It seems that you can forget about caries after going to the dentist and getting a filling. In most cases this is what happens, but not always. Due to the unprofessionalism of the doctor or for other reasons, secondary caries may form. It is difficult for the patient to learn about its existence until the severe pain, and the disease will not develop into a more serious one.
Why can caries form under a filling?
Caries under a filling develops for various reasons:
It is unlikely that it will be possible to understand why recurrent caries occurred. Usually it is caused by several reasons.
Symptoms and diagnostic methods
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The patient will not be able to independently diagnose secondary caries, but it is enough to pay attention to the following symptoms:
Any of these signs or the condition of the tooth, as in the photo, is an indication for visiting the hospital. The doctor is able to determine the presence secondary caries upon visual inspection. However, this is not enough; a visiograph is often used to make a diagnosis.
Visiography appeared relatively recently; it allows you to correctly assess the condition oral cavity and prescribe the correct treatment. It has significant advantages over radiography:
- fast shooting process;
- safety – the radiation dose is ten times less;
- a clear image received on a computer monitor allows you to identify all foci of secondary caries.
The visiograph is used directly throughout the entire treatment period. It helps evaluate the effectiveness of therapy.
Treatment
Treatment methods for secondary caries depend on the volume of affected tissue. If secondary caries has not had time to develop in to the fullest, then the old filling is simply removed. The cavity is thoroughly disinfected, treated with medication and refilled. In some cases, only part of it is removed filling material where the defect is observed.
If the tooth is practically rotting, filling will not help. Either special inlays or prostheses are used. In advanced cases, the tooth is removed.
Removing old filling and re-filling
Re-filling is a procedure that requires special attention. In case of an error, there is a high probability of relapse; the tooth is unlikely to be cured again. The process takes place in several stages:
Photopolymer composites are often used as filling materials, differing for a long time service and high wear resistance. Dentist stains carious areas special means, which shows whether the affected tissue remains.
The doctor’s task is to install a high-quality filling without defects or gaps between the material and the tooth. The patient can help the dentist without interfering with his work:
- keeping your mouth wide open;
- without moving your tongue;
- without swallowing saliva;
- not talking;
- without making unnecessary movements.
Adhesive restoration
Sometimes, due to extensive damage to a tooth by secondary caries, a crown is installed on it after the defect is eliminated with a filling. Adhesive restoration – alternative way treatment of recurrent caries process. Its advantage is its minimal impact on the enamel and preservation of tooth integrity.
The procedure is carried out in one stage; the tooth affected by secondary caries is treated with an adhesive polymer. It restores damaged enamel and reduces its sensitivity.
Crowns and inlays
The dentist installs a crown if the use of other treatment methods is inappropriate, but if the tooth root is damaged by secondary caries, prosthetics are not possible. In this case, removal is indicated.
Crowns are made from various materials:
- medical steel alloys have an unaesthetic appearance, therefore they are used to treat chewing teeth;
- metal ceramics are durable and aesthetic;
- ceramics has the maximum similarity with natural color teeth, but is not able to cope with high loads.
The crown is made from an individual impression and is first placed temporarily. The reaction of the tooth is studied - if it is positive, the prosthesis is fixed on a permanent basis.
Microprosthetics – installation of special prosthetic inlays based on an impression. They are similar to teeth in color and shape, and are also tightly fixed without causing discomfort.
Can caries develop under a filling? The answer here is simple and categorical - yes. It is believed that in the first two to three years after filling the likelihood of a problem occurring is highest, however this complication cannot be tied to a specific time frame. It is also necessary to understand the terminology: sometimes experts mistakenly combine recurrent, or recurrent, and secondary caries. The differences here are obvious: recurrent caries develops on the site of a poorly treated old carious cavity, while the secondary covers earlier healthy tissue under the seal. However, the recurrent carious process is also partly secondary, has a similar nature and is treated using the same methods.
Why does caries develop under a filling? The disease occurs due to increased concentration pathogenic microorganisms. Several factors can lead to this.
Causes of caries under fillings
- During the preparation process, not all affected tissues were removed (the main cause of recurrent caries).
- Violation of antiseptic treatment rules. During the treatment, an infection was introduced, which provoked the proliferation of pathogenic microorganisms.
- Poor quality treatment of the tooth surface at the point of contact with the filling.
- Low quality filling material or significant shrinkage of the filling. Zinc phosphate and amalgam fillings are most susceptible to shrinkage. Caries under a light filling is less common, but this quality (albeit to a lesser extent) is also characteristic of them.
The above points are the main reasons for the development of secondary and recurrent caries, but there are also additional factors, increasing the risk of such complications. These include poor hygiene, poor nutrition, bruxism, mechanical and thermal effects on filled teeth.
Caries under filling: symptoms and diagnosis
Secondary caries under a filling is insidious in that it forms and develops secretly, so at first it is impossible to feel any manifestations of the disease (the so-called hidden caries under a filling). If this is secondary caries of a pulpless tooth, then the patient will be able to detect it on his own only if the filling falls out or the carious area extends beyond its limits. If the tooth pulp was preserved during the previous filling, deep caries under the filling manifests itself much more clearly. Below are symptoms that will help answer the question of how to recognize caries under a filling.
Signs of caries under a filling:
- pain, especially when pressing on the tooth;
- reaction to cold and hot;
- bad smell from the mouth, which occurs when secondary deep caries;
- change in color and mobility of the filling;
- inflammation of the gums in the area of the filled tooth, this is not one hundred percent confirmation that caries has developed under the filling, but in this situation you should definitely consult a doctor so that he can diagnose and take appropriate measures.
It makes almost no sense to talk about how to identify caries under a filling yourself. Accurate diagnosis Only a doctor can diagnose. Carious lesions can be identified using a classic x-ray or its more modern and safer variety - visiography (computer x-ray). A device called a visiograph allows you to take a targeted photograph of a tooth and instantly transmits the image to a computer screen.
Treatment of caries under a filling
Treatment of secondary caries is a complex procedure. This is due to the fact that the tooth already has a prepared cavity, and further removal of the affected tissue can destroy it or complicate filling. This is especially true for pulpless teeth, which themselves are very fragile. If we talk directly about the treatment of secondary caries under a filling, then the entire treatment procedure takes several stages.
Stages of treatment of secondary caries under filling
- removal of old filling
- preparation of carious cavity
- surface treatment antiseptic drugs
- application of an insulating pad
- filling
If deep caries under a filling is diagnosed, endodontic treatment is necessary. In some cases, the patient experiences additional complications (pulpitis under the filling, periodontitis, cyst, and others). In this case, the treatment and recovery process will take much longer.
Primary, secondary, tertiary prevention of caries
Primary, secondary and tertiary prevention of caries refers to a number of measures aimed at preventing and correcting the consequences of the disease in various stages. This classification is also relevant in the case of dental caries under a filling.
| Prevention of caries | Description |
| Primary prevention of caries | Preventing caries before the disease spreads. This includes taking vitamins, correcting nutrition and maintaining healthy image life (all together this is endogenous prevention). Another subtype of primary prevention is exogenous. This includes professional hygiene with a doctor, the use of products to strengthen enamel and teeth, and undergoing fluoridation and fissure sealing procedures. |
| Secondary prevention caries | Primary and secondary prevention of caries differ in that in the second case we are dealing with a formed carious cavity. Secondary prevention of dental caries is a complex of therapeutic and endodontic manipulations aimed at eliminating caries and preserving the tooth. |
| Tertiary prevention caries | Restoring a tooth that has been irreversibly damaged by caries using prosthetics or implantation. |
Secondary caries manifests itself as darkening of the tooth under the filling, as well as characteristic symptoms pathology. Treatment consists of re-preparation of the tooth, removal of all affected tissue and correct positioning fillings. To avoid repeated therapy, it is necessary to treat initially, as well as choose a competent specialist.
Causes of caries under fillings
Treatment includes the following steps:
- Anesthesia.
- Removal of the old filling and all affected tissue. Using a drill and bur, the specialist cleans the enamel and dentin from pathological process and microorganisms. The tooth is cleaned until complete elimination all pathologically changed tissues.
- Held antiseptic treatment fabrics using disinfectants.
- If there is an average and deep cavities A therapeutic pad is installed, which isolates the nerve from the external environment.
- Installation permanent filling. Light and chemical composites, cements, and amalgam are used to fill teeth. The most modern and best are light composite fillings, which harden under the influence of ultraviolet radiation.
- Final processing is carried out - polishing and grinding of the tooth.
Consequences
It is important to notice the development of the disease in time and consult a dentist. In the absence of treatment or late diagnosis, the infection spreads deeper and tissue destruction occurs, and pulpitis and periodontitis can occur. Treatment of these diseases involves and.
With timely and proper treatment no complications arise. The required amount of affected tissue is removed and filled. The prognosis of the disease is favorable.
Prevention
Prevention of the disease on the part of the patient includes careful selection of a specialist, as well as compliance with the rules hygiene care for teeth. It is recommended not to consume excessively solid foods nutrition, get rid of bad habits, periodically visit the dentist for a preventive examination.
Secondary caries is a complication due to improper or unscrupulous dental treatment. Unfortunately, the disease occurs in 20–30% of people after primary treatment. To prevent the development of complications, it is necessary to visit the dentist every six months for examination and prevention.
Useful video about secondary caries
Just because you have a filling placed does not mean that the tooth will always be healthy. Relapse occurs in approximately 30% of cases. A new carious lesion forms under the filling, which gradually destroys the enamel.
Secondary caries begins just a few months after the previous treatment, and in some patients - after 2-3 years. It all depends on the quality of the filling, the person’s immunity and proper care behind the oral cavity.
Why does caries form under a filling?
Relapse occurs due to gross mistakes by the doctor during treatment or as a consequence of improper dental care.
The main causes of caries under fillings:
- Shrinkage of filling material
Shrinkage is the reduction in size of a filling after it hardens. The problem is typical for photocomposites if they are not used according to the protocol. The material should be applied layer by layer, illuminating each layer with a photopolymer lamp. Shrinkage can also occur due to the long service life of the filling - 5 or more years.
- Poor quality junction of tooth enamel and filling
The filling material must be in tight contact with the walls of the tooth. Otherwise, the tightness is broken and a gap (microcrack) is formed. Bacteria will enter this gap and, over time, new caries will appear. Sometimes the gap is so large that food particles get stuck in it, which remain there and begin to rot.
- Erasing filling material
The filling wears out due to the fact that it was not “fitted” correctly or was not polished well enough. Another reason - malocclusion, which leads to increased chewing load on individual teeth. Or simply expiration of service life.
Poor treatment of primary caries
To cure a tooth, you need to thoroughly clean out all carious tissue. Even if the slightest infected area remains with pathogenic bacteria, the disease will begin to progress again, destroying the tooth from the inside. To prevent this from happening, the affected enamel is drilled out with a drill and the resulting cavity is washed with an antiseptic.
Secondary caries often develops due to the patient's negligence. For example, the integrity of a seal can be compromised simultaneous use cold and hot food, habit of chewing too much solid food, lack of oral hygiene.
Symptoms and signs of caries under a filling
The insidiousness of recurrent caries is that long time it goes unnoticed. And only on late stage the person notices the symptoms.
What to pay attention to:
- sensitivity to temperature and chemical stimuli - reaction to cold, hot, sour foods;
- darkening of the enamel around the filling - either the entire enamel or its edges darkens;
- mobility of the filling, feeling of its protruding edges; the appearance of cracks and chips.
What does caries look like under a filling in the picture?
Usually, a visual examination is sufficient to diagnose a relapse. But since the carious lesion is hidden under a layer of filling material, the doctor will need an x-ray.
The image clearly shows the depth and localization of the carious process. The filling blocks the passage of x-rays, so it will appear as white spot. And around this spot there is a dark border, this is secondary caries.
Treatment of secondary caries under a filling
Deep caries under a filling should be cured as quickly as possible, otherwise bacteria will penetrate into the pulp and inflammation of the dental nerve will begin (pulpitis).
Sealing
It is necessary to remove the old composite, clean out all carious tissues and carry out a second restoration. Filling is carried out according to a standard template: preparation with a drill, washing the cavity with an antiseptic, applying an insulating cement pad and layer-by-layer application of a photopolymer composite. The procedure takes about 20 minutes and is performed under local anesthesia.
To prevent recurrence of caries, the method of preventive filling is also used. It consists of sealing fissures - tubercles on the chewing surface of the teeth. These pits are filled with a liquid adhesive material so that food debris and bacterial plaque do not accumulate in them.
Tabs
Re-filling is more difficult, because after removing the old material, a wide cavity is formed. Sometimes there is so little “living” enamel left that there is no longer enough material to restore the tooth. In this case, ceramic inlays are used. These are microprostheses that are made in a dental laboratory using individual impressions of the patient’s teeth.
Inlays replace lost dental tissue, ideally restore the anatomical surface and shape of the crown, and have a color identical to natural enamel. They are considered more reliable and durable than any filling, but cost twice as much.
Treatment prices
Treatment of secondary caries under a filling together with anesthesia and x-ray will cost approximately 3500 rubles. Making an individual ceramic inlay costs about 8,000 rubles. The official guarantee is 6 months for cement fillings and 1 year for composite fillings; during this period you have the right to undergo re-treatment free of charge.
How annoying it is sometimes! Fear is defeated, willpower is taken into account, with a deep breath we sit in the dentist’s chair and go through the entire procedure of placing a filling from beginning to end. And after a couple of years, the brave man notes that a carious lesion is developing again under the old filling. What to do to heal a tooth once and for all?
Causes of secondary caries
Shrinkage of the filling
A common cause of recurrent caries is shrinkage of the filling.
Shrinkage is the reduction in size of a filling as it hardens. Accordingly, such a filling ceases to fit tightly to the walls of the tooth, and a microcrack is formed where carious microorganisms can exist and multiply.
Why does shrinkage occur? Firstly, this phenomenon occurs if the doctor uses low-quality cement to place a filling.
But, alas, even the most advanced and expensive material can shrink for one simple reason - if you do not work with it according to the protocol. Placing a filling in a damp cavity, exposing the light-curing material “in one piece” rather than in small portions – all this leads to the fact that the likelihood of secondary caries increases significantly.
Dentin affected by caries
Most important stage filling - removal of affected tissue
Everyone knows that before placing a filling, the doctor prepares the tooth tissue using a bur machine - the most unpleasant action in the entire treatment procedure, but also the most important. All that blackness that gapes at the site of caries in the tooth is softened dentin, speckled with bacteria and their waste products.
To permanently stop the destruction of tooth caries, all these affected tissues should be carefully removed through drilling to dense, hard dentin. The bottom and walls of the carious cavity should literally “creak” when the doctor runs his instrument over them - which means you can start filling.
I’ll tell you a little secret: if you want to help your dentist clean the carious cavity perfectly, try to behave decently in the chair. Patients who suddenly start jumping and screaming at any new sensation, or who refuse anesthesia, and then suddenly grab the doctor’s hand, cause an involuntary desire to finish the job as quickly as possible. The doctor begins to feel like a kind of Gestapo man, and in the bustle, trying to calm you down, he may miss a piece soft dentin in a secluded corner of the carious cavity. Only interaction with the dentist and joint efforts are the key to perfect tooth filling.
Symptoms of secondary manifestations of the problem
Pay close attention to changes in tooth color - darkening may indicate secondary caries
Let's look at a few main symptoms by which it is easy to determine the appearance of caries under a filling.
- Sensitivity to temperature stimuli of the tooth under the filling. At a minimum, this means that the filling does not adhere tightly to the dentin, and these same temperature stimuli penetrate into the filling-tooth microspace, causing sensitivity in delicate dentin. That is, if secondary caries has not yet begun in such a tooth, it has every chance of occurring.
- Darkening of tooth tissue around the filling– is also a very likely sign of the onset of secondary caries. If you notice in the mirror that the shade of the tooth has changed and gray dentin tissue is visible through the enamel, you should consult a doctor.
- Mobility of the filling, palpable with the tongue. Here, in general, there is nothing special to talk about - caries does occur, and such a filling will soon fall out. It needs immediate replacement. Food can get stuck between the filling and the tooth, causing an unpleasant odor. This situation in the mouth requires an urgent visit to the dentist.
Treatment of the disease
There is only one way out of the situation - re-staging new filling after complete removal old
Treatment of this disease goes according to the standard template, in all cases without exception:
- Complete removal of the old filling.
- Removal of necrotic carious dentin under a filling.
- Antiseptic treatment of the formed cavity.
- Placement of a new filling.
If you neglect the first point and leave part of the filling in place, secondary caries may occur again. In a situation where the filling takes most tooth, the doctor may suggest orthopedic treatment - placing a crown.
And this will be quite competent and justified, since after removing the filling and tissues affected by caries, almost nothing will be left of the tooth, and making a “patchwork quilt” from old and new fillings is very short-lived and can lead to further destruction.
Prevention of caries under fillings
Prevention of secondary caries is very conditional. Basically, it all depends on your attending physician and how and with what he fills the tooth. But even that small part that depends on the patient should be performed responsibly - open your mouth well, sit quietly in a chair, try not to move your tongue excessively and follow all the doctor’s instructions.
During the process of placing a filling, try to restrain the desire to cough, spit, or talk about the weather - these desires are quite natural, but can seriously harm the seal of the filling to the tooth tissue and cause secondary caries. And of course, one of the aspects of preventing secondary caries is to prevent primary caries. This is worth thinking about. Hello. My name is Inna. I am an obstetrician-gynecologist, head of the center