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.
MCB caries assumes the presence of different signs at the base. According to the WHO classification, caries is separated into a separate group.
Classification of caries according to ICD 10
Such a phenomenon as caries ICD 10 is supposed to be divided into the following items:
- K02.0 This is enamel caries, that is, the initial caries, which can be called the stage of chalk stain.
- K021 - caries affecting dentin;
- K02.2 - the so-called caries of cement;
- K02.3 - caries, which has stopped at the moment;
- K.02.3. These include odontoclasia, melanodontoclasia, and meladontia in children;
- K02.8. Other types of dental caries;
- K02.9. Unsubtle caries.
The classification of caries according to microbial density 10 is currently one of the most popular. To its merits, we can attribute the fact that subheadings appeared in it in the form of suspended caries or cement caries.
Topographic classification
This classification of caries, like MCB10, is quite common in our country. For the practical component of the dentist's work, it is extremely convenient, since it takes into account the depth of the tooth damage.
- Carious spot stage... 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 the carious cavity is manifested within the boundaries of the human enamel.
- Medium caries... Tutu is talking about a carious defect that 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 already deep layers of dentin, known as peri-pulpal dentin.
In addition, clinical practice involves the use of the concepts of secondary caries and caries recurrence. Let's see what it is:
- Under secondary caries it is customary to understand all recently formed carious lesions that appear near the filling in a tooth that has been treated earlier. This problem also differs in all the histological features of carious lesions. It manifests itself due to violations of the marginal fit between the hard tissues of the teeth and fillings. A gap appears, into which microorganisms penetrate from the oral cavity, as a result of 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 the resumption of the pathological process when the carious lesion was not completely eliminated during the previous treatment. Most often, this problem is found along the edges of the filling, during the X-ray examination of the patient.
Clinical classification
- Acute caries... It is characterized by the rapid development of changes in the tissues of the tooth, operational transitions of uncomplicated caries to complicated. In this case, after damage, the tissues become soft, weak pigments are expressed.
- Chronic caries... This is a slow process that does not go away for several years and spreads mainly in the plane direction. The tissues that are affected become hard and pigmented and take on brown tones.
- Other forms are also distinguished, such as blooming or sharpest.
Black classification
- Class. Cavities that are located in natural depressions and fissures;
- Class. Cavities on the contact surfaces of molars, both large and small;
- Class. Cavities in the contact areas of the canines, incisors, suggesting the preservation of the incisal edge;
- Class. These are cavities that are also located on the canines and incisors, but the corners and incisal edges are violated;
- Class. We are talking about cavities on the lips, cheeks and tongue in the gingival parts.
Although Black did not describe Grade 6, it is still commonly used today. It refers to the cavities that are located on the tubercles of the permanent teeth, cutting edges of sharp teeth.
RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015
Dental caries (K02)
Dentistry
general information
Short description
Recommended
Expert Council
RSE on REM "Republican Center
health 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 manifests itself after eruption of teeth, in 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: Tooth decay
Protocol code:
ICD-10 code (s):
K02.0 Caries of enamel. White (chalky) spot stage [initial caries]
K02.I Dentin caries
K02.2 Caries of cement
K02.3 Suspended dental caries
K02.8 Other dental caries
K02.9 Dental caries, unspecified
Abbreviations used in the protocol:
MBK - international classification of the disease
Date of development / revision of the protocol: 2015 year
Protocol users: dentist therapist, dentist, general dentist.
Evaluation of the degree of evidence of the recommendations
Table - 1. Scale of the level of evidence
| A | High quality meta-analysis, systematic review of RCTs, or large RCTs with very low probability (++) bias, the results of which can be generalized to the relevant population. |
| V | 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 the relevant population. |
| WITH |
Cohort or case-control study or controlled study 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 +), the results of which cannot be directly extended to the relevant population. |
| D | Case series description or uncontrolled research or expert opinion. |
| GPP | Best Pharmaceutical Practice. |
Classification
Clinical classification:. .
Topographic classification of caries:
· Stage of the spot;
Superficial caries;
· Medium caries;
· Deep caries.
According to the clinical course:
· Fast-flowing;
· Slow-flowing;
· Stable.
Clinical picture
Symptoms, course
Diagnostic criteria for making a 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. |
The general condition is not violated ;
Poor oral hygiene ; Alimentary deficiency of minerals; |
|
Superficial caries: |
short-term pain from chemical and temperature irritants; may be asymptomatic. |
The general condition is not violated ;
Somatic diseases of the body (pathology of the endocrine systems and the gastrointestinal tract); Poor oral hygiene ; Alimentary deficiency of minerals |
|
Medium caries |
short-term pain from temperature, mechanical, chemical irritants; pain from irritants is short-term, after removal of the irritant it quickly passes; sometimes pain may be absent; Aesthetic defect. |
The general condition is not violated ;
Somatic diseases of the body (pathology of the endocrine systems and the gastrointestinal tract); Poor oral hygiene |
|
Rapidly progressive deep caries |
short-term pain from temperature, mechanical, chemical irritants; with the elimination of the stimulus, the pain does not immediately disappear; violation of the integrity of the hard tissues of the tooth; |
The general condition is not violated ;
Somatic diseases of the body (pathology of the endocrine systems and the gastrointestinal tract); Poor oral hygiene ; |
|
Slowly progressive deep caries |
There are no complaints; Violation of the integrity of the hard tissues of the tooth; Tooth discoloration; Aesthetic defect. |
The general condition is not violated ;
Somatic diseases of the body (pathology of the endocrine systems and the gastrointestinal tract); Poor oral hygiene; |
Physical examination:
Table - 3. Data of physical examination of caries in the stain stage
| Caries in the spot stage | ||
| Survey data | Symptoms | Pathogenetic rationale |
| Complaints |
Most often, the patient does not present complaints, may complain about the presence of loose or pigmented spots (aesthetic defect) |
Carious spots are formed as a result of partial demineralization of the enamel in the lesion |
| Inspection |
On examination, they find chalky or pigmented spots that have clear, uneven outlines. The spots can be several millimeters in size. The surface of the spot, in contrast to intact enamel, is dull, devoid of shine |
|
|
Localization of carious spots |
Typical for caries: fissures and others natural grooves, approximal surfaces, cervical region. As a rule, the spots are single, there is some symmetry of the lesion |
The localization of carious spots is due to the fact that in these areas of the tooth even with good hygiene in the oral cavity, there are conditions for the accumulation and preservation of dental plaque |
| Sounding |
When probing, the enamel surface in the area of the spot is quite dense, painless |
The surface layer of enamel remains relatively intact as a result of 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 a demineralized sub- the surface zone of the lesion, water evaporates through the enlarged microspaces of the visible intact surface layer of the enamel, and at the same time its optical density changes |
|
Vital staining of tooth tissues |
When stained with 2% methylene blue solution, carious spots acquire a blue color of varying intensity. The surrounding spot is intact enamel is not stained |
The possibility of dye penetration into the lesion is associated with partial demineralization the subsurface layer of enamel, which is accompanied by an increase in microspaces in the crystal structure of enamel prisms |
|
Thermal diagnostics |
The enamel-dentinal border and dentinal tubules with odontoblast processes are inaccessible to the stimulus |
|
| EDI | EDI values within 2-6 μA | The pulp is not involved in the process |
| Transillumination |
In an intact tooth, light evenly passes through the hard tissues, without giving a shadow. |
The zone of carious lesions looks like dark spots with clear boundaries When the light beam passes through the area destruction, the effect of quenching the luminescence of tissues is observed as a result of changes in their optical density |
Table - 4. Data of 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 (more often from sweet, less often from sour and salty), and so- the same for a defect in hard tissues of the tooth |
Demineralization of enamel in the lesion focus leads to an increase in its permeability. As a result tate of this, chemicals can from the focus of pressure to enter the enamel-dentin area unity and change the balance of the ionic composition of this area. Pain occurs as a result of changes in the hydrodynamic state in the cytoplasm odontoblasts and dentinal tubules |
| Inspection |
A shallow carious cavity is determined within the enamel. The bottom and walls of the cavity more often pigmented, along the edges there may be chalky or pigmented areas 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 acids on enamel |
| Localization |
Typical for caries: fissures, contact surfaces, cervical area |
Places of the greatest accumulation of dental plaque and poor accessibility of these areas for hygienic manipulations |
| Sounding |
Sounding and excavation of the bottom of the carious soil The pain may be severe, but quickly disappearing. The surface of the defect during sounding is rough |
With a close location of the bottom of the cavity to the enamel-dentinal junction with a probe processes of odontoblasts can be irritated |
|
Thermal diagnostics |
short-term pain |
As a result of a high degree of demineralization enamel penetration of a cooling agent can cause a reaction of the processes of odontoblasts |
| EDI |
2-6 μA |
|
Table - 5. Data from physical examination of secondary caries
| Medium caries | ||
| Survey data | Symptoms | Pathogenetic rationale |
| Complaints |
Patients often do not complain or complain of a defect in hard tissue; with dentin caries - for short-term pain from temperature and chemical ny irritants |
The most sensitive area has been destroyed - enamel-dentinal border, dentinal tubules covered with a layer of softened dentin, and the pulp is isolated from the carious cavity with a layer of dense dentin. The formation of replacement dentin plays a role |
| Inspection |
A cavity of average depth is determined, captures the entire thickness of the enamel, enamel- dentinal border and partly dentin |
While maintaining the cariogenic situation, the continuing demineralization of the hard tissues of the tooth leads to the formation of a cavity. The cavity in depth affects the entire thickness of the enamel, enamel- the dentinal border and partly dentin |
| Localization |
The lesions are typical for caries: - fissures and other natural grooves, contact surfaces, cervical area |
Good conditions for accumulation, retention and the functioning of plaque |
| Sounding |
Probing the bottom of the cavity is painless or painless, painful probing in the area of the enamel-dentin junction. A layer of softened dentin is determined. Posts no tooth cavity |
No soreness in the area of the floor of the sti is probably due to the fact that demineralization dentin is accompanied by the destruction of processes odontoblasts |
| Percussion | Painless |
The process does not involve the pulp and periodontal tissues |
| Thermal diagnostics |
pain at temperature nye irritants |
|
| EDI | Within 2-6 μA |
No inflammatory re- pulp stock |
| X-ray diagnostics |
The presence of a defect in enamel and part of dentin in areas of the tooth accessible for X-ray diagnostics |
Areas of demineralization of hard tissues of teeth to a lesser extent delay X-ray rays |
|
Cavity preparation |
Soreness in the area of 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 disappears after eliminate the irritant Pain from temperature and, to a lesser extent, from mechanical and chemical irritants quickly disappears after eliminate 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, is very receptive to the effects of any stimuli The pronounced painful reaction of the pulp is associated with the fact that the layer of dentin that separates the pulp of the tooth from the carious cavity is very thin, partially demineralized and as a result susceptible to the effects of any stimuli |
| Inspection | Deep carious cavity filled with softened dentin |
Deepening of the cavity occurs as a result of continued demineralization and simultaneous disintegration of the organic component of dentin |
| Localization |
Typical for caries |
|
| Sounding |
The softened dentin is determined. The carious cavity does not communicate with the tooth cavity. The bottom of the cavity is relatively hard, probing it painfully |
|
| Thermal diagnostics |
after their elimination |
|
| EDI |
up to 10-12 μA |
|
Diagnostics
List of diagnostic measures:
Basic (mandatory) and additional diagnostic examinations carried out at the outpatient level:
1. Collection of complaints and anamnesis
2. General physical examination (External examination of the face (skin, facial symmetry, skin color, condition of lymph nodes, color, shape of teeth, size of teeth, integrity of hard tissues of teeth, tooth mobility, percussion
3. Sounding
4. Vital staining
5. Transillumination
6. Intraoral tooth X-ray
7. Thermal diagnostics
The minimum list of examinations that must be carried out when referring to planned hospitalization: no
Basic (mandatory diagnostic examinations carried out at the inpatient level (during emergency hospitalization, diagnostic examinations are carried out that are not carried out at the outpatient level): no
Diagnostic measures carried out at the stage of an ambulance emergency: No
Laboratory research: not held
Instrumental research:
Table - 7. Data of instrumental studies
| Rreaction to temperature irritants | Electroodontometry | X-ray methods investigated and I | |
| Caries in the spot stage | No painful reaction to temperature stimuli | Within 2-6 μA | The x-ray shows foci of demineralization within the enamel or no changes |
| Superficial caries |
There is usually no reaction to heat. When exposed to cold, it can feel short-term pain |
The reaction to electric current corresponds to reactions of intact dental tissues and is 2-6 μA |
The X-ray shows a surface defect in the enamel |
| Medium caries |
Sometimes there may be short-term pain at temperature nye irritants |
Within 2-6 μA | On the roentgenogram, there is a slight defect in the tooth crown, separated from the tooth cavity by a layer of dentin of various thicknesses, there is no communication from the tooth cavity. |
| Deep caries |
Sufficiently severe pain from temperatures stimuli, quickly passing after their elimination |
The electrical excitability of the pulp is within normal limits, sometimes it can be reduced up to 10-12 μA |
On the roentgenogram, there is a significant defect in the tooth crown, separated from the tooth cavity by a layer of dentin of various thicknesses, there is no communication from the tooth cavity. There are no pathological changes in the area of the root tops in the periodontium. |
Indications for consultation of narrow 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 of differential diagnosis of caries in the stain stage
| Disease | General clinical signs |
Features |
|
Enamel hypoplasia (spotted form) |
The course is often asymptomatic. Clinically on the enamel surface chalky spots are determined of 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 tubercles). Characterized by strict symmetry and systemic lesions of the teeth 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 (dashed and spotted forms) |
The presence of chalky spots on the enamel surface with a smooth shiny surface Permanent teeth are affected. |
Spots arise in places atypical for caries. Multiple spots, located symmetrically on any part of the tooth crown, not stained with dyes |
Differential diagnosis of enamel caries in the presence of a defectwithin it (k02.0) (superficial caries)
It is necessary to differentiate from secondary caries, wedge-shaped defect, tooth erosion and some forms of fluorosis (chalky-speckled and erosive).
Table - 9. Data of differential diagnosis of superficial caries
| Disease | General clinical signs |
Features |
|
Fluorosis (chalky speckled and erosive form) |
A defect is detected on the surface of the tooth within the enamel |
Localization of defects is not typical for caries. Areas of destruction of enamel are randomly located |
| Wedge-shaped defect |
Defect in hard tissues of teeth enamel. Sometimes there may be pain from mechanical, chemical and physical stimuli |
The 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, not stained with dyes |
|
Erosion of enamel, dentin |
Defect in hard tissues of teeth. Pain from mechanical, chemical and physical irritants |
Progressive defects of enamel and dentin on the vestibular surface of the coronal part of the teeth. The incisors of the upper jaw, as well as the canines and premolars of both jaws, are affected. The incisors of the lower jaw are not affected. The form slightly concave along the depth of the lesion |
|
Enamel hypoplasia (spotted form) |
The course is often asymptomatic. On the enamel surface, chalky spots of various sizes with a smooth shiny surface are clinically determined |
Mainly permanent teeth are affected. The spots are located in areas atypical for caries. kah (on the convex surfaces of the teeth, in the region of the tubercles). Characterized by strict symmetry and systemic lesions of the teeth, according to the timing of their minimum 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) (secondary caries)- should be differentiated from superficial and deep caries, chronic apical periodontitis, wedge-shaped defect.
Table - 10. Data of differential diagnosis of secondary caries
| Disease | General clinical signs |
Features |
|
Enamel caries in the stage stains |
Localization of the process. The course is usually asymptomatic. | Discoloration of the enamel area. Lack of cavity. Most often, lack of response to stimuli |
|
Enamel caries in the stage irregular spots integrity of the surface nasal layer, superficial caries |
Localization of the cavity. The course is often asymptomatic. The 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 is more pronounced in the area of the bottom of the cavity. |
|
Initial pulpitis (pulp hyperemia) deep caries |
The presence of a carious cavity and its localization. Pain from thermal, mechanical and chemical irritants. |
Soreness on probing The pain disappears after the irritation is eliminated. The probing of the cavity bottom is more painful. ZOD 8-12 μA |
| Wedge-shaped defect |
Defect of hard tooth tissues in the area of the tooth neck |
Short-term soreness from stimuli, in some cases soreness during probing. Characteristic localization and shape of the defect |
|
Chronic period dontitis |
Carious cavity Carious cavity, as a rule, reports smiling with the cavity of the tooth. |
Cavity probing without painful. There is no reaction to stimuli. EDI over 100 μA. On the roentgenogram, changes are determined that are characteristic for one of the forms of chronic periodontitis. Painless cavity preparation |
Differential diagnosis of initial pulpitis(pulp hyperemia) (k04.00) (deep caries)
- it is necessary to differentiate from secondary caries, from chronic forms of pulpitis (chronic simple pulpitis), from acute partial pulpitis.
Table - 11. Data of differential diagnosis of deep caries
| Disease | General clinical signs | Features |
| Medium caries |
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. The pains from irritants disappear after they are eliminated. Electroexcitability can be reduced to 8-12 μA |
| Acute partial pulpitis |
A deep carious cavity that does not communicate with the tooth cavity. Spontaneous pains aggravated by all types of mechanical, chemical and physical stimuli. When probing the bottom of the cavity, the soreness is evenly expressed throughout the bottom |
Characterized by pain arising from all types of stimuli, continuing for a long time after their elimination, as well as paroxysmal pain that occurs for no apparent reason. Irradiation of pain may be observed. When probing the bottom of the carious cavity, as a rule, soreness in some area. EOD-25mkA |
| Chronic simple pulpitis | Deep carious cavity communicating with the tooth cavity at one point. On probing, soreness at one point, open pulp horn and bleeding |
Characterized by pain arising from all types of irritants, lasting a long time after their elimination, as well as aching pains. When probing the bottom of the carious cavity, as a rule, soreness in the opened section of the horn of the pulp EOD 30-40mkA |
Treatment abroad
Undergo treatment in Korea, Israel, Germany, USA
Get advice on medical tourism
Treatment
Treatment goals:
· Stopping the pathological process;
· Restoration of the aesthetics of the dentition.
Treatment tactics:
When preparing carious cavities, it is recommended to be guided by the following principles:
· Medical validity and appropriateness;
· Sparing attitude to unaffected tooth tissues;
· Painlessness of all procedures;
· Visual control and convenience of work;
· Preservation of the integrity of adjacent teeth and tissues of the oral cavity;
Rationality and manufacturability of manipulations;
· Creating conditions for aesthetic tooth restoration;
· Ergonomics.
Treatment plan for a patient with dental caries:
The general principles of treating patients with dental caries include several stages:
1. Before the preparation of a carious cavity, it is necessary to eliminate as much as possible the cariogenic situation in the oral cavity, microbial plaque, factors that cause the process of demineralization and tooth decay
2. Teaching the patient oral hygiene, recommendations on the choice of hygiene items and means, professional hygiene, recommendations on diet correction.
3. Treatment of a tooth affected by caries is carried out.
4. In case of caries of the white spot stage, remineralizing therapy is performed.
5. In case of stopped caries fluoridation of the teeth is carried out.
6. In the presence of a carious cavity, preparation of the carious cavity and preparation for filling are carried out.
7. Restores the anatomical shape and function of the tooth with filling materials.
8. Measures are being taken to prevent complications after treatment.
9. Recommendations are given to the patient about the timing of re-treatment and the prevention of dental diseases.
10. A record of treatment is made in the card separately for each tooth, form 43. During the treatment, materials and medicines are used that have permission for use in 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 in the stain 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) (moderate caries)
Table - 14. Data on the treatment of secondary 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:
Outpatient drug treatment:
Table - 16. Data on dosage forms and filling materials used in the treatment of caries
| Appointment | Name of the drug or agent / INN | Dosage, method of administration | Single dose, frequency and duration of use |
|
Local anesthetics used for pain relief. Choose one of the offered anesthetics. |
Аrticaine + epinephrine |
1:100000, 1:200000, 1.7 ml, injection pain relief |
1:100000, 1:200000 1.7 ml, single dose |
|
Articaine + epinephrine |
4% 1.7 ml, injection pain relief | 1.7 ml, single dose | |
|
Lidocaine / lidocainum |
2% solution, 5.0 ml injection pain relief |
1.7 ml, single dose | |
|
Medical pads used in the treatment of deep caries. Choose one of the proposed |
Two-component dental cushioning material based on calcium hydroxide, chemical curing |
base paste 13g, catalyst 11g to the bottom of the carious cavity |
Once dropwise 1: 1 |
|
Dental pad material based on calcium hydroxide |
to the bottom of the carious cavity |
Once dropwise 1: 1 | |
| Radiopaque calcium hydroxide light-curing paste |
base paste 12g, catalyst 12g to the bottom of the carious cavity |
Once dropwise 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 |
Once 2-10ml |
|
Chlorhexidine Bigluconate / Chlorhexidine |
0.05% solution 100 ml, carious cavity treatment |
Once 2-10ml |
|
|
Hemostatic drugs Choose one of the suggested ones. |
Capramine Dental astringent for root canal treatment, 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 amount | |
|
Materials for insulating gaskets 1.Glass ionomer cements Choose one of the proposed materials. |
Glass ionomer filling material, light mixing | Powder A3 - 12.5g, liquid 8.5ml. Insulating gasket | |
| Cavitan plus |
Powder 15g, liquid 15ml Insulating pad |
Mix 1 drop of liquid once with 1 scoop of powder to a paste-like consistency | |
| Ionosil |
pasta 4g, paste 2.5g Insulating pad |
One-time required amount | |
| 2.Zinc Phosphate Cements | Adhesor |
Powder 80g, liquid 55g Insulating gasket |
Once 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 |
Once Medium caries - 1.5g, Deep caries - 2.5g, |
| Charisma |
4,0g seal |
Once Medium caries - 1.5g, Deep caries - 2.5g, |
|
| Filtek Z 250 |
4,0g seal |
Once Medium caries - 1.5g, Deep caries - 2.5g, |
|
| Filtek ultimat |
4,0g seal |
Once Medium caries - 1.5g, Deep caries - 2.5g, |
|
| Charisma |
Base paste 12g catalyst 12g seal |
Once 1:1 |
|
| Evicrol |
Powder 40g, 10g, 10g, 10g, liquid 28g, seal |
Mix 1 drop of liquid once with 1 scoop of powder to a paste-like consistency | |
|
Adhesive system. Choose one of the suggested adhesive systems. |
Syngle bond 2 |
liquid 6g into the carious cavity |
Once 1 drop |
| Prime & Bond NT |
liquid 4.5 ml into the carious cavity |
Once 1 drop |
|
| Hi gel |
gel 5g into the carious cavity |
Once 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 until a paste-like consistency |
| Dentin paste MD-TEMP |
Pasta 40g into the carious cavity |
One-time required amount | |
| Abrasive Pastes | Depural neo |
Pasta 75g for polishing fillings |
One-time required amount |
| Super polish |
Pasta 45g for polishing fillings |
One-time required amount |
Other treatments:
Other outpatient treatments:
according to indications physiotherapeutic treatment according to indications (supragingival electrophoresis)
Treatment effectiveness indicators:
· satisfactory condition;
· Restoration of the anatomical shape and function of the tooth;
· Prevention of complications development;
· Restoration of the aesthetics of teeth and dentition.
Preparations (active ingredients) used in the treatment
Hospitalization
Indications for hospitalization with an indication of the type of hospitalization: No
Prophylaxis
Preventive actions:
Primary prevention:
The 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 of preventive measures, the initial stages of carious lesions can stabilize or undergo reverse development.
Primary prevention methods:
Dental education of the population
· Individual oral hygiene.
· Endogenous use of fluorides.
· Local application of remineralizing agents.
· Sealing of teeth fissures.
Further reference: are not carried out.
Information
Sources and Literature
- Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 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 of clinical guidelines and protocols for the diagnosis and treatment of diseases." 2. Therapeutic dentistry: A textbook for medical students / Ed. E.V. Borovsky. - M .: "Medical Information Agency", 2014. 3. Therapeutic dentistry. Diseases of the teeth: textbook: 3 hours / ed. E. A. Volkova, O. O. Yanushevich. - M.: GEOTAR-Media, 2013. - Part 1. - 168 p. : ill. 4. Diagnostics in therapeutic dentistry: Textbook / T.L. Redinova, N.R.Dmitrakova, A.S. Yapeev and others - Rostov n / D .: Phoenix, 2006. -144p. 5. Clinical materials science in dentistry: textbook / T.L. Usevich. - Rostov n / a .: Phoenix, 2007 .-- 312s. 6. Muravyannikova Zh.G. Dental diseases and their prevention. - Rostov n / a: Phoenix, 2007.-446s. 7. Dental composite filling materials / EN Ivanova, IA Kuznetsov. - Rostov n / a .: Phoenix, 2006. -96s. 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 nnett T. Eme rgi 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 data:
1. Yesembaeva Saule Serikovna - Doctor of Medical Sciences, Professor, Director of the Institute of Dentistry of the Kazakh National Medical University named after Sanzhar 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 of the Department of Therapeutic Dentistry of the Kazakh National Medical University named after Sanzhar Dzhaparovich Asfendiyarov;
4. Tuleutaeva Raikhan Esenzhanovna - Candidate of Medical Sciences, Acting Associate Professor of the Department of Pharmacology and Evidence-Based Medicine of the State Medical University in Semey.
Declaration of lack of conflict of interest: No
Reviewers:
1. Margvelashvili VV - 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
Republican State Enterprise on the Right of Chemical Industry of the Western Kazakhstan State Medical University named after M. Ospanov, head of the Department of Surgical Dentistry.
Indication of conditions for revision of protocols: revision of the protocol after 3 years or when new diagnostic methods or treatment with a higher level of evidence appear.
Attached files
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In accordance with changes in the hard tissues of the tooth and clinical manifestations created several types dental caries classification , they are based on various features.
Caries is one of the most well-known diseases affecting the hard tissues of the tooth. The 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, which would fully satisfy the requirements of specialists. Therefore, the existence of several classifications of the disease is quite justified.
Black caries classification
The greatest recognition among dentists today has received the Black classification of caries, which reflects the depth of the process, as well as the location of carious cavities.
1)
. First grade
(superficial caries
). The cavities are located in the area of natural depressions and fissures. Superficial lesion;
2)
. Second class
(weak caries
). The process develops on the contact surface of the lateral teeth;
3)
. Third class
(moderate caries
). Carious lesions affect the contact surface of the canines and incisors;
4)
. Fourth grade
(severe caries
). An advanced stage of moderate caries. Carious lesions move to dentin at the incisal angle;
5)
. Fifth grade
(very severe caries
). The gingival margin of the lateral or anterior teeth suffers. Basal caries develops;
6)
. Sixth grade
(atypical caries
). The destruction of the incisal 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 .
Mkb caries assumes the presence of different signs in the base. By WHO classification caries stands out in a separate group.
ICD-10 proposes to divide caries into the following classes:
K02.0 Enamel caries chalk stain stage (initial caries)
K02.1 Dentin caries
K02.2 Caries of cement
K02.3 Suspended dental caries
K.02.3 Odontoclasia
Children's melasma
Melanodontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified
Classification of caries according to mkb 10 at the moment it is one of the most popular. To its merits, we can attribute the fact that subheadings 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 identify forms of the disease related to the 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, is not yet subject to destruction. Toothache at this stage of the patient's spots does not bother;
2. Superficial caries - the second stage of the carious process. Tooth enamel continues to deteriorate, but caries does not yet go beyond the enamel layer. The dentin is not damaged, however, a toothache of a periodic nature may already manifest itself. The reaction of the tooth to cold and hot, to sour or sweet is noticeable. Carious spot on the tooth surface 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, is constant;
4. Deep caries , in which only a thin layer of dentin can be preserved. At this stage, the dental tissue is severely damaged. Lack of proper dental treatment at this stage becomes the cause of pulp damage and periodontitis.
Classification by the presence of complications
This classification involves the allocation of two types of caries:
- complicated accompanied by concomitant inflammatory processes. This form of the disease occurs with an untimely visit to a doctor or lack of proper treatment;
- uncomplicated - a typically proceeding process, which presupposes the presence of its individual stages (superficial, medium, 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 in the patient;
2. Subcompensated characterized by an average rate of development;
3. Decompensated , which is characterized by an intense current. At this stage, acute pain in the tooth is diagnosed.
This classification is based on calculating the caries intensity index, which is defined as the sum of carious, filled and extracted teeth (KPU) 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 milk teeth are not counted.
How quickly the carious process develops
In this case, the classification is a composition of the following four categories :
- acute caries ... Signs of tooth damage appear within a matter of weeks;
- chronic caries developing over a longer time. Affected tissues take on a yellowish or dark brown color, staining with plaque and food dyes;
- blooming caries , which entails multiple lesions of the dental tissue. The carious process progresses within a short time;
- secondary caries developing under a previously installed filling as a result of weakening of the tooth enamel, neglect of the rules of oral hygiene, and a decrease in the body's immunity.
Classification of the disease by the intensity of the process
This classification assumes the presence of:
single caries ... In this case, only one tooth is affected;
multiple (systemic) caries ... In this form of the disease, five or more teeth in children are affected, six or more in adults.
Among the patients with such a diagnosis, most often there are those who are sick with acute infectious diseases, diseases of the cardiovascular, respiratory system. Among children suffering from multiple caries, there are those who have recovered chronic tonsillitis, scarlet fever .
Process localization classification
-
fissure caries
, in which the natural grooves of the surface of the teeth are affected; - interdental carious process developing on the contact surface of the tooth. For a long time, the disease may not be diagnosed due to the specific form of the development of the disease: caries, in the process of affecting 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 gums. The reason for the development of the process is insufficient oral hygiene;
- annular caries that affects the circumferential surface of the tooth. Outwardly, it looks like a yellowish or brown belt on the neck;
- hidden carious process developing in a hard-to-see area - the tooth gap.
Development priority classification
It is easy to guess that such a classification divides caries into:
- primary that affects either a healthy tooth or an area that has not been previously treated;
- secondary , which is of a recurrent nature, since it develops in previously healed places.
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. The affected tissues are soft, slightly pigmented (light yellow, grayish-white), moist, easily removed with an excavator.
- Chronic caries characterized as a slow-moving process (several years). The spread of the carious process (cavity) 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, "sharpest", "flowering caries".
In our country, this classification is most widespread. It takes into account the depth of the lesion ,
which is very convenient for the practice of the dentist. - Carious spot stage - there is focal demineralization of the hard tissues of the tooth, and it can proceed intensively (white spot) or slowly (brown spot).
- Superficial caries - at this stage, a carious cavity appears within the enamel.
- Medium 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 (peri-pulpal dentin).
In clinical practice, the terms "secondary caries" and "recurrence of caries" are also used, let us consider in more detail what it is:
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 carious lesions. The cause of its occurrence is the violation of the marginal adherence between the filling and the hard tissues of the tooth, microorganisms from the oral cavity penetrate into the formed gap and optimal conditions are created for the formation of a carious defect along the edge of the filling in enamel or dentin.
2)
Recurrence of caries
- This is the resumption or progression of the pathological process in the event that the carious lesion was not completely removed during the previous treatment. Recurrence of caries is more often found under the filling during X-ray examination or along the edge of the filling.
quite a few, and they are all largely repeated. It is important for a doctor to correctly determine the main parameters: the depth of the lesion, the nature of the course of the process, and to identify the main cause of the appearance of defects.
In some cases it will be unsatisfactory oral hygiene, in others - bad habits, in the third - crowded teeth or congenital abnormalities in the structure of enamel and dentin. A correctly diagnosed diagnosis largely determines the success of further treatment. .
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