Caria dentară

Caria dentară reprezintă una dintre cele mai frecvente afecţiuni ale sistemului dento-maxilar, afectând circa 80-98% din populaţia României şi care se manifestă prin pierderea treptată şi localizată de ţesut dur dentar, sub acţiunea mai multor factori, printre care amintim: nerespectarea igienei orale, consumul crescut de alimente bogate în zahăr, fumatul, stresul şi multe alte cauze pe care le vom detalia în cele ce urmează.

Înainte de apariţia cariei propriu-zise, există însă un proces de acumulare a bacteriilor care, împreună cu resturile alimentare şi saliva, formează un biofilm subţire cunoscut sub denumirea de placă dentară.

În momentul în care consumaţi alimente sau băuturi cu concentraţii ridicate de carbohidraţi, bacteriile din placa dentară transformă aceşti carbohidraţi în energie pentru supravieţuirea lor şi astfel sunt produşi acizii, care în timp distrug straturile dentare şi astfel ia naştere caria.

Recomandarea specialiştilor este să tratăm în stadii cât mai incipiente placa dentară, deoarece dacă este lăsată netratată aceasta creşte riscul de carii şi deteriorări grave ale structurii dintelui, care se pot manifesta prin dureri intense iar tratamentul se poate dovedi un proces destul de complicat şi costisitor. Cu toate că incidenţa cariilor dentare este extrem de crescută, această afecţiune poate fi foarte uşor de prevenit, cu condiţia respectării igienei orale şi a vizitei periodice la medicul stomatolog.

Structura dintelui

Structura dintelui prezintă 4 componente, respectiv: smalţul (parte ace ami dură din exteriorul dintelui), dentina (partea mai puţin dură, de consistenţă osoasă, de sub smaţ şi cement), cementul (partea cu care dintele este fixat în osul alveolar) şi pulpa dentară(partea moală a dintelui din interior, ce conţine nervii şi vasele sangvine).

Factori de risc

Caria dentară ia naştere dintr-un cumul de factori (cei mai incriminaţi fiind bacteriile de la nivelul cavităţii orale, igiena precară, aportul scăzut de fluor, alimentaţia şi fumatul) şi apare în general la dinţii din spate care, datorită formei lor aplatizate, sunt folosiţi în mestecarea alimentelor  şi astfel sunt favorizate depunerile de resturi alimentare în spaţiile interdentare, care cresc numărul de bacterii dăunătoare în lipsa unei igiene orale corespunzătoare.

Bacteriile de la nivelul cavităţii orale se dezvoltă rapid şi favorizează apariţia acizilor care distrug stratul dintelui. Acestea iau naştere frecvent ca urmare a unui periaj efectuat incorect (este recomandat să ne spălăm pe dinţi de cel puţin 2 ori pe zi).

De asemenea, un alt posibil vinovat al apariţiei cariilor este refluxul gastroesofagian, o tulburare gastric în care acizii din stomac ajung în cavitatea bucală şi erodează smalţul pe aprtea internă a dinţilor, în special dinţii superiori.

Dieta este iarăşi un factor de risc major în apariţia cariei dentare. Alimentele care se lipesc de dinţi şi cele cu un conţinut mare de carbohidraţi sunt cele mai periculoase pentru sănătatea dentară. Printre acestea amintim: zahărul, mierea, gemul, ciocolata, băuturile răcoritoare cu zahăr, îngheţata, bomboanele, chips-urile şi chiar pâinea.

Fumătorii sunt de asemenea mult mai expuşi riscului de formare a cariilor dentare deoarece fumul din ţigară scade producţia de salivă şi astfel este scăzută protecţia împotriva acizilor care atacă dintele. Există studii care corelează inclusiv fumatul pasiv de incidenţa crescută a cariilor la copii.

Secreţia de salivă este o problemă şi în rândul persoanelor care urmează anumite tratamente medicale, cum ar fi cele pe bază de antihistaminice, medicamente contra epilepsiei, beta-blocantele, antipsihoticele sau în tratamentul radioterapiei. Această categorie de persoane este mult mai expusă riscului de producţie scăzută de secreţie salivară, prin urmare trebuie să se hidrateze intens şi să aibă o igienă orală foarte bună.

Diagnostic

Deşi majoritatea cazurilor sunt tratate abia în stadiu avansat, trebuie să ştiţi că medicul stomatolog poate stabili un diagnostic de carie dentară însă din stadiu incipient, când simptomele nu sunt evidente cu ochiul liber.

Acesta examinează atât suprafeţele dentare vizibile cât şi pe cele mai puţin accesibile prin intermediul radiografiei dentare şi astfel poate fi stabilit un diagnostic cât mai precis, pentru ca tratamentul să fie aplicat cât mai repede iar rezultatele să fie optime.

Simptomele cariei

De regulă, caria îşi face simţită prezenţa destul de discret, iar simptomele se lasă mult aşteptate, până în momentul în care aceasta se află deja într-un stadiu destul de avansat de evoluţie. Tocmai din acest motiv, este indicat să mergeţi periodic la cabinetul medicului pentru un consult stomatologic.

Majoritatea persoanelor însă ajung la dentist abia în stadiu avansat, când apar:

  • durerile dentare
  • sensibilitatea la rece, cald sau dulce
  • respiraţia devine urât mirositoare
  • dinţii prezintă coloraţii negre, maronii sau gri pe anumite suprafeţe etc.

Astfel de simptome trebuie să pună în alertă pacientul, care trebuie să urmeze, cât mai repede posibil, un tratament adecvat. Ignorarea acestora duce iremedibil la avansarea bolii şi chiar pierderea dintelui.

Tipuri de carii

În funcţie de stadiul de evoluţie, există mai multe tipuri de carii, şi anume:

  • Carii în şanţuri şi fosete (care se formează pe suprafaţa dintelui cu care mestecăm alimentele)
  • Carii pe suprafeţe netede (se formează pe suprafeţele laterale ale dinţilor)
  • Carii pe rădăcina dintelui (apar în special la persoanele în vârstă sau la cele cu boală parodontală activă,unde gingia se retrage şi lasă rădăcina dintelui expusă în cavitatea bucală).
  • Carii secundare sau marginale (se formează între dinte şi obturaţie)
  • Carii recurente sau recidive (apar sub obturaţii şi sunt descoperite prin intermediul radiologiei dentare)

Tratamentul cariei

Tratamentul cariilor dentare diferă foarte mult în funcţie de stadiul de evoluţie al afecţiunii dentare. Astfel, o carie în forma sa incipient, deci fără a forma o cavitate, poate fi simplu tratată de către medicul stomatolog prin aplicarea  unei soluţii cu fluor care are rolul de a stopa procesul de degradare a dintelui, cu condiţia ca pacientul să respecte cu stricteţe regulile elemntare de igienă orală.

Dacă stadiul cariei ajunge deja la lipsă de substanţă, deci la apariţia acelei aşa-numite găuri în stratul dentar, medicul va apela la curăţarea ţesutului dentar alterat şi infectat şi va umple această cavitate printr-o obturaţie, popular denumită plombă.

Cazurile grave de carii, cu evoluţie avansată şi deteriorare adâncă în stratul dentar, necesită cel mai probabil un tratament de canal, care presupune în primul rând  înlăturarea nervului şi sigilarea dintelui (în scopul prevenirii transmiterii bacteriilor în restul organismului), după care se trece la procedura la acoperire a dintelui cu o coroană de înveliş sau se restaurează dintele afectat printr-o obturaţie simplă sau armată.

Plomba (obturaţia) are scopul de a înlocui ţesutul dentar lipsă şi pentru realizarea acesteia sunt folisite diferite tipuri de material dentare, cum ar fi: amalgamul (gri-negru, metalic), cimenturi dentare (de culoarea dintelui) şi materiale compozite (care sunt cele mai apropiate de proprietăţile dintelui natural).

Se întâmplă frecvent însă ca obturaţia să fie doar o soluţie de moment, care nu tot timpul îşi face efectul, astfel că, în aceste situaţii este recomandată restaurarea ţesutului dentar prin încrustaţie – o obturaţie realizată în laboratorul de tehnică dentară (din ceramică, compozit, aur), care este ulterior cimentată pe dinte.

Complicaţiile cariei

Cazurile de degradare avansată a ţesutului dentar care sunt lăsate netratate pot duce la infecţii grave ale gingiilor şi ale osului de sub ele, ambele având rol de susţinere a dintelui. Aceste infecţii pot produce, prin acutizare, un abces dentar, care se manifestă prin dureri intense, umflarea zonei respective, febră şi stare de rău general, iar în acest stadiu dintele nu mai poate fi recuperate şi nu există altă soluţie decât extracţia.

De asemenea, acumularea de placă bacteriană în exces poate duce favoriza apariţiagingivitei, o afecţiune în care gingiile capătă culoarea roşie, sunt inflamate, sângerează la periaj şi sunt dureroase.

Unele cazuri de carie avansată pot conduce la colectarea puroiului la baza rădăcinii dintelui şi astfel se erodează osul care susţine dintele dar se extinde şi infecţia, care va fi tratată chirurgical, prin intermediul unui drenaj, sau mai bine spus a unei incizii a tegumentului sau mucoasei pentru a elimina colecţia de puroi.

Prevenirea cariei dentare

Prima şi cea mai eficientă metodă de prevenire a cariei dentare constă în respectarea igienei orale corespunzătoare, prin periajul de cel puţin 2 pri pe zi (dimineaţa şi seara), executarea corectă a acestuia (se va plasa periuţa în unghi de 45 de grade la nivelul gingiei şi se folosesc mişcări dinspre gingie în jos pentru dinţii superiori, dinspre gingie în sus pentru dinţii inferiori şi mişcări circulare pentru suprafeţele cu care mestecăm, fără a exercita o presiune mare pe periuţa de dinţi).

A doua regulă a prevenirii cariei dentare constă în folosirea aţei dentare şi a apei de gură, care au rolul de a elimina resturile alimentare rămase în spaţiile interdentare şi bacteriile rămase în cavitatea orală.

O altă regulă de aur a prevenirii cariilor este alimentaţia, care nu trebuie să abunde în produse bogate în carbohidraţi, cum sunt: cerealele integrale, pâinea, legumele, fructele, cartofii, orezul sau ouăle.

Şi, pentru final, am păstrat ce e mai greu de evitat, şi anume renunţarea la vicii, în special fumatul, dar şi consumul excesiv de alcool, care afectează nu numai dantura, ci şi alte organe vitale, cum sunt plămânii, ficatul, rinichii sau inima.

Toate măsurile amintite mai sus, la care se adaugă consultul periodic la medicul stomatolog, pot ajuta la prevenirea şi tratarea cu succes a cariilor dentare.

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