Deep Caries

Deep caries is the last stage and the most complicated form of dental caries which affects the deepest layers of dentine involving the pulp resulting in significant destruction of the tooth surface. Deep caries appears as primary decay (develops from superficial and median caries) or secondary decay (occurs under the fillings as a result of their defects or mistakes in disease management).

Forms of deep caries

Two forms of deep caries development are distinguished. They are acute deep caries and chronic deep caries. Acute deep caries is characterized by short-term painful feelings caused by cold and hot food consumption or mechanical irritants, very rarely by chemical stimuli. Such pain lasts even when the influence of irritants is neutralized. Chronic deep caries is associated with fleeting pain caused by mechanical and temperature irritants.

Symptoms of Deep Caries

Deep caries is characterized by soreness of the carious cavity floor during catheterization. Acute pain is experienced when foreign substances or food debris get into the cavity. This pain quickly remits but does not disappear until the remnants are removed. Painful feelings caused by temperature, chemical and other external stimuli are frequent. Deep caries leads to considerable destruction of dental tissues. During visual external examination a minor defect of the tissues can be detected. However, when the enamel is removed, a large carious cavity becomes apparent.

Deep Caries - photo 1
Photo 1. Deep caries.

Diagnosis

Deep caries may be diagnosed by a dentist based on the data of the child’s anamnesis taking into consideration principal and subsidiary diagnostic methods such as X-ray examination, electroodontodiagnostics and thermodiagnostics. Deep caries is diagnosed when the carious cavity is very large and its floor reaches the pulp. The extent of the disease progression can be rated according to the intensity of painful feelings. In very rare cases of deep caries the child may experience no pain at all. This phenomenon may happen when the infection passes through the carious cavity floor and reaches the pulp causing pulp necrosis.

Deep Caries - photo 2
Photo 2. X-ray examination.

Treatment Deep Caries

To treat deep caries in children, it is necessary to relieve pain in the first place. When the oral cavity is anesthetized, the dentist removes the softened dentine from the carious cavity of the affected tooth and fills it with restorative materials. In extremely severe cases when the disease has affected the pulp soft tissues, the dentist will have to extract the nerves. In deep caries treatment along with the restorative material, various antiseptics, pulp calcium-containing caps, sequestrate fluorinated pastes are used. If the treatment is performed by the qualified specialist in time, it is possible to preserve the live tooth and to restore its proper functioning even when the dentine layer is significantly damaged. If it is too late, the affected tooth is usually extracted. The principal goals of deep caries management are: to preserve the tooth pulp viability; to avoid the development and recurrence of dental caries; to stabilize the remineralization process of predentine and dentine; to activate the pulp functionality in order to promote the apposition of new replacing dentine.

Deep Caries - photo 3
Photo 3. Treatment Deep Caries.

Prognosis

To avoid complications, children who received proper treatment of deep caries have to stay under medical supervision for some time as the development of chronic sites of infection is possible. Thus, deep caries is a very severe dental condition but if it is managed properly and adequate oral hygiene becomes a daily practice, the prognosis will be quite favorable. The painful feelings will disappear, the carious cavity will be drilled, treated and filled, and the esthetic and functional characteristics of the affected tooth will be renewed. If deep caries is not treated, tooth decay will progress and acute pulpitis may develop. If the child does not get adequate dental care, the deep stage of dental caries may lead to tooth extraction.

Deep Caries - photo 4
Photo 4. The extreme measure of fighting caries is tooth extraction.

Preventing Tooth Decay

After every meal consumption lots of food particles are left on the tongue, cheeks and teeth. This debris is the most favorable environment for bacterial growth. To avoid tooth decay in general and deep caries in particular, it is necessary to follow simple rules that will help keep the children’s teeth healthy. As dental practice proves, regular dental hygiene reduces the necessity of professional dental treatment by 75-80%. Rational nutrition also plays an important role in tooth decay prevention. Consumption of very cold and very hot food and beverages has a destructive influence on the tooth structure. It is necessary to keep the child’s gingivae healthy as their mucosa protects the oral cavity from microorganisms and bacteria. Regular dental examination guarantees dental health. 

Video: Deep caries treatment

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