Tooth Decay – Fillings and Restorations

Robert Burns described toothache as “thou hell of all diseases”. Toothache is often the result of a tooth decay that has either silently progressed within the confines of a tooth, in the regions not generally seen, such as between the teeth (interdental or proximal areas) that has now reached to the pulp (the part of the tooth that has nerves and blood vessels).

Dental caries or tooth decay is the most common among the three main oral diseases. The other two, being gum disease or periodontal diseases and lastly oral cancers. Tooth decay is the second most common cause of tooth loss and it occurs across the globe, irrespective of age, sex, caste, creed or geographic location. Often attributed to lifestyle factors such as the type of food (sugary and soft diets cause it), but hereditary factors could also play a role in relation to how easily an individual can get affected by it.

Often dental decay starts as a small innocuous or harmless white spot, which denotes an area of demineralisation of the tooth, later spreading to a discolouration of an area of the tooth which could range from yellow, brown or black depending on its severity. In the later stages, it causes severe pain, the severity of which depends on the depth of infection, and it also causes difficulties in eating and speaking. Dental decay can be difficult to treat depending on its extent, and can lead to loss of your precious productive working time.
However, it definitely is preventable to a great extent. The prevalence of dental caries in India is 50%–60%.

How does it happen?

Bacteria or germs in the dental plaque ferment sugary carbohydrate foodstuffs, to produce acids and proteolytic enzymes that cause demineralization and softening of the teeth. The sticky film, that is dental plaque, holds the acids produced by these bacteria in close and continuous contact with the tooth surfaces and prevents it from being washed away by the cleansing action of our saliva. This leads to a cavity being formed carrying with it the bacteria that caused it. Eventually this disease process leads to extensive infection even to the pulp or roots of teeth.

Preventive interventions

We could provide you with preventive protection by giving you very thin fillings called pit and fissure sealants, which close up all the folds and crevices on the top of your back teeth where bacteria could hide. We could also give you regular applications of fluoride varnish that helps in preventing or slowing down the development of decay.

Preventive restorations such as these can be carried out as atraumatic restorative treatment (ART), (which means without cutting or drilling the teeth) and is used routinely as a community-based approach for the treatment and prevention of dental caries in developed countries.

Systemic use of fluoride: (i) Fluoridation of water, milk and salt;
(ii) Fluoride supplementation in the form of tablets and lozenges; and
(iii) Consuming a fluoride-rich diet such as tea, fish, etc.

Topical: (i) Use of fluoridated toothpaste and mouth wash; (ii) use of fluoride varnishes (in-office application - advantages being longer duration of action and high fluoride content); (iii) use of casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), which is available as tooth mousse, helps to remineralize the soft initial carious, demineralized or decayed areas of the teeth.

(iv) Laser Assisted Fluoride Therapy (LAFT) – Laser Assisted Fluoride Therapy is a quick but effective application of fluoride on your teeth which ensures speedy and effective deposition and absorption of the topical fluoride within the enamel of your teeth. This ensures that not only is your teeth is stronger and harder but it also does not dissolve so readily in acidic environments such as those caused by harmful bacteria or by acidic aerated drinks. LAFT decreases the critical pH of the teeth (makes it more resistant to acidic conditions)

The use of various interdental cleaning aids such as dental floss, interdental brush, water pik, etc. supplements the cleansing effect of a toothbrush.

Treatment Options

a) Traditional Fillings – Traditional treatment to Teeth Decay was by preparing an extensive cavity with small drills called burs to remove the decayed tooth structures and also some bordering sound tooth structure and placement of a Silver amalgam filling. The problem with this approach relates to a tooth preparation that also entailed the loss of sound tooth structure and secondly pertaining to the long term corrosion or discolouration of the Silver filling in the mouth, making it look black over time

b) Tooth Coloured Restorations - Composite Restorations – With the advent of newer restorative material we are able to provide aesthetic tooth coloured fillings which look almost like natural teeth themselves. These are restorations of resinous or plastic like material called Composites. Composites though are not as strong as the traditional Silver fillings; they are very aesthetic and also give life like restorations.

Glass Ionomer Restorations – Another version of Tooth Coloured fillings are Glass Ionomer restorations. These restorations are also tooth coloured, though the shade may not exactly match all teeth colours. However, a huge advantage these fillings provide is that they continuously release fluoride even after they are placed in the mouth. This feature gives you some protection against dental decay.
Ceramic Inlays – A little more time consuming yet rewarding modality would be to cement ceramic Inlays in place after cleaning out the decayed portion of the tooth. Ceramic provides tooth contours and life like colour reproduction of the natural tooth. Zirconia, a metal based ceramic can provide vital, strong and beautiful restorations.

Oral health is linked to overall health, happiness, and general well-being of the individual. Take care of your Oral Health and take care of yourself as a whole.