Deep Decay: Diagnosis and Treatment

Deep decay is a disease characterized by pronounced destruction of the hard tissue. The structure of the tooth includes enamel, dentin and pulp – the internal, soft structure. The first stage of decay is the appearance of a white stain on the enamel – a change of color is evident in the demineralized area. Subsequent destruction of enamel, the appearance of a dark spot, is characteristic of medium dental caries. With deep decay, it affects not only the enamel, but also the dentin, located near the pulp (the nerve of the tooth). Cavity cavity from the nerve bundle in this case is separated by a thin strip of dentin, so it is very important to stop the pathological process and prevent pulpitis.

Deep dental caries can be primary or secondary. In the first case, it develops on a previously healthy tooth and is the result of the progression of the average caries and the failure to provide timely dental care. In the second case, deep dental caries develops in a previously treated tooth under a filling. In addition, the disease can occur in two forms: acute and chronic. In the acute course, a narrow entrance wound leads to the cavity.

Chronic deep caries is characterized by a funnel-shaped, wide entrance to the cavity, the bottom of which, in contrast, is narrower.

Symptoms of deep tooth decay

Symptoms of deep caries depend on the type of the disease. All forms are characterized by soreness. It is sharp, but short-lived. This is its difference from the pain of pulpitis, when the tooth “throbbing”, can hurt without irritation, including at night.

With acute deep caries, the tooth hurts mainly as a result of thermal, chemical influences: taking hot or cold, sour, sweet food, drinks. With chronic caries, this symptom is supplemented by pain during mechanical action – chewing, the penetration of food particles into the cavity. As a rule, the pain usually subsides after the exposure of the tooth is stopped.

If the food particles remain in the cavity, the nagging pain may persist until the irritant is removed.

Another symptom is bad breath, but it is not always present. Halitosis can occur with multiple deep cavities or a large cavity in a decayed tooth.

A cavity can take a long time to form. This is especially true if the tooth has already been filled. There may be no symptoms at all, painful signs appear only when the pathological decay of the dentin reaches the bottom of the tooth. The filling may be loose, cracked, chipped, or fall out entirely.

Diagnosis

Deep dental caries is diagnosed by visual examination by a dentist, history and complaints, and instrumental examination. The doctor notes the visible destruction of the crown of the tooth.

In the acute form of the disease, he reveals a deep cavity filled with light colored soft dentin. The instrumental examination consists of plunging a dental probe into the cavity – its bottom is sensitive, so attempts may cause pain.

In the chronic form of deep caries, the walls and the bottom of the cavity are filled with pigmented dentin of a denser structure. Its color can range from brown to black. Probing the cavity is not painful – it is associated with the formation of secondary dentin. Probing the tooth is also not accompanied by pain.

The doctor may also resort to the method of thermodiagnostics. This allows you to evaluate the nature of the reaction to hot and cold. Electrodontodiagnostics reveals the reaction of the pulp to the impact of 2-6 μA current. In some cases the pulp excitability is reduced.

If the doctor suspects secondary deep caries, radiovisiography or X-ray diagnosis will be required. The scan will assess the depth of the lesion, the presence or absence of inflammation in other tissues, including the peri-tooth tissues. The aim image shows 1-3 teeth, but with the help of special computer programs, the doctor can enlarge the studied area for a detailed analysis. On the X-ray, the tooth decay looks like a dark spot.

The basis of diagnostics in general is differentiation of deep caries from other diseases with similar symptoms – some forms of pulpitis, chronic periodontitis, medium caries.

Treatment of deep caries

The main task of therapy is to preserve the functionality of the tooth, preventing complications of the disease. Deep cavities are treated in one or two visits to the dentist. Two visits may be required if the dentist is not sure that the pulp is not affected by an infectious process. He conducts the treatment in several steps:

• Anesthesia – application of a local anesthetic is sufficient.
• Treatment of the cavity – removal of tissues softened by caries, preparation.
• Washing the cavity with antiseptic solutions, drying.
• Application of medication and placement of a temporary filling.

Then it is necessary to wait a few days. If after 3-4 days no painful symptoms are observed, the doctor replaces the temporary filling with a permanent one. If the observation reveals growing pains, it is most likely the pulp is affected – this requires a pulpitis treatment.

If there is no suspicion of possible infection of the pulp, the treatment of deep dental caries is as follows:

• Anesthesia.
• Dissection of the tooth cavity – removal of the affected tissues.
• Medication treatment – rinsing with antiseptic agents.
• Drying the cavity with an air jet.
• Applying medical-isolating gasket on the bottom of the cavity (a gasket with impregnation – calcium hydroxide, eugenol, etc.).
• Filling.
• Grinding, polishing.

The peculiarity and the main difference of deep caries treatment is the need to isolate the pulp. The therapeutic insulating pad is necessary to ensure that the pulp through a thin layer of dentin is not irritated by restorative materials. Such pads not only mechanically protect the tissue from irritation, but also stimulate recovery and contribute to the destruction of bacteria.

In some cases, if the walls and the bottom of the cavity are thick enough, only a filling is used. But often the application of a seal is a necessary measure. It is also worth noting that it is not uncommon to place a gasket under a temporary filling – for a period of 4 weeks to six months. This is to allow the replacement dentin to develop. Visit the doctor after the appointed time is necessary – he will install a permanent filling without the special layer.

Treatment of deep caries with pulp lesions

If after the installation of a temporary filling or even at the stage of diagnosis the doctor found an infection of the pulp, a more complex multistage treatment is planned.

Most often, the pulp is removed, and the root canals are cleaned and treated. However, if the inflammatory process is still at an early stage, the doctor may recommend complete or partial preservation of the pulp – antibacterial therapy will be required.

If there are indications for the removal of the neurovascular bundle, further tactics is determined by the individual characteristics of the disease, the extent of the destruction of the crown part. The doctor can fill the root canals and then the crown part, place a core inlay or a crown, if the proper one is strongly damaged. The latter option requires referral to an orthopedic dentist.

After the treatment of deep dental caries, there may be some pain for some time. Typically, we are talking about a time of no more than 1-2 days, and the pain is moderate, observed only when chewing. If the pain does not subside or gets worse, it is important to visit the dentist again – especially if the pulp is intact.

Treatment prognosis

With the right professional approach it is possible to save a tooth, prevent pulpitis and periodontitis, and avoid having to remove the tooth. Restoration is possible even if the crown part is severely damaged. If the crown is completely destroyed, it is possible to fit an artificial crown, preserving the aesthetics and functionality of the tooth. If dental care is not provided in time, there is a high likelihood of pulp damage, further severe destruction, inflammation of the peri-tooth tissues – periodontitis, and tooth loss altogether.

Preventing deep cavities

In order to prevent complications, it is important to visit the dentist on time, pay attention to proper oral hygiene, limit the consumption of sugary foods and drinks. Timely treatment of the disease at the initial stage, as well as the average caries, allows you to prevent the formation of a deep cavity – this treatment is relatively easier and less expensive.

Deep cavities are prevented by observing the following recommendations:

• visits to the dentist once every 6 months, professional oral cleaning, examination;
• home hygiene – brushing, flossing and rinsing;
• rational nutrition – avoid deficiency of vitamins and minerals.

At Affordable Dentistry of South Florida, we not only treat but also prevent oral health problems. That’s why seeing our doctors on time can help you get rid of dental problems later on. Call us at (786) 808-9988 to schedule an appointment. Our goal is your healthy smile.