15013028 management of deep caries lesion

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Management of Deep cariesLesionEndodontics

4/17/2009

KUILLIYYAH OF DENTISTRY INTERNATIONAL ISLAMIC

UNIVERSITY MALAYSIADr.Shawfekar


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Tooth Decay

Summary

Tooth decay is the destruction of tooth enamel by dental plaque that causes holes known ascavities. 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 sweetfoods 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 andprobing 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 decayedmaterial 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 gumdisease. 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. Theseverity 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, jawswelling 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 anabscess, 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, thetooth 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 canhave the jagged edges smoothed during dental procedures.

People can help reduce their risk of tooth injuries by taking simple precautions, such as wearinga mouth guard and proper headgear when participating in contact sports, wearing a helmet during

sports and using a seatbelt when traveling in a car.


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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-to-

metal crown with cement

base and/ or

pin-composite resin core


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

More than 50% of vital core Devitalization, dowel-core and

destroyed (central) porcelain jacket crown

or porcelain-fused-to-metal crown.


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

Endodontic access and small composite resin

Proximal lesions (combined) restorations on

lingual as well as

proximal surfaces.


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

Endodontic access; large proximal Dowel-core and lesions;

possible loss of incisal jacket crown or

angle (s) (combined) 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 pinted porcelain/metal

lesion fused porcelain crown

3.Total coronal destruction

Crown gone but still vital RCT and post/pin

porcelain/metal fused

porcelain crown


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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 Post/pin crown/overlay

lesion porcelain/metal fused porcelain


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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 oncedaily 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 keeplarge 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 andprobing of the teeth with a special instrument (explorer) can help indicate potential signs ofdamage. 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 patientexperiences. 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 toarrest 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 thehole 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 atooth-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 anartificial 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 asealing material. A dental professional called an endodontist performs this procedure. Once theroot 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 somecases, 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 detectedearly.

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 includetooth 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 isessential 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 twoto 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 eatfewer snacks between meals will reduce the amount of plaque and bacteria that forms in the

mouth. Sugarless chewing gum that contains the ingredient xylitolcan help break down acid thatforms 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 theirwater 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 controlPrevention. 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 5and 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 provideextra 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 lowincome 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 specificallytargeting 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 questionsrelated 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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15013028 management of deep caries lesion

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