Tooth decay treatment


A targeted one Tooth decay treatment inevitably passes the correct assessment Caries depth and condition of the affected tooth.
Various options are available to the dentist here. Often times, caries detectors find that these are liquids that carious spots coloring of the tooth, application. X-ray overview images (OPG) or small pictures of individual teeth (Dental films) allow a precise assessment of the caries depth, but are only made in special cases due to the relatively high radiation exposure.

In the case of deep caries, which can only be removed by drilling, the resulting hole must then be filled. There are different materials for this. Read more here: Tooth filling - what materials are there?

Classification of caries treatment

Is a "rotten tooth“Once recognized as such, further caries treatment depends on the respective Caries stage.

1. As a preliminary stage of a "real tooth decay“ (Initial caries), descaling processes apply in the area of ​​the Enamel. This decalcification (macula alba) appear as small white spots on the tooth surface and can usually be dealt with quickly with fluoride therapy.
In these cases, caries therapy is limited to the use of special fluoride preparations that remineralize and harden the tooth enamel. With the additional use of fluoride toothpastes you should strictly follow the instructions of the treating dentist (Use usually once a week), because an overdose can quickly lead to unsightly fluoride deposits.

2. One Cariesthat not only enamel but also that deep dentine infested (Dentinal caries) and causes a hole in the tooth requires more extensive treatment.
Fluoridation is no longer sufficient here. In this case, the dentist will remove the carious tooth structure and a minimal part of the healthy tooth. This serves to prevent possible new caries formation under the later Tooth filling to avoid. The tooth is then provided with filling material. The filling material is selected individually depending on the tooth condition.

Treatment of deep dental caries

At a deep dental caries (caries profunda), in the more than 2/3 of the dentin is affected, in addition to the actual caries treatment, the "Dental nerve“ (pulp) to protect.
For this reason one must filling always precede a so-called underfill. It involves the introduction of a drug containing calcium hydroxide, which is supposed to stimulate the dentin replica in the depth of the hole.

Only then is the actual Tooth filling carried out. Should the caries attack and / or the preparation of the tooth ("drill“) The outer wall of the tooth has been damaged, so-called matrices are used for shaping. This means that the dentist uses this matrix to reproduce the natural shape of the tooth.

Penetrating dental caries (caries penetrans) extends through the dentin to the Pulp cavity (Pulp cavity), so the pulp is in direct contact with the caries causing bacteria. Are these Pulp and the nerve fibers in it are inflamed and severely damaged, even a tooth filling with underfilling no longer offers adequate caries treatment.
In this case, the tooth pulp and the nerve fibers must be removed. The nerve fibers run within the Tooth root in a channel (Root canal) to prevent the inflammatory processes from spreading to the Jawbone To prevent this, nerve fibers must also be removed from this canal and disinfected. An antibacterial drug is usually 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" tooth filling (Root canal filling / WF). In the case of very deep caries defects, root canal treatment is the most important way to preserve the affected tooth.

Treatment of tooth decay

Caries tends to form in areas that are very difficult to clean. These include, above all, the interdental spaces (= approximal spaces). The removal of caries in the interdental spaces must be done from above. Often this caries can only be made visible on X-rays. When looking at the rows of teeth from above, caries can often not be seen with the naked eye. The caries is still removed from top to bottom.

It is very important that the caries is made completely visible from above so that the dentist can safely remove everything. The principle "As much as necessary, as little as possible" always applies here to the removal of the hard tooth substance. Unfortunately, the caries in the interdental space often "infected" the adjacent tooth with the caries. In this case, the caries is now selectively removed from the side without destroying the tooth from above. In most cases, the filling is made with plastic and is adapted to the tooth color. On request, amalgam can be selected for reasons of cost, because a plastic filling requires a private additional payment by the patient.

Treatment of tooth decay during pregnancy

Of course, you can also go to a dentist to treat your teeth during pregnancy. However, this should not be done in the 1st or 3rd trimester of pregnancy, as the risk of possible consequential damage to the child is very high. Treatment in the 2nd trimemnon is always recommended. Preparations suitable for pregnancy are used for anesthesia.

X-rays should be avoided during pregnancy unless they are essential. However, amalgam must not be used for filling during pregnancy. After caries treatment, very good oral hygiene is very important, especially during pregnancy.Inflammation should be avoided in any case, because the use of antibiotics to combat inflammation is not permitted during pregnancy

Pain during caries treatment

The pain that occurs during caries treatment depends both on the exact location and on the Expansion of the carious defect from.
Superficial tooth decaythat is detected at an early stage can usually without pain be treated. In such cases, the affected patients merely report an uncomfortable feeling after the caries treatment. However, this does not come from the carious defect, but mainly from the Rotational movements of the drill. (see also: Toothache after drilling)
In addition, the pain that occurs in the treatment of caries in the lower jaw should be significantly stronger than in the case of filling therapy in the upper jaw.
Particularly severe pain usually only occurs when deep carious defectsthat are only recognized and treated at an advanced stage. The reason for this is the fact that inside the tooth, more precisely in its medullary cavity, there are tiny nerve fibers. As soon as the carious defect comes close to these nerve fibers, the pain increases significantly during the caries treatment.
For this reason, in the case of pronounced carious defects, a local anesthesia carried out. This includes in upper jaw only that to the affected tooth adjacent area (Infiltration anesthesia). If there is caries in the lower jaw, it usually has to be Half of the lower jaw completely anesthetized become (so-called Conduction anesthesia). In this way, the pain that occurs during caries treatment can be almost completely alleviated. Particularly severe pain always occurs when there is already inside the tooth inflammatory processes have trained. In these cases, you can usually use a local anesthetic no caries treatment without pain be performed.

Caries treatment without drilling

Deep carious defectswhich affect a large part of the tooth substance can usually not be treated without drilling.
In such cases, the areas that have been cariously changed with the drill completely removed and the tooth filled with a replacement material.

Caries treatment without drilling is only at, if at all small carious defects possible. The so-called "Caries infiltration“Is one of the most popular methods of treating caries without drilling.
With this method, the tooth enamel in the area of ​​the cariously changed area with a special plastic gel filled up.
The plastic gel introduced into the tooth enamel penetrates the tooth and prevents the bacterial pathogens responsible for caries from spreading further.

How is tooth decay under a crown treated?

Tooth decay can also develop under a crown. The caries can either already have been present when the crown was created or the reason for this lies in a possible crack, a hole or a gap in the edge of the crown. To remove the tooth decay, the dentist must also remove the crown. If this is not destroyed during removal, it can be put back on after the caries has been removed.

The caries is removed and the area is refilled with plastic. Then the tooth has to be ground again. Depending on the severity of the caries, the old crown can be replaced or a new one created. If the caries has already penetrated the tooth nerve, the tooth must be root canal treated and, in the worst case, pulled.

Read more on the topic: Root canal treatment

Caries treatment can be done with or without drilling.

Before the plastic gel is introduced, the surface of the carious change should be covered with a special liquid to be treated.
In this way, the pathogens that cause caries are to be rendered harmless.
The caries infiltration should be much gentler than the usual caries treatment. This method of treatment is considered by the patient significantly more painless and therefore can without local anesthesia be performed.
In addition, it should also healthy tooth structure for caries infiltration without drilling better preserved.

With conventional caries treatment with the drill, the carious part of the tooth must be completely removed.
In addition, there is usually also a Part of the healthy tooth structure removed. In this way, the carious defect can be prevented from spreading further, but in the long term the tooth will be damaged by the Loss of substance, however, seriously damaged.

By treating caries using caries infiltration, however, the caries can be isolated within the tooth. This prevents the causative pathogens from spreading without damaging healthy tooth structure.
With this form of caries treatment without drilling, however, it must be ensured that neither statutory nor private health insurances cover the costs.
Patients have to pay for all costs themselves. The price of caries infiltration currently varies greatly from practice to practice.

Caries treatment costs

Caries treatment is provided by the statutory health insurance not always fully worn.
In this context, the most important localization and the desired filling material a crucial role.
In the visible front teeth area, the statutory health insurance pays all costs for one tooth-colored plastic filling. This regulation affects the incisors and canines of the upper and lower jaw.
Carious defects in the posterior area, i.e. on the premolars and molars, cannot usually be avoided Personal contribution (i.e. without additional costs for the patient) can be supplied with a plastic filling. The statutory health insurance companies only take over visible fillings in this area amalgam.

A special regulation applies to those patients who are from because of health (for example because of a severe kidney disease) are not allowed to receive caries treatment with amalgam filling.
For these patients, the statutory health insurance will also cover the costs for a plastic filling in the posterior region.

However, the insured also has the option of choosing a tooth-colored plastic filling in the posterior region. The additional costs associated with this form of caries treatment (so-called Additional costs) must then, however borne by the patient himself become.
Depending on the extent of the carious defect, a simple caries treatment can result Costs between 40 and 150 euros cause.

Treatment of caries in toddlers

Early treatment of tooth decay in young children is very important. It is essential to prevent the caries from spreading deep into the tooth, as this would mean a root canal treatment and a crowning of the milk tooth or, in the worst case, an extraction (= removal of the tooth). The affected area will be numbed before treatment. If children are very afraid of the tip being set or of dental treatment and this makes treatment impossible, nitrous oxide anesthesia can be used.

Read more on the topic: Laughing gas. Application, effect and side effect

The caries on the milk tooth is removed and the tooth can then be filled with either plastic or cement. The cement filling is fully covered by health insurance. It is yellow-whitish, softer than plastic and for this reason does not last as long as a plastic filling. The filling with plastic can be adapted very precisely to the tooth color, is suitable for larger areas in contrast to cement and is more durable.

With this filling material, however, a private additional payment must be made. The choice of material depends on the one hand on the size of the carious defect and on the other hand on the location of the caries. In the anterior region, aesthetics are more important than in the molar region and indicate a plastic filling rather than a cement filling.

Read more on the topic: Tooth decay in young children