Tooth decay (also called caries) is one of the most common dental problems especially in younger people and the elderly.

It is caused by sugars in food or drink being used as foods by bacteria in the plaque on the teeth which produces acids as waste products. This acid softens the tooth surface and so as they grow, the bacteria invade into the tooth.

If left untreated, the decay will gradually spread further and further through the tooth eventually leading to the tooth nerve dying off or the tooth breaking.

To treat decay in a tooth, a dentist must remove the infected tooth tissue. Once this is done, a filling material is placed to restore the shape back to the original as closely as possible. There are several different materials which can be used and each has some advantages. The dentist will often discuss what would be best in each situation.

The more decay there was, the larger the filling needs to be and consequently, the greater the risk of post-operative sensitivity or other problems.

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Root Canal Treatment

Within every tooth, there is a soft tissue core which is called the pulp. It contains the nerves which give you feeling from that tooth and blood vessels to keep the nerves healthy. Several things can damage the pulp and unfortunately, it is not always very good at healing.

Some of the most common causes of this damage are

  • extensive tooth decay,
  • previous restorations, particularly deep fillings and crowns,
  • advanced gum disease, and
  • trauma, such as from an accidental injury or repeated pressure from an opposing tooth.

When the pulp is damaged, it may die off quietly or it may develop acute pulpitis first, which causes a very bad toothache. Once the pulp dies, the soft tissue rots inside the tooth and becomes colonised with bacteria which proliferate. This eventually leads to an abscess forming at the tip of the root. In either of these cases (i.e. abscess or pulpitis), the choice of remedy is either to carry out a root canal treatment or extract the whole tooth.

Root canal treatment involves cleaning any pulp debris from inside the roots of the tooth with special files and repeated washing. Once cleaned and dried, the root canal is filled with a rubber material called gutta percha. The aim is to eliminate any space within the root canal system for bacteria to grow. If successful, the tooth will survive free of infection and pain for many years to come. However, the complexity of the treatment, especially in the back teeth, means that there is a higher chance of failure than with most other dental procedures and sometimes the tooth may ultimately need to be extracted.

Root-filled teeth are generally more brittle than a live tooth so they are more likely to break piece off and often require crowning as well.

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