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Tooth decay treatment

author icon By Dr. George Ghidrai

The cheapest and most effective treatment is the preventive treatment. Dental prophylaxis or preventive dentistry is a set of procedures that try to prevent the occurrence of tooth decay and periodontal disease.

Generally, the treatment approach depends on several key factors :

  • whether the carious lesion is cavitated or non-cavitated

  • whether the lesion is active or arrested

  • whether the decay is incipient or recurrent

    • incipient caries describes decay at a location that has not experienced previous decay
    • recurrent caries, also described as secondary, are found on the margins (or underneath) of fillings and other dental restorations

a. Treatment of early lesions

A new carious lesion appears like a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel.

early caries lesion

early caries lesions

Many dental researchers consider that early lesions, which are "non-cavitated", can be arrested and remineralization can occur under the right conditions.

However, this may require some diet changes (especially the reduction in frequency of refined sugars), a proper oral hygiene, and regular application of topical fluoride.

In these conditions, the researchers argue that no drilling on the tooth is necessary since early lesions are reversible.


b. Treatment of cavitated lesions

Once a lesion has cavitated, especially if dentin is involved, remineralization is much more difficult and a dental restoration is usually indicated. Before a restoration can be placed, all of the decay must be removed otherwise it will continue to progress underneath the filling.

cavitated caries lesion

"cavitated" caries lesion

!!!A very important aspect is that the progression of dental caries can be stopped by treatment.

Main goals

The treatment of dental decays has several important goals :

  • To preserve as much of the original tooth structure as possible

  • To prevent further destruction of the tooth

  • To prevent further complications of the decay (such as pulpitis or apical periodontitis)

  • To remove all infected tissue from the decay

  • To return the tooth to function and aesthetic condition with a proper restoration

Procedure

It is very important to know that in general, early treatment is less painful and less expensive than treatment of extensive decays.

  1. Anesthetics

    Local anesthetics, nitrous oxide ("laughing gas") or other prescription medications may be required in some cases to relieve pain or anxiety during or following treatment.

  2. Access cavity

    Enamel is a highly mineralized tissue ; therefore, enamel penetration is usually done using a dental handpiece (drill) at high speed.

    The general rule is to remove as little of the enamel as possible, just enough to get access to the decayed dentin underneath.

  3. Removal of the decayed material

    dental spoon

    dental spoon

    A dental handpiece at low speed is used to remove large portions of decayed material from the tooth.

    A dental spoon, an instrument used to carefully remove decay, is sometimes employed when the decay in dentin reaches near the pulp.

    tooth cavity after preparation

    a cavity after the decayed material
    has been removed

  4. Tooth restoration

    Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to function and aesthetic condition.

    Tooth restoration is discussed in the next chapter.


If the decay has reached the dental pulp, root canal therapy may be required before the tooth can be restored.


c. Treatment of recurrent caries

Recurrent or secondary caries are found on the margins of fillings or underneath fillings or other dental restorations.

recurrent decay

recurrent decays on the margin of amalgam filling

Over the years, dental fillings can weaken, begin to break down or develop rough edges which allows plaque to build up more easily. Moreover, fillings or other dental devices can also stop fitting well, allowing decay to begin underneath them.

The general treatment approach is to completely remove the fillings or dental devices, then all the decayed material is removed and the tooth is restored with a new filling or a dental crown.

Last review and update: May 2019



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