Removal of tooth decay
introduction
In order to be able to remove a tooth decay, the treating dentist must be certain how deep and extensive the infestation of the tooth is. Various options are available to him for this. On the one hand, caries detectors, i.e. liquids that change color when they come into contact with carious areas, are used.
Read more on the topic: How do you recognize tooth decay?
X-ray overview images (OPGs) or small images of individual teeth (dental film) enable the precise assessment of the depth of caries. Since X-rays are generally associated with exposure to radiation, an image is not always taken in the case of caries. As soon as a “rotten tooth” is discovered, the actual removal of the caries begins. Treatment for tooth decay differs depending on the stage of the disease.
Figure tooth decay
Tooth decay
chemical parasitic process
- Tooth enamel -
Enamelum - Dentin (= dentine) -
Dentinum - Tooth pulp in the tooth cavity -
Pulp dentis in Cavitas dentis - Gums -
Gingiva - Cement -
Cementum - Alveolar bone
(tooth-bearing part
the jawbone) -
Pars alveolaris
(Alveolar process) - Nerve fibers and blood vessels
Stage of the disease:
Descaling process (A + B + C)
Minerals dissolve from the
Tooth enamel -
(no toothache)
Progressive tooth decay (D)
Caries reaches the dentin -
(occasional throbbing pain)
Very deep caries defects (E + F)
that reach the pulp -
(severe, stabbing toothache)
the increasing destruction
of nerve fibers can become a
Cause blood poisoning
You can find an overview of all Dr-Gumpert images at: medical illustrations
One "real tooth decay“In any case, a decalcification process goes in the area of the Enamel ahead (Initial caries). These decalcifications are shown as small white spots, so-called "White spots" on the Tooth surface visibly and quickly with simple means.
It is recommended to use fluoride toothpastesthat remineralize the tooth and harden it from the outside. This prevents the caries from spreading further and heals the tooth.
When using such fluoride-containing toothpastes, it is essential to follow the instructions of the treating dentist (mostly use once a week), because an overdose quickly results in unsightly fluoride deposits.
Will the infestation in this stage If not removed, the tooth decay will spread further into the depth of the tooth. As soon as not only the enamel, but also that Dentin (Dentine) is affected, one speaks of dentine caries. This causes the characteristic "hole in a tooth“And has to be removed more extensively.
In this case, the dentist will remove the carious areas and a minimal part of the healthy tooth substance (drill out). The amount of still undamaged tooth substance is removed in order to create a new caries defect under the later one Tooth filling (Secondary caries) to avoid. After the caries-free hole has dried, the dentist fills it with filling material. A basic distinction is made between rigid and plastic filling materials.
Is Caries Removal Painful?
Is the tooth of Caries you should definitely attack this by the dentist remove otherwise the risk of the caries spreading increases enormously and, in the worst case, the tooth is completely infected. The tooth decay can usually only be removed with one Drill.
How deep and how much has to be drilled depends on the caries and how far it has spread in the tooth. The deeper the tooth decay has already penetrated, the more tooth decay will eventually have to be removed.
Everyone is has one individual pain perception. Accordingly, it is not entirely clear whether the removal causes pain or not. The possibility that Increased pain occur and are perceived as unpleasant by the patient, increases with the depth of tooth decay, as one is more and more of pulp approximates, in which the stimulus-transmitting nerves are located.
Is the tooth decay only in the superficial enamel layer is available, drilling is usually not necessary. But if they are removed by drilling, they are Pain very weak until hardly available. However, the further you go to Dentine advances in which the Dentinal tubules lying with the fibers, the greater the pain can become.
You might also be interested in: Toothache after drilling
In order to avoid pain you should definitely consult the dentist about a possible local anesthesia speak. If you are one of the more sensitive people, this is a good option to reduce or eliminate pain. Whether the health insurance will cover the costs must be clarified with the dentist in advance.
A Relationship of trust between Dentist and the patient is often very helpful. In the best case scenario, the dentist will explain the procedure and the pain associated with it beforehand, thereby giving the patient a sense of security, which often has a positive effect on their perception of fear.
All more in-depth caries treatments, which are usually already present when the dentine is affected or also root canal treatments, can be found under Anesthesia instead, as they are often associated with pain. Despite the anesthetic, some people find the treatment at the dentist extremely uncomfortable due to the background noise and the pressure in the jaw.
How can you remove tooth decay without drilling?
Caries can be removed from small occlusal defects (on the chewing surface) with a so-called excavator. This sharp-edged instrument is angled on both sides and has a small, shovel-like widening at the end. This works particularly well in the softer tooth area (dentin or dentin). Larger defects can also be removed with a laser, whereby the "drill noise", which is often perceived as annoying, is now missing. However, this procedure is not entirely free of sensation. Patients report a slight tingling sensation in the treated tooth. Another possibility is the so-called infiltration of small areas that are difficult to access. Here, the surface of the tooth is prepared with the help of a special gel, disinfected with the laser and then the defect that has arisen is sealed with special filling material. In the case of larger defects, however, the diamond drill has to do its job again, because then special shapes have to be brought into the tooth to ensure good adhesion for fillings.
Read more on the topic: Tooth decay treatment
Caries removal with laser
For some time now, lasers have been used in dentistry to remove caries in teeth. Their silent use ensures a pleasant climate in advance. The bundled light is still not completely silent. Small, short, softly stapling noises can be heard, but not remotely the shrill screeching of the drill that a patient is so afraid of. In addition to the possibility of removing caries with the laser, there are also lasers that differ in intensity and handling. They can be used, for example, to clean the root surface of teeth with periodontal disease.
Removal of caries in the interstices
When removing caries in the interdental space, a diamond drill is used to access the posterior area from the chewing surface, for example. In the case of anterior teeth, access to the palate or tongue is generally preferred. A so-called caries detector can be used for this. This is a liquid that is applied to the appropriate place in the tooth and rinsed off with water after a short exposure time (seconds). It leaves behind a more or less discolored dentine real (hard tooth enamel). A band matrix (molded part for filling) made of metal, which can also be applied here to protect the neighboring teeth or to better introduce the filling material, also serves as a barrier for the infiltration gel when removing caries without a drill.
Removal of caries under the crown
Unfortunately, tooth decay cannot be removed under a crown. To do this, you have to open the crown with e.g. remove a so-called shepherd's staff. But this is only possible if it is a cemented, i.e. with, for example, phosphate cement attached crown. Crowns that have been inserted with liquid plastic often do not allow this because they have great adhesive force or they even break when the shepherd's staff is attached (an instrument for hooking under the crown edge). If this method fails, the dentist can only slit the crown on the side and on the chewing surface and then remove it by bending it up, only then can the caries underneath be completely removed. The crown will be destroyed and can usually not be used after this procedure.
You might also be interested in this topic: Toothache under the crown
Can you remove tooth decay by brushing?
Unfortunately, it is not possible to get caries-free again by brushing your teeth. The development of caries is a multifactorial event, which means that at the beginning all factors must come together so that caries can consequently develop. If you change some of these factors, including correct tooth brushing, especially cleaning between the teeth, you will also prevent the development of caries. However, existing carious lesions on the teeth are quite capable of infecting the remaining teeth that have not yet been affected, because caries is understood as an infectious disease.
You might also be interested in this topic: How does tooth decay develop?
Home remedies for tooth decay
There are now more ways to remove tooth decay than just drilling. However, none of these other options are so-called home remedies. Because, as the name suggests, this would require use under domestic conditions. In addition to drilling, caries can be removed or stopped using a laser or infiltration. However, if household remedies are to be understood as conventional remedies, the first priority here is excavation (drilling out caries) with a diamond and hard metal drill. The latest development is ceramic drills, which work more gently than conventional drills, as this method opens up the pulp space (cavity of the tooth nerve) less often and ultimately prevents the tooth from dying off beforehand.
Read more on the topic: How can you cure tooth decay?
Remove caries yourself
Almost everyone is confronted with tooth decay at some point in their life. Sometimes more or less strong, it often goes unnoticed by those affected. In some cases, the caries can spread, which can damage the tooth and the entire tooth support system.
Even if prosthetics are very advanced today, dentures should be avoided as long as possible and the natural tooth should be preserved. To do this, it is necessary to remove the caries in order to catch them early and to fill the hole with a filling.
However, tooth decay is underestimated by many people, and even going to the dentist is a daunting prospect for many, which is associated with discomfort and pain. For this reason, tips and tricks on how to remove tooth decay yourself are often wrongly found on the Internet.
This is also correct in a certain small area, but only when it is a question of small initial caries, a preliminary stage of real caries. This decalcification of the tooth is noticeable as white spots on the tooth, which can hardly be recognized by a layperson. This decalcification can be dealt with with fluoride preparations (fluoridation of the teeth) so that you can treat “caries” from home.
However, the use of these preparations must be discussed with a dentist in any case, as they should not be overdosed in order to avoid unsightly discoloration. It is usually recommended to use it once a week.
Any other type of caries that goes beyond this stage, possibly even has reached the depth of the dentin, cannot be treated by yourself but requires treatment by a dentist.
First and foremost, it is not possible for a layperson to accurately diagnose tooth decay and assess its extent. This requires experience and a trained eye.
Tooth decay can appear in a wide variety of places that cannot be recognized with a mirror that you hold in your mouth. For further examination, special instruments are required, which must be used carefully, for example not to "poke" the caries and to endanger aggravation due to pulp opening etc. Under no circumstances should you “poke around” the caries with a probe or other sharp object.
A drill is required to remove the caries and various filling materials are required for further treatment.
Only the dentist in his practice with the necessary equipment can ensure a complete and safe removal with subsequent filling.
Trying to do this yourself is dangerous to dental health and can make the situation worse.
However, what should be done at home and by every patient to prevent tooth decay is thorough dental care and a healthy diet.
You should brush your teeth at least twice a day to remove the plaque. Mouthwashes, tongue scrapers and dental floss can also be used to catch difficult areas on the tooth.
Regular checks by the dentist and professional teeth cleaning, which should be carried out around twice a year, significantly reduce the risk of deep caries. Only use sugary and acidic foods in small amounts as they attack the tooth and actively influence the development of caries.
Home remedies such as drinking green tea or using alkaline foods are intended to counteract the development of caries. Research is now being carried out on many different methods that should make it possible to remove caries at the dentist without drilling.
How much does it cost to have tooth decay removed?
In the case of patients with statutory health insurance, the costs of removing tooth decay are borne by health insurance. Since several steps are necessary for this, the sole removal cannot be called a cost. Not all of these steps need to be followed for every patient. For the sake of completeness, however, each item that is subject to a charge is mentioned here: vitality test (is the tooth still alive?), Possibly an X-ray, anesthesia (numbing), excavation (removal of caries), special measures when placing the filling that go beyond the usual measure, Protection of the tooth pulp with deeper lesions, etching of the hard dentine and the tooth enamel, so-called bonding, introduction and hardening of the filling material and finishing of the surface. All billing numbers from statutory health insurances and private insurances always include the placing of a filling in combination with the introduction of the sealing material. If a laser is used, however, the health insurers pay nothing, as this service is not anchored in the statutory catalog of services and, according to the GKV, therefore goes beyond the normal sufficient level and is to be charged as a private service. Therefore, there are additional extra costs, which, depending on the dentist, amount to between € 40 and € 70 for a small filling.
The filling materials for tooth decay
While plastic materials (Composites /plastic and amalgam) are introduced directly into the tooth and shaped there, rigid filling materials (e.g. Inlays) outside of the mouth.
Inform yourself here about the different materials for tooth filling.
They are rarely used for small carious defects because of their high price, but they are more stable than plastic filling materials. The removal of caries is generally covered by the statutory health insurances, but both are required Plastic fillings, as well as treatment with rigid materials at an additional cost from the patient.
Patients with established Renal failure are the exception, because in these cases the health insurance company has to cover the full cost of each plastic filling.
At a deep dental caries (caries profunda), in which more than 2/3 of the dentine is affected, in addition to the actual removal of the caries, the "Dental nerve“ (pulp) to protect. For this reason, a filling must be preceded by what is known as underfilling. A calcium hydroxide containing Drug, which is supposed to stimulate the dentin replica in the depth of the hole, is introduced at the bottom of the hole.
Only then does the real Tooth filling carried out. Should the caries infestation and / or the removal of the caries ("drill“) The outer wall of the tooth has been damaged, so-called matrices are used for shaping.
If deep caries is not treated, the so-called penetrating caries arises Dental caries (caries penetrans). The defect passes through the dentin to the pulp cavity (Pulp cavity), so the pulp is in direct contact with the bacteria that cause tooth decay.
These bacteria lead to inflammation, damage tooth pulp and the nerve fibers in it. If the dentist wants to remove this caries and preserve the tooth, he can no longer do this with a tooth filling including underfilling, but rather has to clear out the entire tooth pulp and the nerve fibers located in itRoot canal treatment).
The resulting cave in the Tooth root must be filled with body-compatible materials (Root canal filling) and the tooth closed. In the case of very deep caries defects, root canal treatment is the most important way to preserve the affected tooth. In the case of very extensive caries defects, a Dental crown become necessary.
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