Depending on the nature of the changes occurring in the hard tissues of the tooth, as well as clinical manifestations, several ways have been created to classify dental caries.
Microbial caries presupposes the presence different signs at the core. According to the WHO classification, caries is classified as a separate group.
Classification of caries according to ICD 10
The phenomenon of caries ICD 10 suggests dividing into the following points:
- K02.0 This is enamel caries, that is, the initial one, which can be called the chalk spot stage.
- K021 – caries affecting dentin;
- K02.2 – so-called cement caries;
- K02.3 – caries, which is this moment paused;
- K.02.3. This includes odontoclasia, melanodontoclasia, and meladonthenia in children;
- K02.8. Other types of dental caries;
- K02.9. Unrefined caries.
The classification of caries according to ICD 10 is currently one of the most popular. Among its advantages we can include the fact that sub-categories appeared in it in the form of suspended caries or cement caries.
Topographic classification
This classification of caries, like ICD10, is quite common in our country. For the practical part of a dentist’s work, it is extremely convenient, since it takes into account the depth of damage to the tooth.
- Stage of carious spot. At the same time, we can observe demineralization of the hard tissues of a particular tooth, which can be either slow in the form of brown or intense in the form of a whitened spot.
- Superficial caries . This stage assumes that carious cavity manifests itself within the boundaries of human enamel.
- Average caries. Here we are talking about a carious defect, which is located within the boundaries of the mantle dentin - its surface layer.
- Deep caries. Here we are talking about a pathological process that affects the deep layers of dentin, known as peripulpar dentin.
In addition, clinical practice involves the use of the concepts of secondary caries and recurrent caries. Let's figure out what it is:
- Under secondary caries It is generally accepted to understand all newly formed carious lesions that appear near the filling in a tooth that was treated previously. This problem is also distinguished by all the histological features of carious lesions. It appears due to violations of the marginal contact between the hard tissues of the teeth and fillings. A gap appears into which microorganisms penetrate oral cavity, as a result, the conditions for the appearance of a carious defect at the boundaries of the filling in dentin or enamel become extremely favorable.
- Recurrence of caries. This is progress or resumption of the pathological process when the carious lesion was not completely eliminated during the previous treatment. Most often, this problem is detected at the edges of the filling, during an X-ray examination of the patient.
Clinical classification
- Acute caries. It is characterized by the rapid development of changes in tooth tissues, the rapid transition of uncomplicated to complicated caries. In this case, after the lesion, the tissues become soft and weak pigments are expressed.
- Chronic caries . This slow process, which does not go away for several years and spreads mainly in the planar direction. The tissues that are affected become hard and pigmented, acquiring brown tones.
- There are also other forms, such as blooming or sharp.
Black classification
- Class. Cavities that are located in natural recesses and fissures;
- Class. Cavities on the contact surfaces of molars, both large and small;
- Class. Cavities on the contact areas of fangs and incisors, suggesting preservation of the cutting edge;
- Class. These are cavities that are also found on the canines and incisors, but the angles and cutting edges are broken;
- Class. We are talking about cavities on the lips, cheeks and tongue in the gingival parts.
Although Black did not describe Class 6, it is still often used today. It refers to the cavities that are located on the cusps of permanent teeth, the cutting edges of sharp teeth.
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2015
Dental caries (K02)
Dentistry
general information
Short description
Recommended
Expert advice
RSE at the RVC "Republican Center"
healthcare development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 15, 2015
Protocol No. 12
DENTAL CARIES
Dental caries is a pathological process that appears after teething, during which demineralization and softening of the hard tissues of the tooth occur, followed by the formation of a defect in the form of a cavity. .
Protocol name: Dental caries
Protocol code:
ICD-10 code(s):
K02.0 Enamel caries. Stage of "white (chalky) spot" [initial caries]
K02.I Dentin caries
K02.2 Cement caries
K02.3 Suspended dental caries
K02.8 Other dental caries
K02.9 Dental caries, unspecified
Abbreviations used in the protocol:
MBK -international classification illnesses
Date of protocol development/revision: 2015
Protocol users: dentist therapist, dentist, general dentist.
Assessment of the degree of evidence of the recommendations provided
Table - 1. Level of evidence scale
| A | A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population. |
| IN | High-quality (++) systematic review of cohort or case-control studies or High-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias, the results of which can be generalized to relevant population. |
| WITH |
Cohort or case-control study or controlled trial without randomization with low risk of bias (+). Results that can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +) whose results cannot be directly generalized to the relevant population. |
| D | Case series or uncontrolled study or expert opinion. |
| GPP | Best pharmaceutical practice. |
Classification
Topographic classification of caries:
· stain stage;
· superficial caries;
· average caries;
· deep caries.
By clinical course:
· fast-flowing;
· slow flowing;
· stabilized.
Clinical picture
Symptoms, course
Diagnostic criteria for diagnosis
Complaints and anamnesis [2, 3, 4, 6,11, 12]
Table - 2. Data collection of complaints and anamnesis
| Nosology | Complaints | Anamnesis |
|
Caries in the spot stage: |
usually asymptomatic; feeling of increased sensitivity to chemical irritants; aesthetic flaws. |
General state not violated ;
Poor oral hygiene ; Nutritional deficiency minerals; |
|
Superficial caries: |
short-term pain from chemical and temperature irritants; may be asymptomatic. |
General condition not disturbed ;
Somatic diseases body (pathology endocrine systems And gastrointestinal tract); Poor oral hygiene ; Nutritional deficiency of minerals |
|
Average caries |
short-term pain from temperature, mechanical, and chemical stimuli; pain from irritants is short-term, after eliminating the irritant it quickly passes; sometimes there may be no pain; Aesthetic defect. |
General condition not disturbed ;
Somatic diseases of the body (pathology of the endocrine systems and gastrointestinal tract); Poor oral hygiene |
|
Rapidly progressing deep caries |
short-term pain from temperature, mechanical, chemical stimuli; with the removal of the stimulus, the pain does not immediately disappear; to damage the integrity of hard dental tissues; |
General condition not disturbed ;
Somatic diseases of the body (pathology of the endocrine systems and gastrointestinal tract); Poor oral hygiene ; |
|
Slowly progressing deep caries |
No complaints; Violation of the integrity of hard dental tissues; Change in tooth color; Aesthetic defect. |
General condition not disturbed ;
Somatic diseases of the body (pathology of the endocrine systems and gastrointestinal tract); Poor oral hygiene; |
Physical examination:
Table - 3. Data from physical examination of caries at the spot stage
| Caries in the spot stage | ||
| Survey data | Symptoms | Pathogenetic rationale |
| Complaints |
Most often, the patient has no complaints; he may complain about the presence of inter- macular or pigmented spot (aesthetic defect) |
Carious spots are formed as a result of partial demineralization of the enamel in the lesion |
| Inspection |
On examination, chalky or pigmented spots with clear, uneven outlines. The size of the spots can be several millimeters. The surface of the stain, unlike intact enamel, is dull and lacks shine. |
|
|
Localization of carious spots |
Typical for caries: fissures and others natural depressions, approximal surfaces, cervical region. As a rule, the spots are single, there is some symmetry of the lesion |
The localization of carious spots is explained by the fact that that in these areas of the tooth even with good hygiene the oral cavity has conditions for the accumulation and preservation of dental plaque |
| Probing |
When probing the enamel surface in the area of the spot is quite dense, painless |
The surface layer of enamel remains relatively intact due to the fact that, along with the process of demineralization, the process of remineralization is actively underway due to the components of saliva |
| Drying the tooth surface |
White carious spots become more clearly visible |
When dried from demineralized sub- in the superficial zone of the lesion, water evaporates through the enlarged microspaces of the visible intact surface layer of enamel, and at the same time its optical density changes |
|
Vital staining of tooth tissues |
When stained with a 2% solution of methylene blue, carious spots acquire a blue color of varying intensity. Surrounding spot intact enamel does not stain |
The possibility of dye penetration into the lesion is associated with partial demineralization subsurface layer of enamel, which is accompanied by an increase in microspaces in the crystalline structure of enamel prisms |
|
Thermodiagnostics |
The enamel-dentin border and dentinal tubules with processes of odontoblasts are inaccessible to the influence of the stimulus |
|
| EDI | EDI values are within 2-6 µA | The pulp is not involved in the process |
| Transillumination |
In an intact tooth, light passes evenly through hard tissue without creating a shadow. |
The carious lesion area looks like dark spots with clear boundaries When a light beam passes through an area destruction, the effect of extinguishing the glow of tissues is observed as a result of changes in their optical density |
Table - 4. Data from physical examination of superficial caries
| Superficial caries | ||
| Survey data | Symptoms | Pathogenetic rationale |
| Complaints |
In some cases, patients have no complaints are. More often they complain about short-term pain from chemical irritants (usually from sweet, less often from sour and salty), and so- or a defect in the hard tissues of the tooth |
Demineralization of enamel in the affected area due to leads to an increase in its permeability. As a result that's why chemical substances may from the outbreak pressure to enter the zone of enamel-dentin junction unity and change the balance of the ionic composition of this areas. Pain occurs as a result of changes in the hydrodynamic state in the cytoplasm odontoblasts and dentinal tubules |
| Inspection |
A shallow carious cavity is identified within the enamel. The bottom and walls of the cavity are often pigmented, there may be chalky or pigmented areas along the edges, characteristic of caries in the spot stage |
The appearance of a defect in the enamel occurs if a cariogenic situation persists for a long time, accompanied by exposure to acids on enamel |
| Localization |
Typical for caries: fissures, contact surfaces, cervical area |
Places largest accumulation plaque and poor accessibility of these areas for hygienic manipulations |
| Probing |
Probing and excavation of the bottom of the carious cavity Loss may be accompanied by severe but fleeting pain. The surface of the defect is rough when probing |
When the cavity bottom is close to the enamel-dentin junction when probing In this case, the processes of odontoblasts may be irritated |
|
Thermodiagnostics |
short-term pain |
As a result high degree demineralization enamel, penetration of a cooling agent can cause a reaction of odontoblast processes |
| EDI |
2-6 µA |
|
Table - 5. Data from physical examination of average caries
| Average caries | ||
| Survey data | Symptoms | Pathogenetic rationale |
| Complaints |
Patients often do not complain or complain of a hard tissue defect; for dentin caries - for short-term pain from temperature and chemical Chinese irritants |
The most sensitive area is destroyed - enamel-dentin border, dentinal tubules covered with a layer of softened dentin, and the pulp is isolated from the carious cavity by a layer of dense dentin. The formation of replacement dentin plays a role |
| Inspection |
The cavity is determined medium depth, captures the entire thickness of the enamel, enamel dentinal border and partially dentin |
If the cariogenic situation persists, Continued demineralization of the hard tissues of the tooth leads to the formation of a cavity. The depth of the cavity affects the entire thickness of the enamel, the enamel dentinal border and partially dentin |
| Localization |
The affected areas are typical for caries: - fissures and other natural recesses, contact surfaces, cervical region |
Good conditions for accumulation and retention and functioning of dental plaque |
| Probing |
Probing the bottom of the cavity is painless or painless; probing in the area of the enamel-dentin junction is painful. A layer of softened dentin is determined. Messages no tooth with cavity |
No pain in the bottom of the cavity ity is probably due to the fact that demineralization dentin is accompanied by destruction of processes odontoblasts |
| Percussion | Painless |
The process does not involve pulp and periodontal tissues |
| Thermodiagnostics |
pain due to temperature new stimuli |
|
| EDI | Within 2-6 µA |
No inflammatory re- pulp shares |
| X-ray diagnostics |
The presence of a defect in the enamel and part of the dentin in areas of the tooth accessible for x-ray diagnostics |
Areas of demineralization of hard dental tissues are less delayed by X-rays rays |
|
Cavity preparation |
Pain in the bottom and walls of the cavity |
|
Table - 6. Data from physical examination of deep caries
| Deep caries | ||
| Survey data | Symptoms | Pathogenetic rationale |
| Complaints |
Pain from temperature and, to a lesser extent, from mechanical and chemical irritants quickly passes after eliminating the irritant Pain from temperature and, to a lesser extent, from mechanical and chemical irritants quickly passes after eliminating the irritant |
The pronounced painful reaction of the pulp is due to the fact that the dentin layer separating the dental pulp from the carious cavity is very thin, partially demineralized and, as a result, very regenerative. susceptible to the effects of any irritants. The pronounced pain reaction of the pulp is due to the fact that the layer of dentin separating the dental pulp from the carious cavity is very thin, partially demineralized and, as a result, very resistant. susceptible to any stimuli |
| Inspection | Deep carious cavity filled with softened dentin |
Deepening of the cavity occurs as a result of pro- ongoing demineralization and simultaneous disintegration of the organic component of dentin |
| Localization |
Typical for caries |
|
| Probing |
Softened dentin is detected. The carious cavity does not communicate with the tooth cavity. The bottom of the cavity is relative hard, probing it is painful |
|
| Thermodiagnostics |
after they are eliminated |
|
| EDI |
up to 10-12 µA |
|
Diagnostics
List of diagnostic measures:
Basic (mandatory) and additional diagnostic examinations carried out on an outpatient basis:
1. Collection of complaints and medical history
2. General physical examination (External examination of the face (skin, facial symmetry, skin color, condition lymph nodes color, shape of teeth, size of teeth, integrity of hard tissues of teeth, mobility of teeth, percussion
3. Probing
4. Vital staining
5. Transillumination
6. Intraoral radiography of the tooth
7. Thermal diagnostics
Minimum list of examinations that must be carried out when referring for planned hospitalization: no
Basic (mandatory diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations not carried out at the outpatient level are carried out): no
Diagnostic measures carried out at the stage of emergency care: No
Laboratory research: are not carried out
Instrumental research:
Table - 7. Data instrumental studies
| Rresponse to temperature stimuli | Electroodontometry | X-ray methods studied and I | |
| Caries in the spot stage | Pain reaction no response to temperature stimuli | Within 2-6 µA | The radiograph reveals foci of demineralization within the enamel or no changes |
| Superficial caries |
There is usually no reaction to heat. When exposed to cold, it may feel short-term pain |
Reaction to electricity corresponds reactions of intact dental tissues and constitutes 2-6 µA |
An x-ray reveals a superficial defect in the enamel |
| Average caries |
Sometimes there may be short-term pain due to temperature new stimuli |
Within 2-6 µA | On the radiograph, there is a minor defect in the crown of the tooth, separated from the tooth cavity by a layer of dentin of varying thickness; there is no communication from the tooth cavity. |
| Deep caries |
Quite severe pain from temperature - irritants, quickly passing after they are eliminated |
Electrical excitability of the pulp is within normal limits, sometimes it can be reduced up to 10-12 µA |
On the radiograph, there is a significant defect in the crown of the tooth, separated from the tooth cavity by a layer of dentin of varying thickness; there is no communication from the tooth cavity. There are no pathological changes in the area of the root apex in the periodontium. |
Indications for consultation with specialists: not required.
Differential diagnosis
Differential diagnosis of enamel caries in the stage of white (chalky) spots (initial caries) (k02
0) - should be differentiated from the initial stages of fluorosis and enamel hypoplasia.
Table - 8. Data differential diagnosis caries in the spot stage
| Disease | Are common Clinical signs | |
|
Enamel hypoplasia (spotted form) |
The course is often asymptomatic. Clinically on the enamel surface chalky spots are detected various sizes with a smooth shiny surface |
The spots are located in areas atypical for caries (in the convex surfaces of the teeth, in the area of the tubercles). Characterized by strict symmetry and systematicity of tooth damage in accordance with the timing of their mineralization. The boundaries of the spots are clearer than with caries. Stains are not stained with dyes |
|
Fluorosis (striped and spotted forms) |
The presence of chalky spots on the surface of the enamel with a smooth shiny surface Permanent teeth are affected. |
Spots appear in places atypical for caries. The stains are multiple, located symmetrically on any part of the tooth crown, are not stained with dyes |
Differential diagnosis of enamel caries in the presence of a defectwithin its limits (k02.0) (superficial caries)
It is necessary to differentiate from average caries, wedge-shaped defect, dental erosion and some forms of fluorosis (chalk-mottled and erosive).
Table - 9. Data on the differential diagnosis of superficial caries
| Disease | General clinical signs |
Features |
|
Fluorosis (chalky- mottled and erosive naya forms) |
A defect is detected on the surface of the tooth within the enamel |
The localization of defects is not typical for caries. Areas of enamel destruction are located randomly |
| Wedge-shaped defect |
Defect of hard tissues of teeth enamel. Sometimes there may be pain from mechanical, chemical and physical irritants |
Defeat of a peculiar configuration (in the form wedge) is located, in contrast to caries, on the vestibular surface of the tooth, at the border of the crown and root. The surface of the defect is shiny, smooth, and cannot be stained with dyes. |
|
Enamel erosion, dentin |
Defect of hard dental tissues. Pain from mechanical, chemical and physical irritants |
Progressive defects of enamel and dentin on the vestibular surface of the crown of the teeth. Incisors are affected upper jaw, as well as canines and premolars of both jaws. Incisors lower jaw are not affected. Form slightly concave along the depth of the lesion |
|
Enamel hypoplasia (spotted form) |
The course is often asymptomatic. On the surface of the enamel, chalky spots of various sizes with a smooth shiny surface are clinically determined |
Primarily permanent teeth are affected. The spots are located in areas atypical for caries. kah (on the convex surfaces of the teeth, in the area of the tubercles). Characterized by strict symmetry and systematicity of tooth damage according to the timing of their neralization. The boundaries of the spots are clearer than with ka- riese. Stains are not stained with dyes |
Differential diagnosis of dentin caries (to 02.1) (medium caries)- should be differentiated from superficial and deep caries, chronic apical periodontitis, wedge-shaped defect.
Table - 10. Data on the differential diagnosis of moderate caries
| Disease | General clinical signs |
Features |
|
Enamel caries in stage spots |
Process localization. The course is usually asymptomatic. | Change in color of the enamel area. Absence of a cavity. Most often, lack of response to stimuli |
|
Enamel caries in stage spots with disturbance integrity of the surface bone layer, superficial caries |
Localization of the cavity. The course is often asymptomatic. Presence of a carious cavity. The walls and bottom of the cavity are most often pigmented. |
Mild pain from chemical irritants. The reaction to cold is negative. EDI - 2-6 µA The cavity is located within the enamel. When probing, pain in the area of the cavity bottom is more pronounced |
|
Initial pulpitis (pulp hyperemia) deep caries |
The presence of a carious cavity and its location. Pain from temperature, mechanical and chemical stimuli. |
Pain on probing The pain goes away after eliminating the irritants. Probing the bottom of the cavity is more painful. ZOD 8-12 µA |
| Wedge-shaped defect |
Defect of hard dental tissues in the neck of teeth |
Short-term pain from irritants, in some cases pain on probing. Characteristic location and shape of the defect |
|
Chronic period dontit |
Carious cavity A carious cavity, as a rule, reports - with the tooth cavity. |
Probing the cavity without painful. There is no reaction to stimuli. EDI over 100 µA. The x-ray shows changes characteristic of for one of the forms of chronic periodontitis. Cavity preparation is painless |
Differential diagnosis of initial pulpitis(pulp hyperemia) (k04.00) (deep caries)
- must be differentiated from average caries, from chronic forms pulpitis (chronic simple pulpitis), from acute partial pulpitis.
Table - 11. Data of differential diagnosis of deep caries
| Disease | General clinical signs | Features |
| Average caries |
A carious cavity filled with softened dentin. Pain from mechanical, chemical and physical irritants |
The cavity is deeper, with well-defined overhanging edges of the enamel. Pain from irritants goes away after they are eliminated. Electrical excitability can be reduced to 8-12 µA |
| Acute partial pulpitis |
A deep carious cavity that does not communicate with the tooth cavity. Spontaneous pain aggravated by all types of mechanical, chemical and physical stimuli. When probing the bottom of the cavity, the pain is evenly expressed along the entire bottom |
Characterized by pain that arises from all types of irritants, which continues for a long time after their elimination, as well as pain of a paroxysmal nature that occurs without visible reasons. There may be irradiation of pain. When probing the bottom of a carious cavity, there is usually pain in some area. EDI-25uA |
| Chronic simple pulpitis | A deep carious cavity communicating with the tooth cavity at one point. On probing there is pain at one point, the pulp horn is exposed and bleeds |
Characterized by pain arising from all types of irritants, which continues for a long time after their elimination, as well as pain aching character. When probing the bottom of the carious cavity, as a rule, there is pain in the exposed area of the pulp horn EDI 30-40uA |
Treatment abroad
Get treatment in Korea, Israel, Germany, USA
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Treatment
Treatment goals:
stopping the pathological process;
· restoration of dental aesthetics.
Treatment tactics:
When preparing carious cavities, it is recommended to be guided by the following principles:
· medical validity and feasibility;
· gentle treatment of unaffected tooth tissues;
painlessness of all procedures;
· visual control and ease of operation;
· maintaining the integrity of adjacent teeth and oral tissues;
· rationality and manufacturability of manipulations;
· creating conditions for aesthetic restoration of the tooth;
· ergonomics.
Treatment plan for a patient with dental caries:
The general principles of treating patients with dental caries include several stages:
1. Before preparing a carious cavity, it is necessary to eliminate as much as possible the cariogenic situation in the oral cavity, microbial plaque, factors causing the process of demineralization and tooth decay
2. Teaching the patient about oral hygiene, recommendations on the choice of hygiene items and products, professional hygiene, recommendations on diet correction.
3. Treatment of a tooth affected by caries is carried out.
4. For caries at the white spot stage, remineralizing therapy is carried out.
5. When caries has stopped, fluoridation of teeth is carried out.
6. If there is a carious cavity, the carious cavity is prepared and prepared for filling.
7. Restoring the anatomical shape and function of the tooth with filling materials.
8. Measures are taken to prevent complications after treatment.
9. Recommendations are given to the patient about the timing of re-application and the prevention of dental diseases.
10. The treatment is recorded in a card separately for each tooth, form 43-u. During treatment, materials and medications are used that are approved for use on the territory of the Republic of Kazakhstan
Treatment of a patient with enamel caries in the stage of a white (chalky) spot (initial caries) (k02.0)
Table - 12. Data on the treatment of caries at the spot stage
Treatment of a patient with enamel caries M (k02.0) (superficial caries)
Table - 13. Data on the treatment of superficial caries
Treatment of a patient with dentin caries (k02.1) (medium caries)
Table - 14. Data on the treatment of average caries
Treatment of a patient with initial pulpitis (pulp hyperemia) (k04.00) (deep caries)
Table - 15. Data on the treatment of deep caries
Non-drug treatment: Mode III. Table number 15.
Drug treatment:
Drug treatment provided on an outpatient basis:
Table - 16. Data on dosage forms and filling materials used in the treatment of caries
| Purpose | Name of the medicinal product or product/INN | Dosage, method of application | Single dose, frequency and duration of application |
|
Local anesthetics used for pain relief. Choose one of the proposed anesthetics. |
Articaine + epinephrine |
1:100000, 1:200000, 1.7 ml, injection pain relief |
1:100000, 1:200000 1.7 ml, once |
|
Articaine + epinephrine |
4% 1.7 ml, injection anesthesia | 1.7 ml, once | |
|
Lidocaine/ lidocainum |
2% solution, 5.0 ml injection pain relief |
1.7 ml, once | |
|
Therapeutic pads used in the treatment of deep caries. Choose one of the suggested ones |
Two-component dental lining material based on calcium hydroxide, chemically cured |
base paste 13g, catalyst 11g to the bottom of the carious cavity |
Once drop by drop 1:1 |
|
Dental lining material based on calcium hydroxide |
to the bottom of the carious cavity |
Once drop by drop 1:1 | |
| Light-curing radiopaque paste based on calcium hydroxide |
base paste 12g, catalyst 12g to the bottom of the carious cavity |
Once drop by drop 1:1 | |
|
Demeclocycline+ Triamcinolone |
Paste 5 g to the bottom of the carious cavity |
||
|
Chlorine-containing preparations. |
Sodium hypochlorite | 3% solution, treatment of carious cavity |
One time 2-10ml |
|
Chlorhexidine bigluconate/ Chlorhexidine |
0.05% solution 100 ml, treatment of carious cavity |
One time 2-10ml |
|
|
Hemostatic drugs Choose one of the suggested ones. |
Capramine Dental astringent for treatment of root canals, for capillary bleeding, liquid for topical use |
30 ml, for bleeding gums | Once 1-1.5 ml |
| Visco Stat Clear | 25% gel, for bleeding gums | One time required quantity | |
|
Materials intended for insulating gaskets 1.Glass ionomer cements Choose one of the proposed materials. |
Lightweight glass ionomer filling material | Powder A3 - 12.5g, liquid 8.5ml. Insulating gasket | |
| Kavitan plus |
Powder 15g, liquid 15ml Insulating pad |
Mix 1 drop of liquid with 1 scoop of powder once to a paste-like consistency. | |
| Ionosil |
paste 4g, paste 2.5g Insulating pad |
One time required quantity | |
| 2.Zinc phosphate cements | Adhesor |
Powder 80g, liquid 55g Insulating gasket |
One time Mix 2.30 g of powder per 0.5 ml of liquid |
|
Materials intended for permanent fillings. Permanent filling materials. Choose one of the proposed materials. |
Filtek Z 550 |
4.0g seal |
One time Average caries - 1.5g, Deep caries - 2.5g, |
| Charisma |
4.0g seal |
One time Average caries - 1.5g, Deep caries - 2.5g, |
|
| Filtek Z 250 |
4.0g seal |
One time Average caries - 1.5g, Deep caries - 2.5g, |
|
| Filtek Ultimate |
4.0g seal |
One time Average caries - 1.5g, Deep caries - 2.5g, |
|
| Charisma |
Base paste 12g catalyst 12g seal |
One time 1:1 |
|
| Evicrol |
Powder 40g, 10g, 10g, 10g, liquid 28g, seal |
Mix 1 drop of liquid with 1 scoop of powder once to a paste-like consistency. | |
|
Adhesive system. Select one of the proposed adhesive systems. |
Syngle Bond 2 |
liquid 6g into the carious cavity |
One time 1 drop |
| Prime&Bond NT |
liquid 4.5 ml into the carious cavity |
One time 1 drop |
|
| H gel |
gel 5g into the carious cavity |
One time Required amount |
|
| Temporary filling materials | Artificial dentin |
Powder 80g, liquid - distilled water into the carious cavity |
Mix 3-4 drops of liquid once with the required amount of powder to a paste-like consistency |
| Dentin paste MD-TEMP |
Paste 40g into the carious cavity |
One time required quantity | |
| Abrasive pastes | Depural neo |
Paste 75g for polishing fillings |
One time required quantity |
| Super polish |
Paste 45g for polishing fillings |
One time required quantity |
Other types of treatment:
Other types of treatment provided on an outpatient basis:
according to indications, physiotherapeutic treatment according to indications (supragingival electrophoresis)
Indicators of treatment effectiveness:
· satisfactory condition;
· recovery anatomical shape and functions of the tooth;
· prevention of complications;
· restoration of aesthetics of teeth and dentition.
Drugs (active ingredients) used in treatment
Hospitalization
Indications for hospitalization indicating the type of hospitalization: No
Prevention
Preventive actions:
Primary prevention:
Basis primary prevention of dental caries is the use of methods and means aimed at eliminating risk factors and causes of the disease. As a result preventive measures initial stages carious lesions may stabilize or undergo reverse development.
Primary prevention methods:
· dental education of the population
· personal hygiene oral cavity.
· endogenous use of fluorides.
· local application remineralizing agents.
· sealing of dental fissures.
Further management: are not carried out.
Information
Sources and literature
- Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015
- List of used literature: 1. Order of the Ministry of Health of the Republic of Kazakhstan No. 473 dated 10.10.2006. “On approval of the Instructions for the development and improvement clinical guidelines and protocols for the diagnosis and treatment of diseases.” 2. Therapeutic dentistry: A textbook for students medical universities/ Ed. E.V. Borovsky. - M.: “Medical information Agency", 2014. 3. Therapeutic dentistry. Dental diseases: textbook: in 3 hours / ed. E. A. Volkova, O. O. Yanushevich. - M.: GEOTAR-Media, 2013. - Part 1. - 168 p. : ill. 4. Diagnostics in therapeutic dentistry: Tutorial/ T.L. Redinova, N.R. Dmitrakova, A.S. Yapeev, etc. - Rostov n/D.: Phoenix, 2006. -144 p. 5. Clinical materials science in dentistry: textbook / T.L.Usevich. – Rostov n/d.: Phoenix, 2007. – 312 p. 6. Muravyannikova Zh.G. Dental diseases and their prevention. – Rostov n/d: Phoenix, 2007. -446 p. 7. Dental composite filling materials / E.N. Ivanova, I.A. Kuznetsov. – Rostov n/d.: Phoenix, 2006. -96 p. 8. Fejerskov O, Nyvad B, Kidd EA: Pathology of dental caries; in Fejerskov O, Kidd EAM (eds): Dental caries: The disease and its clinical management. Oxford, Blackwell Munksgaard, 2008, vol 2, pp 20-48. 9. Allen E Minimal interventiondentistry and older patients. Part1: Risk assessment and caries prevention./ Allen E, da Mata C, McKenna G, Burke F.//Dent Update.2014, Vol.41, No. 5, P. 406-408 10. Amaechi BT Evaluation of fluorescence imaging with reflectance enhancement technology for early caries detection./ Amaechi BT, Ramalingam K.//Am J Dent. 2014, Vol.27, No. 2, P.111-116. 11. Ari T The Performance of ICDASII using low-powered magnification with light-emitting diode headlight and alternating current impedance spectroscopy device for detection of occlusal caries on primary molars / Ari T, Ari N.// ISRN Dent. 2013, Vol.14 12. Be n n e t t T. Emergi ng technologies for diagnosis of dental caries: The road so far / Bennett T, Amaechi// Journal of applied physics 2009, P.105 13. Iain A. Pretty Caries detection and diagnosis: Novel technologies/ Journal of dentistry 2006, No. 34, P.727-739 14. Mackenzie L, The minimally invasive management of early occlusal caries: a practical guide/Mackenzie L, Banerjee A. // Prim Dent J. 2014, Vol. 3, No. 2, P.34-41. 15. Sinanoglu A. Diagnosis of occlusal caries using laser fluorescence versus conventional methods in permanent posterior teeth: a clinical study./ Sinanoglu A, Ozturk E, Ozel E.// Photomed Laser Surg. 2014, Vol. 32, No. 3, P.130-137.
Information
List of protocol developers with qualification information:
1. Esembaeva Saule Serikovna - Doctor of Medical Sciences, Professor, Director of the Institute of Dentistry of the Kazakh National Medical University named after Sanjar Dzhaparovich Asfendiyarov;
2. Abdikarimov Serikkali Zholdasbaevich - Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry of the Kazakh National Medical University named after Sanzhar Dzhaparovich Asfendiyarov;
3. Urazbayeva Bakitgul Mirzashovna - assistant at the Department of Therapeutic Dentistry of the Kazakh National Medical University named after Sanzhar Dzhaparovich Asfendiyarov;
4. Tuleutaeva Raikhan Yesenzhanovna - candidate of medical sciences, acting associate professor of the department of pharmacology and evidence-based medicine State Medical University of Semey.
Indication of no conflict of interest: No
Reviewers:
1. Margvelashvili V.V - Doctor of Medical Sciences, Professor of Tbilisi State University, Head of the Department of Dentistry and Maxillofacial Surgery;
2. Zhanarina Bakhyt Sekerbekovna - Doctor of Medical Sciences, Professor
RSE at the University of Western Kazakhstan State Medical University named after M. Ospanov, head of the department of surgical dentistry.
Indication of conditions for revision of protocols: review of the protocol after 3 years or when new diagnostic or treatment methods with a higher level of evidence become available.
Attached files
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The information posted on this site should not be used to unauthorizedly change doctor's orders. The editors of MedElement are not responsible for any personal injury or property damage resulting from the use of this site. In accordance with changes in the hard tissues of the tooth and clinical manifestations, several types have been created
classification of dental caries , they are based on various features. Caries is one of the most known diseases , affecting the hard tissues of the tooth. The process of development of the disease is accompanied by thinning of the enamel,
softening of dentin
and the formation of a carious cavity. Speaking about dental caries, it is impossible to limit ourselves to just one classification that would fully satisfy the requirements of specialists. Therefore, the existence of several classifications of the disease is quite justified.
1)
. Classification of caries according to Black
(The greatest recognition among dentists today is the Black classification of caries, which reflects the depth of the process, as well as the location of carious cavities.
). The cavities are located in the area of natural depressions and fissures. The defeat is superficial;
2)
. Second class
(weak caries
). The process develops on the contact surface of the lateral teeth;
3)
. Third class
(caries medium degree
). Carious lesions affect the contact surface of the canines and incisors;
4)
. Fourth grade
(severe form of caries
). Advanced stage of moderate caries. Carious lesions move onto the dentin at the incisal angle;
5)
. Fifth grade
(very severe caries
). The gingival margin of the lateral or front teeth suffers. Radical caries develops;
6)
. Sixth grade
(atypical caries
). Destruction of the cutting edge is observed.
Classification of the disease according to ICD-10 | WHO
Depending on the nature of the changes occurring in the hard tissues of the tooth, as well as clinical manifestations, several methods have been created classify dental caries .
ICD caries assumes the presence of different characteristics in the basis. By WHO classification caries stands out in a separate group.
ICD-10 suggests dividing caries into the following classes:
K02.0 Enamel caries chalk spot 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
Classification of caries according to ICD 10 is currently one of the most popular. Among its advantages we can include the fact that sub-categories appeared in it in the form of suspended caries or cement caries.
Classification of the carious process by the depth of the lesion | MMSI
Dentists consider this classification of caries to be the most convenient. Therefore, it has become widespread in the domestic space. Experts distinguish forms of the disease related to uncomplicated and complicated course of the disease: 1. Spot stage – the initial stage, when white stripes or dark spots appear on the enamel, but it itself is smooth to the touch and is not yet susceptible to destruction. Toothache at this stage of the stain does not bother the patient;
2. Superficial caries – the second stage of the carious process. Tooth enamel continues to decay, but caries does not yet extend beyond the enamel layer. Dentin is not damaged, however, toothache of a periodic nature may already manifest itself. The reaction of the tooth to cold and hot, sour or sweet is noticeable. A carious stain on the tooth surface is rough to the touch;
3. Moderate caries , when the carious lesion has passed the enamel layer and affected the upper layers of dentin. The pain intensifies and is constant;
4. Deep caries , in which only a thin layer of dentin is preserved. At this stage, the dental tissue is severely damaged. Lack of proper tooth treatment at this stage causes pulp damage and periodontitis.
Classification according to the presence of complications
This classification involves distinguishing two types of caries:
- complicated , accompanied by accompanying inflammatory processes. This form of the disease occurs when a doctor is not consulted in a timely manner or due to the lack of proper treatment;
- uncomplicated – a typically occurring process, which presupposes the presence of its individual stages (superficial, middle, etc.).
Types of caries by degree of activity:
1. Compensated caries , characterized by the absence of obvious progress in the carious process. The teeth are slightly affected, which does not cause discomfort to the patient;
2. Subcompensated , characterized by an average rate of development;
3. Decompensated , which is characterized by intense flow. At this stage it is diagnosed sharp pain in the tooth.
This classification is based on calculating the caries intensity index, which is defined as the sum of carious, filled and extracted teeth (CPU) in one child. If there are both milk teeth and permanent teeth in the oral cavity, then the amount is calculated for them separately (KPU + KP). Extracted baby teeth are not counted.
How quickly does the carious process develop?
IN in this case The classification is a composition of the following four categories :
- acute caries . Signs of dental damage appear within a matter of weeks;
- chronic caries , developing over a longer period of time. Affected tissues take on a yellowish or dark brown color, stained with plaque and food coloring;
- blooming caries , which entails multiple lesions of dental tissue. The carious process progresses over a short time;
- secondary caries , developing under a previously installed filling as a result of weakening of tooth enamel, neglect of the rules of oral hygiene, and decreased immunity of the body.
Classification of the disease according to the intensity of the process
This classification assumes the presence of:
single caries . In this case, only one tooth is affected;
multiple (systemic) caries . This form of the disease affects five or more teeth in children, six or more in adults.
Among patients with such a diagnosis, most often there are those who are ill with acute infectious diseases, cardiovascular diseases, respiratory system. Among children suffering multiple caries, those who have been ill are observed chronic tonsillitis, scarlet fever .
Classification by process localization
-
fissure caries
, in which the natural recesses of the surface of the teeth are affected; - interdental caries process , developing on the contact surface of the tooth. Long time the disease may not be diagnosed due to specific shape development of the disease: caries, in the process of damage to the tooth surface, develops towards the center of the tooth, and the cavity itself is covered with healthy enamel layers;
- cervical caries , which is localized between the root and crown of the tooth, in the area adjacent to the gum. The reason for the development of the process is poor hygiene oral cavity;
- ring caries , affecting the circumferential surface of the tooth. Outwardly it looks like a yellowish or brown belt on the neck;
- hidden carious process , developing in a difficult-to-see area - the dental crevice.
Classification according to the primacy of development
It is not difficult to guess that this classification divides caries into:
- primary which affects either a healthy tooth or an area that has not previously been treated;
- secondary , which is recurrent in nature, because it develops in previously healed areas.
Sometimes this type of carious process is called internal: the disease is often localized in the area under the filling or crown.
Clinical classification of dental caries
- 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.
- Chronic caries 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.
- There are also other forms of caries , for example, “acute”, “blooming 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 a dentist. - Stage of carious spot – focal demineralization of the hard tissues of the tooth is observed, and it can proceed intensively ( White spot) or slowly (brown spot).
- Superficial caries – at this stage a carious cavity appears within the enamel.
- Average caries – at this stage, the carious defect is located within the surface layer of dentin (mantle dentin).
- Deep caries – 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)
Recurrence of caries
– this 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.
quite a lot and they are all largely repeated. It is important for the doctor to correctly determine the main parameters: the depth of the lesion, the nature of the process, and to identify the main cause of the defects.
In some cases this will be poor oral hygiene, in others – bad habits, in others – crowded teeth or congenital disorders in the structure of enamel and dentin. A correct diagnosis largely determines the success of further treatment. .
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