Cervical caries
Synonyms
Tooth rot, tooth decay, tooth decay
introduction
From a medical point of view, caries is a carbohydrate-modified infectious disease that is primarily triggered by bacterial pathogens. Caries can basically occur on any section of the tooth.
Experience has shown that carious defects develop on molars, but mainly in the area of the chewing surfaces. The necks of the teeth in particular are at risk on the front teeth.
A carious defect is caused by irregular or poorly performed oral hygiene. Food residues, which mainly accumulate in the interdental spaces and on the tooth surface, form an ideal breeding ground for bacterial pathogens.
Would you like to find out more about the development of tooth decay and its treatment? Read on below. How does tooth decay develop?
Due to the release of special metabolic end products, the tooth substance is damaged in the long term and caries is provoked. Carious defects in the area of the tooth neck (dental neck caries) are particularly dangerous, as the medullary cavity can open early with damage to the nerve fibers.
The consequences are toothache and, in the worst case, loss of the affected tooth.
Find out more at: How do you recognize tooth decay?
Figure tooth decay
Tooth decay
chemical parasitic process
- Tooth enamel -
Enamelum - Dentin (= dentine) -
Dentinum - Tooth pulp in the tooth cavity -
Pulp dentis in Cavitas dentis - Gums -
Gingiva - Cement -
Cementum - Alveolar bone
(tooth-bearing part
the jawbone) -
Pars alveolaris
(Alveolar process) - Nerve fibers and blood vessels
Stage of the disease:
Descaling process (A + B + C)
Minerals dissolve from the
Tooth enamel -
(no toothache)
Progressive tooth decay (D)
Caries reaches the dentin -
(occasional throbbing pain)
Very deep caries defects (E + F)
that reach the pulp -
(severe, stabbing toothache)
the increasing destruction
of nerve fibers can become a
Cause blood poisoning
You can find an overview of all Dr-Gumpert images at: medical illustrations
Symptoms
The symptoms of dental caries can be varied. This fact is due to the fact that the clinical appearance of dental neck caries depends on its stage. In the beginning, affected patients usually show no symptoms.
You do not feel any pain and cold or warm dishes do not irritate the tooth substance. Neck caries in the early stages usually only shows itself as a slightly whitish discoloration along the tooth neck. At this stage, the treatment of the carious defect is usually simple and gentle on the tooth substance.
As the neck caries progresses, the defects in the tooth substance become clearly visible. In addition, as the neck caries progresses, excessive reactions to cold or hot drinks and food can be determined. Consuming foods containing sugar can also be perceived as unpleasant by affected patients. In the presence of dental cervical caries, pain usually only occurs as soon as the medullary cavity has been opened and the nerve fibers it contains have been attacked.
At the beginning, this pain is not permanent, but occurs occasionally and then disappears completely (intermittent pain). Only in the course does the pain perceived by the patient take on a permanent character.
In addition, various fragrances are released in the course of the carious defect, which produce the typical putrid halitosis (Foeter ex ore). If cervical caries occurs in the area of a previously placed filling, the filling material can loosen.
With advanced dental caries, inflammation of the gums develops within the medullary cavity, which can spread to the bone and cause swelling in the mouth.
Read more on the topic: Pain in the neck of the tooth
causes
Exposed tooth necks are becoming more common, so that more and more tooth necks are lying in the oral cavity without the protective gums and are an easy target for bacteria.
The most common cause of receding gums is brushing your teeth. This seems surprising at first, because we actually do something good for our teeth with daily brushing. This is of course correct, but all too often toothbrushes that are too hard are used and too much pressure is exerted on the tooth and gums during the brushing process.
It is believed that the harder you press and scrub back and forth, the better the plaque is removed. With the right toothbrushing technique and the right instruments, this problem can be easily resolved.
If you are affected, you can get advice from your dentist who will give you tips on optimal dental care and technology. Medium-hard bristles and a gentle "sweep" from the gums to the tooth are a good start. Electric toothbrushes are particularly suitable, as they clean the tooth thoroughly and give a warning signal to indicate that the contact pressure is too strong.
Acidic drinks and fruit also have a negative effect on the tooth and can promote the development of cervical caries. Another cause that promotes retraction of the gums is periodontitis, i.e. an inflammation of the tooth supporting structure. The structures that secure the tooth are attacked by bacteria and the tooth runs the risk of losing its secure fit in the tooth socket. The gums begin to regress in this process.
Basic physical illnesses, such as diabetes, also increase the risk of periodontitis and thus the development of cervical caries. Exposed tooth necks are very sensitive to pain, so a cool breeze can already trigger pain. They also offer a predilection point for tooth decay. If the gums have retreated and lost their protective function, the tooth neck can easily be attacked by the bacteria.
Read more on the topic: Tooth neck is exposed - what to do?
Neck caries on the molar
In the area of the molars, carious defects occur more frequently on the chewing surfaces. This fact is due to the fact that the chewing surface of a Molar has deep grooves (so-called fissures). Due to the shape of these fissures, food particles can easily stick and act as a breeding ground for bacterial pathogens serve. Although cervical caries is far less likely to develop on a molar than on an anterior tooth, the spaces between the teeth must be cleaned thoroughly every day.
The bristles of an ordinary toothbrush usually do not get far enough into the Interdental spaceto keep this completely from food scraps and Dental plaque to free.
Only through the regular use of so-called interdental brushes can the formation of cervical caries on the molar tooth be effectively prevented.
In a molar tooth, neck caries is also expressed at the beginning (initial caries stage) by the appearance of whitish discoloration.
In the further course there is a clear sensitivity to thermal stimuli, which are permanent in the presence Toothache flows out. Neck caries can be dangerous, especially on a molar.
As soon as the carious defect and thus also the bacterial pathogens have penetrated the hard tooth substance and opened the medullary cavity, the affected tooth has to go through a laborious process Root canal treatment be treated.
In the course of this treatment, the root cavity must be cleared out and the nerve fibers completely removed. Only after the root canals have been sealed with a filling material can the actual restoration of the affected molar tooth be carried out.
Neck caries under the gums
In most cases, dental caries can be treated quickly and easily. In particular, those carious defects that are discovered in the early phase can usually be removed without leaving any residue. Consequential damage usually does not remain. The treatment of neck caries under the is much more difficult Gums (Gingiva).
On the one hand, this is due to the fact that a Caries is usually discovered as such very late below the gum line. In other words: The affected patient only visits a dentist when the medullary cavity has opened, the nerve fibers embedded in it have been attacked and pain occurs.
The initial situation of the tooth is already so bad at this point that extensive root canal treatment has to be carried out. On the other hand, the intact gingiva has to be lifted a little off the surface of the tooth in the course of the treatment of neck caries under the gums. This is the only way for the treating dentist to fully understand the extent of the carious defect and to remove it completely. For the Gingiva However, this procedure itself is a trauma. In the course of the treatment of neck caries under the gums, many patients complain of irritation and Inflammation of the gums.
treatment
The danger in the presence of dental caries lies in the fact that the Tooth neck has no enamel portion compared to the crown.
Carious defects in the area of the tooth neck consequently reach the medullary cavity much faster and can lead to the development of inflammatory processes there. Neck caries in the early phase can usually be treated easily. The treatment is the same as for normal tooth decay: the damaged tissue is removed and the hole is filled.
See more under: Tooth neck filling
If the affected patient already complains of severe pain, a simple filling therapy is no longer sufficient. The cervical caries must be treated with a root canal preparation and subsequent filling. The goal of one Root canal treatment is to remove as much as possible all germs and inflamed tissue residues from the medullary cavity. During the entire treatment, the tooth must be put through cotton rolls and suckers saliva to be protected.
The tooth with deep cervical caries is anesthetized and then opened with the "drill". In the next step, the pulp and the nerve fibers in it must be completely cleared out. The practitioner succeeds in doing this with the help of different lengths Root files (Reamer, Hedstrom or K-files), which also differ from one another in their diameter.
The root files are used in an orderly order (the diameter increases). An alternating rinse with different solutions must then be carried out. The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial Chlorhexidine (CHX) and sodium hypochlorite.
As soon as the Tooth root germ-free and dry, it is with so-called Gutta-percha points and filled with a density cement. As a rule, an X-ray control image is used to check whether the root reaches the tip (apex) is filled and the tooth is then closed.
Remove dental caries
Since the Bacteria not on the tooth, but on Neck of the tooth because of its lack of protective Enamel layer is very sensitive and therefore the tooth decay easily into the inside of the tooth can spread is one quick treatment of dental caries is advisable.
Is this first only present superficiallyIt is enough to get all teeth from the dentist clean carefully to leave and then with a Fluoride therapy remineralizationby storing minerals. At a deeper tooth decay, this must be removed by the dentist and then filled with a filling. It will affected tissues with a drill, usually one Round burr at low speed, removed until the Caries disappeared without leaving any residue is. In dentistry one speaks of Caries excavation. Then the resulting hole with a Filling material Mistake.
The Removing the tooth decay corresponds to the removal of a caries on the Dental crown. Can of filling material many different be chosen based on the extent of the defect and on Patient's request orientate. Materials on Plastic base are well suited in most cases. But the tooth decay is already more advanced, a simple filling is no longer enough and a Root canal treatmentat which all bacteria removed from the medullary cavity is initiated. Then this too will with a filling Mistake.
Drill
Is the Tooth neck affected by tooth decay and if it is not only initially present, the caries must be removed, what with a drill happens. The removal of this tooth decay is similar to that which takes place during an excavation on the tooth crown. The Rose borer as a classic means of Caries removal. This is round, With different diameter available and serpentine toothed. It is made from stainless steel, Tool steel or hard metal. Polymer models are also available that support the Put less stress on dentinHowever, the tooth decay does not always completely remove and leave an area that less adhesive for the later adhesive.
Of the Rose borer removes that carious tissues at low revolutions (between 500 and 4500 revolutions per minute). This best practice is simple and effective in the application, but can with too much heat damage the pulp and due to the Noise unpleasant be for the patient. To the Treatment painless to shape becomes a local anesthesia (Local anesthesia) is used.
filling
Various materials can be used to fill a dental caries. In most cases, the choice of the suitable filling material depends on the extent of the carious defect as well as on the individual wishes of the respective patient.
Filling materials containing plastic are usually particularly suitable for treating dental caries. After removing the carious areas, the dentist applies a viscous liquid, which is supposed to strengthen the interaction between tooth substance and plastic.
The plastic-containing filling material can then be applied in a deformable form and passed through Curing light to be cured.
In order to create an ideal transition between tooth substance and plastic, the tooth neck filling is ground and smoothed with fine arrows. The filling of a dental caries with amalgam is usually carried out rather rarely. This is because amalgam is sometimes more than controversial as a filling material.
costs
The costs vary depending on the filling material and the size of the filling. In the case of fillings in the anterior region, the health insurance companies even pay for a composite filling.
From the 4th tooth, i.e. the 1st small molar, an additional payment has to be made for a composite filling.
Tooth neck fillings can also vary greatly in size. It is seldom a single-sided filling. The defect usually protrudes towards the interdental space, which leads to a multi-surface filling therapy. This is of course more expensive than if only one area has to be restored. The costs for a three-sided filling can range between 60 and 150 €. That depends entirely on the treating dentist.
If the tooth neck filling becomes insufficient within 2 years, so it has to be renewed, this is a case for the health insurance company. The repetitive filling is usually taken over by her.
Pain with a tooth neck filling
As with any dental procedure, pain can occur. During the treatment these can mostly be switched off by local anesthetics.
You may also experience pain after treatment that may not have been present before. Any grinding of a tooth can irritate the tooth nerve, but this will pass.
In addition, the gums can be easily attacked, especially with fillings in the neck of the tooth, which, however, regenerate completely after a few days, i.e. it is healed.
In the case of very deep fillings, a type of underfill or medication may have to be placed under the filling material. These are often slightly acidic in their pH value, which could make the tooth sensitive. You should avoid extremely hot and very cold food for a few days after a tooth neck filling.
How can I treat neck caries myself?
Even few dentists admit that tooth decay can sometimes calm down. This means that you don't have to drill out every tiny spot directly. However, it is also difficult to say that you have to leave these places and wait and see what happens.
Once the neck caries is left in place and under observation, one can try to contain the caries by thorough cleaning.
You can find more information here: Dental care
Nowadays there are many sweeteners as an alternative to sugar, for example xylitol, which at the same time inhibits the caries bacteria.
Caries is more likely to develop on exposed tooth necks, as there is no hard enamel there, but the softer root cement. This can be strengthened with local fluoridation measures and made less vulnerable, for example with mouth rinses and fluoride varnishes.
Read more about this under: Fluoridation of teeth
Some patients resort to homeopathic remedies. Alternative products such as brine toothpaste, comfrey root, coral or eggshell lime or similar are available for additional treatment. possible. However, there are no studies that show that these alternative methods are really successful.
