Cervical caries under the gums
Cervical caries can be treated easily and quickly in most cases. Especially those carious defects that are discovered in the early stages can usually be removed without leaving any residue. Consequential damage is usually not left behind.
The treatment of cervical caries under the gums (gingiva) is much more difficult. One reason for this is that caries below the gum line is usually discovered very late. In other words, the affected patient does not see a dentist until the medullary cavity is opened, the nerve fibres stored in it have been attacked and pain develops.
The initial situation of the tooth is already so bad at this point that an extensive root canal treatment must be carried out. On the other hand, the intact gingiva has to be lifted a little bit from the tooth surface in the course of the treatment of cervical caries under the gum. Only in this way is the dentist able to fully understand the extent of the carious defect and remove it completely. However, this procedure represents a trauma for the gingiva itself. In the course of the treatment of cervical caries under the gums, many patients complain of irritation and inflammation of the gums.
Treatment
The danger of cervical caries lies in the fact that the neck of the tooth has no enamel in comparison to the crown. Consequently, carious defects in the area of the cervix reach the medullary cavity much faster and can lead to the development of inflammatory processes there. Early-stage cervical caries can usually be easily treated.
The treatment corresponds to that of a normal caries in the area of the crown of the tooth: the damaged tissue is removed and the hole is filled. See more below: Cervical filling If the affected patient already complains of severe pain, a simple filling therapy is no longer sufficient. The cervical caries must be treated by root canal preparation and subsequent filling.
The aim of a root canal treatment is to remove as many germs and inflamed tissue remains from the medullary cavity as possible. Throughout the entire treatment, the tooth must be protected from saliva by absorbent cotton rolls and teats. The tooth, which has deep cervical caries, is anaesthetized and then opened with a “drill”.In the next step, the tooth pulp, including the nerve fibers inside, must be completely removed.
The dentist does this with the help of root files of different lengths (Reamer, Hedstrom or K-files), which also differ in their diameter. The root files are used in an orderly sequence (the diameter increases). Afterwards an alternating rinsing with different solutions must be carried out.
The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial chlorhexidine (CHX) and sodium hypochlorite. Once the tooth root is sterile and dry, it is filled with so-called guttapercha points and a dense cement. As a rule, an X-ray control image is used to check whether the root is filled to the tip (apex) and the tooth is then sealed.
Since in the case of cervical caries, the bacteria are not located on the tooth but on the neck of the tooth, which is very sensitive due to its lack of a protective enamel layer, and the caries can therefore easily spread to the inside of the tooth, rapid treatment of cervical caries is advisable. If the caries is only superficially present, it is sufficient to have all teeth thoroughly cleaned by the dentist and then to accelerate the remineralization with a fluoride therapy by storing minerals. In case of deeper caries, it must be removed by the dentist and then filled with a filling.
The affected tissue is removed with a drill, usually a rose bur at low speed, until the caries has disappeared without residue. In dentistry this is called caries excavation. The resulting hole is then filled with a filling material.
The removal of the caries corresponds to the removal of a caries on the crown of the tooth. There are many different types of filling material to choose from, depending on the extent of the defect and the wishes of the patient. Plastic-based materials are suitable in most cases.
However, if the caries is already more advanced, a simple filling is no longer sufficient and a root canal treatment, in which all bacteria are removed from the pulp cavity, is initiated. Afterwards, this is also treated with a filling. If the neck of the tooth is affected by caries and is not only initially present, the caries must be removed, which is done with a drill.
The removal of this caries is similar to that which takes place at the crown of the tooth during an excavation. In this case, the rose bur is considered the classic means of caries removal. It is round, available in different diameters and has spiral teeth.
It is made of stainless steel, tool steel or hard metal. Models made of polymer resin are also available, which are less stressful for the dentine, but do not always remove caries completely, leaving a surface that is less adhesive for the subsequent adhesive. The rose bur removes the carious tissue at low revolutions (between 500 and 4500 revolutions per minute).
This proven method is simple and effective to use, but too much heat can damage the pulp and be uncomfortable for the patient due to the noise. In order to make the treatment painless, a local anesthetic (local anesthetic) is used. Various materials can be used to fill a dental neck caries.
In most cases, the choice of a suitable filling material depends on the extent of the carious defect as well as on the individual wishes of the patient. Filling materials containing plastics are usually particularly suitable for the treatment of cervical caries. After removing the carious areas, the dentist applies a viscous liquid, which is intended to strengthen the interaction between the tooth substance and the plastic material.
Afterwards, the resin-containing filling material can be applied in a malleable form and cured by polymerization light. In order to create an ideal transition between tooth substance and plastic, the cervical filling is ground and smoothed with fine arrows. The filling of cervical caries with amalgam is usually performed rather rarely. This is due to the fact that amalgam is sometimes more than controversial as a filling material.
