If I get Decay, what can be done?

It is important that you regularly see a dentist because not all decay will give you symptoms.

I am amazed at how often I take X-rays and find some deep dentine caries that hasn’t given the patient even a glimmer that anything was wrong. The patient is equally shocked to find out they might be looking at a root canal} instead of just a [[il|74|filling.

The earlier it’s picked up the better, it can mean the difference between a simple treatment and a more expensive and complex procedure.

What needs to be done depends on the extent (type) of caries i.e. how far into your tooth it has progressed; the position of the caries and the state of the nerve.

• Enamel caries

(i) If caries is confined to the enamel in-between the teeth on a bitewing X-ray, then to stop it progressing, a change in environment and an improvement in your hygiene is needed. See- preventing dental caries.

(ii) If caries is on the fronts and sides of the teeth, the above approach is also recommended.

(iii) If caries is in the top of the tooth ie. ‘pits and fissure caries’, the shape of the valleys and grooves make fluoride and improved brushing less effective and the area is very hard to monitor. Because of this, watching and waiting is not generally advised and the questionable area should either be sealed with a fissure sealant (dental sealant), or investigated with a small drill and then a preventative filling placed.

• Dentine caries

(i) If the caries is easily accessible for cleaning and monitoring on the fronts and sides of your teeth, putting in place preventative measures and checking how things go regularly is an option- if, of course, you regularly see your dentist! If this approach has failed i.e. there is evidence that the caries is continuing- (‘active’ as opposed to ‘arrested’), a filling should be done, before the nerve is compromised. A filling should also be carried out, if uncomfortable symptoms such as sensitivity are being experienced or where you are conscious of the appearance of the tooth.

(ii) If the caries is into dentine on the X-ray, either in-between the teeth, or on the top of the tooth, then a filling is required as soon as possible. If the caries has not progressed through the ADJ, prevention may be attempted; but you must understand the need for more regular X-rays to monitor its progression and that a filling will need to be done should any worsening be observed.

• Pulpal caries 

(i) Sometimes when cleaning out caries you find that more dentine has been laid down and that the nerve has retreated. It is sometimes possible to fill and monitor these teeth, especially if the symptoms are that of ‘reversible pulpitis’ not ‘irreversible pulpitis‘.

Most of the time however, once the caries has reached this level the nerve inside the tooth will have been affected beyond repair or ‘Irreversible pulpitis’, and the treatment for this, in order to stop you from getting pain, is either a root canal treatment to save the tooth, or an extraction

Sometimes the dental caries may have destroyed too much of the tooth for it to be restorable. In these circumstances the only thing that can be done is an extraction and to think about filling the space. A root canal is pointless if the tooth cannot be made useful afterwards.

It is also worth having a read of:

(i) ‘My dentist said, “The filling is very deep,” what does this mean?’
(ii) Do I have to have a filling?’

They will provides some additional useful information.