Hidden caries (both under a filling and on a “healthy” tooth)
As a rule, such caries develops asymptomatically, for more than one month or even a year, it does not manifest itself in any way, but destroys the tooth tissue from the inside. And at some inopportune moment, a part of the tooth, thinned by caries, breaks off.
What to do?
Treat the tooth at the dentist: remove all tissues affected by caries and restore the tooth (with a filling, ceramic inlay or crown, depending on the degree of its destruction). And be sure to check all other teeth for hidden caries!
How to avoid?
See your dentist for preventive examinations more often in order to promptly detect hidden caries at an early stage, when treatment is easier, faster and cheaper.
Reasons for violation
The receding gum from the tooth is a pathological condition that dentists call recession. This is one of the main manifestations of periodontitis. The tissues surrounding the tooth become inflamed due to infection by pathogenic microflora. Because of this, the gums shift and peel off, which leads to loosening and loss of teeth.
Factors that provoke this disorder also include:
- insufficient oral hygiene,
- injury to the oral mucosa,
- accumulation of soft plaque and tartar,
- advanced caries and pulpitis,
- poor quality dental fillings,
- wearing ill-fitting dentures,
- smoking and other bad habits.
Gum recession can also occur due to serious chronic diseases. Exposure of the neck of the tooth is often observed in patients with vitamin deficiency, diabetes mellitus, endocrine diseases, and pathologies of the cardiovascular system.
Incorrectly restored tooth
- Poor performance of the filling , violation of technology and methodology during restoration (we will not dwell on this).
- The type of restoration is inadequately selected, in a word, “too big a filling” (i.e. they put a filling in cases where it can no longer be placed, but there are all the indications for “more serious” ceramic restorations (inlays, crowns).
I would like to dwell on the second reason in more detail.
Competent dentists know that there is an index of tooth surface destruction (DSI), which must be taken into account before restoring teeth in order to do it correctly. For you, dear patient, I will describe it in a simplified way. If the tooth is not severely damaged (conditionally up to 40% of the surface), a filling is an excellent way to restore it. Destruction of 40 to 70% of the surface requires the manufacture of a ceramic inlay or strengthening of the tooth with various pin structures.
If there is a significant degree of destruction of the tooth surface (more than 70%), the tooth should be correctly restored with a crown. In a word, the type of tooth restoration depends on the degree of destruction.
What's wrong with a filling?
Each recovery method has its own indications. So, a filling is necessary and can be placed in cases of small and medium degrees of tooth decay. If the decay is significant, a large filling can split the tooth in half.
Let's find out why!
Any material (even metal) expands when heated (remember the temperature of the tea you drink!). Temperature changes are a fairly common occurrence that our teeth encounter (from hot tea to ice cream). The coefficient of thermal expansion of filling materials is still higher than that of tooth tissue. That is, when hot food is consumed, the filling expands more than the tooth tissue that surrounds it. The larger the volume of the filling, the greater the expansion (this is why a large volume of the filling is so undesirable).
Of course, this expansion is minimal, not noticeable to any eye and not perceptible. However, add to it a chewing load (which far exceeds temperature deformations), a large filling, thinned tooth tissue, and the likelihood of chipping increases many times over.
Unlike filling materials, ceramics (from which crowns and inlays are made) have a closer coefficient of thermal expansion to the tooth tissues, and therefore do not contribute to its chipping. In addition, it is stronger. That is why it is correct to restore severely damaged teeth not with fillings, but with ceramic restorations. There are other physical phenomena that affect the change in the size of the filling and, as a result, the splitting of the tooth.
All of the above, of course, is true only with an adequately completed restoration (even fillings, even crowns). An inaccurate hand of a master can lead to chipping even with ceramic restorations, and on the contrary, a skillful hand can place a large filling so that it will last a long time. However, there is a limit to everything and it is better not to go beyond the indications for restorations if you want to get guaranteed and reliable work.
Conclusion : you should not expand the indications for conventional fillings too much; they are not capable of qualitatively restoring a badly damaged tooth. But in case of minor tooth decay, fillings have proven themselves to be excellent!
Let me give you a photographic example.
The patient complained that it was painful for her to bite on one of her teeth, that something “crunched” in it.
Upon examination, we determined: tooth 4 on the upper jaw: it has a medium-sized filling (at first glance). And a movable, broken tooth wall, which is held together only by the gums. This wall is no longer attached to the tooth.
The broken fragment of the tooth is mobile, easily moved to the side, but has not yet been removed.
View of the tooth after removing the broken wall: the cheek wall was chipped under the gum. A large filling and a thin remaining tooth wall on the palatal side are visible. Some doctors may try to restore such a tooth using a crown (with preliminary extension); some doctors will offer a perhaps more predictable option: removal and subsequent implantation.
Why are teeth restored incorrectly?
It’s absurd, but often the dentist follows the patient’s lead. The patient, not fully understanding all the subtleties and features of the distribution of the load when chewing, refuses the inlay or crown and asks the doctor to “put a filling”, they say, I’ll work with it a little more, and only then the crown! As a result, at the most inopportune moment, a “piece” of the tooth breaks off. As a result, such “pity” of the doctor for the patient turns out to be a bigger problem for the patient than timely adequate tooth restoration.
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How to properly restore teeth?
When treating a tooth, the doctor must remove all carious tissues, old fillings, movable walls, if any, completely clean the tooth and only then assess the degree of destruction (which walls and cusps have survived, whether they are able to bear the load, how the load on this tooth will be distributed during different methods of restoration, whether chips of any wall are possible, whether its restoration will lead to a split of the root, etc.). After such an assessment, it is determined how to properly restore the tooth: is it possible to put a filling, or does it need to be “strengthened with a pin,” or would it be more correct to use a ceramic inlay or a crown.
Conclusion: a properly selected restoration will preserve the tooth for many years, protect it from further destruction, and the patient from having to redo the work in a few years.
Symptoms of gum recession
In dentistry, there are several types of receding gums, each characterized by its own symptoms, but the general symptoms of gum recession
are as follows:
- tissue volume decreases;
- bleeding during dental hygiene;
- there is swelling, redness of the gums;
- the molar root is exposed;
- there is a high sensitivity to temperature changes;
- caries may develop;
- eating food causes pain and discomfort;
Advanced cases include multiple cervical caries, discoloration of enamel, teeth are located at a far distance from each other. When teeth are exposed, food debris and plaque accumulate in the pockets. Purulent contents are released. The initial stage does not entail unpleasant symptoms, which is why most patients are unaware of the presence of the disease. To prevent gum recession, you need to visit the dentist every six months!
Injury
Single or chronic - the third reason for possible tooth chips
A single injury occurs when there is a blow, an accident, or accidentally biting on a hard object while chewing.
There are three types of chronic injury
- Due to malocclusion (when the teeth do not close correctly, some teeth may receive excessive load, close in the wrong areas, at the wrong angle, or with an opponent that is not their power). For example, a powerful fang of the lower jaw can be positioned in such a way that when closed, it will severely injure the incisor on the upper jaw, which is much inferior to it in size and power. As a result of such long-term closure, the incisor can get into big problems, and the patient will face the need for treatment or removal.
- Due to the absence of other teeth (when a number of teeth are missing, their work is performed by the remaining ones; excessive load may one day result in a fracture of the tooth, a break in its wall, or a split in the root).
- Due to bruxism (“idle” teeth grinding) or other parafunctional manifestations.
How to avoid?
- Be sure to restore missing teeth (there are a lot of ways today, there are even temporary prosthetics if for some reason you need to postpone dental treatment).
- Consult an orthodontist, orthopedist or periodontist about bite problems and undergo orthodontic treatment if indicated.
- Get advice from an orthopedist/gnathologist and psychotherapist about the possible causes of bruxism and take possible measures that the doctor recommends.
Prevention
Preventive measures are carried out in healthy people, as well as in patients after treatment. In order to reduce the likelihood of primary periodontitis or its relapse, it is necessary to follow some rules:
- Brush your teeth daily and thoroughly with a suitable toothbrush and toothpaste.
- Use additional products (dental floss, balms, etc.).
- Periodically have your mouth professionally cleaned at your dental clinic.
- Visit the dentist at least twice a year.
- Treat caries and other dental diseases in a timely manner.
- Try not to injure your gums.
- If gums become inflamed, painful or bleeding, consult a doctor immediately.
- Include vitamins and minerals in your diet.
- Lead a healthy lifestyle, give up bad habits.
These simple recommendations will help maintain the oral cavity in proper condition and prevent the development of many dental diseases, including periodontitis.
What to do if your tooth chipped?
See a dentist.
The doctor will remove the broken wall, take x-rays of the tooth, and evaluate its safety. If the tooth is not broken much, the root is not damaged or almost not damaged, then it can be restored. Then the tooth is prepared (if necessary, dental canals are treated, caries and old filling materials are cleaned), how badly it is damaged is assessed and the best way to restore it is selected (filling, inlay or crown). If the tooth cannot be saved, it is removed and replaced with an implant or other available method.
Diagnosis and treatment
A dentist will help determine why the gums are moving away from the teeth. The specialist will collect anamnesis, conduct an instrumental examination of the oral cavity, study the results of x-rays and make an accurate diagnosis. Then the doctor will draw up a treatment plan taking into account the stage of periodontitis and the clinical picture. It may include:
- professional teeth cleaning – removal of plaque and tartar;
- curettage of periodontal pockets - cleansing the subgingival area from various deposits;
- anti-inflammatory treatment - rinsing the oral cavity with antiseptic agents;
- Antibacterial therapy – if there is a bacterial infection, the doctor prescribes antibiotics to the patient.
In advanced cases, surgical intervention is indicated:
- removal of the affected part of the mucous membrane followed by suturing;
- flap surgery to restore the required volume of gum tissue.
Pulsation without pain
Pulsating sensations in the gums without significant pain are the most likely symptom of the development of apical periodontitis: the process of releasing space for purulent exudate that accompanies the problem causes the sensation of a distinct pulse within the jaw.
As a rule, there are no unpleasant sensations at rest, but they appear under any stress (during hygiene, when eating food, when applying pressure). The symptom is characteristic of any inflammatory processes in periodontal tissues, as well as in the initial stages of the formation of a hilar cyst.
