Median caries, also called dentine caries, represents a particularly serious health problem. It manifests itself in the structural damage of a tooth affecting the enamel as well as the dentine layer. The risk factors of the median stage caries do not differ from the risk factors of dental caries development in general. They include the bacterial factor that is the presence of caries-causing bacteria in the oral cavity, the diet rich in carbohydrates and predisposition of the organism to dental caries development. Children as well as pregnant and breastfeeding women make up the risk group for tooth decay. Dental caries develops from initial lesions to median stage more progressively in these people.
The dentine layer is prone to the development of dental caries because of its porous and poorly calcified structure. It is perforated by innumerable dental microtubules which make up a favorable environment for progressive transmission of dental caries and emergence of dental cavities. There are two principal types of dentine caries. They are acute dental caries and chronic dental caries. The specific feature of chronic dental caries is that the child does not complain about any symptoms. That is why it is so important to visit the dentist’s office regularly to detect and treat dental caries in time. Tooth decay management in children is especially significant. Regular oral cavity sanitations performed by the pediatric dentist will protect the child from the progression of different pathologies and promote normal mastication and proper growth and development of the child’s denture.
Photo 1. Median Caries.
Unpleasant painful feelings on the stage of median caries are impermanent, usually caused by temperature (hot or cold), chemical (salty, sweet, sour) and mechanical (intrusion of food into the carious cavity) irritants. Pain may be experienced when food and beverages are consumed. The dentinoenamel junctions which are the most sensitive part of the tooth are damaged on the stage of median caries. Thus, when they are completely destroyed, tooth decay may become absolutely asymptomatic. The carious cavity on the tooth surface is of an average size and filled with softened dentine and food debris. Median caries can be suspected if unpleasant odor emanates from the child’s oral cavity. It affects many teeth and a great amount of food debris is collected and rotted in the oral cavity.
Photo 2. Toothache is a tooth decay symptom.
Median caries diagnosis is based on the data acquired during visual, tactile and instrumental examinations. X-ray examination is also administered to detect the median stage of tooth decay. While diagnosing dentine caries in children, pediatric dentists pay attention not only to the localization and size of the carious defect but consider the overall condition of the teeth in the oral cavity as well. Median caries diagnosis includes estimation of the developmental rate of caries progression, emergence of secondary caries lesions on the previously treated teeth, examination of defects of the restorative treatment administered before. Modern methods of diagnosis and median caries treatment allow patients to protect the tooth viability and to prevent further progression of the disease.
Photo 3. X-ray examination.
Median caries treatment is obligatory. It presupposes removal of pathologically deformed tissues from the affected tooth enamel and dentine and fixing of the defects by direct and indirect restorations. The affected tooth has to be drilled. Even though this procedure causes unpleasant painful feelings, the dentist must perform it. If this procedure is missed, recurrent caries will definitely appear around the filling. Moreover, if carious tissues are left in the cavity, caries progression is inevitable. As the cavity for the filling is formed, it must be cleaned with water, air and antiseptic. When all the preparation steps are complete, the dentist will proceed with immediate tooth filling. While treating the median stage of dental caries in children, general anesthesia is administered in virtue of the patients’ age. The method of direct restoration using glass-ionomer materials is used to manage the condition of median caries in children. In severe caries cases a crown may be placed on a child’s tooth, but on the viable tooth only.
Photo 4. Treatment of Median Tooth Decay.
If the tooth decay is detected in time, appropriate management of the affected tooth is performed by the dentist, and the child follows the hygiene rules, the prognosis will be quite favorable. Painful feelings will disappear, the pathological process will be liquidated, esthetic and functional characteristics of the tooth will be renewed. If the median stage of caries is not treated, the pathologic process will proceed deeper into the tooth structure causing more serious complications.