Pit and Fissure Caries: Causes, Diagnosis and Treatment


Pit and fissure caries is a type of dental lesion that forms in the anatomical recesses of the molars and premolars. Even with careful oral hygiene, it is extremely difficult to completely clean out pathogenic microflora from hard-to-reach places. Recesses in the teeth become a good place for the accumulation of food debris and the further emergence and development of bacteria.

What is Pit and Fissure Caries?

Fissure dental caries affects the chewing part of the crowns of the tooth, and with untimely treatment develops quite quickly. The formation of this pathological process is influenced primarily by the anatomical features of the molars. The presence of deep fissures with insufficient quality of oral hygiene is the main reason for the formation of this disease.

An equally significant fissure caries cause is given the nature of nutrition. Dentists recommend eating coarse plant foods, as this cleans the surface of the teeth and prevents softening of dental tissues. Also, the cause of the development of fissure caries are:

  • genetic predisposition to the development of caries;
  • chronic diseases that caused a change in the composition of saliva;
  • lack of vitamins and nutrients in the body;
  • malnutrition;
  • frequent consumption of food with a large number of carbohydrates.

Fissure and tooth decay most often occurs in children. In addition to the fact that the enamel of milk teeth is less strong than on molars, children ignore the importance of regular oral hygiene: they forget or brush their teeth insufficiently. They also gnaw on toys and other household items. However, dentists also diagnosis of pit and fissure caries in adult patients. The reason is the same as in children: insufficient oral care and missed scheduled visits to the dentist.

Diagnosis of Pit and Fissure Caries

Fissure caries in the early stages is difficult to diagnose during a routine dental examination. So, how to detect pit and fissure caries when it is not yet noticeable? The most informative diagnostic method is dental fluoroscopy. This allows diagnosis of fissure caries in the tooth's hard tissues long before the onset of clinical symptoms, which is important in the case of a latent carious course of the disease.

Symptoms of caries directly depend on the stage of the pathological process:

  1. Initial. The area demineralizes, which appears as a white spot. Only a specialist can determine where pit and fissure caries first occur during a thorough visual inspection.
  2. Superficial. The lesion affects the deep layers of the enamel, but the hard tissues are still healthy. The patient feels discomfort during sour or sweet food.
  3. Average. Caries penetrates deeper and begin to actively destroy the tooth, while acute pain is felt, especially during eating or brushing. The pathological process begins to spread deep into the tooth.
  4. Deep. There are sharp or aching pains that significantly reduce the quality of life. They do not pass even at night. If you do not consult a doctor, then there is a high probability of developing periodontitis or pulpitis.

The progression of pit and fissure caries is determined by the doctor during the examination. Depending on the degree of damage, a suitable course of therapy is prescribed. In some cases, an additional x-ray is required to assess the nature of the lesion. Identification of a pathological process requires immediate treatment, as it creates conditions for preserving the maximum volume of tooth tissues. The peculiarity of pit and fissure cavity caries is that it does not spread across the width, but into the lower tissues of the tooth, which causes an increased risk of pulpitis. With a neglected form of the pathological process, therapeutic manipulations become useless, and surgical intervention becomes the only solution.

Pit and Fissure Caries Treatment

The treatment of pit and fissure caries includes conservative and surgical methods. The first type of therapy is carried out only at the initial stage of the disease. For this, the dentist makes a pit and fissure caries diagnosis. The dentist does deep fluoridation – this will help increase the strength of the enamel and prevent its destruction. First, mechanical cleaning of the teeth is performed to remove the remnants of food and plaque, and then the surface of the tooth is covered with fluoride compounds. They seal the tooth and protect it from further decay.

Surgical treatment is possible at any stage and involves the preparation of the tooth, followed by sealing the pits and fissures or filling the cavity. Restoration of the integrity of the tooth using photopolymer or glass ionomer materials is carried out in the most gentle ways, trying to remove only tissues damaged by caries. Before starting pit and fissure caries treatment, the doctor always makes anesthesia, then they clean the chewing surface of the tooth from plaque, and only after that they do proceed to the preparation. A feature of restorative filling is the application of a special material – sealant, over the filling.

In some cases, dentists may recommend restorative inlays. It is fabricated by a dental specialist in a laboratory. First, the tissues affected by caries are drilled out, and an impression is taken from them, according to which the technician already makes inlays from different materials. It turns out to be as individualized as possible, therefore, after its fixation, even small gaps do not remain in the tooth, through which pathogenic microorganisms and organic acids that destroy the tooth could penetrate.

Tooth decay treatment in children is similar to adult therapy. Children's teeth are less mineralized, so they are more susceptible to destruction by the carious process. Treatment methods for children in the early stages mainly consist of sealing fissures with the help of special liquid formulations. Also, use the method of deep fluoridation. To do this, the tooth is cleaned of plaque and treated with special fluoride compositions that saturate the tooth with fluorine ions and thus protect it from further destruction. In other cases, when the destruction has crossed the border of the enamel, sealing is used.

The prognosis for detecting caries fissures and pits is almost always favorable. Modern dentistry allows you to carry out all the necessary therapeutic measures to avoid the progression of the pathological process. Knowing what is pit and fissure caries and not ignoring preventive measures can help reduce the risk of complications. They consist of careful observance of oral hygiene, regular visits to the dental clinic, and enrichment of the diet with vitamins and minerals.