Treatment of tooth decay

Tooth decay is damage to the teeth caused by bacteria that produce acids which erode the tooth enamel (the outermost layer of the tooth). The process begins with the build-up of bacterial plaque on the teeth, particularly in areas where brushing is inadequate or difficult to reach. 

The acids produced by bacteria, following the breakdown of sugars and carbohydrates in the diet, begin to erode the enamel, forming lesions which, if left untreated, can progress and affect deeper structures of the tooth, including the dentine (the second layer of the tooth) and even the dental pulp.

According to the World Health Organisation (WHO), oral health conditions affect nearly 3.5 billion people worldwide, particularly the poor and vulnerable. Over 530 million children suffer from untreated dental caries in their primary teeth (baby teeth) and 796 million people are affected by periodontal disease.

Poor oral hygiene

Inadequate brushing leads to the colonisation of the oral cavity by harmful bacteria and a deterioration in the quality of the oral biofilm. Furthermore, failure to use dental floss leads to the accumulation of bacterial plaque in the interdental spaces, promoting the development of caries on the lateral surfaces of the teeth. Poor oral hygiene contributes to the development of gingival inflammation and periodontal disease, increasing the risk of tooth loss.

Excessive sugar consumption

Foods and drinks high in sugar contribute to increased acidity in the mouth. Bacteria in dental plaque break down sugars, producing acids that erode tooth enamel, promoting the development of cavities. Frequent consumption of sweets and fizzy drinks increases the risk of tooth damage, especially if oral hygiene is poor or inadequate.

Smoking

Smoking affects oral health, contributing to tooth discolouration and the build-up of tartar. Furthermore, the nicotine and tar in tobacco reduce the body’s ability to fight infections, weakening the immune system. This increases the risk of gum disease, as well as complications following dental procedures. In the long term, smoking is a major risk factor for the development of oral cancer.

Lack of fluoride

A lack of fluoride in your dental care routine reduces the enamel’s resistance to acid attacks from bacteria in the mouth. Fluoride helps to remineralise teeth and prevent tooth decay, and is essential for maintaining oral health. Using fluoride toothpaste and fluoridated mouthwash can significantly help to strengthen enamel and prevent tooth demineralisation.

The symptoms of tooth decay can vary depending on the stage of the condition. Initially, tooth decay may be asymptomatic, but as it progresses, it can cause the following symptoms:

1. Tooth sensitivity

One of the first signs of tooth decay is sensitivity to hot, cold, sweet or acidic foods and drinks.

2. Toothache

As tooth decay progresses and gets closer to the tooth’s nerve, sporadic or constant pain may occur, which intensifies during chewing.

3. Visible spots on the tooth

Early-stage tooth decay may manifest as white, brown or black spots on the surface of the tooth.

4. Unpleasant taste or bad breath

Bacteria in the cavities created by tooth decay can cause an unpleasant taste in the mouth and halitosis (bad breath)

5. Visible hole or cavity in the tooth

In advanced stages, tooth decay can erode the enamel and dentine, leaving a visible cavity in the tooth.

6. Discomfort when biting

If the decay is extensive, the affected tooth may cause pain when pressure is applied during biting or chewing.

Today, treating tooth decay is much easier thanks to technological advances developed over time, designed to support both dentists’ work and patients’ comfort.

Depending on the extent of the decay and the damage to the tooth layers, we choose the appropriate treatment method, consistently utilising the modern technologies available, such as dental loupes, the microscope or the dental laser.

All these procedures fall within the scope of restorative dentistry, which includes various types of treatment designed to restore the functionality and aesthetics of the affected tooth.

Before we begin treating tooth decay, it is important to isolate the tooth to be treated using a rubber dam.

The rubber dam is a rubber or latex device that we use in our clinics to isolate the treatment area, particularly when carrying out restorations following the removal of tooth decay. As an essential tool in dentistry, playing a major role in increasing the efficiency, safety and quality of dental treatments, the rubber dam also offers numerous advantages, such as:

• Isolation of the operating field – it protects the cavity against contamination by saliva and bacteria, which is essential for the success of the treatment, as a dry surface is required to achieve optimal adhesion of the filling material (filling).
•    Patient protection – by preventing the swallowing or inhalation of foreign bodies.
• Treatment efficiency – the dentist’s visibility and access are improved, leading to a shorter treatment time.
• Reduced risk of infection – it limits the exposure of the treated tooth to bacteria in the oral cavity.

Magnifying glasses in dentistry are optical instruments that provide magnification of the field of view, helping dentists to work with greater precision during dental treatments. They are used to improve visibility and ensure greater accuracy when working on small surfaces and fine details of the teeth. The use of loupes has become standard practice in modern dentistry, significantly improving both the quality of dental work and the comfort of dentists.

Advantages of using loupes in dentistry:

1. Superior magnification

Loupes typically offer a magnification of between 2.5x and 6x, allowing the dentist to observe details that might be difficult to see with the naked eye.

2. Increased precision

The use of loupes allows for more precise removal of cavities and the application of fillings with a better fit, contributing to the long-term success of the treatment.

3. Improved posture:

Loupes help dentists maintain correct posture whilst working, thereby preventing back pain or muscle tension caused by incorrect positioning.

4. Early detection

They can help identify early-stage cavities, dental fissures or other subtle problems that might go unnoticed without magnification.

5. Versatility

They are useful in most dental procedures, including restorative treatments (fillings), periodontics (gum treatment), oral surgery and endodontics (root canal treatments).

Types of loupes

1. Frame-mounted loupes: These are the most common and are attached to a pair of spectacles, providing magnification directly in front of the eyes.

2. Headband-mounted loupes: These are attached to a headband or head strap, offering the advantage of greater stability and customised adjustment.

3. Magnifiers with integrated lighting: Some magnifiers are equipped with an LED light source, which helps to illuminate the work area directly and precisely.

We use a microscope when treating tooth decay, as it is a modern, advanced technique that offers maximum precision in detecting and treating it. It allows us to work with very fine details and minimise damage to the healthy tissue surrounding the decay.

The microscope is used by DENT ESTET dentists not only for the treatment of dental caries, but for many more complex procedures, such as root canal treatments in endodontics, where visibility and precision are essential for the success of the treatment.

Advantages of treatment using a microscope:

1. Early detection of caries

Consultations at our clinic are much more effective since we started using the microscope. It allows us to identify cavities at a very early stage, when they are not visible to the naked eye or even on an X-ray. This enables less invasive treatments, preserving as much of the healthy tooth structure as possible.

2. Precision in removing decayed tissue

The microscope provides up to 20x magnification of the field of view, allowing even the smallest carious lesions or cracks to be detected. With the aid of the microscope, the dentist can remove only the area affected by decay, managing to preserve as much of the healthy tooth tissue as possible. This precision is particularly important in the case of small cavities or in areas that are difficult to access.

The microscope provides enhanced visibility, allowing the dentist to be extremely precise, which results in less discomfort for the patient and a faster recovery time.

3. Minimally invasive restoration

Using minimally invasive techniques, the microscope helps to create cavities that are very well prepared for restorations (fillings), ensuring fine, clean margins. This contributes to better adhesion of the restorative materials and greater durability.

4. Superior quality of fillings

Tooth repair is carried out with greater precision, resulting in more accurate and long-lasting fillings.

The laser emits a concentrated beam of light, which vaporises the tissue affected by decay or bacteria, cleaning the affected area and preparing the tooth for the subsequent filling. Laser technology can be used on both enamel and dentine without damaging healthy tissue.

Advantages of laser treatment for tooth decay:

1. The laser is minimally invasive

It is less aggressive on healthy dental tissue, allowing for more precise removal and maximum preservation of the tooth structure.

2. Pain-free or minimal discomfort

In many cases, laser treatment can significantly reduce the need for anaesthesia, as it is less invasive and causes less discomfort compared to a conventional drill.

3. Much quieter and vibration-free

Unlike a dental drill, the laser operates more quietly and does not create vibrations, which can reduce patient anxiety.

4. Low risk of infection

The laser sterilises the treated area, reducing the risk of infection and speeding up healing.

5. Increased precision

The laser allows for an extremely precise approach, reducing the chances of damaging healthy tissue around the cavities.

Limitations of using a microscope:

Slightly higher cost: Laser equipment is slightly more expensive, which can lead to higher costs for dental treatments.

Not suitable for all types of cavities: Laser treatments are not always effective for all cavities, especially large or deep ones. In most cases, it is recommended for small or medium-sized cavities.

Laser treatment for tooth decay is therefore a modern, effective and comfortable alternative to traditional methods, offering benefits both to you, our patients, and to us, the dentists. 

However, it is worth noting that it cannot completely replace conventional methods in all situations.