Introduction
Targeted caries treatment is inevitably preceded by the correct assessment of the depth of caries and the condition of the affected tooth. The dentist has various options at his disposal. Caries detectors, i.e. liquids that stain carious areas of the tooth, are often used.
X-ray overview pictures (OPG) or small images of individual teeth (tooth films) allow an exact estimation of the depth of caries, but due to the relatively high radiation exposure they are only made in special cases. In case of deep caries, which can only be removed by drilling, the resulting hole must be filled afterwards. There are different materials for this purpose.
Classification of caries treatment
Once a “rotten tooth” has been identified as such, further caries treatment depends on the stage of caries. 1. decalcification processes in the area of the tooth enamel are regarded as a preliminary stage of “real caries” (initial caries). These decalcifications (macula alba) appear as small white spots on the tooth surface and can usually be quickly controlled with fluoride therapy.
Caries therapy in these cases is therefore limited to the application of special fluoride preparations that remineralize and harden the tooth enamel. When additionally using fluoride toothpastes, it is important to follow the instructions of the dentist (usually once a week), because an overdose can quickly lead to unsightly fluoride deposits. 2. caries that affects not only the enamel but also the deeper dentin (dentine caries) and causes a hole in the tooth must be treated more extensively.
Fluoridation is no longer sufficient here. In this case the dentist will remove the carious tooth substance and a minimal part of the healthy tooth. This serves to prevent a possible new caries formation under the later tooth filling. Afterwards the tooth is covered with filling material. The filling material is selected individually according to the condition of the tooth.
Treatment of deep dental caries
In the case of deep dental caries (caries profunda), where more than 2/3 of the dentin is affected, it is important to protect the “tooth nerve” (pulp) in addition to the actual caries treatment. For this reason a filling must always be preceded by a so-called underfilling. This is the insertion of a calcium hydroxide containing medication, which is supposed to stimulate the dentin reproduction in the depth of the hole.
Only then is the actual tooth filling carried out. If the outer wall of the tooth has been damaged by the caries and/or the preparation of the tooth (“drilling”), so-called matrices are used for shaping. This means that the dentist uses these matrices to reproduce the natural shape of the tooth.
Penetrating dental caries (caries penetrans) extends through the dentine to the pulp cavity (pulp cavity), so the pulp is in direct contact with the caries causing bacteria. If the pulp and the nerve fibers in it are inflamed and severely damaged, even a dental filling with underfilling no longer offers adequate caries treatment. In this case, the tooth pulp, including the nerve fibers, must be removed.
The nerve fibres run inside the root of the tooth in a canal (root canal). To prevent the inflammatory processes from spreading to the jawbone, this canal must also be freed of nerve fibres and disinfected. Usually, an antibacterial medication is left in the tooth for a few days.
This treatment is called root canal preparation (short: WK). The dentist then fills the root canal with a material that is compatible with the body and places both an underfilling and a “normal” filling (root canal filling/WF). Root canal treatment is considered the most important way to preserve the affected tooth in cases of very deep caries defects.
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