A filling is a way to restore a tooth damaged by decay back to its normal function and shape. When a dentist fills your teeth means he or she will remove the decayed tooth material, cleans the affected area and then fills the cavity with a filling material.
The types of fillings :There are three major types of direct filling materials (direct fillings are placed in a prepared hole in a tooth, carved or molded to look like a tooth, and then light cured or allowed to harden.
The most common scenario is the case of decay that has gotten so deep into the tooth that on the X-ray it looks like it's already reached the nerve of the tooth. The dentist tells you it looks like you need a root canal....Sometimes the dentist will see "a shadow" at the tip of the root. That indicates bone loss that results from the changes in chemistry that happens when a tooth has already abscessed (is infected) and the nerve has already been dead for a while (probably several months or longer). In that case there is no choice other than extraction or root canal treatment (RCT).
But often there is no clearly defined shadow at the end of the root. In these cases the dentist has to drill out the old fillings and decay and see how deep the decay goes. If the nerve has not been reached. Just a filling should fix it. Sometimes after getting all the decay out there will be a small spot where the nerve has been reached and that spot will normally bleed a little. That's called "an exposure". If the exposure is small and if the bleeding is slight and the colour of the exposure looks like pretty healthy tissue, the dentist can opt to do a pulp cap.
A pulp cap just means trying to sterilize the area as well as possible, stopping the small bleeding and placing an appropriate filling over it. In the past the technique was to place calcium hydroxide over it and then a normal filling (usually amalgam).
Modern pulp-capping is mostly done using a bonded composite technique right over the exposure - with NO calcium hydroxide layer. When they are done well and in the right situation , pulp caps have a very good chance of working for a long time. It's just for those teeth in the in-between stage where the nerve is irritated but still alive and healthy enough to repair itself given a reasonable chance.
The pulp-capping gives it a chance by getting rid of the decay and the bacteria that are in the decay and by creating a clean dressing over it with the filling. It's not unlike cleaning out a dirty cut or scrape on your skin and placing a clean bandage over it.
Pulp capping is an operative technique designed to preserve the vitality of a potentially infected pulp. There are two broad types of pulp capping - the direct and the indirect pulp caps. As mentioned above, they are only successful if the pulpal infection is very mild.
An Indirect Pulp Cap is a procedure that is used when the dentist gets close to the nerve when removing decay. This is a perfectly proper dental procedure and is used in cases where the nerve (or pulp) would be exposed if all the decay were removed from the cavity. Regarded as a conservative treatment, the application of medicated cement in the temporary filling helps the pulp of the tooth to repair itself by containing the decay and allowing the buildup of a wall of tooth structure between the pulp and the decayed material.
This is a "holding action". When your dentist removes the temporary filling, he may take an X-ray to determine if the pulp has healed. If so, the balance of the decay is removed, and a permanent restoration or filling, can be placed in the tooth.
In summary, your dentist is trying to keep your tooth alive, avoiding the need for a root-canal filling, pulp capping or extraction of the tooth.
Direct pulp cap is a term used for a procedure in which a dressings/lining is placed into direct contact of the exposued pulpal area. This is usually carried out following a carious or traumatic pulp exposure. Calcium hydroxide is the most commonly used dressing.
Step1: Examination and Vitality Testing
The dentist will look at the tooth and X-rays to determine if your tooth is a candidate. In general, pulp capping is done if the tooth is still alive, meaning that the nerve has not died. To test this, the dentist may use one of many tests. One is an electric vitality test, where the dentist must gauge your reaction to different stimuli to the tooth.
Other ways to test a tooth are to ask questions and look at the tooth. The tooth should have its natural colour and not be darkened. Surrounding gum tissue should be pink and not red and swollen. There should be no puss pockets in the gum near the bone of the tooth (which may indicate infection or abscess.) The dentist may even look at an X-ray to look for infection in the bone surrounding the tooth.
Other ways to test a tooth are to ask questions and look at the tooth. The tooth should have its natural colour and not be darkened. Surrounding gum tissue should be pink and not red and swollen. There should be no puss pockets in the gum near the bone of the tooth (which may indicate infection or abscess.) The dentist may even look at an X-ray to look for infection in the bone surrounding the tooth.
Step 2: Removal of decay
In Direct pulp capping the dentist drills out the decay of a tooth, and then places a medicinal dressing over the exposed pulp. The tooth can then form dentin over the pulp.
Step 3: Filling
The dentist may do a permanent filling. Otherwise, the dentist will use a temporary filling. If so, you will come back about 6 months later to make sure dentin has formed over the pulp and then get the permanent filling done.
A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.
"Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.
When a tooth's nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth.
A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth.
The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Diagnosis (Decision is made to remove the tooth's nerve).
Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.
An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.
Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep out contaminants -- like saliva and food -- out between appointments.
At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.
At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.
The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking and restore it to full function. Your dentist will discuss the need for any additional dental work with you.
