Treatment and prevention of caries in Kyiv

Caries begins with the demineralization of enamel. Without timely treatment, the process spreads to dentin, and in the case of deep lesions, approaches the pulp and can cause its inflammation. According to WHO estimates, about 2 billion people have caries of permanent teeth, while approximately 510 million children are affected by caries of primary teeth. At an early stage, the tooth does not hurt: changes may appear only as a white or dark spot. Even with a deep lesion, there may be no discomfort. At the network of dental clinics DDC (Dobrobut Dental Clinic), caries treatment begins with an examination and determination of the depth of the lesion.

How to tell if a tooth needs treatment

At the initial stage, a person often does not feel any changes. What should raise concern is a new matte, white, brown, or black area, roughness of the enamel, darkening of grooves, or food getting stuck in one place. When the process reaches dentin, a brief reaction to sweets, sour, hot, or cold may occur.

A carious cavity is not always visible in the mirror. Lesions between teeth or beneath the edge of an old restoration are often discovered only during examinations and radiological diagnostics. If pain occurs spontaneously, bothers at night, or does not subside long after the irritant is removed, the process may have reached the pulp. In such a case, one should not delay a visit to the doctor.

How a tooth changes at different stages of caries

At the early stage of caries, enamel loses minerals, which can lead to a matte spot. As it progresses, a defect forms, spreading into dentin, and with deep lesions, it approaches the pulp. The tooth may react to sweets and temperature irritants, but the absence of pain does not rule out caries. The depth of the process is determined by the doctor after cleaning and drying the surface, and if necessary, with the help of an X-ray. The color of the spot itself does not indicate the stage.

Surface and moderate caries

Surface caries is limited to enamel. A small defect appears on it, but there is usually no significant pain. If the surface is still intact and only active demineralization is present, the doctor may recommend:

• professional hygiene;
• fluoridation;
• remineralization;
• ICON infiltration. 

The choice of method depends on the location and activity of the focus.

Moderate caries spreads into dentin—less dense tissue beneath the enamel. At this stage, the cavity increases, food gets stuck more often, and the tooth may briefly react to temperature or sweets. In such circumstances, the doctor removes the affected tissues and restores the defect with a composite material, selecting its shade and shape to match the tooth.

Deep caries and risk to the nerve

In deep lesions, a thin layer of dentin remains between the carious cavity and the pulp. In this case, specialists talk about deep caries. Treating it does not automatically mean removing the nerve. If the pulp is viable and there are no signs of irreversible inflammation, the dentist tries to save it. The approach is determined based on the nature of the patient's pain, the depth of the defect, test results, and radiological diagnostics.

However, when bacteria have already caused pulpitis, mere filling is insufficient. In this case, treatment for pulpitis is required, involving root canal treatment. Therefore, early consultation with a specialist reduces the extent of intervention and helps preserve teeth.

How caries is treated at DDC

At Dobrobut Dental Clinic, an individual treatment plan is developed after diagnostics. The scope of intervention depends on the stage of the lesion, location of the cavity, condition of the pulp, previous restorations, and load on the tooth. Local anesthesia is used if necessary, and a rubber dam is employed for isolating the working area from saliva.

How the examination proceeds

The dentist clarifies complaints, examines the teeth under good lighting, evaluates the condition of the enamel, grooves, contact surfaces, and edges of fillings. If necessary, sensitivity tests are conducted, the reaction to tapping is checked, and a targeted or bitewing X-ray is prescribed. Radiography allows for the detection of hidden lesions and assessment of their proximity to the pulp.

However, a spot is not always caries, and pain does not always originate from a visible defect. Therefore, treatment begins only after confirming the diagnosis. If plaque and tartar need to be removed before restoration, professional teeth cleaning may be required.

Restoring a tooth after removing affected tissues

The procedure is usually performed under local anesthesia. The doctor cleans the cavity of infected dentin, treats it, and applies composite layer by layer. Each layer is cured with a photopolymer lamp. After modeling the anatomical shape, the dentist checks contacts with neighboring teeth and the bite, and then shapes and polishes the surface.

Filling teeth not only closes the cavity. Quality restoration returns the tooth's correct shape, ensures a tight fit, and allows for even distribution of chewing load. If the defect is significant, a ceramic inlay or another method may be used instead of a filling.

Caries on front teeth

Caries on front teeth requires particularly precise reproduction of color, translucency, relief, and shape of the tooth. Before treatment, the shade is determined considering neighboring teeth, and restoration is modeled so it is not noticeable during conversation or smiling. In cases of significant destruction, the method of restoration is chosen after evaluating the remaining tissues and bite.

Why caries appears under an old filling

Secondary caries develops at the edge of the tooth or under a restoration when, over time, its tightness is compromised and bacteria enter the micro-gap. The risk of its formation increases due to material wear, chipping, cracking, significant chewing loads, and inadequate hygiene. Externally, the problem may appear as darkening at the edge of the filling, but the final conclusion is made after examination.

During treatment, the old restoration is removed, affected tissues are eliminated, and it is assessed whether the tooth is sufficient for repeat direct restoration. If the defect covers a large part of the crown, the dentist may suggest an inlay or crown. Depending on the situation, a therapist, endodontist, orthopedist, and other specialists may be involved in the planning.

How to prevent new caries after treatment

A new filling restores a certain defect but does not eliminate risk factors. Therefore, for prevention, it is crucial to:

• brush teeth twice a day with fluoride toothpaste selected according to age and doctor's recommendations;
• clean interdental spaces daily with floss or interdental brushes;
• reduce the frequency of snacking and consumption of sugary drinks;
• avoid biting hard objects and consult a doctor if a filling chips;
• attend check-ups at intervals defined by the dentist.