Inflammation treatment
If a caries has been diagnosed under a dental crown, the root of the tooth is inflamed, or excessive wear of the dental crown has occurred, in most cases it will be removed. The detection of caries under a crown turns out to be not so easy. The dentist tests the crown margin after the caries to detect secondary caries or arranges for an X-ray to be taken.
It is difficult to evaluate this, because the metal crown can overlay the image. The subsequent removal of the crown requires precise work, as the existing tooth stump, gums and bone must not be damaged. Removal depends on the type of attachment.
If the crown is already very loose, it may be possible to remove it by simply turning it, but if it is more firmly attached, special instruments are required, e.g. a dedicated grinding wheel and spreading pliers. After removal, the stump is examined by the dentist and the necessary treatment is performed.This can be the removal of the caries or a root canal treatment. Depending on the situation, the previously removed crown is either reinstalled or a new one is made.
The removal of the crown is covered by the health insurance company in these cases, if it is clinically reasonable. If there is an inflammation under the crown, the tooth must be reamed to remove all the inflammatory tissue so that the inflammation is prevented from spreading. If the crown is provisionally fixed, it can be taken down and does not have to be drilled through.
The root canal treatment is carried out on the affected tooth and after completion the crown is reattached. However, if the crown has already been definitely cemented, it may not be possible to loosen or loosen it and the tooth must be treated through the crown. In this case, a hole is drilled through the crown and the root canal treatment is carried out.
After the treatment is completed, the hole is filled with plastic. The crown can still be used, but it is an unattractive solution from an aesthetic point of view. The use of antibiotics is at the discretion of the practitioner, as antibiotics are only available on prescription.
In the majority of cases, an antibiotic is used in the case of an inflammation under the crown, if the inflammation has a tendency to spread and there is a risk that the pathogen cells could enter the bloodstream. If bacteria from the abscess enter the bloodstream, a systemic infection that affects the entire body, known as sepsis, occurs. Since sepsis is life-threatening, attempts are made to use the antibiotic in addition to dental treatment in order to eliminate the bacteria from the body more quickly.
The antibiotic is given in addition to a relief incision of an abscess or a drilling of the affected tooth to remove the bacteria. The bacteria are thus contained and destroyed much faster than if only surgical or dental treatment is carried out. Aminopenicillins are considered to be the antibiotic of choice for inflammation of the oral cavity and especially for teeth.
These include ampicillin or amoxicillin, which have been scientifically proven to be the most effective because they are bactericidal, which means that the bacteria are destroyed directly. Furthermore, aminopenicillins should also be used in pregnant women, as they have the lowest risk for the unborn child. For patients with penicillin allergy, the alternative antibiotic is clavulanic acid or clindamycin, which are not as effective as aminopenicillins. In general, all antibiotics must be taken as directed. The antibiotic must be taken for a certain number of days, usually 4-5, so that no bacteria survive, which can get used to the antibiotic and form the dreaded resistances.