspect and sanitize the oral cavity.

The video presents Additional Information on the topic of the article.

Timely treatment will help you quickly and painlessly get rid of caries. Preventive measures prevent damage to the enamel. It is always better to prevent illness than to treat it.

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WHO classification of caries. Unfortunately, there is no unified caries classification system that would fully satisfy the requirements of clinicians. Today there are several dozen classifications of caries

When diagnosing carious tooth lesions, dentists use the following classifications:
Caries classification:
1. According to the depth of damage to tooth tissue:
- initial,
- superficial,
- average,
- deep
2. According to pathomorphological changes:
- caries in the spot stage (white spot, light brown spot, black),
- enamel caries (superficial caries),
- average caries,
- medium deep caries (corresponds to deep caries clinic).
3. By localization:
- fissure,
- approximal,
- cervical.
4. According to the degree of disease activity:
- compensated form,
- subcompensated form,
- decompensated form.
5. Basic: WHO classification of caries (ICD-10, 1995):
- enamel caries
- dentin caries
- cement caries.
6. Zonal classification (Lukomsky, 1949).
1. Carious stain: a) chalk-acute process; b) pigmented-chronic.
2. Superficial caries (enamel caries), acute and chronic.
3. Average caries (dentine caries), acute and chronic.
4. Deep caries (caries of suprapulpal dentin), acute and chronic.

7. Classification of MMSI(1989)

I. Clinical forms:
1. Spot stage (carious demineralization):
a) progressive (white or light yellow spots);
b) intermittent (brown spots);
c) suspended (dark brown spots).
2. Carious defect (disintegration):
A. Enamel caries (superficial).
B. Dentin caries:
a) medium depth;
b) deep.
B. Cement caries.
II. By localization:
1) fissure caries;
2) caries of contacting surfaces;
3) caries of the cervical region.
III. With the flow:
1) fast-flowing caries;
2) slow-moving caries;
3) stabilized process.
IV. By intensity of damage:
1) single lesions;
2) multiple lesions;
3) systemic damage.
In practice, the term secondary, or recurrent, caries is used when the process develops next to the applied filling in a tooth with living pulp.

International classification of diseases ICD-10
- codes and ciphers of diagnoses and diseases.

K00-K93 Diseases of the digestive system
.
K00-K14 Diseases of the mouth, salivary glands and jaws
.
K02 Dental caries
(Dental caries,)
K02.0 Enamel caries
K02.1 Dentin caries
K02.2 Cement caries
K02.3 Suspended dental caries
K02.4 Odontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified
(Tooth caries,)

Dental caries should be considered as a polymorphic pathological process, characterized by focal demineralization of hard dental tissues with the formation of a carious cavity, capable of worsening throughout life, stabilizing, acquiring various activities and being in varying degrees compensation.

Dental caries. Definition, classification, assessment of the intensity and prevalence of caries, treatment methods.

Question 1. Definition of caries.

CARIES is a pathological process in the hard tissues of the tooth that occurs after teething and consists of focal demineralization of the enamel with subsequent formation of a cavity.

The main reasons for the development of dental caries.

    Presence of dental plaque

    Use in large quantities easily fermentable carbohydrates

Factors contributing to the development of dental caries:

    acidic saliva reaction

    crowded teeth

    low concentration minerals(fluoride) in enamel

    presence in the oral cavity additional conditions for plaque retention (braces, orthopedic structures)

    hyposalivation

Question 2. Classification of caries according to MMSI.

The MMSI classification of caries was developed taking into account the depth of the carious cavity:

1. Caries in the spot stage (MACULACARIOSA) – focal demineralization of enamel, without cavity formation:

    white spot - indicates an active carious process

    pigmented spot - indicates some stabilization of the process.

2. Superficial caries (CARIESSUPERFICIALIS) – carious cavity is localized within the enamel

3. Average caries (CARIESMEDIA) – the carious cavity is localized within the dentin, slightly deeper than the enamel-dentin border.

4. Deep caries (CARIESPROFUNDA) - the carious cavity is localized in dentin and predentin (near the pulp).

Question 3. International classification of caries according to WHO (from the International Classification of Diseases, 10th revision)

    Initial caries (chalk spot stage).

    Enamel caries.

    Dentin caries.

    Cement caries.

    Suspended caries.

THE RELATIONSHIP OF THESE TWO CLASSIFICATIONS:

1. Caries in the spot stage

    White spot

    pigmented spot

Initial caries

Suspended caries

2. Superficial caries

Enamel caries

3. Average caries

Dentin caries

4. Deep caries

Corresponds to the nosological unit “Initial pulpitis - Pulp hyperemia”, because accompanied by initial changes in the dental pulp.

Cement caries

Question 4. Classification of Black's carious cavities.

Black class

Localization of the carious cavity

Chewing surfaces of molars and premolars, blind fossae of molars and incisors.

Contact surfaces of molars and premolars.

Contact surfaces of incisors and canines without disturbing the cutting edge.

Contact surfaces of incisors and canines with violation of the cutting edge.

Cervical areas of all groups of teeth (on lingual and vestibular surfaces).

Cavities located on the tops of the cusps of molars and premolars, on the cutting edge of the incisors.

Question 5. Diagnosis of dental caries.

    Carious stain - when dried, a loss of enamel shine is detected; for differential diagnosis with non-carious lesions, vital staining of the enamel is used to identify focal demineralization. METHYLENE BLUE IS USED, AS WELL AS SPECIAL SOLUTIONS – “CARIES MARKERS”.

    Carious cavities are detected by probing

    With the help of X-ray therapy, carious cavities on contact surfaces are detected, as well as caries under fillings.

Question 6. Assessment of the prevalence of dental caries:

The Dental Caries Prevalence Index is used to estimate the prevalence of dental caries. The index is calculated as follows:

Question 7. Assessment of the intensity of caries:

The intensity of caries is assessed using the KPU index:

For each patient, the number of carious, filled and extracted teeth is counted, then the results are summed up and divided by the number of patients examined.

In some cases (especially in children), the KPP index is used - the sum of filled and carious surfaces (the extracted tooth is counted as 5 surfaces).

The KPU index allows you to assess not only the intensity of caries, but also the level of dental care: if components K and U predominate, then the level of dental care should be considered unsatisfactory, if component P predominates, it should be considered good.

The main groups of the survey are 12-year-old children, 35-44 years old.

(for 12 years old)

very low level of caries intensity 0-1.1

low level of caries intensity 1.2-2.6;

average level of caries intensity 2.7-4.4;

high level of caries intensity 4.5-6.5;

very high level of caries intensity 6.6-7.4;

Question 8. Methods for treating caries:

    non-invasive (remineralizing therapy)

    invasive (preparation followed by filling).

Remineralization therapy is most effective in the presence of a white carious spot. It is carried out as follows: professional hygiene, application of calcium preparations, application of fluoride preparations.

Practice - rubber dam.

A rubber dam is a system for isolating the working area from saliva, as well as protecting adjacent teeth and soft tissues of the oral cavity from damage by the bur.

Indications:

    treatment of dental caries

    endodontic dental treatment

    dental restoration

    use of Air-Flow devices

Contraindications:

    severe periodontitis

    allergy to latex

    patient's reluctance.

The set includes: punch, clamp pliers, clamps, latex, chords or wedges.

Using rubber dam:

    holes are marked on the latex using a template

    holes are made using a punch

    latex is placed on the extracted teeth, clamps are fixed on the extracted tooth or on neighboring teeth, fixation with the help of wedges or chords is also possible.

    At the clinic, flosses are tied to the clamps (to be pulled out if inhaled or swallowed)

    Latex is stretched over the frame

    In the International Statistical Classification of Diseases and Related Health Problems of the World Health Organization, Tenth Revision (ICD-10):

    K02.0 Enamel caries

    Stage of “white (chalky) spot” [initial caries]

    K02.1 Dentin caries

    K02.2 Cement caries

    K02.3 Suspended dental caries

    K02.4 Odontoclasia

    K02.8 Other dental caries

    K02.9 Dental caries, unspecified

    General approaches to the diagnosis and treatment of dental caries:

    Diagnosis of dental caries is made by collecting anamnesis, clinical examination and additional methods examinations. The main task in diagnosis is to determine the stage of development of the carious process and select the appropriate treatment method. During diagnosis, the localization of caries and the degree of destruction of the crown of the tooth are established. Depending on the diagnosis, a treatment method is chosen.

    The principles of treating patients with dental caries provide for the simultaneous solution of several problems:

    Elimination of factors determining the demineralization process;

    Warning further development pathological carious process;

    Saving and Restoring anatomical shape tooth affected by caries and functional ability the entire dental system;

    Prevention of development pathological processes and complications;

    Improving the quality of life of patients. Treatment for caries may include:

    Elimination of microorganisms from the surface of teeth;

    Remineralizing therapy at the “white (chalky) spot” stage;

    Fluoridation of hard dental tissues for suspended caries;

    Preservation of healthy hard dental tissues whenever possible, excision of pathologically altered tissues with subsequent restoration of the tooth crown;

    At taking anamnesis find out the presence of complaints of pain from chemical and temperature irritants, an allergic history, the presence somatic diseases. Targeted identification of complaints of pain and discomfort in the area of ​​a specific tooth, complaints of food getting stuck, patient satisfaction appearance tooth, the timing of the onset of complaints, when the patient noticed the appearance of discomfort. Determine whether the patient is carrying out proper hygiene care for the oral cavity, the patient’s profession, regions of his birth and residence (endemic areas of fluorosis).

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