When dentists fix a cavity, there are many options. Dentists have multiple filling materials to choose from when restoring a tooth to form and function. For example, some dentists use silver fillings, while others use tooth colored composite fillings. There have been debates on the aesthetics of both materials, the longevity, the strength, the wear resistance and numerous other factors of evaluating these filling materials. Even further, some dentists use a material called resin modified glass ionomer which has the added benefit of fighting tooth decay. Other restorative options include gold, porcelain and other metals. Clearly there are many choices of materials that affect the difficulty, the cost, the longevity, the beauty, and the function of a tooth with decay.
Further options your dental surgeon must decide while fixing a cavity is how large the cavity is and the best way to approach it. When decay is in between the teeth, some dentists will approach the decay conventionally, that is from the chewing surface. Another newer technique is called the “tunnelling” approach. In this approach, the total size of your cavity is smaller and leaves stronger parts of the tooth in tact, however, it is more difficult to perform. Other approaches to removing decay in between the teeth is to restore the tooth with a lab fabricated material which requires the tooth preparation to fulfill certain requirements. Additionally, some dentists approach decay between teeth with crowns. The range of choices for treating decay is wide.
Similarly, there are many options when removing decay. Many dentists start removing decay in the most conservative manner, that is with a small bur. Many dentists will remove the decay in the deepest part of the grooves. Decay will spread underneath the surface of the tooth and it is important to remove the decay and any unsupported tooth structure. Choosing which tooth structure to bevel, smooth, and round are important parts of preparing a tooth for a filling. Further, deciding on the best way to approach decay that is very deep and close to the nerve of the tooth carries specific implications. Some dentists will leave a small amount of unhealthy tooth structure that is close to the nerve to allow the body to fight the infection. Further, they will place disinfectants and medicines to give the tooth the best chance of being symptom free. Other dentists may choose to risk exposing the nerve of the tooth in order to remove the infection. In this approach, medicines will be placed on the nerve of the tooth to prevent further infection and pain from the tooth. Both are valid treatment choices, but carry certain risks. Agents used when cleaning and desensitising these deep areas are impressive. There has been a lot of research surrounding the nerve tissue and it is important for a dentist to be well versed in appropriate material selections to ensure the best possible outcome. There are many possible outcomes during the removal of decay.
There are choices and options involved in “routine” dental visits. One of the most important choices a dentist helps the patient make is which teeth need treatment. Dentists use multiple modalities to examine and diagnose tooth decay. However, the threshold for dentists to surgically intervene varies. Many dentists will attempt to arrest and reverse small cavities with prescription fluorides and other materials. Other dentists in the same situation will recommend conservative resin restorations or sealants. Further, and still within the standard of care, other dentists will advise a patient to have a tooth restored with a filling. These choices will be based on your diet, hygiene practices, tooth susceptibility and other factors.
After highlighting the array of choices a dentist helps make for and with you, it should be clear that dentists are highly trained. Further, the attention to detail and ability to convey important information are necessities of the profession. Through continuing education, licensing, and credentialing standards, dentists assure you they are qualified for the task. It is important to discuss the possibilities of how to make your mouth cavity and decay free with a dentist you feel comfortable in a relaxed atmosphere.
Alex Krempa, D.M.D.
6350 Airport Blvd.
Mobile, Alabama 36608