Management of Deep caries Lesion

Endodontics
4/17/2009

KUILLIYYAH OF DENTISTRY INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

Dr.Shawfekar

Tooth Decay
Summary
Tooth decay is the destruction of tooth enamel by dental plaque that causes holes known as cavities. It strikes people of all ages, but is particularly prevalent in children ages 5 to 17 years, according to the U.S. Centers for Disease Control and Prevention. A sticky film called dental plaque is the source of tooth decay. Plaque is made up of a combination of bacteria, acid, food particles and saliva. When a person consumes food, especially drinks high in sugars or carbohydrates, dental plaque builds up on the teeth and gradually erodes their structure. Damage can occur in any part of the tooth that is exposed to plaque, from the crown at the top down to the softer body of the tooth (dentin) and the inner core of the pulp, which contains nerve fibers and blood vessels. Patients with tooth decay do not usually experience any symptoms initially. However, if a cavity is not detected and begins to progress, it will often cause pain, particularly when eating sweet foods or when the tooth is exposed to hot or cold substances. Tooth pain may be the first physical symptom of tooth decay. A dentist usually diagnoses tooth decay during a dental examination. Visual inspection and probing of the teeth with a special instrument can help indicate potential signs of damage. X-rays may be taken to confirm a diagnosis or to reveal hidden cavities. Treatment for tooth decay varies depending on the nature and extent of the damage a patient experiences. In most cases, a dentist treats cavities by using a dental drill to remove the decayed material before filling the remaining space with dental amalgam or composite resin. More significant damage may require an artificial crown or root canal.

Tooth Decay & Damage Center Tooth decay is the destruction of teeth due to the interaction of teeth with bacteria and food. Plaque build-up can lead to tartar formation and, eventually, cavities (dental caries) and/or gum disease. Tooth injuries can involve a damaged, fractured or cracked tooth, as well as trauma such as tooth loss. Bruxism (teeth grinding or clenching) can lead to tooth surface loss.

Summary
Tooth injuries may include damage to teeth as a result of falls, accidents and other mishaps. These injuries can cause teeth to become chipped, cracked, partially displaced or completely
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dislodged from the socket in the mouth. In most cases, a tooth injury requires the care of a dentist or other medical professional. The severity of injury depends on which portions of the tooth have been damaged. The tooth is composed of the crown, root, dentin, enamel and pulp. Patients are urged to seek emergency help whenever a permanent tooth is knocked out, jaw swelling indicates a potential fracture or bleeding of the gums does not stop despite firm pressure. Tooth injuries may be described as uncomplicated or complicated. Uncomplicated injuries do not expose the pulp, which reduces the chance of infection and loss of the tooth. On the other hand, complicated injuries do expose the pulp to potential infection, which can lead to the death of the pulp. If the pulp dies, pus may begin to build up near the root tip in the jawbone. This is called an abscess, and it can damage the bone around the teeth.

When a permanent tooth is completely knocked out, it can still be saved. Teeth have the best chance of being saved if they are replaced within 30 minutes of falling out. After two hours, the tooth has a low probability of surviving. Primary teeth that are completely knocked out of the socket cannot be reimplanted. A dentist can stabilize teeth that are loose but still intact. Teeth that are chipped or cracked can have the jagged edges smoothed during dental procedures. People can help reduce their risk of tooth injuries by taking simple precautions, such as wearing a mouth guard and proper headgear when participating in contact sports, wearing a helmet during sports and using a seatbelt when traveling in a car.

A. Moderate damage(deep carious lesion) to central tooth structure (vital teeth)

Deep proximal lesions impinging on porcelain jacket crown or vital core (central) porcelain -fused-tometal crown with cement base and/ or pin-composite resin core

B. Severe damage(deep carious lesion) to central tooth structure (vital teeth)

More than 50% of vital core destroyed (central)

Devitalization, dowel -core and porcelain jacket crown or porcelain-fused-to-metal crown.

C. Minimal damage (non-vital teeth) endodontically treated teeth

Endodontic access and small Proximal lesions (combined)

composite resin restorations on lingual as well as proximal surfaces.

D. Moderate damage (non-vital teeth) endodontically treated teeth

Endodontic access; large proximal possible loss of incisal angle (s) (combined)

Dowel-core and lesions; jacket crown or porcelain-fused-to-metal crown.

1. moderate to severe damage

ClassII (MOD)medium lesion

Porcelain crown or Pined inlay/overlay

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2. Severe damage

Class II (MOD) big/complex lesion

pinted porcelain/metal fused porcelain crown

3. Total coronal destruction

Crown gone but still vital

RCT and post/pin porcelain/metal fused porcelain crown

C. Treatment planning for endodontically treated posterior teeth 1. Minimal damage

RCT done MOD lesion

Inlay/Olay porcelain or metal fused porcelain crown

2. Moderate to severe damage

RCT done MOD Complex lesion

Post/pin crown/overlay porcelain/metal fused porcelain

3. Total coronal destruction

Crown gone lesion

post crown

Crown gone lesion

post crown

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The single most important method of preventing tooth decay is to reduce the amount of plaque and bacteria in the mouth. Regular tooth brushing at least twice daily and flossing at least once daily is essential in decay prevention. In addition, patients should have their teeth professionally cleaned in a dentists office at least twice a year. People with certain conditions (e.g., diabetes) may require more frequent cleanings. Patients who avoid sugary and starchy foods, candies and beverages (such as sodas) can keep large amounts of plaque and bacteria from forming in the first place. Fluoridation and dental sealants can also help prevent decay.

Diagnosis methods for tooth decay

A dentist usually diagnoses tooth decay during a dental examination. Visual inspection and probing of the teeth with a special instrument (explorer) can help indicate potential signs of damage. In some cases, pits or holes in the teeth may be visible. In other instances, the surface of the tooth may prove to be soft when probed with an instrument. X-rays may be taken to confirm a diagnosis or to reveal hidden cavities.

Treatment options for tooth decay

Treatment for tooth decay varies depending on the nature and extent of the damage a patient experiences. If acid has not yet eroded through the enamel (a condition typically indicated to dentists by white spots on the tooth, but no holes), the tooth may repair itself naturally with the
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use of fluoride treatments provided in a dental office or at home. However, once a cavity has penetrated the enamel, it cannot be reversed. Instead, the goal is to arrest further progression of the cavity. Left untreated, a cavity typically continues to deepen and worsen, although the length of time a cavity takes to progress varies. Dentists typically treat cavities by using a dental drill to remove the decayed material and fill the hole with a material such as dental amalgam (made from silver alloyed with copper or other materials), composite resin (made of a tooth-colored substance) or porcelain (also made of a tooth-colored substance). Gold inlay is sometimes used when greater strength is needed. If the damage from a cavity is extensive, the dentist may have to cover the filling with an artificial crown. This helps minimize the risk of a weakened tooth cracking. Crowns typically are made of gold, porcelain or porcelain fused to metal. When damage extends into the interior of the tooth, a root canal procedure may be needed to remove the tooths pulp (including the nerve and blood vessel tissue) and replace it with a sealing material. A dental professional called an endodontist performs this procedure. Once the root canal is finished, the tooth is covered with an artificial crown. Before any of these procedures are performed, the patient receives a local anesthetic or nitrous oxide (laughing gas) provided by a mask placed over the patients mouth and nose. In some cases, a general anesthetic will be used so that the patient is not conscious during the procedure. Treatment is usually less extensive, less painful and less expensive when the cavity is detected early. In most cases, the prognosis after treatment is excellent. However, some patients may experience complications such as pain, discomfort or tooth sensitivity. More serious complications include tooth abscess from fracturing of a tooth. All of these complications can be treated.

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Prevention methods for tooth decay

The single most important method of preventing tooth decay is to reduce the amount of plaque and bacteria in the mouth. Regular brushing at least twice daily and flossing at least once daily is essential in achieving this goal. In addition, patients should have their teeth professionally cleaned in a dentists office at least twice a year. People with certain conditions (e.g., diabetes) may require more frequent cleanings. X-rays may be taken during dental visits every year or two to identify potential trouble spots in the early stages. Patients who avoid sugary and starchy foods, candies and beverages (such as sodas) can prevent large amounts of plaque and bacteria from forming in the first place. In addition, patients who eat fewer snacks between meals will reduce the amount of plaque and bacteria that forms in the mouth. Sugarless chewing gum that contains the ingredient xylitol can help break down acid that forms on the teeth. Brushing after snacks will also help prevent plaque from forming. Fluoridation can also help prevent tooth decay. In the past several decades, the number of cavities has declined substantially as a result of fluoridation. Many cities add fluoride to their water system, and children in these communities have 29 percent fewer cavities than children in communities without fluoridation, according to the U.S. (CDCP) Centre for Disease control Prevention. Regular fluoride treatments at a dentists office can also help protect teeth, especially in children. Finally, dental sealants can be applied to a childs molars and premolars once they fully erupt into the mouth. Sealants can be applied when the first permanent molars come in between ages 5 and 7, and when the second set comes in between ages 10 and 14. These sealants are a plastic, protective coating that can be applied to the chewing surfaces of back teeth. Sealants provide extra protection from cavity formation. In some cases, they can even arrest the formation of a cavity once it has begun. Some states provide dental sealant programs through schools for low income families. Although sealants are usually applied to childrens teeth, some adults may benefit from the procedure. Researchers are investigating additional methods to prevent tooth decay, including specifically targeting the bacteria that cause decay, inhibiting the growth of these bacteria and promoting good bacteria to compete with cavity-causing bacteria.

Questions for your doctor about tooth decay

Preparing questions in advance can help patients to have more meaningful discussions with their dentists regarding their conditions. Patients may wish to ask their doctor the following questions related to tooth decay. What are the most important steps for preventing tooth decay? 1. What type of toothbrush and dental floss should I use? 2. Would I receive greater benefit from having professional cleanings more often than every
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six months? 3. How can I find out if my tap water is fluoridated? If it isnt, should I take fluoride supplements? 4. What types of foods should I avoid to lower the risk of tooth decay? 5. Should I have sealants applied to my teeth, or am I too old for this procedure? 6. Can the decay on my tooth be reversed? If so, what treatments are available? 7. What are the risks associated with various treatments for tooth decay? 8. If I need a root canal, can you suggest a good endodontist? 9. Should I chew sugarless gum after eating?

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