Formation of secondary caries under a filling: symptoms with photos and treatment of the defect. Causes and symptoms of caries under a filling, treatment of secondary tooth damage Treatment of secondary caries

A bacterial infection such as caries is distinguished by the fact that its activity continues even after treatment, at least until the pathogenic microflora is destroyed. The resumption of this disease is called secondary caries or it is also called caries under a filling.

The difficulty here is that the development of the disease in the secondary form may not manifest itself in any way, the disease affects deeper and deeper layers, and the patient does not feel any discomfort and the problem becomes obvious only during the treatment process, when the old filling is removed. It also happens that the disease affects tooth enamel, which has not previously experienced its harmful effects.

Soreness

After a visit to the dentist, patients often experience pain, this happens for the following reasons:

• increased sensitivity as a result of intervention in the oral cavity from the outside;
• the appearance of a cyst;
• development ;
• allergic reaction to the filling material used;
• inflammatory process in tissues and nerves;
• relapse of the disease.

The reason for the need to change old fillings

The question of the need to replace an old filling with a new one often arises before patients; many of them doubt whether this should be done, since the tooth does not cause any concern. However, it should be said that the appearance of caries under the crown is quite possible and this can be caused by very specific reasons, in particular, there may be a medical error, for example, incomplete removal of infected tissue. In addition, the filling does not last forever, its service life is on average about 5 years, and after that a variety of situations are possible.

Thus, we can say that replacement of the filling must be performed in the following cases:

• violation of the tightness of the seal due to which pathogenic organisms penetrate under it;
• severe wear of the seal as a result of its long service life;
• violation of anatomical proportions in the process;
• aesthetic unattractiveness of the installed product.

It is worth remembering that, despite the importance of the aesthetic component, health issues must be put at the forefront, therefore, if problems arise with installed fillings, you need to take care of their timely replacement.

Causes of secondary disease

Secondary caries can manifest itself for various reasons, the most common include the following:

• incorrect initial installation of a filling, when there is a difference between the tooth and the surface of the material used, which serves as a place for the accumulation of harmful microorganisms;
• insufficient level of enamel preparation for the installation procedure;
• incomplete removal of tissues affected by caries;
• Caries under a filling can develop if the first filling was too large.

Symptoms

As mentioned above, it is not easy to recognize secondary caries; however, there are certain symptoms, the appearance of which serves as an alarming signal and a reason for an early visit to the dentist. These include the following factors:

1. The appearance of pain in individual teeth.
2. Inflammation of the gums, their swelling.
3. Manifestation of bleeding gums.
4. The appearance of an unpleasant odor in the mouth.

You can also pay attention to some external signs, in particular, the filling will change its color either completely or along the edges, in addition, cracks or chips may appear in the enamel.

Risk factors and diagnosis

There are several external factors, the action of which contributes to the patient developing caries under the filling;

• prolonged exposure of the tooth to food that is too cold or hot;
• prolonged consumption of excessively hard foods or the habit of gnawing on something;
• excess friction as a result of malocclusion;
• insufficient attention to oral hygiene.

A specialist can diagnose the disease during a routine examination, however, this is not always enough and here X-ray and visiography data come to the aid of the dentist.

Secondary VS recurrent – ​​let’s understand the terminology

When they talk about secondary caries, they mean that under the filling placed on the tooth, new foci of the disease are formed. The reason for their appearance is microorganisms that have penetrated through cracks under the filling. In addition, secondary caries also affects the damage to tooth enamel, which is located near the installed filling.

The concept of recurrent caries includes the resumption of the disease in the place where previously treatment was carried out. In most situations, this occurs through the fault of the doctor, since either there was poor quality treatment of the affected area, or due attention was not paid to the use of antiseptics and the infection was not completely destroyed.

Development mechanism

A secondary disease that affects healthy teeth develops in three stages:

1. Microscopic gaps appear between the material used in treatment and the tooth.
2. Pathogenic microorganisms begin to penetrate into these cracks and crevices.
3. The proliferation of pathogenic organisms and the release of toxins that have a destructive effect on tooth enamel and installed fillings.

As a result, rejection of the material used begins.

Bacteria return to resume their “lost” business

Poor initial treatment is the most likely reason that caries under the filling begins to develop again. This usually results from the following actions:

• the doctor did not remove all the affected tissue during treatment;
• the outer surface of the tooth was not prepared very well, as a result of which microcracks will soon begin to form on it;
• subsidence of the filling.

Possible consequences

If you ignore the emerging symptoms of the return of caries, the patient risks getting a number of problems and complications, namely:

• deep damage to bone tissue infection;
• caries damage to adjacent healthy teeth;
• the process of destruction of the root and dental canal;
• tooth loss.

The main danger of secondary caries is that an inflammatory process develops in the pulp, which over time will lead to tissue death.

Tooth lesions due to hidden caries

It is usually not difficult to notice even with the naked eye; the extent of the damage received and its nature can be determined due to the duration of the process and its localization on the tooth damaged by the infection. Localizations of hidden caries include:

• on the back and adjacent walls of the tooth, which is extremely difficult to notice during a visual inspection;
• under crowns or fillings installed with errors and inaccuracies;
• in those areas of the tooth that are located under the gum, since it is difficult to clean out food debris with a toothbrush;
• in the natural pits of the so-called “back teeth”, which are also not easy to notice during examination.

Usually, the diagnosis of hidden caries becomes possible in the later stages of the disease, less often in the middle stages and almost never in the early stages. That is why the dentist begins treatment when the peripulpal tissues and dentin already have extensive damage.

Treatment and prevention

Treatment of caries of an already pulpless tooth is based on the removal of a previously placed filling. Next, the procedure is carried out and it is extremely important that it is carried out at the highest level of quality, otherwise the potential threat of the return of caries will arise again. Then a new filling is installed.

In the fight against caries, prevention plays a vital role, since preventing a disease is always easier than treating it later, especially in the late and advanced stages. Therefore, it is necessary to regularly and promptly visit the dentist for preventive examinations. If any damage, even the most minor, occurs, you should immediately visit a specialist to fix this problem.

Video on the topic

When an infection develops on the tooth enamel, the dentist removes the carious lesion and applies filling material. Cases often arise when caries forms under a filling. If it is not eliminated in a timely manner, complications will arise in the form of penetration of pathogenic microorganisms into the deep tissues of the tooth and the formation of pulpitis. To prevent infection, visit a specialist once every six months for a preventive examination.

Secondary caries is the development of an infectious process on the enamel around the filling. Occurs due to incomplete closure of the composite material and the tooth, a gap is formed between them. The process develops gradually, the person does not feel pain. The lesion is detected after 3-6 months when examining the oral cavity; the tissue around the filling darkens.

Recurrent caries is the proliferation of bacteria under a filling, which occurs due to incomplete removal of the bacterial focus. The infection process is directed deep into the tooth, towards the pulp. After 2-3 weeks, acute pain appears. When examining the oral cavity, no changes are observed.

The mechanism of caries development under fillings

During the development of caries, mechanisms occur under the filling that damage the tooth from the inside.

1. A gap forms between the tooth and the composite material. If the doctor cleans the carious area poorly, microbes multiply and penetrate deep into the dentin to the pulp.
2. Pathogenic microorganisms and saliva containing enzymes enter under the gap. This promotes tissue destruction.
3. Bacteria multiply, produce toxins and waste products that destroy living tissue and penetrate the composite material. It is being rejected.

The development of bacteria under the filling, why does this happen?

Many patients want to know why caries forms under a filling in order to avoid this process. For secondary caries to occur, damaging factors are necessary, which may arise through the fault of the dentist or the patient himself.

1. Poor quality removal by the doctor of the infectious focus from the tooth surface, on which filling material was subsequently applied. Lack or poor quality antiseptic treatment. If there is a minimum amount of bacteria remaining, a pathological focus will develop.
2. Poor quality filling. The reason may be the cheap cement material, the lack of use of an ultraviolet lamp to quickly harden the filling.
3. The formation of pores in the filling, as a result of which it sags and collapses. The infection penetrates and multiplies, resulting in caries on the filling.
4. Absence of a complete junction between your own tissues and the applied filling. Microcracks appear and are filled with pathogenic microorganisms.
5. If the filling is poorly polished, there is no tight connection between the teeth. The applied material is gradually erased. Cracks form in it. The infection gradually penetrates inside.

There are additional factors that cause secondary caries to develop faster. With alternating exposure to hot and cold temperatures, inflammation worsens and pain intensifies. If a person uses his teeth for other purposes (opening bottles, cracking nuts), has an incorrectly positioned jaw or teeth constantly rub against each other, cracks form in the composite coating.

Dmitry Sidorov

Orthopedic dentist

An important factor in the appearance of any species is the absence or incompleteness. If there is an infectious focus under the filling, caries develops faster with constant plaque on the surface of the tooth. The enamel and pulp are simultaneously affected.

How to diagnose?

Detection of caries under a filling is difficult, since in the early stages the tooth looks healthy, its surface is white and there is no plaque. Only infection that forms along the edges of the filling material (brown or black stripes) is visually detected.

With a hidden infectious focus, pain appears 3-6 months from the onset of the lesion. It may be constant or occur with chewing and pressure. A complaint of pain should prompt the doctor to conduct additional diagnostic procedures. These include the use of a visiograph or an x-ray machine. With the first option, the procedure and obtaining the image are faster, and a smaller dose of radiation affects the person. The image shows the infectious focus and the depth of the lesion.

How to treat secondary caries at the dentist?

For the treatment of secondary caries, the following methods exist: re-filling, crown installation, adhesive restoration, microprosthetics. The choice of method depends on the condition of the tooth, the degree of destruction of the lateral surfaces, and the depth of spread of pathogenic microorganisms. If it is possible to save your own tooth without cutting down and installing a crown, the doctor will offer the patient removal of the infection and secondary filling; this is the most gentle method.

Re-filling

After secondary caries is detected, the doctor performs tests to determine the condition of the pulp, since the infection may have spread to it. The tooth is exposed to alternating thermal stimuli, and electroodontodiagnosis is performed (using a weak discharge current). When there is pain from cold and hot air. If caries has developed, electrical conductivity decreases, and with advanced pulpitis it becomes even less.

Dmitry Sidorov

Orthopedic dentist

If pulpitis is not detected, the dentist removes the filling, removes the carious cavity, and carefully treats the tooth surface with an antiseptic. The doctor places a protective pad to prevent damage to the pulp. If cracks appear in the filling, pathogenic microorganisms will not be able to pass through it.

The next stage is the application of composite material. It must be of high quality so that it does not allow or absorb foreign substances and microorganisms. The material is applied in layers, each time using an ultraviolet lamp. These actions prevent the appearance of bubbles filled with bacteria and premature destruction of the filling. After applying the last layer, the surface is cut down so that there is an exact joint between the upper and lower rows of teeth. This prevents discomfort to the patient and excessive pressure on the tissue.

Crown installation

A crown is installed if secondary caries under a filling has not been treated for a long time, and the side walls of the tooth have collapsed. In this case, the use of composite material is not possible. The dentist first makes an impression from which the crown is made. The side surfaces of the tooth are filed down. The doctor must ensure that no bacterial focus remains.

The crown material depends on the patient’s preferences; metal-ceramic bases are often used. When installing the device, the patient should not feel discomfort, especially when chewing.

Adhesive restoration

Adhesive restoration is a technique for restoring dental tissue using hypoallergenic materials. Unlike filling, the adhesive material completely adheres to its own tissues, eliminating the appearance of cracks and microcracks.

A dental technician works with the dentist to create a model of the oral cavity. It shows exactly which wall of the tooth is destroyed, whether there are cracks and damage in places hard to reach for the dentist.

There are two adhesive techniques presented in the table:

Methodology	Description
Straight	It is carried out in one stage. Used for small defects. The doctor grinds the affected surface and rinses it with an antiseptic. The composite material is placed into the formed cavity, fixed and hardened. The cost of the technique is low.
Indirect	An impression of the jaw is made. Using it, the dental technician selects the composition and shape of the composite material. The tooth is prepared for reconstruction (ground down), and protective veneers are applied to it for the duration of the procedures. The technician makes a permanent inlay, which is fixed to the tooth using dental cement. The procedure does not cause pain and does not damage soft tissues. The technique is more expensive.

Microprosthetics

Microprosthetics is a procedure for fabricating a cavity into a tooth. The technique is used for minor tissue damage and extensive destroyed areas. The restoration method is considered gentle and does not damage soft tissues.

There are several types of materials used for the procedure; they are presented in the table.

Materials used	Description
	Thin plates placed on top of the tooth. Protect the surface, improve shape, prevent the development of bacterial outbreaks and plaque from products (tea, coffee). Made in any colors and shapes.
Tabs	Production of strong and durable ready-made fillings. There is no need to apply the composite material layer by layer on the tooth; the inlay is completely made by the dental technician.
Pins	Used when the crown is completely destroyed. The pin is made of various materials, most often metal, and is inserted into the root of the tooth. An artificial crown is placed on top.

For microprosthetics, several stages of preparation are carried out. They make a cast. The surface affected by bacteria is cut off and treated with antiseptics. Then the materials chosen by the doctor and the patient are applied. Their service life is from 15 to 20 years.

What consequences can the disease have?

Caries is not only a violation of the patient’s aesthetic appearance. It has many complications if left untreated. If it develops under a filling, the patient does not notice the disturbances for a long time. Microorganisms multiply, release toxins, and pressure in the cavity increases. If the composite material is dense, the resulting bacteria and secreted pus cannot come to the surface. They spread to the soft tissue (pulp).

The pulp consists of connective tissue, blood vessels and nerves. It is separated from dentin by a protective hard surface, when damaged, an active inflammatory process begins. At this stage pain appears. The main danger of pulpitis is the increased risk of bacteria entering the vascular bed, which will cause sepsis (blood poisoning), which will lead to death if the patient is not provided with emergency medical care.

select a competent doctor for the treatment of caries, who uses high-quality materials;

be examined by a dentist every six months;

treat infectious diseases of the oral cavity (sore throat, periodontitis) to prevent the spread of bacteria;

if pain appears, immediately consult a doctor, its sudden disappearance is not an indicator of recovery, perhaps the pulp has completely undergone necrosis (death);

adhere to a balanced diet; products must contain all microelements and nutrients.

Conclusion

Not every patient or dentist will notice the development of caries under composite material in time. To prevent an extensive infectious process, it is necessary to visit a doctor for a routine examination. In case of pain, which is the first symptom of the development of caries under a filling, additional diagnostic tests are prescribed to identify the affected areas.

Secondary caries manifests itself as darkening of the tooth under the filling, as well as characteristic symptoms of the pathology. Treatment consists of re-preparation of the tooth, removal of all affected tissue and proper placement of the filling. 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:

1. Anesthesia.
2. Removal of the old filling and all affected tissue. Using a drill and bur, the specialist cleans the enamel and dentin from pathological processes and microorganisms. The tooth is cleaned until all pathologically altered tissues are completely eliminated.
3. Antiseptic treatment of fabrics is carried out using disinfectants.
4. In the presence of medium and deep cavities, a therapeutic pad is installed, which isolates the nerve from the external environment.
5. Installation of a permanent filling. For filling teeth, light and chemical composites, cements, and amalgam are used. The most modern and best are light composite fillings, which harden under the influence of ultraviolet radiation.
6. 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 correct treatment, complications do not 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 of hygienic dental care. It is recommended not to eat excessively hard foods, get rid of bad habits, and periodically visit the dentist for a preventive examination.

Secondary caries is a complication of improper or unscrupulous dental treatment. Unfortunately, the disease occurs in 20–30% of people after initial 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

Within 2-4 years after filling a tooth affected by caries, its secondary manifestation is possible. The problem comes back again. The difficulty of timely detection of new lesions is that the processes of their formation develop under the filling. In this case, you have to go to the dentist with acute or aching pain, with already advanced caries.

Important! When there are microcracks between the filling and the tooth tissue, bacteria can easily enter there, causing the development of secondary caries. It is also customary to refer to the further spread of caries to the healthy part of the tooth next to the filling.

Recurrent caries manifests itself directly at the site of treatment already performed. Its cause usually lies in a careless approach on the part of the doctor:

• damaged dentin was not completely removed;
• antiseptic rules were violated, an infection develops due to bacteria remaining in the lesion.

It is almost impossible to accurately determine the cause of secondary or recurrent caries. It can be associated both with the dentist’s negligence during filling, and with shrinkage of the filling itself. Both factors appear very often, and the two types of caries can develop in combination.

Secondary caries is a carious lesion of a filled tooth; it develops and proceeds completely unnoticed, and the first signs appear already at the last stage, when the disease becomes more advanced.

How does this happen

Secondary caries gradually affects healthy tooth tissue near the filling:

• microcracks appear between the filling material and the tooth tissue;
• a pathogenic environment in the form of microbes and bacteria penetrates into the resulting cracks;
• Bacteria, in the process of intensive reproduction in favorable conditions, produce acids that destroy tooth enamel and impair the strength of the filling material. As a result, it begins to be rejected until it falls out.

And bacteria multiply and destroy

The reason for the further development of tooth damage under the installed filling is initially due to poorly carried out treatment:

1. The process of cleaning the carious cavity was carried out carelessly, incompletely, and the affected tissue remained.
2. Before installing the filling, the outer surface of the tooth was unsatisfactorily prepared. This leads to cracks and the tissue around the filling crumbles.
3. If the filling material is capable of decreasing in size during the hardening process, like photopolymers under the influence of light, then such a filling will sag over time. Microbes penetrate into the resulting cracks.

Caries does not always return due to negligence or non-compliance with the treatment protocol by the doctor. Sometimes it's all about fillings installed a long time ago. Their “service life” has expired, they sagged and wore out, becoming mobile, which contributed to the penetration and development of pathogenic microorganisms underneath them.

Typically, secondary caries develops due to poor-quality filling material or its natural aging. The filling decreases in size and shrinks. A microcrack forms between it and the tooth wall, into which carious bacteria enter, causing this disease.

The wear resistance of the filling material and the quality of treatment are constantly subjected to serious tests:

• sudden changes in temperature when eating hot and cold foods, such as hot soup and iced drinks, ice cream and coffee;
• love for solid foods - nuts, seeds, tough meat, caramel, crackers;
• problems with the structure of the dental system, incorrect closure of teeth, malocclusion;
• a tendency to unconsciously (in sleep) grinding, knocking, clenching the jaws - bruxism, which leads to abrasion of the enamel layer as a result of frequent friction;
• improper care of teeth and oral cavity, poor brushing of teeth, when food particles remain between them, provoking the appearance of plaque containing bacteria.

Diagnostics

If a regular, regular examination by a dentist does not reveal the problem, but there is a suspicion of secondary caries, then a visiograph will help establish an accurate diagnosis.

In cases of deep carious lesions of hard tooth tissue, progressive periodontitis or pulpitis, a fairly new diagnostic method is used - visiography. With its help, a full examination of the condition of the teeth and gums is carried out, and the necessary treatment is selected based on the results. Teeth with fillings installed can also be examined using this method.

The advantages of this technique are:

• speed of rendering the image and displaying it on the computer screen;
• 10-15 times lower, which means safer, radiation dose compared to taking an x-ray;
• the image on the computer monitor is clear, you can enlarge it and see the details of the localization of inflammation in the mouth.

The same method is used when examining restored teeth after secondary caries. With the help of a visiograph you can see and evaluate the effectiveness and quality of treatment.

A visiograph is a device that allows you to take pictures of teeth using a special sensor, which transmits the image to a computer.

Clinical picture of secondary caries

1. Toothache, worse when touched.
2. Gums bleed and hurt.
3. Smell of rotting breath.
4. Inflamed oral mucosa, redness in the mouth.
5. Change in color and mobility of the existing filling.
6. Black spots on the enamel of healthy teeth.
7. Increased, painful sensitivity of tooth enamel, swelling near the filled tooth.
8. A developing inflammatory process; in advanced cases, an increase in body temperature is possible.

At first, secondary or recurrent caries does not reveal itself. Symptoms, along with severe, acute pain, appear in the advanced stage of its development. This often requires radical dental treatment, including removal of the affected tooth.

Dental care

Attention! In case of deep carious lesion of the tooth, right down to the root, it is removed. The decision is made by the doctor after a thorough examination and diagnosis.

If the tooth can still be saved, then use:

Re-filling

Treatment is carried out in the following sequence:

• drilling out the affected part of the tooth;
• removal of old fillings, damaged, dead particles of dental tissue;
• dentin and enamel are carefully and thoroughly processed with a drill;
• carry out antiseptic treatment of the cavity of the damaged tooth with special preparations;
• an insulating insert-gasket is installed, which is mandatory and helps to preserve dentin for a long time;
• A filling is installed to replace the old one.

Whether the tissues damaged by caries have been completely removed after re-treatment can be seen by staining them with a special dye.
During re-filling, the main thing is to ensure a tight fit of the new filling to the tooth tissue. This depends both on the doctor’s scrupulousness and the patient’s behavior. He should try to fulfill all the doctor’s requests and not interfere with him:

• keep your mouth wide open
• don't move your tongue
• do not swallow saliva,
• do not attempt to talk or move during the procedure.

When treating secondary caries, teeth are refilled: removing old fillings – cleaning the cavity from carious lesions – treating tooth canals – sealing canals – installing a filling – aesthetic design of the filling.

Microprosthetics

In some cases, microprosthetics are indicated even for children.

Attention! The point of microprosthetics is to manufacture and install a special inlay into the affected tooth. It is at the same time a prosthesis, securely fastened and completely invisible to others.

The damaged tooth is processed, the affected parts are removed, and then an impression is made. Based on the impression, a ceramic inlay is made in the laboratory; it can also be made of another material. The tab is firmly fixed, perfectly matching in color and size. It is not felt like a foreign body. If such a procedure is impossible for certain reasons, a crown is placed.

Adhesive restoration

Instead of installing a crown, an adhesive polymer is used, which is applied to the tooth, restoring and protecting the enamel from the effects of temperature changes, making it less sensitive to irritants (sour, sweet, salty). This occurs due to the high degree of adhesion (from Latin - sticking) in relation to tooth enamel of the material used for this procedure. This restoration restores the tooth, making it stronger and more durable. With this dental procedure, the impact on it is minimal, especially on tooth enamel.

Crown installation

If re-installation of the filling is impossible, extension cannot be carried out, and any other method of treating recurrent caries is not applicable, then the affected tooth is covered with a crown. It can be made of medical steel (used mainly on distant teeth due to its unaesthetic, rough appearance), metal-ceramic (durable, aesthetically attractive) or ceramic (poorly withstands load, fragile, but cannot be distinguished from real teeth). To do this, the damaged tooth is removed or prepared in a special way before installing a crown: the canals are filled, the tooth is ground and ground. Measurements are then taken, a plaster cast is taken, and the ground tooth or teeth are covered with a temporary plastic crown or bridge before the crown or bridge is made.

If, during the treatment of secondary caries, it is not possible to refill the teeth, then you can install a crown or bridge by first preparing the teeth (cleaning of caries, grinding treatment and fitting for an artificial crown).

After careful fitting, the crown made from the impression is installed on special cement. There is an option when the crown is placed on non-permanent cement in order to monitor the behavior of the diseased tooth under it and its effect on neighboring, healthy ones. If there are no negative consequences, then the cement is replaced with permanent one.

Consequences of secondary caries

If secondary caries was not diagnosed on time and treatment was not carried out, then serious complications are possible:

• the root and canals of the tooth are destroyed;
• caries spreads to adjacent, healthy teeth;
• deep layers of bone tissue are affected;
• tooth extraction due to its complete destruction.

Important! Secondary caries leads in some cases to pulp necrosis due to its severe inflammation. It is caused by the irritating, toxic effects of chemicals used in treatment or the filling material.

Traumatic exposure during the treatment and treatment of a tooth can also cause an inflammatory process.

In cases where secondary caries has led to the destruction of the canals and roots of the tooth, treatment is pointless. It is more rational to remove the diseased tooth to prevent caries from damaging neighboring teeth.

Prevention measures

Careful, proper care of teeth and oral cavity is the main preventive measure for the development of recurrent caries. To do this, you need to use high-quality toothpastes, brushes, dental floss, and rinses. A mandatory visit to the dentist for oral hygiene is recommended twice a year.

These simple measures and efforts will help stop the development of caries at an early stage or prevent it. It is especially necessary to take care of this for those who already have fillings and crowns installed in order to prevent secondary caries.

We visited the dentist, got a filling, but after some time the treated tooth reminded us of its presence – did the living enamel change color, or did it cause pain? Most likely, this is a reaction to the resulting secondary caries. Its difference from the primary one is only that it is not in the public domain, but between the tooth and the filling.

According to statistics, resumption of the disease occurs in 30% of cases, and the first signs of an unhealthy tooth again appear within 3 years. However, with the rapid nature of bone tissue destruction, new caries can be detected within 2–4 months after the last filling.

Why caries again?

The occurrence and progress of secondary caries is influenced by the quality of the filling, the degree of oral hygiene, the characteristics of personal immunity, as well as external loads - uneven bite, bad habits (for example, the habit of gnawing seeds).

Basically, relapse occurs due to the formation of space between the tooth wall and the filling. As soon as the width of the microcrack exceeds 50 microns, saliva begins to enter it - conditions are created that promote the growth of colonies of cariogenic bacteria. Caries does not affect the filling itself - it is the dental tissue that serves as a breeding ground for multiplying microorganisms.

Treatment errors as a cause of secondary caries

1. In the process of treating a carious tooth, the doctor must use a professional detector - a liquid that changes the color of tissues affected by caries. If this point is neglected, the surface will be poorly prepared: the damaged tissue will not be completely removed, and its remains with the bacteria in it will provoke further development of the disease.
2. Also a precedent is the violation of sealing technology. And the larger the filling, the larger the affected area and, accordingly, the greater the risks. The plastic material shrinks during the hardening process, so the correct filling is formed in layers. One way to compensate for shrinkage is to apply a fluid polymer to the walls of the cavity. If the reliefs of the cavity and the filling do not match, complete adhesion does not occur, and the cavity turns out to be poorly filled with filling material.
3. The junction of the tooth and the filling should not be felt on the outer surface - the junction should be smooth, otherwise plaque will linger on the uneven surfaces, provoking the proliferation of Streptococcus mutans.

Preventive measures

With an average service life of 5 years, fillings cost differently for everyone. Less or more depends on individual factors. Each change of filling entails an expansion of the cavity and, as a result, a decrease in healthy dental tissue. To increase the interval between “repairs”, it is important to visit the dentist once every six months. It is possible that simple leveling (grinding, polishing) of the surface at the junction of the tooth and filling will protect the tissue from further destruction.

Prevention of secondary caries includes the following measures:

• daily brushing of teeth;
• microcrack control;
• regular examinations;
• timely treatment of teeth and gum diseases.

What to do and how to treat

Secondary caries on clearly visible surfaces can be detected independently, but only a dentist can assess the condition of fillings that are not visualized. This usually occurs during a thorough inspection using a special tool. If there are no external signs of the disease, but there is anxiety, aching pain, or the tooth has become sensitive to cold, hot and sweet, an x-ray is taken. The image determines the cause of the pain, and it shows the internal lesion of the dental tissue.

If diagnosed