Necrosis of hard dental tissues - serious disease dental system. If necrosis is not treated in a timely manner, it will lead to impairment of chewing function.

Today, every year doctors record cases of necrosis of hard dental tissues. And the percentage of cases is only increasing every year.

Causes of the disease

They can provoke the development of a pathological process various reasons. They can be both external and internal factors.

External factors:

• Eating foods rich in food acids.
• Impact of production acids on the enamel layer (costs of the profession).
• Radiation exposure.
• Electromagnetic radiation.

It should be noted that necrosis caused by electromagnetic radiation appeared not so long ago. Typically, this type of necrosis is observed in people who spend most of their time at the computer. As a rule, programmers are included in this group of people.

Internal factors:

• Disruption of the endocrine system.
• A disease that affects the central nervous system.
• Long-term intoxication of the body.
• Pregnancy period.
• Hereditary factor.

The most favorite localization of lesions in necrosis of hard dental tissues is the cervical region of the frontal group of teeth. Rarely, cervical lesions appear on large molars.

How does the disease progress?

First, a small white formation appears with a shiny surface. If treatment is not started at this stage, then these small spots, in a short period of time, increase in size and lose their shine. From this moment on, the lesions are no longer smooth, but acquire some roughness.

If treatment is not started now, the enamel layer under the lesion will very quickly collapse, exposing the dentin. Necrosis will begin to rapidly destroy the underlying layers of the tooth.

The enamel of the affected teeth becomes so fragile that it can be scraped off the surface of the tooth without much effort.

If the enamel layer of the teeth begins to lose shine and becomes rough, this may indicate initial stage necrosis of hard dental tissues.

First, white small spots appear on the teeth, which over time acquire big sizes. The color of the lesion also changes over time, acquiring a brown tint.

The enamel of teeth exposed to necrosis becomes very fragile. Therefore, if you probe pathological foci, you can detect areas of destruction.

Patients suffering from necrosis complain of pain in the teeth from any irritant: sour, sweet, cold, hot. Sometimes the pain becomes unbearable. As soon as the impact is eliminated irritating factor, the pain stops immediately.

It is necessary to point out once again that teeth located in the anterior part of the dental arches are most often susceptible to necrosis. And necrotic foci appear on the vestibular surface of the tooth, most often in the cervical area.

How to diagnose a pathological process?

Typically, patients suffering from necrosis of hard dental tissues come to see a specialist with the corresponding complaints: stains on the teeth and increased sensitivity.

It is not difficult for a qualified dentist to make a diagnosis after examining the oral cavity. But sometimes there are still cases when necrosis is mistaken for a wedge-shaped defect or erosion.

Such errors arise because all three forms pathological processes have one localization.

However, if you collect a complete history and carefully examine the lesions, it becomes clear that these forms have significant differences among themselves.

Dentists, after making a diagnosis of necrosis of hard dental tissues, try to choose a treatment that will lead to strengthening of the enamel layer and the disappearance of sensitivity.

However, if the patient seeks specialized dental care on late stage diseases, when the dentine layer is included in the process, then the only treatment option remains - prosthetics from an orthopedic dentist.

In any case, treatment will consist of several stages:

1. External examination and examination of the oral cavity.
2. Conversation with the patient to find out the causes of the disease.
3. Selection of adequate treatment.
4. Recommendations for the patient.

The dentist informs the patient about the need hygiene care behind the oral cavity, even with existing sensitivity. Selects individual hygiene products and a method of brushing his teeth.

It is important that the patient follows all the recommendations of the attending physician. After the cause of the disease is determined, the patient must eliminate the pathological factor from his life, but this is not always possible, especially in patients with tumors who are undergoing radiation therapy. Then symptomatic treatment is carried out, covering the teeth in the affected areas with agents that help strengthen the enamel layer. Typically, these products contain calcium phosphates. In addition, sensitive areas are covered with special varnishes that reduce pain.

The patient must expect that the treatment will be long. It is impossible to achieve strengthening of enamel in several sessions.

Disease prevention

For cancer patients, special lead mouth guards were invented to reduce the pathogenic effects of radiation rays on dental tissues. Patients are required to wear these aligners before each radiation treatment. In addition, dentists recommend preparatory therapy before each radiation therapy session: remineralizing therapy in combination with a course of antioxidants.

If necrosis appears as a result of harmful production, then the management of these production workshops should take care to install powerful supply and exhaust ventilation. In addition to ventilation, a good preventive measure in acid production is the installation of columns with water containing alkaline environment. Workers should rinse with this water oral cavity several times a day, preferably every 120 minutes.

People working in such industries must be in special dispensary observation in dental clinics.

Quite often there is a chemical or acid necrosis hard tissues of teeth. Household chemical necrosis is associated with constant use of hydrochloric acid for diseases gastrointestinal tract, with the use large quantity acid-containing food products, drinking, taking medications.

Occupational acid necrosis is the result of the action of a pair of inorganic and organic acids (hydrochloric, formic, etc.) and is observed in people working at chemical plants.

Etiological The factor is acid. It is associated with the direct action of acids and their pairs on tooth tissue, resulting in both necrosis of the organic substance and chemical dissolution of the mineral substrate of the enamel. Histologically thinning of the enamel, loss of its prismatic structure, deposition of replacement dentin, obliteration of the tooth cavity, vacuolar degeneration of the pulp, reticular atrophy are determined. During electronic examination, areas of destruction in the form of an amorphous demineralized zone are observed in the enamel and dentin.

Clinic. One of the first clinical signs Acid necrosis is a feeling of teeth on edge; there may be complaints of a feeling of “sticking” of the upper teeth to the lower ones when the jaws are clenched. Subsequently, increased sensitivity to temperature and mechanical stimuli is revealed. Over time, these sensations become dull and disappear due to the deposition of replacement dentin or pulp necrosis. The vestibular surfaces and the cutting edge of the frontal group of teeth are affected first, followed by the closure surfaces and contact surfaces of all teeth. On early stages the area of ​​enamel damage looks matte, rough, not demarcated from the surrounding tissues. Subsequently, there is a rapid decline in the hard tissues of the tooth in an oblique direction from the cutting edge to the neck of the tooth. The cutting edge becomes thin, the teeth - shorter, resembling a wedge shape, are destroyed both in width and thickness, gaps form between the teeth, and the bite decreases. When enamel is lost, pigmented areas of dentin become dark.

Classification acid necrosis:

The first stage is the loss of only enamel;

The second stage is the loss of enamel and dentin;

Third degree - loss of enamel and dentin with the formation of secondary dentin;

The fourth degree is loss of enamel and dentin, accompanied by damage to the pulp. The pulp necrotizes painlessly, but if it progresses very quickly, there may be clinically pronounced inflammation.

Differential Diagnosis of acid necrosis is carried out with caries in the spot stage, with superficial and medium caries, with hypoplasia, erosive and destructive forms of fluorosis, and hereditary dental lesions. With amelogenesis imperfecta, marble disease, Stanton-Capdepont syndrome, signs similar to acid necrosis appear in the form multiple lesions teeth with a change in their color and rapid decline of hard dental tissues with a decrease in bite. The time of onset of pathology varies ( hereditary pathology is formed before teething), with acid necrosis, a connection is established with the etiological factor - the work of patients at chemical plants, etc. Hypoplasia and fluorosis, in contrast to acid necrosis, are formed during the formation of tooth tissue and appear immediately after their eruption. Hypoplasia is characterized by symmetry and systematicity of the lesion, smooth, shiny enamel. With fluorosis, the lesions are also multiple, as with acid necrosis, but have dense tissue and a smooth, shiny surface. Their appearance is associated with excess fluorine content in water, endemic foci. Common ground between multiple caries and acid necrosis - these are defects in the hard tissues of the tooth, they have a rough surface, lacking shine, density, with uneven edges, pain on probing, a progressive course, with complaints of pain from irritants. The differences between them are as follows: the localization of caries is limited to characteristic areas - the cervical, contact surface, fissure, pit, and with acid necrosis the lesions are extensive, occupying almost the entire vestibular surface with transition to the contact surfaces. With caries, there is no pronounced abrasion of the hard tissues of the tooth and changes in the shape of the crowns of the teeth (with caries hard tissues teeth are destroyed within the defect). In acid necrosis, unlike caries, the presence of occupational hazard, and therefore a more progressive course of the disease is observed. Differential diagnosis of acid necrosis with a wedge-shaped defect and erosion presents fewer difficulties (the location, shape, type of defect, and the course of the process will be different).

Treatments. General treatment begins with stopping or minimizing exposure of teeth to the chemical agent. Calcium gluconate (or calcium glycerophosphate) is prescribed orally 0.5 x 3 times a day for 3-4 weeks with a break of 2-3 months; multivitamins. Remineralizing therapy is applied locally.

In case of significant defects after complex remineralization therapy, glass ionomer cement is used to restore the defects.

Yu.A. Fedorov, V.A. Drozhzhina (1997) propose treatment of acid necrosis, taking into account the degree of its manifestation and severity: in the initial forms, complex retherapy is prescribed for 3-6 months (calcium glycerophosphate 1.5 g per day for 30 days in a row; “Klamin” 1-2 tablets, or "Fitolon" 30 drops 2-3 times a day 15 minutes before meals for 60 days in a row; multivitamins "Kvadevit" 2 - 3 tablets per day for 30 days brushing teeth and applying for 15 minutes using phosphate-containing dental pastes “Pearls”, “Cheburashka”, “Bambi” daily for 5 - 6 months in a row). Well general treatment repeats every 3 months. If there are significant tissue defects after complex retherapy is carried out after 3-6 months rehabilitation treatment using glass ionomer cements, and when the bite is reduced - through rational prosthetics.

Prevention is important:

Compliance with safety regulations;

Improving working conditions - ventilation of premises, use of filters, absorbers, personal protective equipment;

Mouth rinses alkaline solutions every 2 hours; full-fledged balanced diet With obligatory use dairy products, fruits, vegetables;

To prevent household chemical necrosis, it is necessary to use glass tubes for taking acidic drugs, rinse your mouth with alkaline solutions, and apply fluoride-containing pastes;

Medical examination, during which preventive treatment of teeth is carried out. Remineralizing solutions and fluoride compounds.

Acid (chemical) necrosis of teeth is the result of local influences. This lesion is usually observed in long-term workers in the production of inorganic (hydrochloric, nitric, sulfuric) and somewhat less frequently organic acids. One of the first clinical signs of acid necrosis is a feeling of sore throat, increased sensitivity to temperature and mechanical stimuli. Sometimes there is a feeling of teeth sticking when they are closed.

Emergence the specified pathology primarily associated with the direct effect of acids on tooth enamel. In the workshops of such industries, acid vapors and gaseous hydrogen chloride accumulate in the air, which, when entering the oral cavity, dissolve in saliva. The latter becomes acidic and decalcifies the hard tissues of the tooth.

The progression of chemical necrosis of hard dental tissues changes appearance enamel of the teeth of the frontal group: it becomes matte and rough. Sometimes the enamel takes on a dirty gray tint or other dark pigmentation. The abrasion of dental tissues is sharply expressed.

With acid necrosis, the incisors and canines are most severely affected. The enamel disappears in the area of ​​the cutting edges of the crowns; in this case, sharp, easily breakable sections of the tooth crown are formed. Then the process of destruction and abrasion spreads to the enamel and dentin of not only the vestibular, but also the lingual surface of the incisors and fangs. The crowns of these teeth are shortened, the cutting edge becomes oval, and the crown takes the shape of a wedge. Gradually, the crowns of the front teeth are destroyed to the gingival margin, and the group of premolars and molars is subjected to severe abrasion.

Mild forms of acid necrosis can be observed in patients with achilic gastritis, who, for the purpose of treatment, are forced to take orally a 10% solution of hydrochloric (hydrochloric) acid. At the same time, there is increased abrasion of the cutting, edges of the incisors and the chewing surface of large molars.

Treatment. The same as with necrosis of hard dental tissues.

Prevention. Prevention of acid necrosis of teeth is carried out primarily by designing supply and exhaust ventilation in workshops in which columns with alkaline water for frequent rinsing of the mouth. As observations have shown, workers should carry out this procedure every 1 1/2 - 2 hours.

All chemical production workers must be registered with a dispensary. Preventive treatment of teeth with fluoride preparations and remineralizing solutions is carried out during clinical examination.

Acid necrosis of teeth

Acid (chemical) necrosis of teeth is the result of local influences. This lesion is usually observed in long-term workers in the production of inorganic (hydrochloric, nitric, sulfuric) and somewhat less frequently organic acids. One of the first clinical signs of acid necrosis is a feeling of sore throat, increased sensitivity to temperature and mechanical stimuli. Sometimes there is a feeling of teeth sticking when they are closed.

Causes of acid necrosis of teeth:

The occurrence of this pathology is primarily associated with the direct effect of acids on tooth enamel. In the workshops of such industries, acid vapors and gaseous hydrogen chloride accumulate in the air, which, when entering the oral cavity, dissolve in saliva. The latter becomes acidic and decalcifies the hard tissues of the tooth.

Pathogenesis of acid necrosis of teeth:

The progression of chemical necrosis of hard dental tissues leads to a change in the appearance of the enamel of the front teeth: it becomes matte and rough. Sometimes the enamel takes on a dirty gray tint or dark pigmentation. The abrasion of dental tissues is sharply expressed.

With acid necrosis, the incisors and canines are most severely affected. The enamel disappears in the area of ​​the cutting edges of the crowns, and sharp, easily broken off areas of the tooth crown are formed. Then the process of destruction and abrasion spreads to the enamel and dentin of not only the vestibular, but also the lingual surface of the incisors and fangs. The crowns of these teeth are shortened, the cutting edge becomes oval, and the crown takes the shape of a wedge. Gradually, the crowns of the front teeth are destroyed to the gingival margin, and the group of premolars and molars is subjected to severe abrasion.

Mild forms of acid necrosis can be observed in patients with achilic gastritis, who, for the purpose of treatment, are forced to take orally a 10% solution of hydrochloric (hydrochloric) acid. In this case, there is increased abrasion of the cutting edges of the incisors and the chewing surface of large molars. To prevent this, it is recommended to take acid through glass or plastic straws.

Treatment of acid necrosis of teeth

If lesions occur, measures are taken to help eliminate hyperesthesia and strengthen dental tissue. If there is significant tooth decay, orthopedic treatment is indicated.

Prevention of acid necrosis of teeth:

Prevention of acid necrosis of teeth is carried out primarily by designing supply and exhaust ventilation in workshops in which columns with alkaline water are installed for rinsing the mouth. As observations have shown, workers must carry out this procedure every 1/2-2 hours.

All chemical production workers must be registered with a dispensary. Preventive treatment of teeth with fluoride preparations and remineralizing solutions is carried out during clinical examination.

Dental injuries - tooth bruise, tooth dislocation, tooth fracture. Treatment.

Acute tooth trauma occurs immediately efficient cause. Often patients do not seek help immediately, but after a long period of time. This makes it difficult to diagnose and treat such lesions. The type of injury depends on the force of the blow, its direction, and the location of application. Great importance has age, dental and periodontal condition.

Acute trauma in 32% of cases causes destruction and loss of anterior teeth in children.

In temporary teeth, the most common occurrence is tooth dislocation, fracture, and less commonly, crown fracture. In permanent teeth, the frequency is followed by the breaking off of part of the crown, then dislocation, bruise of the tooth and fracture of the tooth crown. Dental trauma occurs in children of different ages, however, temporary teeth are often injured at the age of 1-3 years, and permanent teeth - at 8-9 years.

Bruised tooth. In the first hours, significant pain occurs, which intensifies when biting. Sometimes a rupture occurs as a result of a bruise vascular bundle, there may be hemorrhage into the pulp. The condition of the pulps is determined using odontometry, which is carried out 2-3 days after the injury.

Treatment consists of creating peace, achieved by eliminating solid foods from the diet. In young children, the tooth can be excluded from contact by grinding the cutting edge of the antagonist crown. Grind the edges of the crown permanent tooth undesirable. In case of irreversible damage to the pulp of the affected tooth, trepanation of the crown, removal of the dead pulp and filling of the canal are indicated. If darkening of the crown occurs, it is bleached before filling.

Tooth dislocation. This is a displacement of the tooth in the socket that occurs when a traumatic force is directed laterally or vertically. In normal periodontal condition, significant force is required to displace the tooth. However, with bone resorption, dislocation can occur from hard food and be accompanied by damage to the integrity of the gums. It can be isolated or in combination with a fracture of the tooth root, alveolar process or jaw body.

· Complete tooth luxation is characterized by its falling out of the socket.

· Incomplete dislocation - partial displacement of the root from the alveolus, always accompanied by rupture of periodontal fibers over a greater or lesser extent.

· Impacted dislocation is manifested by partial or complete displacement of the tooth from the socket towards the body of the jaw, leading to significant destruction of bone tissue.

The patient complains of pain in one tooth or group of teeth, and significant mobility. Accurately indicates the time of occurrence and cause.

First of all, it is necessary to decide whether it is advisable to preserve such a tooth. The main criterion is the condition of the bone tissue at the root of the tooth. If it is preserved for at least 1/2 the length of the root, it is advisable to preserve the tooth. First, the tooth is placed in its original place (under anesthesia), and then it is kept at rest, excluding its mobility. For this purpose, splinting is carried out (with wire or quick-hardening plastic). Then the condition of the dental pulp should be determined. In some cases, when the root is displaced, the neurovascular bundle ruptures, but sometimes the pulp remains viable. In the first case, with necrosis, the pulp must be removed and the canal sealed; in the second case, the pulp is preserved. To determine the condition of the pulp, its reaction to electricity. The response of the pulp to a current of 2-3 μA indicates its normal condition. It should, however, be remembered that in the first 3-5 days after injury, a decrease in pulp excitability may be a response to traumatic exposure. In such cases, it is necessary to check the condition of the pulp over time (repeatedly). Restoration of excitability indicates restoration of a normal state.

If the tooth reacts to a current of 100 μA or more during repeated examination, then this indicates pulp necrosis and the need for its removal. If a tooth is injured, the root may be driven into the jaw, which is always accompanied by rupture of the neurovascular bundle. This condition is accompanied by pain, and the patient points to a “shortened” tooth. In this case, the tooth is fixed in the correct position and the necrotic pulp is immediately removed. It is recommended to remove it as early as possible to prevent decay and staining of the tooth crown in a dark color.

In case of acute injury, there may be a complete dislocation (the tooth is brought in by hand or the fallen tooth is inserted into the socket). Treatment consists of tooth replantation. This operation can be successful with intact periodontal tissues. It is carried out in the following sequence: the tooth is trepanned, the pulp is removed and the canal is filled. Then after treating the root and hole antiseptic solutions the tooth is inserted into place and fixed (in some cases, splinting is not necessary). If there are no complaints of pain, observation and x-ray control are carried out. The tooth root, replanted in the first 15-30 minutes after injury, is only slightly resorbed, and the tooth remains for many years. If replantation is carried out in more late dates, then root resorption is radiologically determined within 1 month after replantation. Root resorption progresses, and by the end of the year a significant part of it is resorbed.

Tooth fracture

Crown fracture does not present any diagnostic difficulties. Volume and character therapeutic intervention depend on tissue loss. If part of the crown is broken off without opening the pulp chamber, it is restored using a composite filling material. The exposed dentin is covered with an insulating lining, and then a filling is applied. Best results achieved when restoring the crown using a cap. If the conditions for fixing the filling are insufficient, then parapulp pins are used.

If a tooth cavity is opened during an injury, the first step is anesthesia and removal of the pulp; if there are no indications and conditions for its preservation, the canal is sealed. In order to improve the conditions for fixing the filling, a pin can be used, which is fixed in the canal. The lost part of the crown is restored with a composite filling material using a cap. In addition, an inlay or an artificial crown can be made.

It should be remembered that restoration of the broken part of the tooth should be carried out in the coming days after the injury, since in the absence of contact with the antagonist in short time This tooth moves and the adjacent teeth tilt towards the defect, which will not allow further prosthetics without prior orthodontic treatment.

Tooth root fracture. Diagnosis depends on the type of fracture and its location, and most importantly, the possibility of preserving and using the root. Decisive in diagnosis is X-ray examination.

The most unfavorable are longitudinal, comminuted and diagonal oblique fractures, in which roots cannot be used for support.

With a transverse fracture, much depends on its level. If a transverse fracture occurs at the border of the upper 1/3-1/4 of the root length or in the middle, then the tooth is trepanned, the pulp is removed, the canal is filled, and the fragments are connected with special pins. In case of a transverse fracture in the quarter of the root closest to the apex, it is enough to fill the canal of the larger fragment. The apical part of the root can be left without intervention.

After canal filling important has recovery correct position tooth and avoid injury when closing the jaws.

Most often, dental damage occurs in childhood and have their own characteristics of diagnosis and treatment, due to significant differences from damage to the teeth of an adult. Damage to teeth in children occurs more often as an independent type of injury and much less often in combination with injuries to other parts of the face.

IN last years this pathology is becoming more common. This is facilitated by the popularization of such types of sporting events as hockey, football and others that require forceful struggle during the game. The prevalence of this pathology has not been sufficiently studied. Data from M. Marcus (1951) indicate more high prevalence injuries of the anterior teeth - 16-20% of the total number of children examined. The upper incisors are most often affected by injury. The ratio of the number of injured upper to lower incisors is 3:1. Boys are injured 2 times more often than girls.

It should also be noted that in recent years the number of cases of complicated trauma has increased: odontogenic cysts of the frontal region; inflammatory processes this area, often leading to the cessation of the formation of the root system of the teeth and a decrease in the functional value of a tooth or group of injured teeth, which ultimately ends in their early loss. These types of complications indicate that many specialists are little familiar with the specifics of treatment traumatic injuries teeth in children.

Treatment of dental trauma in children at all stages can be limited to a period of several days or weeks, or can last up to 2-3 years.

This duration is determined by the severity of the injury, the degree of formation of the root system of the injured tooth and the method of its treatment.

Based on extensive experience and analysis of the results of treatment of this pathology, it is considered appropriate to divide the entire period of rehabilitation of a child with dental trauma into three stages.

· Stage I - initial treatment, which begins from the moment the child contacts the doctor until he is provided with specialized medical care.

At stage I, emergency care is provided to a child with a dental injury in any medical institution. A patient with a dental injury without damage to the soft tissues and bones of the facial skeleton and without a concussion should be referred to a dentist. Considering that this pathology is mainly dealt with by a pediatric dentist-therapist, it is better if the child, bypassing other specialists, immediately gets to him. The dentist-therapist is obliged to provide him with specialized assistance, and the sooner this assistance is provided, the better the long-term treatment results will be. This assistance includes the following actions: assessment general condition child, making a diagnosis, providing pain relief (if necessary) or prescribing analgesics. Delaying specialized treatment within 1-2 days entails fewer complications than hastily performed unqualified care, which often leads to irreparable complications resulting in the loss of a permanent tooth.

· Stage II of specialized medical care begins with collecting anamnesis, determining the cause of injury, including specialized treatment until clinical recovery. This includes:

· correct design medical documentation;

· taking anamnesis;

· carrying out clinical methods research (inspection, palpation, percussion);

· transillumination study;

X-ray examination;

based on the obtained clinical and additional methods research establishment correct diagnosis;

· carrying out specialized treatment.

· Stage III- follow-up treatment and restoration of function of injured teeth, clinical observation.

Dividing the rehabilitation of children with trauma into three stages helps proper provision medical care on each of them - from direction to to the right specialist before providing the patient with qualified specialized treatment.

It is generally accepted that necrotic damage (necrosis) of hard tissues of teeth is a rather serious disease, in advanced stages leading to a significant (from a physiological point of view) deterioration of the usual chewing function. As sad as it is to realize this, with each new year, the overall incidence of this disease (necrotic damage to hard dental tissues) increases noticeably.

Statistics say that today, the total number of people suffering from necrotic lesions of hard dental tissues is becoming significantly larger than what was recorded 10 or 15 years ago. In addition, today doctors are faced with the emergence of ever new (unknown ten years ago) forms of necrotic lesions of teeth, which creates certain practical difficulties in the treatment of such diseases.

The causes of the development of necrotic lesions (necrosis) of hard tissues of teeth can be a variety of factors. Moreover, the reasons for the development of this disease can relate to both external and internal influences.

If speak about external factors development of the problem, then the cause of some violation of the physiologically normal integrity of dense tooth enamel may be excessively frequent exposure of the teeth to various food acids. In such cases, doctors diagnose the so-called acid necrotic lesion (Necrosis) of hard dental tissues. Often this pathology can develop in people who work for a long time in large industrial enterprises, whose work is directly related to the use of certain aggressive acids, etc.

Another factor that obviously contributes to the partial or complete destruction of enamel may be powerful radioactive radiation, for example, we are talking about undergoing treatment courses of powerful radiation therapy. In addition, doctors identify another very special form of so-called computer necrosis. This is a condition where the problem develops primarily due to negative impact powerful electromagnetic radiation from computer monitors directly onto the enamel of our teeth.

But let’s say that endogenous (or internal) factors of the active development of necrosis include certain disturbances in the full functioning of the glands internal secretion, numerous diseases of the central nervous system (CNS). Chronic intoxication of the body with certain substances can contribute to the development of necrosis. normal pregnancy, and even just heredity.

Quite often, when the functionality of the thyroid gland decreases (with a disease such as hypothyroidism), a cervical form of necrotic damage to hard dental tissues can develop. No less often, cervical necrosis can occur in women carrying a baby.

It must be said that necrotic damage to hard dental tissues can be different in its varieties. This could be, for example, cervical necrosis, which is characterized by the formation of some necrotic foci directly in the area of ​​the necks of certain teeth - incisors, premolars or canines. We note that in extreme in rare cases necrotic lesions may form on the necks of molars.

This disease usually debuts with the primary formation of very small chalky spots, which differ from other problems by their shiny surface. Quite quickly over a short period of time, the area of ​​such whitish lesions increases. After a while, the spots lose their shine, and in return, on the contrary, a certain roughness appears.

A little later, the enamel with this disease becomes matte and changes its color to darker shades. Subsequently, directly on the areas previously affected by stains, the tooth enamel simply disappears and the dentin is almost completely exposed. Further, if the disease progresses, the boundaries of such dental lesions only increase noticeably over time.

At the most advanced stages, the enamel of teeth affected by necrosis becomes so weak and friable that it becomes possible to simply scrape it off with the simplest dental instruments. In addition, in patients suffering from cervical necrosis, as a rule, everything becomes as sensitive as possible.

Moreover, increased sensitivity extends to literally all types of existing irritants: it can be cold, too hot, salty or excessively sour food. It is believed that with a timely (usually urgent) visit to an experienced dentist, necrotic lesions of tooth enamel can be eliminated, thereby significantly inhibiting the further progress of such an unpleasant and dangerous disease.

Secondly, it certainly can be acid necrosis. Such a defeat solid tissues of certain teeth may arise as a result of a somewhat aggressive effect on tooth enamel certain acids and sometimes alkalis. It is generally accepted that at certain enterprises associated with the production of acids (or in other places where certain acids are used daily on a large industrial scale) a huge amount of so-called acid vapors can accumulate directly in the air.

Actually, such vapors can quite easily penetrate the oral cavity of any person who works daily at such an enterprise. Further, after the initial entry into the oral cavity, acidic vapors mix (and quite easily) with saliva, thereby making it acutely acidic. As a result, acidic saliva gradually begins to destroy tooth enamel, washing out calcium from them every day.

The most dangerous for tooth enamel are considered to be nitric, sulfuric, as well as acetic, lactic and, of course, phosphoric acids. Some alkalis can be no less dangerous in this sense.

Most often, the acid variant of the disease is characterized by patients’ complaints of excessive increased sensitivity tooth enamel. For unbearable pain when exposed to even minimal temperature or mechanical external stimuli. In some cases, the disease is accompanied by a feeling of the teeth themselves sticking together immediately when they are habitually closed.

Often as it progresses of this disease the enamel may become downright rough; in some cases it may acquire an unpleasant grayish tint. As a rule, in the future, fairly rapid abrasion of the surface of the teeth can occur. After which some shortening and even destruction of the dental crowns is observed, and the destruction can occur right down to the nearest gingival margin.

Symptoms

Clinically, the manifestation of necrotic damage to dental tissues can begin with a simple loss of shine and smoothness of the enamel. Primary symptom necrosis can be called the formation of small chalky spots on the teeth; over time, such spots usually change color; they can even become dark brown.

As a rule, in the center of the pathological lesion, some softening of the tooth tissue and the formation of one or another defect may be observed. Note that in this case, the enamel itself can become extremely fragile, and can even be easily chipped off using a dental excavator. Often with necrosis, dentin is also highly pigmented.

It must be said that usually quite a lot of teeth can be affected by necrosis. With such a lesion, patients always complain of significant pain that occurs at the slightest impact on the tooth of temperature, elementary mechanical or chemical external stimuli. Such pains often go away very quickly literally immediately after the removal of the irritant itself.

It is generally accepted that such negative manifestations can occur against the background of certain disturbances or restructuring of the standard functions of our endocrine glands (we are talking primarily about the work of the thyroid gland and gonads). Necrosis often occurs during pregnancy, puberty, etc.

This disease is characterized by the formation of limited foci of necrosis of dental tissue directly on the vestibular surface, as well as in the area of ​​​​the necks of teeth (usually incisors, canines, or small molars). Note that necrosis of large molars can occur, but is still much less common.

As a rule, cervical necrosis will be characterized by the rather rapid appearance of very specific (typical) zones of so-called superficial demineralization. However, when studying specific sections of teeth that have whitish spots, with their polarizing microscopy, doctors usually find pronounced subsurface changes, despite the fact that the outer layer of enamel remains perfectly preserved.

In such cases, doctors can clearly see the so-called lines of Retzius; a central darkened zone with lighter areas along the periphery can be easily determined. Some authors argue that these are actually the main characteristic symptoms and signs for any carious lesion. And on this basis, it is believed that necrotic damage to the enamel is nothing more than an incredibly rapidly progressing carious process.

Diagnostics

Diagnosing this disease is not difficult. Moreover, such diagnostics usually take place in a regular dentist’s chair.

Nevertheless, the active, cervical type, necrodental enamel should always be clearly differentiated from the most pronounced (or advanced) stages of the so-called wedge-shaped defect, and also from advanced dental erosions.

It should be said that these diseases most often have real similarities solely in their localization of individual elements of the lesion. Namely, localization on the neck of a particular tooth or simply near it. At the same time, the appearance of specific foci of pathological lesions, meaning, with the three described types of pathology, will necessarily have significant and strictly characteristic features of a particular disease.

Prevention

It is believed that measures to prevent various forms of necrotic lesions (Necrosis) of hard dental tissues may be somewhat different and depend on which form of the disease may develop in a particular patient. For example, to reduce the powerful direct impact radiation exposure on the teeth (which can lead to the development specific forms necrosis) doctors can make individual lead mouth guards. These are devices that patients wear immediately before each of their prescribed radiation therapy treatments.

Doctors also talk about the need to reduce the indirect effects of so-called penetrating radiation by conducting a preliminary (used again, before each irradiation procedure) full (most often monthly) course of both general and local remineralization therapy. Moreover, it is desirable that this procedure was carried out in combination with the administration of a complex of antioxidants.

But let’s say they usually try to prevent acid forms of necrosis of dental tissues in global ways. More often this is done through the design of so-called supply and exhaust powerful ventilation in acid production. Such ventilation is usually installed to prevent necrosis, directly in production workshops.

By the way, in such workshops, columns filled with alkaline water can additionally be installed. In fact, it is necessary to rinse the mouth with such water throughout the day to prevent acid forms of necrosis. According to recent observations, workers in such industries should carry out alkaline rinsing procedures at least every two hours.

In addition, to prevent the development of this disease, literally all workers of large chemical production plants are required to be registered with a special dispensary and periodically undergo preventive examinations with a dentist. At the same time, doctors try to carry out preventive dental treatment with specialized fluoride preparations or modern remineralizing solutions directly during such medical examination.

Treatment

Almost always, when necrotic lesions of tooth enamel occur, doctors try to take all measures that can help eliminate severe hyperesthesia (sensitivity), and, of course, strengthen the tissues of the teeth themselves. Unfortunately, if the destruction of such teeth is too significant, only full orthopedic treatment can be indicated.

In the treatment of necrotic lesions of teeth, great attention is paid to eliminating excessive sensitivity of teeth when using external irritants. And here everything will depend not only on the experience and high qualifications of your attending physician, but also on the specific patient, since this problem is very complex.

In all cases, without exception, the dentist treating necrosis must select procedures for the patient only individually. The doctor must choose the right means for everyday hygienic care directly for the entire oral cavity. Teach how to properly clean affected teeth, etc.

Equally important will be unquestioning adherence to basic medical recommendations. After all, only through precise, targeted and, most importantly, systematic therapeutic actions can a patient achieve complete elimination of such an unpleasant dental problem.

It is also necessary that the doctor first try to find the main local reasons development of this disease, and the patient again tried to eliminate them. In case of moderate enamel pathology, when there is a slight exposure of the neck of the tooth, various varnishes or solutions can be used that slightly reduce pain.

But still, sometimes it is simply impossible to eliminate the causes of necrosis. For example, it is impossible to cancel a powerful radiation therapy, in a cancer patient in order to save his teeth, etc. And in this case, dentists recommend courses to restore the very integrity of the enamel. Most often, the sensitivity of restored teeth returns to normal gradually.