Dental Carries: What is caries? Treatment of cavities and types of fillings

Caries is a disease caused by bacteria in the mouth, e.g., L. acidophilus, S. mutans, S. salivarius, S. mitis, S. sanguinis, E. faecalis. They metabolize sugars, producing acids that initiate the cariogenic process.

As a result of caries , the hard tissues of the tooth are demineralized. Initially, carious lesions attack the tooth enamel, then they reach the dentin (then we can feel pain), and finally reach the pulp (then the pain is very strong), destroying the tooth structure from the inside. The whole process is time-consuming, so regular visits to the dentist help to detect caries at an early stage of development, and the sooner the caries is healed, the better. In addition, the cost of treatment will be cheaper.

What causes dental caries?

• A diet rich in products with a high sugar content (sweets, salty snacks, sweet drinks, highly processed products),
• Neglecting proper oral hygiene,
• Accumulated tartar,
• Chronic dry mouth
• Teeth susceptibility to demineralization processes.

Carious lesions

Cavities , commonly known as holes in the teeth, arise as a result of developing caries. Regular visits to the dentist are essential to find them. Cavities often develop under the surface of the tooth, therefore they are invisible and only the physician’s trained eye is able to assess whether our dentition has carious changes. Cavities most often appear in the interdental spaces (which the bristles cannot reach when brushing the teeth), at the gum line and on the chewing surfaces of molars.

Everyone, regardless of age, is at risk of developing cavities, especially when we neglect proper oral hygiene. However, people who suffer from a dry mouth are much more prone to developing cavities. Saliva has bactericidal and anti-cariogenic properties, and, to some extent, it cleans the surfaces of the teeth from microbes. Therefore, people whose salivary glands chronically produce too little of it should pay special attention to the condition of their teeth.

Types of carious lesions

There are three types of cavities :

• coronal defect – located on the chewing surface of the tooth and in the interdental spaces. It is the most common type of cavity in adults and children.
• root defect – develops on the tooth root, which is not protected by the enamel layer, which makes it more vulnerable to the attack of caries. This is because with age the gums recede and reveal a fragment of the tooth root.
• Recurrent caries – around fillings and crowns, plaque tends to accumulate excessively. Then, the task of caries is easier and it may begin to develop around the existing filling. Over time, the filling may lose its tightness, so that bacteria have an open path to the inside of the tooth and the so-called secondary caries may occur .

Treatment of cavities

The method of caries treatment depends on the stage of the disease. For this reason, the dentist first carefully examines the teeth and assesses their condition. If he finds carious lesions, he can take an X-ray to check the extent of the defect and whether it has reached the pulp. Then a course of treatment is planned.

When the carious lesion has just started to be visible as small spots on the tooth surface, remineralization is enough. It is a simple procedure that does not even require drilling and filling the cavity. An agent rich in fluorine in the form of a varnish or gel is applied to the infected area. As a result, the damaged area can be rebuilt and the development of caries is inhibited. However, the preparation should be applied at least several times for the treatment to bring the desired results. In addition to remineralization, ozonation can be used. Ozone has a strong bactericidal effect, which definitely slows down the development of caries, and the procedure itself is painless and short, it takes only 20 seconds.

When the carious lesion is larger and the lesion has reached the dentin, it is necessary to remove the diseased tissue mechanically. For this purpose, the dentist drills the tooth with a special drill. This procedure is unpleasant and painful for most patients, especially when the cavity is large. For this reason, the dentist may administer local anesthesia , which starts working within several seconds after administration. Then the treatment is painless.

Mechanical debridement is a necessary step in the treatment of the cavity. The carious lesion should be completely removed thoroughly and precisely. Leaving even a small amount of caries in the dentin will make it continue to grow and destroy its structure until it reaches the pulp. After removing the entire carious lesion, the dentist fills the resulting hole with a tight filling that prevents microorganisms from penetrating deep into the tooth.

If caries is not detected early enough, it will reach the pulp, infecting the only living tissue of the tooth. In this case, root canal treatment is necessary, during which the pulp is removed and the dental canals are cleaned, disinfected and tightly filled. Then, depending on the condition of the tooth crown, the dentist rebuilds it with a composite, and if it is badly damaged, a prosthetic crown should be placed.

Types of dental fillings

In dentistry, many materials are used that can serve as a filling used in the treatment of carious cavities . Light and chemically cured, glassomer, porcelain and amalgam seals are available.

Light and chemically cured fillings

Light-cured fillings are the most frequently used. They guarantee high aesthetics of the filling. The color can be matched to the shade of the patient’s teeth, so that the filling is almost invisible, so they can also be used to fill cavities in the front teeth.

The light-cured composite has the consistency of plasticine and can be modeled after application. The hardening of the material occurs under the influence of light from a polymerization lamp. In addition to their aesthetic appearance, they are also very durable, because the filling is connected to the tooth with special bonding systems.

A very similar type of filling are chemically cured composites , which are also used to treat both front and back teeth. Unfortunately, they are definitely less durable, and their aesthetics also leave a lot to be desired compared to the light-cured composite. In the case of a chemically hardened filling , the liquid and the powder are mixed and applied to the defect site. As a result of the chemical reaction, the mixture hardens, then the seal can be smoothed and adjusted to the patient’s bite.

Amalgam fillings

The amalgams consist, among others, of made of silver, zinc, mercury and copper. They are currently being abandoned because they contain toxic mercury and are unsightly. In addition, they discolor tooth tissues and conduct high and low temperatures. Their only advantage is durability and low price.

Glassomer fillings

This type of filling is mainly used in the case of milk teeth. They consist of special cements and are less aesthetic and durable than composites. They can wear off and crumble. However, it binds very well with the tooth tissues and releases fluorine ions that regenerate enamel and dentin and prevent the development of caries in the future.

The combination of glassomer cement and composite ( compomer fillings ) is also used to treat milk teeth. They have the advantages of glassomer fillings and are more durable than them. Unfortunately, they are not very aesthetic.

Porcelain fillings

Porcelain fillings are also known as onlays and inlays . They are used when there is an extensive tooth loss, but a complete prosthetic crown is not needed. Before placing the porcelain filling, the tooth should be properly prepared, and the filling itself is prepared on request in a specialized laboratory. Onlay and inay fillings are very aesthetic, their color can be matched to the color of the patient’s teeth.

The onlay filling recreates the chewing surface and the tops of the tooth cusps. In contrast, the inlay is used on large chewing surfaces and on the slopes of the nodules.
Their advantage is high durability and resistance to discoloration (occurring, for example, as a result of drinking coffee and tea).

Recommendations after the treatment of cavities

1. Conservative treatment is most often performed under local anesthesia. Due to the anesthesia, you may feel numbness on the face on the side of the procedure, and sometimes there are difficulties in speaking or swallowing. 
2. Until full sensation is regained, it is recommended to refrain from meals. You should also be careful when drinking beverages. The symptoms of anesthesia gradually disappear within an hour.
3. The currently used materials that recreate hard tooth tissues (fillings) thanks to the technique of their hardening using a UV lamp are resistant to external factors immediately after their insertion and do not require drying or biting restrictions, so you can eat immediately after the visit.
4. When treating cavities in teeth that already have at least one side missing, the dentist places a metal or foil ring (matrix) on the tooth, the edge of which is placed in the gap between the tooth and the gum. Hence, in some cases, after the anesthesia is over, you may feel a little pain in the area of the treated tooth. These symptoms disappear 1-3 days after the visit.
5. After a dental visit where fillings are placed, you can perform normal or standard oral hygiene procedures, such as brushing your teeth with a brush and paste, using floss and an irrigator, or rinsing liquid. 
6. It is very important to scrupulously follow the appointment schedule and dental treatment plan.