Dental caries in decompensated form. Acute caries - when it blooms in the mouth, but does not smell Caries compensated decompensated subcompensated

Caries is considered the most common dental disease, especially. The occurrence of the disease is due to a change in the acid-base balance on the surface of the enamel. This is due to fermentation caused by various microorganisms (cariogenic bacteria).

Blooming acute caries is the most acute and rapidly progressive form of the disease.

Briefly about terminology

According to the degree of damage, flowering caries refers to. According to the nature of the course and the rate of development, the disease can proceed in the form of:

Blooming caries refers to the acute form of the lesion, which is characterized by a high rate of development. Acute caries, in turn, differs in the degree of destruction and intensity of development:

Compensated. It develops slowly, without exacerbations. Symptoms are practically absent, tooth enamel is slightly affected.
Subcompensated. Carious lesions develop over several months. At the initial stage, they do not manifest themselves in any way, the symptoms are mild.
decompensated. It progresses rapidly and can cover several teeth at once. Development is accompanied by severe pain.

There are a lot of classifications of types and types of caries. This division is due to the nature of the flow, intensity, rate of development and area of the lesion.

Decompensated form - and the whole world is not enough ...

Decompensated caries is considered the most dangerous and requires immediate treatment. There are other names that accurately characterize this form of the disease: blooming or multiple acute caries.

The process of infection and destruction occurs in a very short time. As a rule, several teeth are affected at once. Within a month, the diseased tooth is completely destroyed.

The decompensated form of the disease is characterized by the formation of a deep carious cavity with a narrow entrance and a wider base. This means that the surface of the teeth is almost not destroyed, and the internal tissues of the tooth are more damaged. The cavity base and walls are filled with strongly softened dentin.

The peculiarity of this carious process is that there is no response to inflammation and infection of the teeth in the body. There are no obstacles to the rapid development of the lesion, so the disease proceeds quickly and aggressively.

Causes and risk groups

Foci of defeat are indicated by arrows

Blooming caries can develop both primarily, due to the progression of the middle form of the disease, and secondarily, on a sealed tooth. Causes a carious process of bacteria (streptococci).

During the fermentation of food in the mouth, lactic acid is formed, which damages the enamel, opening up access for bacteria to the inside of the tooth. They penetrate into the dentin, provoking the withdrawal of calcium salts. This leads to softening and destruction of the hard tissues of the tooth.

Cariogenic bacteria multiply in. If it is not removed, the disease begins to progress rapidly. The main causes of acute caries are:

persistent disorders of the immune system;
poor diet with a lack of trace elements;
a serious lack of calcium and fluoride in the body;
avitaminosis of varying degrees;
decrease in the bactericidal properties of saliva;
violation of the metabolic processes of the body;
the presence of chronic diseases.

To provoke an exacerbation, accelerating the process of the disease, can be wrong (non-compliance with hygiene) and bad habits. Children are most often exposed to the most acute form of the disease, especially during the growth of milk teeth. Also at risk may be:

adolescents, during the period of hormonal changes in the body;
children suffering from tuberculosis or other serious infectious diseases;
patients with impaired absorption of trace elements, especially calcium;
patients with HIV infection who have reduced immunity;
elderly people with various chronic diseases.

Patients who are at risk need to undergo examinations on time.

Symptoms of the disease

The main clinical manifestation of the most acute form of caries is, which is acute. It appears as usually short term.

It can become a response to stimuli of a different nature: temperature, mechanical, chemical. If the carious cavity is filled with food debris, then the aching pain continues for a long time. Also, the main symptoms of a flourishing disease are:

unpleasant ;
, abundantly covering the teeth, which quickly form again after cleansing the oral cavity;
seals fall out, as the process of destruction quickly develops under them;
the patient has viscous and slippery saliva, which does not clean the teeth.

There are a number of other signs by which it is easy to determine the acute form of caries:

during a visual examination, it is possible to detect a disease at different stages of development with several foci on one tooth;
the appearance on the surface of tooth enamel or a change in the color of the enamel in a gray tint.

Most of the symptoms are pronounced. They can be seen without a qualified inspection.

Diagnostic criteria and methods

To make a diagnosis, the dentist, using a special mirror and a dental probe, examines the oral cavity. When probing an infected tooth, acute pain appears. During the examination, the dentist establishes and identifies:

the degree of destruction of the tooth surface;
depth of the carious cavity;
pain reaction to temperature, with the help of thermal exposure;
pulp response to current using electroodontodiagnostics.

To make a more accurate diagnosis and identify the size of the lesions, and are prescribed.

Provision of medical care

Treatment of acute caries takes place in several stages. It is aimed at the complete removal of damaged tissues and the preservation of a healthy area of \u200b\u200bthe tooth. The whole procedure is performed using modern equipment. Treatment includes the following:

Possible complications and consequences

After the treatment, within a few days, increasing pain may appear. This indicates damage to the pulp and the possible development of inflammation -. In this case, the filling is removed and the affected pulp is removed, followed by root canal filling. If possible, clean only the upper part of the pulp.

You should immediately contact a specialist in the following cases:

aching constant pain, not relieved;
swelling or redness of the gums next to the filled tooth;
the wrong size of the filling, which provokes soreness.

Complications can be avoided if the treatment is carried out efficiently and in a timely manner.

The consequences could be much more serious. In addition to the development of pulpitis, there is a risk of inflammation of the ligaments holding the tooth (development). The worst option is tooth loss (extraction).

Preventive measures

For the preservation of teeth, especially in the presence of the disease in its initial form, it is very important to carry out prevention. The main preventive measures include:

necessary at least twice a day;
use special anti-inflammatory toothpastes against caries;
use by cleaning interdental spaces;
rinse the mouth after each meal;
observe the temperature regime;
limit the consumption of sweet and softened foods.

With good dental hygiene, you can keep your teeth healthy for a long time. Most importantly, visit the dentist in a timely manner to identify and treat caries in the early stages.

Caries is a fairly common disease in the field of dentistry. Under the influence of pathogenic bacteria, the destruction of tooth enamel, dentin and cement occurs. If timely treatment is not carried out, then carious spots can destroy the tooth and lead to its loss. The presented disease has many forms and classifications.

The concept of "decompensated caries or blooming caries" means that the body can not cope with infections.

Blooming caries in a child

caries classification

Caries is classified into several subgroups. The intensity of the progression of the disease appears in the following forms:

Compensated carious lesion. This stage can develop over many years. The severity of the process may stop if the patient begins to regularly consume foods rich in vitamins and various trace elements and systematically conduct oral hygiene.
Subcompensated carious lesion. The inflammatory process spreads at an average speed (within several months).
Generalized carious lesion. The process of localization of bacteria is quite rapid, there is damage to several teeth at once. At risk are people with chronic infectious diseases and adolescents.
Decompensated form of caries (acute) is the most dangerous pathology. The process of enamel damage occurs "at the speed of sound." Literally in fourteen days you can lose a tooth.
Acute caries is formed due to reduced bactericidal components of saliva, lack of daily oral hygiene, poor nutrition, heredity, and a reduced immune system.

Forms of caries - schematic representation

Diagnostics

Acute deep caries is especially dangerous if left untreated. This lesion is detected quite easily, unlike other forms of the disease.

The main symptomatic manifestations of the disease are expressed:

multiple, white or dark spots on the enamel of the teeth;
acute, long-term pain sensations of the dentoalveolar region;
strong, unpleasant reactions to cold, hot food or drinks.

As soon as the presented symptoms were noticed, an examination of the oral cavity should be carried out immediately.

Sometimes carious lesions are small, but the described symptomatic manifestations are observed. In this case, you should not postpone a visit to the dentist!

Indeed, under a slight darkening of the tooth surface, the deepest carious cavity can be hidden.

Diagnosis of the disease is carried out by a qualified dentist. The decompensated form is determined by:

extensive formation of a carious cavity;
narrow passage;
a large or small amount of destroyed dentin;
acute pain on probing.

Caries at the stain stage

To determine the exact diagnosis, the doctor uses a probe and a dental mirror. If the carious cavity is hidden and inaccessible, the patient is sent to the X-ray room, where a picture of the diseased tooth is taken. The second method of diagnosis is transillumination. In this case, the carious section is illuminated with a bright light flux emanating from a special lamp. Another diagnostic method is fissurotomy. Hidden carious lesion is determined by prophylactic excision.

Children with weakened immune systems are most susceptible to the disease. The covering of temporary teeth is thin and permeable. Therefore, the destruction occurs quite rapidly. On one affected tooth, several holes can form at once. Initially, the incisors are affected from above. An inflammatory focus is formed at the base of the gum. Then the infection affects the cutting edge and circumference of the tooth.

Blooming caries in children is often complicated

In turn, the lower milk teeth are more resistant to the disease. This factor is related to the location of the incisors. They are located near the salivary gland, which actively protects tooth enamel from pathogenic microbes.

In addition, deep caries is very often observed in children who abuse sweets!

Consequences and complications

Acute, deep caries is quite dangerous for human health. The neglected form of the disease can provoke serious diseases of the oral cavity. Without dental treatment, pulpitis, periodontitis, periodontitis are formed, tooth enamel splits, which results in tooth loss.

In addition, decompensated carious lesions indicate impaired functioning of the body as a whole. Without caries therapy, the production of salivary glands decreases, its bactericidal properties decrease. Such a process negatively affects the entire oral cavity.

Generalized dental caries

A carious lesion that occurs in a pregnant woman can adversely affect the health of the fetus.

Treatment

Therapy of acute caries is divided into three stages:

elimination of affected tissues of the tooth;
removal of the dental nerve;
tooth restoration.

Let's consider each stage of treatment separately.

The scheme of treatment of caries in decompression form

Stage 1

Removal of the tissue connection occurs under the action of anesthesia or anesthesia. This is due to the special soreness and sensitivity of the tooth. In other words, the patient will not feel pain or unpleasant symptoms. As soon as the anesthesia has taken effect, the affected sections of enamel and softened dentin are drilled with the help of a dental burr. After the procedure, the oral cavity is treated with a special, antibacterial septic tank. It should be noted that the anesthetics used are absolutely harmless and hypoallergenic. In addition to the drill, there are other methods for removing affected tissues. In modern clinics, dental sandblasting (washout) and a dental laser are used to evaporate the infection.

Stage 2

The next step in treatment is to remove the nerve. If tooth decay progresses, pathogenic bacteria have penetrated into the area of the pulp (neurovascular bundle), which means that the elimination of the nerve is inevitable. Extraction of the nerve is performed by special equipment. Then the dentist cleans the root canals, seals the carious cavity, where calcium-containing paste is used, the Calcium Hydroxide mixture is ideal.

Stage 3

The last step in the treatment of caries is the restoration of the coronal region. Special photopolymer composites restore the original shape of the tooth. With severely destroyed enamel (more than fifty percent), filling will not give the desired result. This will require the installation of an artificial metal-ceramic or porcelain crown.

Therapy of the advanced form of caries is difficult and lengthy. To conduct a quality treatment, you will need a double visit to the dentist.

The result of caries treatment - before and after

During the first appointment, the removal of the affected tissues and the treatment of the oral cavity will be done. The second visit includes the restoration of the tooth.

So that the compensated form of caries does not develop into an acute stage of the disease, it is necessary to carry out a planned sanitation of the oral cavity. Regular visits to the dentist will allow you to timely identify diseased areas in the area of \u200b\u200bthe teeth and gums. Checking the dentoalveolar system is the key to the health and durability of your teeth!

In the WHO classification (10th revision), caries is a separate heading.

Enamel caries, including "chalk spot".

Dentin caries.

caries cement.

Suspended caries.

Odontoclasia.

Another.

unspecified.

Process depth classification

For a practitioner, a topographic classification is more convenient and acceptable:

A) uncomplicated(simple) caries

Caries stage spots(carious spot).

At this stage, the tooth enamel changes color due to the formation of a chalk stain on it. At the same time, the surface remains smooth, since the enamel is still at the initial stage of destruction. At this point, it is important to prevent further development of the disease. In the early stages, it is easier, cheaper, and painless to cure caries. At the first stage, tooth treatment begins with the stain removal procedure. Then the enamel is remineralized, that is, special preparations are applied to the neck of the tooth (for example, solutions of sodium fluoride and calcium gluconate).

Superficial caries.

At the next stage, the untreated chalk spot becomes rough in time. The tooth in this place hurts from hot, cold food, and also becomes sensitive to sweet and sour. Treatment of this stage of cervical caries will consist in grinding the area of the tooth affected by caries. Then, by analogy with the treatment of the previous stage, remineralizing therapy is carried out.

Medium caries.

At the third stage, caries begins to penetrate deeper. Dentin is affected. Serious damage to the tooth becomes clearly visible. Pain becomes more frequent, intense and prolonged. Treatment of secondary caries consists in removing the damaged part of the tooth, treating it with medications and installing a filling.

deep caries.

When damage to an untreated tooth reaches the peripulpal dentin, the stage of deep caries begins. The treatment procedure consists in the removal of the damaged part of the tooth, treatment with medications, the introduction of remineralizing drugs and the installation of a filling. In the absence of treatment of this disease, further destruction of the dentin and damage to the pulp (nerve) of the tooth occurs - pulpitis and, as its further outcome, periodontitis.

B) complicated caries(pulpitis, periodontitis)

This classification takes into account the depth of the process, which is important for choosing a treatment method.

Classification according to the severity of the process

Clinical observations have established that the severity and speed of the carious process determine the methods and tactics of treatment. According to their results T. V. Vinogradova a classification of caries according to the severity and prevalence of the carious process was proposed:

Compensated form. With this form, the average intensity of caries is less than the average intensity for this age group. The process is slow, existing carious cavities are lined with hard pigmented dentin (chronic caries).

Subcompensated form. The average intensity of caries is equal to the average for this age group.

Decompensated form, or "acute caries". The average intensity of caries is much higher than the average for this age group. With this form, the carious process occurs intensively, multiple carious cavities are observed, which are filled with soft dentin. The extreme form of acute caries is the so-called "systemic lesion" of teeth by caries, in which all or almost all teeth in the cervical region are affected.

Caries is a disease known in all corners of the globe, and it is difficult to find a person who would not have faced this problem at least once in his life. The disease affects hard, thinning enamel and penetrating into the deep layers of dentin, creating a carious cavity in them. Most often, damage is visually noticeable, except when only the deep layers of tissues are damaged.

Causes of the disease

Dentists identify a lot of theories for the occurrence of carious lesions, but the main ones remain unchanged:

Abuse of excessively salty or sweet foods.
Lack of carbohydrates and vitamins in the diet.
Low content of strengthening fluorine in tooth enamel.
Neglect of oral hygiene.
Infectious diseases.
genetic predisposition.
Features of the structure of the tooth, the presence of natural grooves on the surface of the enamel, in which microorganisms accumulate, prone to subsequent decay.

All of the above factors to some extent affect the acid-base balance of the oral cavity, creating a favorable environment for the development of pathogenic bacteria under the tooth enamel. As a result of the gradual washing out of calcium from the dental tissue, the enamel is destroyed, and a carious cavity is formed. There are many criteria by which the classification of caries is built, and this is quite justified. An extended classification according to several parameters allows you to make the most reliable diagnosis, determine the degree of neglect of the process and treatment options for the disease.

Black classification

The most used by dentists is the Black classification of caries. It reflects not only the location of carious destruction on the surface, but also the depth of the studied lesion. Designations of a variety of the latter occur through classes - the higher the class, the more neglected the disease:

WHO/ICD 10 classification

The classification of caries according to WHO (World Health Organization) is based on the identification of a specific affected area and highlights the following points with codes:

The classification of caries according to is considered the most popular in the practice of modern dentists. It is convenient in that it has clarifications in the form of paragraphs devoted to a suspended illness and its other types.

Classification according to the primacy of the disease

Dental practice divides caries according to the frequency of occurrence:

Primary - on a previously undiseased tooth, caries is formed, the etiology, the classification of which occurs through analysis and relation to one or another category.
Secondary, or recurrence, - appears on the surface of the organ, previously subjected to sealing. It occurs due to a violation of the fit of the filling to the tissues of the tooth, as a result of which a gap is formed in which a favorable environment is created for the development of pathogenic bacteria.

Topographic classification

This is a gradation that distinguishes the types of caries according to the degree of canal damage. It is as common in determining the diagnosis as the classification of caries according to ICD 10. The following stages of damage are determined:

Classification by intensity

According to the intensity of infection of the oral cavity, 2 types of the course of the disease are distinguished:

Among patients with multiple caries, there are often people with diseases of the cardiovascular system. If the disease affects the teeth of a child, most likely, he had been ill with scarlet fever or tonsillitis. Careful prevention of multiple caries for a child under three years of age is the silvering of milk teeth.

Classification according to the formation of complications

Untimely treatment of patients with dental diseases is observed quite often. It is not difficult to guess what such ignoring of the problem is fraught with. Of course, today there is also a classification of caries by complications. According to her, it happens:

Complicated. The disease is accompanied by inflammatory processes in the oral cavity. Flux is a variation.
Uncomplicated. The classification of caries makes it possible to understand that this is a type of disease that proceeds according to generally accepted stages, including superficial, medium and deep.

The rate of development of the carious process

The development of the disease occurs in each person with varying intensity depending on external factors and individual characteristics of the body. There are several categories of caries:

Spicy. Symptoms of the disease appear very quickly - within one to two weeks.
Chronic. The disease develops over a longer time and is characterized by the appearance of yellowish or brown spots on the affected surface of the enamel.
Flowering. Progressive type, in which multiple enamel lesions are observed in a relatively short time.

Features of the course of the disease in children

Classification of caries in children is carried out according to the same criteria as in adults. In pediatric dentistry, there is also a gradation according to the intensity, the primacy of the disease, the presence of complications, etc. The only distinguishing feature is the division into caries of the milk and permanent tooth.

Carious lesions of the mammary organs cause no less discomfort than permanent diseases. In children, caries is much more common than in adults, so it is necessary to accustom the child to proper oral hygiene as early as possible and limit the use of sweets. Considering that milk teeth are still temporary, the treatment tactics may differ slightly from the treatment of a permanent tooth.

Silvering of milk teeth in children

Modern parents during a preventive visit to the dentist are faced with such a thing as silvering teeth in a child. This procedure is carried out in order to prevent and treat the initial stages of caries. In fact, the process is a "freeze" of the course of the disease.

The procedure is painless, during which the dentist applies a special composition containing silver to the tooth enamel using a cotton swab. A protective film is formed on the teeth, which prevents the settling and development of pathogenic bacteria on the surface of the enamel.

Features of the clinical course of the carious process in children are associated with the nature of the structure of the hard tissues of the tooth and the properties of the reactivity of the child's body. In children with various chronic diseases, in violation of the general condition and quality of oral care, dental caries occurs especially often.

For many years, various authors have proposed the allocation of various clinical forms of caries. In 1972 T.F. Vinogradova, on the basis of a clinical analysis of the dynamics of the development of dental caries in several thousand children of various age groups, proposed, depending on the degree of activity of the carious process, to distinguish three forms of caries:

I degree of activity - compensated form of caries;
II degree of activity - subcompensated form of caries;
III degree of activity - decompensated form of caries.

To characterize each of these forms, the author is based on the average value of the intensity of dental caries,(indicator of KPU teeth) of the corresponding age group. The number of carious cavities, their localization, the increase in the intensity of caries and other indicators are also taken into account.

Compensated form of caries. Dental tissues in children of this group are highly resistant to the pathological process. Index KPU 3 is equal to or less than 5. The first molars are affected mainly. Carious cavities are localized on surfaces typical for caries (chewing, approximal), have dense, pigmented walls and bottom. The increase in intensity is low (up to 0.9). The transition of uncomplicated forms of caries to complicated ones occurs no earlier than after 12 months. Based on this, the frequency of examination of such children for timely sanitation is 1 time per year.

Subcompensated form of caries. Dental tissues are less resistant to caries than in children of group I, however, the destruction is not as fast as in children of group III. Index KPU 3 ranging from 6 to 8. Chalk-like spots of carious nature are absent. The term for the transition of uncomplicated forms of caries to complicated forms is 7 months. For timely rehabilitation of such children, it is necessary to examine - 2 times a year.

Decompensated form of caries.Characterized by the rapid development of destructive processes in the hard tissues of the tooth. Affected tissues are soft, slightly pigmented, moist, easily removed by an excavator. Caries affects all groups of teeth. Carious foci are localized not only on typical surfaces, but also on the so-called "immune" zones (labial, lingual, palatine surfaces, molars, mandibular incisors). The intensity of caries is very high. The KPU 3 index is more than 8. More than 2 carious cavities can fall on one affected tooth. Many teeth with complicated forms of caries, destroyed, subject to early removal. Pulpitis and periodontitis proceed as primary chronic processes with mild symptoms. The rate of transition from uncomplicated caries to complicated is 3.3 months. There is a high increase in the intensity of caries (2.2). Children of this group are characterized by the presence of focal demineralization of teeth (chalky spots of a carious nature), poor hygienic condition of the oral cavity (GI-3.0). Laboratory studies indicate a decrease in nonspecific resistance of the organism. Many children have chronic somatic diseases. Children with a decompensated form of caries for the purpose of rehabilitation should be examined every 3 months.

Clinic of caries depending on the degree of activity of the carious process.

superficial caries.

Superficial caries is clinically characterized by the presence of an enamel defect reaching the enamel-dentin border. In some cases, a carious spot without a visible defect is visually determined.

With superficial caries, most children do not show any complaints or may complain of pain from chemical (sweet, salty) irritants, which quickly disappear after their elimination. Probing of the carious cavity is almost always painless. The clinical picture is directly dependent on the activity of the carious process.

With a compensated form of caries, the lesion is single, the process is often localized in the fissures of the molars and premolars. The enamel defect is rough, but dense, pigmented, prone to process stabilization.

In the decompensated form of caries, several teeth are simultaneously affected, the localization of cavities can be on the chewing, proximal surfaces, the cervical region, as well as on the "immune" zones in the region of the molars and the cutting edges of the incisors and canines. When probing, light, pliable, softened enamel is determined. The carious process is not inclined to stabilization and very quickly passes into the next stage - medium caries.

Superficial caries is differentiated with an erosive form of hypoplasia, fluorosis, and with caries in the stain stage.

With systemic hypoplasia, unlike caries, spots and defects are symmetrical, located parallel to the cutting edge and are detected on all teeth that form in one period of development, when probing is smooth, painless.

With chalk-speckled and erosive forms of fluorosis, any surfaces of different groups of teeth are affected. Lesions are diverse in size and shape, painless, resistant to caries.

With caries in the stain stage, in contrast to superficial caries, when probing, the enamel is smooth and painless.

Superficial caries in the area of fissures differentiates from deep non-mineralized fissures, which are diagnosed as soon as possible after teething.

Medium caries

Medium caries is characterized by the presence of a carious cavity reaching approximately the middle zone of dentin (lesion within the mantle dentin). Above the pulp, respectively, the affected area remains a powerful layer of healthy tissue. At the bottom of the cavity, the dentin is partially softened. Pain sensations arise from various stimuli (mechanical, thermal, chemical). When they are removed, the pain quickly disappears. Sometimes children complain of discomfort when food enters the carious cavity. In temporary teeth, medium caries is often asymptomatic and is detected during preventive examinations by a dentist.

During an objective examination, probing in the area of the enamel-dentin border is usually painful, sensitivity in other areas is absent or significantly reduced.

With a compensated form, lesions are localized in "typical" zones - on the chewing and approximal surfaces of the tooth. Carious cavities with smooth edges, the adjacent area of the enamel is not changed in color. The dentin of the walls and bottom of the cavity is pigmented, dense, difficult to excavate.

With a decompensated form of caries, characterized by the defeat of a larger number of teeth, carious cavities can be localized on any surface, including in atypical, so-called "immune" zones. The enamel in the center of the lesion is destroyed, along the edges of the defect - fragile, undermined. Dentin is light, moist, easily removed by an excavator, after which a relatively dense light bottom of the carious cavity is determined.

Differentiation of medium caries should be with deep caries. With medium caries, the depth of the carious cavity is within the mantle dentin, probing is painful along the enamel-dentin border, and with deep caries, the carious cavity reaches the pulpal dentin, which is painful when probing along the entire bottom. The need for differential diagnosis of secondary caries with chronic gangrenous pulpitis and chronic periodontitis is associated with the possibility of developing complicated forms of caries in children in teeth with a relatively shallow carious cavity that does not communicate with the tooth cavity. In chronic periodontitis, there is no pain from various irritants, and with moderate caries, short-term pain is noted after exposure to thermal and mechanical stimuli. On the radiograph with caries, there are no changes in the periapical tissues, and with chronic gangrenous pulpitis and chronic periodontitis, bone resorption is noted in the periodontal area.

deep caries.

Deep dental caries in children is the last stage of uncomplicated caries, which is characterized by a pronounced destruction of the hard tissues of the tooth with the formation of an extensive carious cavity. A thin layer of softened or pigmented dentin remains above the pulp chamber.

Due to the morphological and functional features of the dentin and pulp in children, deep tooth decay is always accompanied by pronounced reactive and degenerative changes in the pulp. Therefore, when diagnosing deep caries of temporary and permanent teeth with unformed roots, special care should be taken.

With deep caries, children complain of acute short-term pain after eating from temperature, chemical and mechanical stimuli, after the elimination of which the pain quickly disappears.

Deep caries in children with a compensated or subcompensated form is characterized by a slow development of the process, as a result of which the phenomena of demineralization, the formation of replacement dentin and the remineralization of the walls of the carious cavity proceed almost simultaneously. On examination, dense walls and the bottom of the cavity, painted in a brownish color, are found. Probing of the dentin is slightly painful along the entire bottom.

In children with a decompensated form of caries, with a deep carious lesion, replacement dentin, which performs a barrier function against infection, often does not have time to form. As a result, there may be clinically detectable signs of pulpal irritation. Dentin is supple, light. Excavation of softened dentin, as well as probing the bottom of the cavity, is painful, especially in the region of the pulp horns. The pulp chamber was not opened.

Deep caries in children must be differentiated from medium caries, acute focal pulpitis, and chronic fibrous pulpitis.

For acute focal pulpitis, unlike deep caries, spontaneous pains with long light intervals, night pains are characteristic. Probing the bottom of the carious cavity is painful at one point, in the projection area of the focus of inflammation of the pulp. For chronic fibrous pulpitis, in addition to the nature of pain, the presence of a carious cavity is distinctive, often communicating with the cavity of the tooth at one sharply painful point, which opens after the removal of softened dentin.

In children, X-ray diagnostics is sometimes used to clarify the diagnosis of "deep caries". According to the radiograph, you can determine the shape and size of the carious cavity, roughly determine the thickness of the supra-pulp layer of dentin, and the absence of changes in periodontal tissues.

The use of the method of electroodontodiagnostics in children is very limited. However, with good contact with the child, it is possible to carry out EOD. The electrical excitability of the pulp in deep caries in permanent teeth with formed roots is close to normal and is within 10 μA.

The diagnosis of "Deep caries" in temporary teeth is extremely rare. For the purpose of differential diagnosis in temporary teeth, softened dentin should be completely removed with an excavator. If at the same time the tooth cavity is opened, then it is easy to clarify the diagnosis: the presence of a painful bleeding pulp indicates an asymptomatic chronic
chronic fibrous pulpitis, necrotic coronal pulp - a sign of chronic gangrenous pulpitis or chronic periodontitis. If, after removal of the softened dentin, the bottom is dense, light or slightly pigmented, it is possible to treat the tooth as deep caries with the imposition of a medical pad. In small crying children with a deep cavity, it is sometimes useful to cover the cavity with a bandage of water dentin (diagnostic bandage) for several days in order to clarify the diagnosis.