Caries

Synonyms in the broader sense

Carie, tooth decay

English : Decay

introduction

Dental caries is the world's most common disease.
Especially in countries where sugarcane is grown, such as South America, Cuba or Mauritius, it occurs particularly often because the people like to chew sugar cane because of the sweetness.

What is tooth decay?

Caries on the tooth

The caries, also called tooth decay, is a chemical-parasitic process. Organic acids and bacteria produced by bacteria interact directly and cause the destruction of the hard tooth substance. The caries destroys the enamel and the dentin, called dentin ( see also anatomy tooth), progressing, without the possibility of the body's own regeneration, since a blood supply in this area is not present. The bacteria responsible for the production of acids are those that absorb sugar and produce acid through their metabolism. The main germ is Streptococcus mutans, which, however, is not present in the oral cavity from birth, but is only transmitted through intimate contact with the mother, for example by kissing. The caries is therefore an infectious disease.

Figure caries

Figure symptoms of caries: sectional image of healthy tooth (left) and stages of the disease (A - F)

Caries (tooth rot)
chemical parasitic process

  1. Enamel -
    filmstrip final
  2. Dentin (= dentin) -
    dentine
  3. Denture in the tooth cavity -
    Pulp dentis in Cavitas dentis
  4. Gums -
    gingiva
  5. Cement -
    cementum
  6. alveolar bone
    (tooth-bearing part
    the jawbone) -
    Pars alveolaris
    (Alveolar process)
  7. Nerve fibers and blood vessels
    Stage of the disease:
    Descaling process (A + B + C)
    Minerals dissolve out of the
    Enamel -
    (no toothache)
    Progressive caries (D)
    Caries reaches the dentin -
    (temporarily throbbing pain)
    Very deep caries defects (E + F)
    that reach the dental pulp -
    (strong, stinging toothache)
    the increasing destruction
    of nerve fibers can become one
    Lead to blood poisoning

How does tooth decay develop?

Sugar is the most common cause of tooth decay

By including food (see also nutrition), which in most cases also contain sugar, although often hidden, the bacteria are constantly stimulated to produce acid. However, it will not always be caries, because the saliva with its content of calcium is able to repair the first beginnings of decalcification. Only when the acid attack is stronger than the remineralization, it comes to the formation of tooth decay.
First, the enamel is decalcified, which is noticeable by a white discoloration. At this stage, with the top melt layer still intact, fluoride feeds may still stop the process. However, if the top layer is already broken, the progress of the destruction is unstoppable.
More about the stages of caries development under: How does caries develop?

The carious dissolution of the enamel continues and reaches the dentine, which is the softer dentin compared to the enamel. This process takes some time. As the dentin is not as resistant as the enamel, the caries in the dentin continues faster but inexorably, undermining the enamel. This is reflected in a dark discoloration.

The undermined enamel becomes so thin that it breaks in. At least now, the extent of the destruction is recognizable. X-rays can confirm the findings. As caries profunda the even more profound caries is called. Through the dentin run fine channels, in which there are nerve fibers that reach into the dental pulp. That is why pain now occurs, especially sweet, because the bacteria produce acid, but also on temperature stimuli.

If nothing is done, the destruction of the tooth continues and reaches the pulp, the pulp, with its blood and nerve supply. After severe pain, the pulp is destroyed and eventually the tooth can be lost.
In younger people, tooth decay is the most common reason for the loss of teeth, in the elderly the diseases of the periodontium.

The different stages of caries development

A tooth decay can be divided into four different stages.

  • The first stage describes the initial lesion or the caries initialis . In this development phase, only the enamel is decalcified or demineralized and still no break in the surface palpable. Therefore, this stage is still reversible and controllable by targeted fluoridation. All other stages are irreversible and must be treated with measures such as a filling therapy.
  • In the second phase there is a melt break-in, which, however, only affects the uppermost layer of hard tooth substances.
  • If the caries continues to spread, it reaches the dentine and is in the third decay stage. This stage is called enamel - dentin lesion or caries profunda . Once the dentin has been reached by the caries, it progresses much faster because the dentin has less hardness and is easier to penetrate.
  • The last stage is reaching the pulp. The caries is now completely penetrated by enamel and dentin and affects the pulp. The nerves and blood vessels are metabolized by the bacteria and thereby die.
    At this stage, a pure filling therapy can not save the tooth. The tooth must first be treated with a root canal treatment in order to completely rid the dental pulp of bacteria and to complete the root canals with a root filling. Subsequently, the tooth may be treated with a filling therapy and, at best, with a crown to restore its complete stability.

How do the holes develop from tooth decay?

The bacteria metabolize low-molecular sugars to acids, which damage the tooth substance as a waste product of the microorganisms. The acids demineralize the enamel and decompose the tooth hard substance, causing a break in the surface. This incipient hole is the portal of entry for other bacteria and their acid, which continue to expand in depth.

Thus, for the dentist, the typical means of caries diagnostics is the careful scanning of the tooth surfaces with the probe. In the case of caries, a break in the surface can be felt with the probe and the probe remains stuck there. Due to the tendency to propagate into the deep, the well-known typical holes of caries arise.

caries bacteria

There are well over three hundred different bacterial species in the oral cavity of the oral cavity, of which only two species belong to the caries bacteria. These bacteria can metabolize the sugar of the food absorbed as substrate into acids (especially lactic acid) and cause lasting damage to the tooth. These bacteria primarily include Streptococcus mutans and Lactobacilli.
The main caries bacterium is Streptococcus mutans, which settles in the plaque. From the ingested sucrose Streptococcus mutans forms glucan molecules, with which it can also adhere to smooth surfaces such as the enamel.

Caries bacteria can be transmitted from person to person through saliva. The bacteria can be detected by microbial saliva tests. Both type and number of bacteria can be determined. A high number of Streptococcus mutans and Lactobacilli speak for a high caries risk, a low number for a low.
But only if the bacteria can use food leftovers, also caries, which means that infection with Streptococcus mutans with excellent oral hygiene does not become tooth decay.

Detect caries

The problem with a tooth decay is usually that it is barely recognizable at first. Affected patients usually do not seek out a dentist until toothache is already present. In these cases, however, the caries is already very advanced and requires a more extensive therapy. For this reason, it is recommended to go twice a year to the so-called check-up.

The dental check-up is a cash benefit and all costs are fully covered by both private and statutory insurance. In addition, bonus points can be earned by regularly participating in a dental health care program. These bonus points can significantly reduce the own contribution of patients who need to be treated with a dental prosthesis (such as a crown or bridge).

In addition, it is quite easy for the dentist to recognize a possible caries early on and treat it in a simple manner. If there is a suspicion of caries, an X-ray examination usually follows the control. The X-ray image helps to recognize how deeply the carious defect has already penetrated into the tooth substance. In addition, it is advisable to carry out a radiographic check at regular intervals even with existing fillings. This helps to detect at an early stage whether a new caries has formed under the filling material or if there are inflammatory processes in the area of ​​the root of the tooth root.

Furthermore, so-called caries detectors are often used in the dental practice. These are substances that can be applied to the tooth and change their color in the presence of caries. Individuals who want to check the condition of their teeth at regular intervals can pay attention to the following characteristics of tooth decay. To detect caries early, care should be taken to see if the teeth:

  • have whitish discoloration

  • have brown spots

  • have sticky spots

How can you recognize caries yourself?

For the layman caries is usually only visible in the later stages, if the lesion already affects a large part of the tooth. Tooth decay can present itself in different colors. An initial demineralization of the enamel can be recognized as a white discoloration, which corresponds to a decalcification. This demineralization is the precursor of caries in which the surface is still intact and can be stopped by targeted fluoridation the formation of a tooth decay.

If there is an initial caries with surface break-in, it can turn a yellowish to brownish color. It is usually very small and hardly visible to the person in the mirror. As this carious lesion grows in depth, the hole often does not grow larger, but it remains a punctate discolored opening port that spreads only in depth like a balloon. Patients often notice black punctate discoloration, especially on hard-to-clean areas such as the fissures. These so-called "black spots" are usually inactive caries sites, which have no tendency to spread if they are regularly fluoridated targeted. These black spots have about 80% of the population.

The dentist will notice no snagging when touching the probe with the inactive caries, the black spots are probing hard. Nevertheless, these sites should be checked regularly so that the inactive carious form does not turn into an active form and spread further into the depths.

Furthermore, caries lesions in the interdental space are invisible to both the person concerned and to the dentist by sole inspection. In this case, the dentist can detect the caries only by X-ray diagnostics. In general, it is quite difficult for the person affected to recognize caries, because the disease can take so many different forms and is difficult to detect without special diagnostics. Therefore, a semi-annual check at the dentist should not be waived.

Occur

The incidence of tooth decay may vary from person to person. There are people who rarely or never get tooth decay and others who have carious defects. Why this is so, is not quite clear, it is believed that they are genetic influences that are responsible for these differences.

Too much caries occurs when the salivation is too low. This is the case, for example, after x-ray radiation in the head area.

Certain areas of the teeth are particularly susceptible to the onset of a carious event. These are the interdental spaces, the tooth surfaces and the tooth necks. Here plaque can accumulate particularly well and is more difficult to remove. Especially in the interdental spaces, the detection of decay may be difficult because the first signs may be covered by gums. Malocclusions (dental anomalies) also favor the occurrence of tooth decay.

But any area that is difficult to access for daily oral care has a higher risk of caries. Thus, the molars and wisdom teeth are often affected because of their location of tooth decay.

Tooth decay in the interdental space

The interdental space represents a niche, which means that there is more caries here, as the site is difficult for the patient to access. The toothbrush does not reach the bottlenecks between the teeth with its bristles and therefore these gaps have to be cleaned with additional aids such as dental floss or interdental brushes.

Since this cleaning method is one of the least popular and is not used by a large part of the population, the leftovers may remain in this space for a longer period of time. The microorganisms then have free rein to use these food remains as a substrate and to multiply - as a degradation product caused by the acid production caries.

In most cases, both adjacent teeth are affected by the caries. Furthermore, this caries can usually go unnoticed and unhindered, as it is clinically invisible to the dentist. The caries in the interdental space can only be detected by X-ray diagnostics and remains without them in secret. Therefore, it is important to remove any remaining food in the interdental spaces as early as possible in order to give the bacteria no chance to caries in these gaps.
Also, regular fluoridation in the interdental spaces can sustainably protect against caries formation.

Caries on milk teeth

Milk teeth are significantly more porous in nature than the permanent teeth and are therefore less well protected from tooth decay .. This is because the mineral content of the tooth enamel of the deciduous teeth is much lower, which is why a caries lesion spreads at a greater speed. Furthermore, the relations of the layer thickness of the deciduous teeth are different. The enamel layer is significantly thinner, the dentin layer is thicker than in a permanent tooth. The pulp, the pulp, is much larger and is thus achieved faster and sooner than with a permanent tooth.

Therefore, there is also a greater risk that the dentist will hit the pulp during caries removal than with permanent teeth. In this case, a root canal treatment of the deciduous tooth is required to ensure the placeholder function of the tooth as long as possible. Another problem is the poor oral hygiene of many children. Limited motor and mental abilities (especially in toddlers) make them less able to brush their teeth and make tooth plaque easier to infect.
Furthermore, a poor diet by many sweetened drinks and food can increase the risk of caries.

Caries under a filling

If a tooth is affected by caries, it will be treated with a filling therapy. Filling materials are variable. After this filling therapy, the destroyed carious tissue is removed and replaced with restorative materials.

It may well happen that caries occurs again under the filling at the filling edges in the hard tooth substance. These caries is called secondary caries. This secondary caries occurs much more often under plastic fillings than in amalgam fillings. This is because amalgam has a bactericidal effect that protects the filling margins from decay. Plastic has no anti-bacterial effect, which increases the incidence of secondary caries.

It is especially important to thoroughly clean teeth that have been treated with a filling, especially the interdental spaces. If bacteria can adhere to the rim of the filling, it is often easy for them to reach the intact tooth under the filling and lead to secondary caries. Progressive secondary caries can be a reason why a filling breaks out or gets lost. The caries softens the hard tissue under the filling and thus dissolves the bond between the filling and enamel or dentin, so that the filling can dissolve.

Reasons for secondary caries may be reduced oral hygiene, but incomplete caries removal can also leave behind bacteria that can cause caries under the filling. A very old plastic filling may also have become leaky, since the filling edges discolour after a certain time and are not as durable as for example amalgam. Therefore, especially the edges of plastic fillings should be checked regularly and replaced after a few years.

Caries under the crown

A crown serves the tooth as protection against further tooth hard tissue loss, especially if the tooth is already weakened by carious lesions. As with secondary caries under a filling, can also form caries under a crown. The reasons for the development of secondary caries are similar. After some time, the cement, with which a crown is attached, can wash out and open a gap.
If this gap is not perceived and accordingly carefully cleaned, bacteria can freely enter this groove under the crown and weaken the healthy hard tooth substance by caries. If bad oral hygiene is added, the bacteria can use the food remnants as a substrate and metabolize them.

As the enamel layer has been almost completely removed by preparing for the crown, the tooth is hardly protected, as long as the microorganisms get under the crown. The caries then usually progresses quickly and can quickly infect the pulp and nerves.
Furthermore, a treatment error or a mistake of the dental technician may also be a reason for a leaky crown. If the marginal margins of the crown are only slightly too large, this represents a portal of entry for tooth decay, which will promptly provide for secondary caries. The tricky part is that the caries remains radiologically invisible, as the crown completely absorbs the X-rays and ensures no insight into the interior. Therefore, even the dentist usually notices quite late, for example on a leaky edge, that secondary caries has formed under the crown.

The cervical caries

In tooth decay, the teeth are particularly sensitive to pain.

Cervical caries is now not like most caries on the occlusal surface, but, as the name suggests, in the cervical area. This can, as physiologically provided, be closely covered by the gums, or exposed due to external influences, such as excessive brushing or gum disease. If it is free, it is particularly easy for bacteria to reach it.

The tooth neck represents the transition from the tooth crown to the tooth root. The tooth crown is covered with tooth enamel and changes into tooth cement at the tooth neck, which covers the dentin in the area of ​​the root. The enamel is very hard and the real protection against tooth decay. In the area of ​​the cervix, however, this is no longer present, so that the dentin can be attacked unhindered by bacteria. These have it very easy in this area, as they start directly at the softer dentin and can reach the tooth pulp relatively quickly, from there it is only a small jump to the root canal.

The main cause of caries in the cervical area are exposed cervicals. The causes of exposed tooth necks are different. The main reason is usually a periodontitis.
But even the consumption of nicotine can help.
Exposed tooth necks can also catch people brushing their teeth regularly, but they are putting too much pressure on the toothbrush, which may be too hard, and are also using toothpaste with strong abrasives. As a result, the gums are subjected to great stress, so that the small tissue fibers travel and the gums retract.
The way for bacteria on the tooth neck is free.

The best precaution against cervical caries is not to give the bacteria the ability to cause tooth decay at all.
Since the main cause is exposed tooth necks, one should prevent periodontitis or gingivitis.
The most important thing is a good and sufficient oral hygiene. Brush the teeth at least 2 times a day with a toothpaste containing fluoride, with a not too hard toothbrush and little pressure. Perform the movements circling from the gum to the crown of the tooth at an angle of 45 °.
Electric toothbrushes remove plaque even more reliably and easily. Tongue scrapers, mouthwashes and dental floss, for the hard-to-reach interdental spaces, must be used as a supplement. Also very important is adherence to the control appointments, at least twice a year, at the dentist.
Professional teeth cleaning can also be done during such a visit.

therapy

Effective caries therapy can only be guaranteed if the treating dentist makes a correct assessment of the depth of the caries and the condition of the affected tooth. For this purpose, the dentist various diagnostic options are available. In some cases, special solutions, caries detectors, can help to identify carious defects in the tooth. These solutions stain the defect after they have been applied to the dry tooth.

In addition, a suitable imaging method can be performed before the onset of caries therapy. In dentistry, two different procedures are usually used. If several teeth have carious sites in different quadrants, an X-ray survey (orthopantomogram, OPG) can be made. If there is caries on only one tooth, a so-called tooth film should be taken. This allows an exact estimate of the depth of the caries. However, as X-rays are always exposed to radiation exposure, imaging procedures should only be used in special cases. The therapy of small carious defects can usually be carried out without imaging.

Once a caries has been identified as such and the extent of the defect has been determined, the actual treatment can be started. The therapy in the presence of caries depends primarily on the exact location and the respective caries stage. In this context, different forms of caries must be distinguished.

The so-called initial caries is considered a precursor to a real tooth decay. These are decalcification procedures in the area of ​​the enamel, which show up as small white spots on the tooth surface. The treatment of this form of caries is usually done by applying a fluoride-containing substance. In this way, the attacked enamel can be remineralized and cured. In addition, fluoride toothpastes can help protect the affected tooth from further damage.
When using fluoride-containing toothpastes, however, the instructions of the treating dentist must be followed. In fact, an overdose can lead to unsightly fluoride deposits on the tooth surface within a very short time. In a tooth decay, which is not limited only to the enamel, but also the deeper dentin (dentin) attacks, needs in the

Usually a much more extensive therapy. Fluoridation of the tooth surface can no longer stop the spread of the carious defects in the presence of such dental caries. In the treatment of this form of tooth decay, the treating dentist must remove the carious tooth substance together with a minimal proportion of healthy tooth. Only in this way can a possible caries formation under the restorative material (so-called secondary caries) be prevented. Afterwards, the tooth must be completely drained and provided with a filling material. The choice of the most suitable filling material depends both on the condition of the tooth and on the desire of the patient.

When treating caries, a distinction is made between rigid and plastic filling materials. Rigid fillers are typically used only for more extensive carious defects. They must be made outside the oral cavity, in a dental laboratory and then inserted into the tooth. For this reason, the rigid filling materials are significantly more expensive than the plastic ones. In terms of stability, however, the advantage is clearly on the side of the rigid filling materials. The group of plastic filling materials mainly includes composites (plastics) and amalgam. After preparation and draining of the tooth, these substances can be introduced directly into the cavity, shaped and cured there. In contrast to the rigid materials, they are especially suitable for the supply of small caries.

In the meantime, mainly plastics are used in the treatment of tooth decay. The reason for this is the fact that amalgam fillings are said to be hazardous to health. A dental filling made of amalgam, however, seems to be much more durable than a plastic filling. The treatment of a tooth decay is basically borne by both the statutory, as well as the private insurance. However, the preparation of a plastic filling, as well as the therapy with a rigid restorative material require an additional payment of the patient. The only exceptions here are anterior fillings and fillings in patients who are not allowed to be treated with amalgam (for example, in case of intolerances, allergies or kidney dysfunctions). In these cases, at least the cost of a plastic filling is fully borne by the health insurance companies. Patients with a so-called caries profunda (deep caries), in which more than 2/3 of the dentin are affected, require a much more extensive therapy.

In addition to filling, the affected patients should also protect the dental nerve (pulp). For this reason, the usual tooth filling must always precede a so-called underfilling. In this case, a calcium hydroxide-containing drug, which is intended to stimulate the formation of dentin, is introduced into the depth of the cavity. A so-called penetrating caries (caries penetrans), however, already extends through the dentin into the dental cavity (pulp).

If it comes to the formation of inflammatory processes in the affected tooth, the pulp must be removed together with the nerve fibers located therein. In this extensive caries therapy, the roots of the tooth with small hand drills ( see also: toothache after drilling) processed and then thoroughly disinfected ( root canal preparation ). In addition, in most cases, an antibacterial drug must be introduced into the tooth and left there for a few days. Following this form of caries therapy can be completed by filling the root canals (root canal filling). Depending on the severity of the inflammatory processes, the prognosis can vary significantly. It can be assumed that the large number of treated teeth requires further therapy after some time. If the patient experiences pain again after completing the root canal treatment, a so-called root tip resection usually has to be performed. If this treatment attempt also fails, the affected tooth must be removed from the jaw.

Can you cure tooth decay?

No disease is as widespread worldwide as the tooth decay or to German tooth decay. Nearly every human in the population has or had a carious lesion that needed to be treated with painful restorative therapy. But can caries also be cured differently?

If caries in the initial stage has not yet breached and damaged the surface, the initial demineralization can be reversed by fluoridation. In this case, no filling therapy is necessary. Once damage to the surface (ie a hole) has been caused by caries, fluoridation is no longer sufficient and the tissue destroyed by caries must be removed mechanically.

Many new lasers like the E - YAG laser want to avoid the unpopular drill, which is not possible in particularly deep cases, as the laser can not remove the complete caries here. Therefore, in the majority of cases only the conventional filling therapy brings the desired success.

Can you laser caries?

The lasering of caries is a novel method to remove caries targeted. It uses the so-called Erbium-Yag laser, which emits light of a wavelength that is absorbed by the moisture of the tooth. Das Wasser dehnt sich dabei so aus, dass Mikroexplosionen entstehen, die das weiche Kariesgewebe durch die Energieerzeugung entfernen.
Bei der Behandlung trägt der Patient einen Gehörschutz, da die Anwendung relativ laute Schläge erzeugt.

Allerdings können die E- Yag- Laser heutzutage den Bohrer noch nicht ersetzen, da sie bei tiefer Karies nicht effizient genug arbeiten. Die Kosten für eine derartige Behandlung betragen etwa fünfzig bis zweihundertfünfzig Euro pro kariösem Zahn. Außerdem gibt es keinerlei wissenschaftliche Evidenz für die Kariesentfernung mit Laser, weshalb der Laser den mechanischen Bohrer bislang noch nicht verdrängen konnte.

Hausmittel gegen Karies

Generell können Hausmittel die Schmerzsymptomatik einer Karies lindern, allerdings können sie die Karies nicht stoppen oder gar rückgängig machen.
Das Kauen auf Nelke und Kurkuma hat sich dabei bewährt um die Beschwerden durchaus zu lindern. Nelkenextrakt ist bereits seit tausenden von Jahren ein bewährter Wirkstoff in der Zahnmedizin, dessen beruhigende Wirkung bekannt ist.
Außerdem soll normales Haushaltssalz die Kariesaktivität eindämmen, was allerdings aufgrund fehlender wissenschaftlicher Evidenz stark anzuzweifeln ist.

Ist eine irreversible Schädigung der Zahnhartsubstanz durch Karies vorhanden (dh ein tiefes Loch, das bis ins Dentin reicht)kann kein Hausmittel die Behandlung durch eine Füllungstherapie ersetzen. Generell sollte die häusliche Anwendung von Mitteln mit dem behandelnden Zahnarzt abgesprochen werden um die Therapiemaßnahmen gegen die Karies nicht zu beeinträchtigen.

Ist Karies ansteckend?

Es ist zwar allgemein bekannt, dass Erkrankungen, die durch virale oder bakterielle Erreger hervorgerufen werden, ansteckend sind. Das dies auch für Karies zutrifft ist den meisten Menschen jedoch nicht bewusst. Bei Karies handelt es sich um eine Zahnerkrankung, die durch bakterielle Erreger hervorgerufen wird. Laut Weltgesundheitsorganisation (kurz: WHO) handelt es sich bei Karies sogar um die weitest verbreitete Infektionskrankheit überhaupt. Man geht davon aus, dass ungefähr 95 Prozent der Weltbevölkerung davon betroffen sind. Alle Menschen kommen zunächst ohne die karies-verursachenden Bakterien auf die Welt. Da diese Erkrankung jedoch ansteckend ist, müssen die bakteriellen Erreger zunächst in die Mundhöhle gelangen. In der Regel findet die Übertragung der relevanten Erreger bereits in der frühen Kindheit statt. Vor allem die gemeinsame Nutzung von Besteck

oder das Säubern eines Schnullers mit Speichel der Mutter, gehört zu den häufigsten Übertragungswegen. Nach der Übertragung siedeln sich die karies-auslösenden Bakterien innerhalb der Mundhöhle des Kindes an, vermehren sich und persistieren dort über Jahre. Es kann davon ausgegangen werden, dass ein direkter Zusammenhang zwischen Kariesrate und Alter bei Ansteckung besteht. Je früher die ansteckenden Bakterien übertragen werden, desto höher kann die spätere Kariesrate sein. Studien zufolge bekamen von den Kindern, die in den frühen Lebensjahren infiziert wurden, ungefähr 89 Prozent noch vor dem fünften Lebensjahr Karies. Bei Karies handelt es sich demnach um eine weit verbreitete Infektionskrankheit, die hoch ansteckend ist.

symptoms

Die Symptome für eine Karies lassen sich nicht eindeutig einem Muster zuordnen, sondern sind aufgrund ihrer langen Wirkdauer, je nach Stadium abhängig.
Zu Beginn weiß der Patient noch nicht einmal, dass er darunter leidet, denn Schmerzen treten erst mal keine auf. Der Nahrungsaufnahme kann ganz gewohnt nachgegangen werden, ohne, dass man bei sehr kalten oder auch heißen Getränken etwas spürt. Sichtbar ist es hingegen schon, nämlich in Form von kleinen weißen Pünktchen. Sollten diese zufällig, zum Beispiel bei der regelmäßigen Kontrolle von einem Zahnarzt entdeckt werden, hat man sehr gute Chancen, sie ohne weiteren Aufwand und sehr substanzschonend behandeln zu lassen, sodass der Eintritt ins nächste Stadium verhindert werden kann.

Mit der Zeit werden diese weißlichen Verfärbungen immer mehr sichtbar und auch der Patient verspürt die ersten Symptome. Schmerzen treten periodisch auf, verschwinden also für einen gewissen Zeitraum, kehren jedoch auch wieder. Die Phasen des Nichtauftretens werden seltener, bis der Schmerz dauerhaft zu Tage kommt.

Essen und Trinken gestaltet sich von Mal zu Mal als unangenehmer. Besonders heiße oder kalte Getränke, süße und klebrige Speisen oder auch säurehaltiges Obst treiben einem beim Verzehr den Schmerz ins Gesicht und von Genuss kann keine Rede mehr sein. Man greift sich mit der Hand an die Stelle von außen mit der Hand und ist froh, wenn nichts mehr diese Stelle berührt. Die Karies kann sich auf das umgebene Gewebe ausbreiten, sodass der Schmerz noch stärker wird.
Ein weiteres Symptom ist ein fauler Geruch aus dem Mund.

Schmerzen durch Karies

Tückisch an dem Verlauf einer Kariesentwicklung ist, dass Schmerzen erst in einem weit fortgeschrittenen Stadium entstehen. Zuvor ist der Zahn nahezu symptomlos, was den Betroffenen die kariöse Läsion gar nicht bemerken lässt.

Die erste Phase, in der die Karies noch reversibel ist, wird von den Patienten gar nicht wahrgenommen und sind eher als Zufallsbefund bei der zahnärztlichen Kontrolle feststellbar. Meist werden Schmerzen erst spürbar, wenn die Karies durch den Schmelz das Dentin erreicht. Im Dentin sind kleine Kanäle zu finden, die mit dem Zahnmark in Verbindung stehen, durch die die Bakterien die Pulpa schnell erreichen können. Die Nerven innerhalb der Pulpa reagieren auf den durch die Bakterien entstehenden Reiz und der Patient verspürt Schmerzen.
Diese Schmerzen werden durch besonders zuckerhaltige Speisen kurzfristig verstärkt, auch besonders kalte Getränke und Speisen können zu der Symptomatik führen. Die Schmerzen haben dabei ziehenden stechenden Charakter, aber nur von kurzer Dauer und bei besonderen Anlässen wie der Nahrungsaufnahme.

Kann man Karies im Röntgenbild sehen?

Röntgenbilder sind für den Zahnarzt ein diagnostisches Hilfsmittel um Karies zu erkennen. Vor allem bei den Stellen, die von außen nicht sichtbar sind, wie z. B.an den Zahnflächen zwischen den Zähnen, kann der Zahnarzt mit Hilfe von Bissflügelaufnahmen Karies detektieren.
Im Röntgenbild ist Karies als dunkle Stelle in der Zahnkrone oder an der Wurzel zu erkennen, die sich vom restlichen Zahn abhebt. Allerdings lässt sich eine anfängliche entstehende Karies kaum in einem Röntgenbild erkennen, erst bei einem Einbruch der Schmelzoberfläche lässt sich dies auch in der Strahlendiagnostik erkennen.
Deshalb sind regelmäßige Röntgenaufnahmen auf der Basis der allgemeinen Untersuchung etwa alle zwei Jahre durchaus sinnvoll, um Kariesentstehung frühzeitig zu erkennen und gezielt zu therapieren, denn selbst der Zahnarzt kann nicht immer alle Zahnflächen optimal begutachten und einschätzen.

prophylaxis

Die für die Entstehung von Karies verantwortlichen Bakterien sammeln sich im Zahnbelag, der sich zwischen Zahn und Zahnfleischrand bildet, an. Deshalb ist es für die Prophylaxe wichtig, diesen Zahnbelag mittels Zahnbürste, Zahnpasta und Zahnseide zu entfernen. Denn es gilt der Spruch: „ Ein sauberer Zahn wird nicht krank."

Da aber Fluoride die Widerstandskraft des Zahnschmelzes gegen Säureangriffe stärken, sollten in jedem Fall fluoridhaltige Zahnpasten oder Spüllösungen Verwendung finden. Fluoride verstärken auch den remineralisierenden Effekt des Speichels.

Ein anderer Weg wäre der gänzliche Verzicht auf Zucker, aber dies ist sicherlich auch nicht möglich. Eine vielversprechende Maßnahme ist die besonders in Skandinavien geübte Verwendung von Xylit anstelle von Zucker. Xylit kann vom Streptococcus mutans nicht aufgenommen und verarbeitet werden, und es kommt letztendlich zum „Verhungern „ dieses für die Karies verantwortlichen Keimes. Xylit ist aber teuer und deshalb nicht in allen Nahrungsmitteln zu verwenden. Zur Zeit ist es hauptsächlich ein Bestandteil von Kaugummis.

Bei Jugendlichen, deren Seitenzähne noch nicht von Karies befallen sind, bietet sich eine Versiegelung der besonders gefährdeten Zahnoberflächen an. Dabei werden die Grübchen mit Kunststoff aufgefüllt und so gegen Säureangriffe geschützt. Diese prophylaktische Maßnahme hat sich bestens bewährt und unter dem Namen Fissurenversiegelung bekannt.

Was ist ein Kariesdetektor?

Ein Kariesdetektor ist eine Lösung, die der Zahnarzt verwendet um zu überprüfen, ob er die vorhandene kariöse Läsion komplett beseitigt hat und die Ränder der Kavität kariesfrei sind. Der Detektor ist eine Flüssigkeit, die aus einem Lösungsmittel und einem Farbstoff besteht. Das Lösungsmittel kann in abgestorbenes und von Bakterien befallenes Zahnbein eindringen und der Farbstoff verfärbt diese Bereiche sichtbar. In gesunde oder demineralisierte Zahnhartsubstanz kann der Kariesdetektor nicht eindringen, sodass nur die kariösen Bereiche eingefärbt werden.

Der Behandler kann sich nun selbst kontrollieren, ob die kariösen Bereiche vollständig entfernt worden sind und in wieweit er noch Karies nachentfernen muss. Dadurch lässt sich durch den Kariesdetektor nekrotisches Gewebe von gesundem unterscheiden, was nicht nur während der Behandlung als Kontrolle dienen kann, sondern auch durchaus als diagnostisches Hilfsmittel verwendet wird.

In den meisten Fällen besteht der Kariesdetektor aus dem Lösungsmittel Propylenglykol und dem Farbstoff Erythrosin.

Summary

Die Karies ist eine weltweit verbreitete Infektionskrankheit. Organische Säuren und Bakterien sind die auslösende Ursache für die Zerstörung der Zahnhartsubstanz. Die im Zahnbelag befindlichen Bakterien verarbeiten den Zucker zu aggressiven organischen Säuren. Die Therapie besteht in der totalen Entfernung des infizierten Gewebes und anschließender Füllung mit geeigneten Materialien. Die Prophylaxe umfasst die Entfernung der Zahnbeläge durch sorgfältig durchgeführter Mundhygiene, für die das notwendige Instrumentarium zur Verfügung steht.

Tooth decay and cavities - causes, symptoms, diagnosis, treatment, pathology (December 2019).


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