Tooth decay, or cavities (technically known as “dental caries”) can be treated in several ways, depending upon their size and how far they have progressed into the tooth. These include fillings, onlays, root canals, crowns, and – the standard treatment many years ago – removing the tooth altogether.
– Cavities –
Tooth decay takes the form of cavities: essentially, holes in a tooth created by bacteria eating away at the hard structures of the tooth. In the early stages, these are usually quite painless, because the outer surface of the tooth has no nerves. The farther into the tooth the bacteria move, the closer they get to the nerves in the centre of the teeth, however – and, therefore, the more painful the tooth will become.
Unfortunately, the outer layer of the tooth, the hard layer of enamel, never regenerates once it has been damaged. In the very early stages, areas which have begun to demineralize (to dissolve in the acids produced by the bacteria) can be made to remineralize. However, once an area of enamel has been lost, it will never recover. The underlying structure, called dentin, can regenerate, but also deteriorates far more quickly. Finally, if the infection reaches the nerve (or “root”) at the centre of the tooth, much more drastic options like root canals must be undertaken to prevent the risk of tooth loss and extremely serious internal infections.
Dentistry tends to be quite expensive. However, as a general rule, earlier treatments like fillings cost far less than later treatments like crowns and root canals, and are also more likely to be adequately covered by insurance policies. As a result, although it can be difficult to finance, paying for dental treatment as soon as possible can reduce both high costs and severe pain later on.
– Fillings –
The first option for repairing tooth decay is to fill in the cavity with a metal, porcelain, or composite (white) plug called a filling. In this case, a dentist will remove the infected area of the tooth, and then place filling material on the tooth, letting it harden to take the shape of the missing tooth structure.
In general, a properly installed filling can last for a number of years before requiring replacement. However, while it can fill a hole in a tooth to prevent further decay, it cannot replace the lost strength of the area that was lost. As a result, cavities which have grown too large, and weakened the basic structure of the tooth, may not be effectively treated with fillings. Either the filling will be too large and prone to simply fall out, or – worse – it will leave the tooth perilous weak, and prone to fracture, crack, or break.
In general, it’s time to consider a filling if a tooth has become sharply sensitive to cold food and drink. However, this may just be due to relatively harmless types of tooth sensitivity; only a dentist can say for sure whether a cavity exists which requires treatment.
– Crowns and Onlays –
In such cases, dentists will instead recommend a more radical treatment: onlays and crowns, which instead of simply filling in a missing area of the tooth attempt to reconstruct large areas of the tooth which have been lost to decay. A crown, which is the most expensive treatment, “caps” the tooth, placing a full protective layer over the entire tooth so that it will be fully protected from further decay as well as the risk of breakage.
Because these techniques attempt to rebuild the tooth rather than just fill in a small missing section, they require moulds to be prepared and specific, custom-made dental devices to be manufactured. In the past, this required the use of a medical laboratory, and the high fees which came along with it – plus multiple trips to the dentist to have the moulds taken and then the caps installed. Today, many dental offices are investing in a fabrication device called CEREC, which manufactures the custom-made pieces inside the dentist’s office using computer modelling. As a result, crowns can now be installed in a single dentist’s visit in those offices.
– Root Canal –
If your tooth sensitivity lingers for a long time after cold food and drink, or especially if it has started to become sensitive after hot food and drink, this is a warning sign that the bacteria in the cavity may have pushed all the way through the hard outer sections of the tooth (the enamel and the dentin) and reached the nerve, or root, at the centre of the tooth. Because the nerve is highly susceptible to infection, this is an extremely serious situation. Unfortunately, a root canal may be possible to stop this infection from spreading through the tooth and then down into the jaw below the tooth, through an abscess.
A root canal is a type of dental surgery in which the dentist drills a small hole through the tooth to reach the nerve (after numbing the mouth, of course), then extracts the numbed nerve material and replaces it with filler material, usually a plant material called gutta percha. By removing the infected nerve, this removes the risk of the infection spreading.
Once the nerve has been removed, the tooth is clinically dead. This is not necessarily a problem: its hard outer structure will remain, and you can therefore use the tooth more or less as normal, provided you take good care of it. However, it will always be more vulnerable and brittle than teeth nearby. As a result, rather than simply a filling for the surgical hole in the tooth, dentists will usually also recommend a crown for the affected tooth, so that it is fully protected in the future.
– Tooth Extraction –
In the worst cases, irreparably damaged teeth must be removed. Pulling out teeth used to be the default option for dentists; today, it is considered an absolute last resort. If you do resort to having teeth removed, be aware that this will cause nearby teeth to shift in position, possibly causing further dental problems. Dentists can install permanent false teeth, rooted via posts to the jawbone in a manner similar to real teeth, but this process is both uncomfortable to the patient as well as extremely expensive.