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Conservative Dentistry and Endodontics

Tooth Decay

Tooth decay is the name given to diseases that appear in the form of dark or opaque (white) cavities in the enamel, dentin, and cementum hard tissues of the teeth.

Bacteria secrete acid to acquire the necessary nutrients from food remains in the mouth.  These acids decompose the teeth’s mineral tissue and break down the tooth’s enamel, leading to tooth decay and what dentists refer to as ‘cavities’. 

People who consume a lot of acidic or sugary foods, and those whose water supply carries low levels of fluoride are in greater danger of tooth decay than others.  While saliva provides a natural defence mechanism against bacteria generated acids, it cannot single-handedly prevent cavities.  Diseases or medications that reduce the flow and amount of saliva speed up the formation of cavities.  It is because it increases the flow of saliva that dentists frequently recommend sugar-free chewing gum.

What Can Be Done to Prevent Tooth Decay?
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Brushing teeth after breakfast, before going to bed, and flossing regularly are the most effective means.  As food particles are mostly collected in the chewing surfaces of the teeth’s dents and where the teeth meet, small headed toothbrushes should be preferred.  The inner, outer, and chewing surfaces of the teeth should be brushed, as well as the top of the tongue; dental floss should be used for the areas between the teeth.  Toothbrushes should be of medium or soft hardness and should be replaced periodically.  The bristles of the brush should not be worn down, and should be kept in a bacteria-free environment.  Mouthwashes with fluoride can assist brushing as they have an antiseptic effect and provide a fresh and clean feeling while fighting bad breath.

Consuming sugary and acidic foods during main courses and refraining from eating between meals are also preventative measures.  At the present day, tooth decay is more common than it used to be.  For example, research has shown that while in earlier civilizations the tooth decay ratio in people was no more than 5%, today that ratio can reach 95%.  The reason for this is the change in eating habits.  As earlier civilizations ate hard and natural foods, a natural cleaning of the teeth would occur.  At the present day, with the growth of the ready-to-eat food industry, consumption of such foods has also increased.  Easily accessible foodstuffs like biscuits, sugar, chocolate, and cola are all ingredients that stick to teeth and cause bacteria; they are accepted as the main reason for the increase in tooth decay.  Periodic visits to the dentist are the best way to prevent or diagnose a cavity.  Timely consultation of a dentist in cases where teeth are sensitive to hot and cold, aching, or show forms of early stage cavities with a chalk-like or brown color and dents, will change the process of the treatment and decrease its level of difficulty.

Another means of preventing tooth decay is by the strengthening of tooth elements.  The most powerful material used to strengthen teeth is “fluor” compounds.  When fluoro compounds are applied to teeth that are in the development phase or have newly emerged in the mouth, they penetrate the teeth and form a tooth structure more resistant to decay.  Fluoro compounds’ decay-preventing effect takes place in four ways:

  • By adding specific proportions of fluoro compounds into drinking water, 
  • Giving the child dietary fluoride tablets sold on the market, 
  • By benefitting from the fluoro compounds found in table salt, toothpaste, or mouthwashes, 
  • Dentist applying fluoride gel onto the teeth.

The easiest amongst these is to brush the teeth in the morning and before bed with fluoride toothpaste starting at the age of 3, and using fluoride mouthwash after the age of 6.  Other practices are not yet widespread in Turkey, and lack the necessary infrastructure.  For example in most regions, there is no net standard study regarding the fluoro content of drinking water and amounts ingested with diets.  Fluoride is a necessary element for the body.  However, excess intake can cause change in tooth color or deformation in bones.  Therefore its use aside from toothpaste and mouthwash must be done under a physician’s care.

DENTAL TREATMENT

Treatment of the destruction of teeth caused by tooth decay, trauma, and various genetic and immunologic diseases is mainly divided into two areas: Conservative and Endodontic.

CONSERVATIVE DENTAL TREATMENT PRACTICES
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Conservative dental treatments are operative treatments relating to the visible, enamel and dentin areas of the teeth.  In these treatments, the area of the tooth that has decayed or deteriorated in another manner is cleaned and distanced with the use of special technological tools used in dentistry.  The healthy part of the tooth remaining is then isolated with special materials and restored with filling materials, imitating the natural structure of the tooth.  While many permanent filling materials have been used to date, at present the most commonly used are amalgam (metallic) and composite (white) fillings.  http://www.tdb.org.tr/avds/h6.html

Amalgam Fillings (Metallic Fillings)
   

Amalgam fillings are also known as silver fillings.  Amalgam is derived from mixing silver, tin, and copper alloys with mercury.  Comprising 45-50% of the mixture, mercury creates a durable filling material by bonding the metals together.  Amalgam fillings have been used and developed for 150 years in dentistry and are still frequently used today.  The main reasons for using amalgam fillings are that they are harmless, long lasting, and cheap.  The fact that they can be easily prepared and applied in a short period of time is its other advantages. 

Its greatest disadvantages are that they contain a toxic material like mercury, and are not aesthetic.  To date, no consensus has been reached through research regarding the toxicity of the mercury in fillings.  Many researchers have indicated that the amount of mercury released from fillings after chewing and grinding processes is much less than those consumed from water, air and food.  Although it has been claimed that certain diseases thought to be caused by mercury have been cured upon removing the amalgams, no scientific proof has been established.

Tooth Colored Fillings (Composite Resin)
    
What is Composite Resin?

Composite resin is a plastic mixture with silicon dioxide particles.  Because it is tooth colored, it is referred to as a “white filling”.  Even though in the 1960’s they were only used on the front teeth, as the material was highly developed they became less eroding and more resistant to chewing pressures, making them suitable for the back teeth as well. 

How are composite fillings done?

Composite fillings are placed on prepared cavities layer by layer, each layer hardened by a special light.  Once this process is complete, composite fillings are shaped and corrected in accordance with the tooth.  All these processes take longer than that of amalgam fillings.  Recently, the durability and life of composite fillings has come close to that of amalgam fillings. 

The greatest advantage of composite fillings is that they are aesthetic.  Also, because these fillings bind strongly with the teeth, they support teeth tissues and prevent them from breaking and transmitting heat.  Composites are not only used for restoring cavities, but can also be used for their cosmetic effects to change the color and shape of teeth.  Its main disadvantage is sensitivity in the area after being applied.  The color of the fillings may slightly change with the consumption of dying products such as coffee or tea. 

Polishing can also be done in the same session with composites.  However, with large restorations or series of restorations for multiple teeth, it is better in terms of aesthetics and functionality to call in the patient one more time for controls and perform any necessary corrections.

Large losses on the front teeth can be restored with these materials.  Therefore it should be explained to patients that taking care when chewing will extend the life of the restoration.  It should also be reminded that no matter how well polished they are, especially fillings on the front teeth can be dyed by certain foods or beverages.  In patients where eroded teeth have been restored, it is important to recommend softer toothbrushes and corrections in their brushing techniques.


ENDODONTIC TREATMENT PRACTICES
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Endodontics is the branch of dentistry involved with problems that have advanced to the pulp of the tooth.  When endodontic treatment is mentioned, root canals are the first thing that comes to mind.  Root canals are generally the most feared dental treatment of them all.  The part of the tooth visible in the mouth is called a “crown”, while the part inside the bone, not visible in the mouth, is called the “root”.  Teeth are made up of several layers.  The outermost layer of the crown, or the part visible in the mouth, is called enamel.  It is one of the most rigid tissues in our body.  The root part of the tooth which is under the gums and surrounded by bone is covered by the cementum layer.  Below the enamel and cementum layers is the dentin layer.  It is the largest layer and unlike enamel, contains the nerve endings.  By this, it plays a role in the pain mechanism.

Under the dentin layer is the tooth pulp.  This is where the nerves and vessels of the tooth are located.  The pulp plays an important role in the eruption and development of tooth.  Once the tooth has erupted, the pulp relays any problems the tooth may have via its pain mechanism.  The pulp is at the centre of the tooth and in the canals of roots.  The connecting tissues that feed the tooth are made up of blood vessels and nerves.  Once the tooth has matured, the pulp can be safely removed from the pulp chamber or root canals.  Endodontic treatment, commonly referred to as canal treatment, is the process of removing the pulp from its location.

What are the Symptoms?

Pain and sensitivity in the teeth caused by cold or hot foods and drinks, as well as pain induced while eating might indicate an infection or the beginning of an infection.  Extreme color changes in the teeth might also be a sign of infection.   In teeth where the decay has reached the pulp but has remained untreated, the infection may migrate from the root apex to the jawbone, causing small or larger swelling.  In such cases, the use of antibiotics is appropriate together with dental procedures.  The general opinion is that a tooth causing swelling in the face should be extracted once the swelling has diminished.  However, this is a very outdated notion.  Even teeth that cause a serious infection can be kept intact through canal treatment, and can serve alongside the other healthy teeth for several years.

A canal treatment can be done in one or two sessions, depending on the condition of the tooth.  For an infected tooth, a few sessions may be necessary ensure that the infection has been completely removed.  The treatment may pose challenges depending on the position of the tooth.  Multiple and curved canals in a tooth can also make treatment more difficult.  An uncomplicated canal treatment is generally completed in one session.  Once the canal treatment is completed, the tooth may be restored with a crown or a filling if necessary.

Following canal treatment, especially after the treatment of living teeth, a bearable ache may present itself for a few days or when pressure is applied on the tooth.  This is a normal pain following canal treatment.  Protecting the treated tooth for a couple of days will prevent the pain.  The success rate for canal treatments performed at present is 90%