Annotation:

The majority of the world’s population suffers from dental caries. This disease is highly prevalent and occurs in about 95% of the population. In dental caries, complex pathological processes are observed, involving both rapid and slow necrotic changes in the tooth tissues. As a result of these necrotic processes, cavities are formed.

Introduction:

Dental caries is the most widespread oral disease in the world, caused by the erosion of tooth enamel due to harmful bacterial infections. It occurs when acids produced by the consumption of sugary and acidic foods accumulate on the teeth, leading to pathomorphological changes.

In modern dentistry, effective methods have been developed to prevent caries and treat it at early stages. Studying caries, its prevention, and modern treatment methods play a crucial role in maintaining health.

The purpose of this article is to provide detailed information about the causes, development mechanisms, symptoms, treatment, and prevention methods of caries. Understanding caries and exploring ways to prevent it can contribute to improved dental health and well-being.

Causes

a) The onset of dental caries usually begins with the formation of bacterial plaque that accumulates in the mouth. This plaque mainly consists of bacteria, proteins found in saliva, and food debris.

b) Bacteria (such as Streptococcus mutans and Lactobacillus, which are cariogenic) thrive in the fluctuating pH environment of the mouth. These bacteria metabolize sugars on the tooth surface and produce organic acids.

Effect of acids:

Acids introduced into the oral cavity (such as lactic acid) affect the mineral components of the tooth enamel, primarily calcium and phosphate, leading to demineralization. During the demineralization process, there is a reduction in the mineral content of the enamel and dentin layers of the tooth.

Mechanism of Caries Development

Changes in the enamel layer:

Initial stage: Caries initially begins with the loss of the enamel’s mineralization process, initiating demineralization. The structure and strength of the enamel deteriorate, leading to yellowing. Although demineralization occurs in the enamel, the tooth surface remains intact at this stage. The early stage of caries appears as “white spots.”

Changes in the dentin layer:

Middle stage: Demineralization progresses into the dentin layer, causing mineral loss and damage to the dentinal tubules. At this stage, the surface layer is destroyed, but the pulp (the inner part of the tooth) is not yet affected. Changes in the dentin appear as yellow or brown discoloration. Demineralization in the dentin weakens the tooth structure, making it more susceptible to damage.

Changes in the pulp layer:

Advanced stage: This is considered the final stage of caries, where inflammation and swelling occur in the pulp. When the pulp nerves are affected, the tooth becomes painful and sensitive. Infections in the pulp lead to inflammation (e.g., pulpitis), usually causing pain and swelling and requiring dental intervention for treatment.

Morphological changes of caries:

Morphological forms: Caries can appear in various forms—dot-shaped, linear, or polygonal. As caries progresses, both the structure and shape of the tooth change accordingly.

In the diagnosis of caries:

Radiographic images and microscopic examinations play an important role in identifying the morphology of the tooth. With the help of radiography, it is possible to determine the depth and extent of the carious lesions.

Histological Changes

Bacterial infection:

Bacteria play a major role in the development of caries. They metabolize glucose present in the oral cavity and produce acids, which lead to the demineralization of the tooth. Under microscopic examination, the structure of the damaged enamel is clearly visible, showing a high concentration of bacteria and evident demineralization processes.

Damage to tooth layers:

In the histological view of caries, processes of demineralization, mineral loss, and tissue changes in the dentin and pulp are clearly observed. Changes in the dentin layer are characterized by particle breakdown and surface weakening.

Demineralization and Remineralization Processes

Demineralization:

The demineralization process plays a crucial role in the progression of caries. Acids produced by bacteria dissolve the minerals in the enamel and dentin layers of the tooth. Initially, demineralization occurs only in the enamel, but over time, it can also affect the dentin and pulp.

pH level and tooth demineralization:

As the pH level in the mouth decreases (e.g., after consuming sugary foods), acids are produced that accelerate demineralization. If the pH drops below 5.5, enamel begins to demineralize, leading to yellowing or discoloration of the tooth.

Remineralization:

As the opposite of demineralization, the remineralization process allows for the repair of tooth structure. Minerals such as calcium, phosphate, and fluoride present in the oral cavity support remineralization. However, this process is only effective if the demineralization is in its early stages.

Treatment of Caries

The treatment of caries includes a series of medical procedures aimed at stopping its progression and restoring the tooth. Treatment methods vary depending on the stage of caries development. The main goal of treatment is to ensure complete restoration of the tooth and prevent further disease. Below are the main methods and approaches used to treat caries at different stages.

1. Treatment of Early-Stage Caries

Preventive treatment:

At the early stage of caries (when tooth discoloration or white spots are present), it is essential to stop demineralization and support the remineralization process. The main treatment methods at this stage include:

Use of fluoride:

Fluoride helps stimulate the remineralization process. It assists in forming new mineral layers on the surface of the tooth, which strengthens the tooth and prevents the progression of caries.

Remineralization agents:

Treatment with preparations containing calcium, phosphate, and other minerals can also be effective. These agents help restore the outer layers of the teeth.

Improved oral hygiene:

Regular brushing, flossing, and the use of mouth rinses reduce bacterial plaque accumulation and help prevent caries.

2. Treatment of Moderate-Stage Caries

Tooth filling:

If caries has progressed to the moderate stage, affecting the dentin layer, the filling method is used. The damaged part of the tooth is removed, and the cavity is filled with a dental filling. Fillings can be made from various materials, including amalgam (silver), composite, or ceramic.

Composite materials:

These materials match the color of natural teeth, offering an aesthetically pleasing and durable solution. Composite fillings help restore the damaged part of the tooth and return it to its original shape.

Ceramic fillings:

In some cases, when a large portion of the tooth needs treatment, full restoration is done using ceramic materials. These materials provide a natural tooth-like appearance and high durability.

3. Treatment of Advanced-Stage Caries

Endodontic treatment (root canal therapy):

If caries has reached the pulp (the inner part of the tooth) and an infection has developed, root canal therapy is required. The goal of this procedure is to eliminate the inflammation in the pulp and remove the infection.

Cleaning the canal and removing damaged tissue:

The pulp must be cleaned, and the infected tissues removed. Once the canal is cleaned, it is filled with special materials.

Tooth restoration:

After root canal treatment, the tooth is usually restored using crowns or other restorative materials to ensure full functionality and structure.

Application of a crown or onlay:

If the tooth is severely damaged, a crown may be placed to strengthen it. A crown protects the tooth externally and restores its normal shape and function.

4. New Treatment Methods

Laser therapy:

Laser technology can also be used in dental treatment. With the help of a laser, the damaged part of the tooth can be removed accurately and effectively. This process is less painful and promotes faster healing.

Ozone therapy:

Ozone gas can be used in the treatment of caries. Ozone neutralizes bacteria and helps restore the mineral content of the tooth.

                                                  Conclusion

The development mechanism of caries begins with the demineralization process caused by bacteria converting sugar into acids, which alters the structure of the tooth. In the prevention and treatment of caries, oral hygiene, proper nutrition, the use of fluoride, and regular dental check-ups play an important role. Proper maintenance and early detection of dental issues are effective in eliminating pathological changes.

This article highlights important aspects of caries morphology in detail. The morphology of caries—its impact on and changes within the tooth structure—is essential for fully understanding the progression of the disease. Morphological changes in caries occur in several layers of the tooth: enamel, dentin, and pulp.

Studying the morphology of caries helps in understanding the changes within these layers. Over time, these changes significantly affect the structure, function, and appearance of the tooth. Understanding caries morphology is vital for developing effective strategies for its prevention and treatment.

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Ahmadova Sarvinoz was born in Altinkol district, Andijan region. She is a student of the Faculty of Dentistry at the Andijan Branch of Kokand University in Andijan region.