Identifying caries by scraping with a microscope
◆ Using a microscope, we remove the decayed teeth while making them visible
At our clinic, we diagnose cavities by visual inspection and X-ray imaging to determine the level of cavities. In particular, it is quite difficult to judge the "proximal caries" that occurs between teeth by visual inspection alone, so imaging is considered to be effective.
To improve the level of visual examination, a microscope that can magnify teeth is useful. There is a limit to what can be seen inside a small, dark mouth with the naked eye, and there are times when you have to rely on your senses and experience to see what you cannot see. This leads to inconsistencies in treatment methods. Using a microscope, we can determine which areas need to be properly filed down and proceed with treatment while preserving any teeth that can be saved.
Detecting cavities from X-rays
"Image diagnosis" is also important for the examination and diagnosis of cavities. In general dental treatment, panoramic X-rays that take pictures of the entire mouth are often used, but especially in the back teeth, images overlap, and while deep cavities can be found, cavities that have developed on adjacent surfaces (between the teeth) are difficult to find.
Dental photographs (smaller X-rays than panoramic ones) are effective in diagnosing adjacent caries. These are also used to evaluate the presence or absence of caries that may be progressing.
We use a microscope to improve the level of our visual examination, and by improving our method of taking X-rays, we can obtain even more information through image diagnosis, allowing us to comprehensively identify any problems in your mouth.
Diagnose treatment methods for cavities
Cavities come in a variety of sizes (depths). At our clinic, we determine the extent of the cavities based on the diagnostic criteria shown above. We then determine the treatment method according to the size of the cavities.
◯State0,1
We will provide follow-up care to ensure that the condition of the tooth surface does not deteriorate. Proper daily brushing and professional care will be performed regularly to prevent unevenness on the tooth surface. The use of fluoride is also effective. Fluoride toothpaste, which can be used for home care, is also effective. At dental clinics, it is possible to apply a higher concentration of fluoride than toothpaste containing fluoride, which can further strengthen the tooth surface.
◯State 2
Compared to 0 and 1, this is a state in which bacteria have penetrated deeper into the enamel. If bacterial growth can be contained within the enamel, there is no need to grind the tooth. However, compared to the surface of a healthy tooth, bacterial penetration is already evident, so care must be taken. Cavities in this state do not cause pain, so there are no subjective symptoms. In order to stop the progression of cavities, it is necessary to develop a brushing habit and improve your oral environment.
At our clinic, if the cavity is in State 1 or 2, we will first start Nordic-style preventive management treatment by a dental hygienist to improve the oral environment (initial periodontal disease prevention treatment). The treatment of the cavity is to manage it so that it does not get bigger without drilling the cavity.
◯State 3
Although bacteria have invaded the enamel-dentin junction, it is not yet possible to say for certain that the bacterial infection has clearly reached the dentin. This is the borderline between whether to treat the cavity by grinding the tooth or to manage the caries without grinding. If you can manage the caries by improving the oral environment, or if you cannot avoid the risk of the caries progressing, you will have to choose to grind the tooth.
◯State 4
This is a condition where bacteria have invaded the dentin, beyond the boundary between enamel and dentin. When bacteria invade dentin, the rate at which cavities progress increases. It is said that cavities in dentin progress about twice as fast (or even faster, depending on the oral environment) compared to cavities in enamel. Even with cavities in this state, in many cases there are no subjective symptoms such as pain. It can be said that cavities progress asymptomatically. Even if you cannot see the cavity (cavity hole) with your eyes, in many cases bacteria have invaded the dentin from between the teeth (adjacent surfaces) and created the cavity.
Unfortunately, applying fluoride is ineffective in this condition, and the infected tooth must be drilled down.
When grinding teeth
① Preserve as many healthy teeth as possible
2. Don’t leave any bacteria behind
3) Filling the cavity so as to prevent bacteria from entering
④It is important to create a cleaning environment that makes brushing easy.
Regarding filling treatment, the treatment is completed in one session per area, but filling is not possible if there is bleeding or inflammation of the gums, so before filling treatment, a dental hygienist will perform Nordic-style preventive management treatment to prepare the environment around the tooth before proceeding with filling treatment. It will take at least two weeks for the condition of the gums to improve.
◯State 5
This is a cavity where bacterial infection is found even further inside the dentin than in Stage 4. The bacterial infection has spread to areas close to the pulp, and the cavity has spread to the inner half of the dentin. In this state, it is possible that some of the bacteria has already reached the pulp (tooth nerve). It may be necessary to undergo treatment to remove the pulp in the future.
When caries is close to the pulp, if the infected dentin is ideally removed, part of the pulp will be exposed (pulp exposure), and there is a risk that the pulp that could have been saved will become infected during treatment. In such cases, the stepwise method (a two-stage method of caries treatment) may be selected. This treatment method involves removing the caries and filling it twice. With this treatment method, retreatment is performed about six months after the first treatment, so it takes at least six months until the treatment is completed.
If it is clear that the tooth pulp has been affected, root canal treatment must be performed immediately. In this case, the condition of the tooth will only worsen if you wait. The number of bacteria will increase rapidly, the inflammation will intensify, and the prognosis after treatment will also worsen.
There are cases where you feel strong pain, but the pain gets better when you notice it, but it is important not to make a self-diagnosis. In some cases, the living pulp may have become necrotic and you no longer feel pain. In any case, the tooth decay is deep and has progressed, so early examination and diagnosis are necessary.
<Stepwise method>
The stepwise method is a caries treatment method that is suitable when tooth decay has progressed deeply and the possibility of part of the pulp being infected cannot be denied, but there is currently a possibility that the pulp can be saved without extraction.
This treatment method is not suitable for cases where bacterial infection has clearly spread to the dental pulp. In cases where this treatment method is suitable, if the infected dentin is ideally removed, part of the dental pulp will be exposed (exposed pulp), and there is a risk that the pulp that could have been saved will become infected during the treatment.
Therefore, in the first approach, we remove as much of the dentin as possible, which is thought to be highly infected and has a large amount of bacteria, and confirm that there is no pulp exposure. We then fill the area closest to the pulp with medicine to suppress inflammation, and then completely seal the cavity with dental composite resin. After that, we will observe the treated area for at least six months to see if any pain or problems occur. If sensitivity or pain occurs, unfortunately, we can diagnose that the bacteria have reached the pulp, and the pulp cannot be preserved, so we will move on to root canal treatment.
If no particular pain or problems occur, it can be determined that the pulp can be preserved at this point. Therefore, after six months, the dental composite resin and medication that were sealing it will be removed, and any remaining infected dentin near the pulp will be further removed. Once it has been confirmed that the pulp is no longer exposed, the cavity will be sealed again with dental composite resin.
There is a reason for waiting six months between the first and second treatments. This is because, while waiting for the effects of the medicine, we are also waiting for the human immune response that causes the dental pulp itself to try to escape from the bacteria. By changing the shape of the dental pulp and moving away from the bacteria, the possibility of removing the caries to a deeper level increases after six months. If the number of bacteria can be reduced in the first treatment, it is possible to slow the progression of the caries. Cavities do not progress suddenly. They are the result of caries progressing over a long period of time, at least in years. Therefore, the caries will not suddenly worsen during the six-month waiting period. Rather, it is a waiting period to prevent the caries from worsening.
However, the stepwise method is not a treatment that can preserve all nerves. If there is even a small possibility of preserving the pulp, we will do our best to recommend it to those who wish to undergo treatment. Preserving the pulp extends the life of the tooth and allows you to make use of your natural tooth.
◆Precise filling of cavities
When grinding teeth, it is important to 1) leave as much healthy tooth as possible, 2) not leave any bacteria behind, 3) fill the area in a way that prevents bacteria from entering, and 4) create an environment for cleaning by making the area easy to brush.
① Preserve as many healthy teeth as possible
When grinding teeth, a cutting tool called a diamond bur is used. Diamond burs come in various sizes and shapes, and the most appropriate tool is used depending on the state of the cavities. When performing naked eye treatment with insurance-specified tools, it is difficult to distinguish between healthy and infected tooth tissue, so the only way to remove cavities is by rough touch using large diamond burs or hand tools.
Using a microscope (dental microscope), we can magnify the tooth with caries by several dozen times and examine the condition of the caries in more detail. By using a special bur, we can minimize the amount of healthy tooth tissue that is removed as much as possible, and only the areas with caries can be scraped off and filled.
2. Don’t leave any bacteria behind
By using a microscope, it is possible to clearly see and distinguish between infected dentin and healthy tooth tissue. It is possible to quickly approach the infected tooth tissue without having to drill the tooth based on a guess based on the X-ray.
Also, because there is a risk of over-cutting infected dentin when cutting at high speeds, it is important to remove the infected dentin little by little with hand tools. In particular, dentin must be carefully removed from areas where cavities may be close to the pulp. In such cases, a two-stage cavity treatment method called the stepwise method may be effective. Cavity treatment is intended to protect the pulp. It is important to prevent the spread of bacterial infection to the dentin in order to protect the pulp.
3) Filling the cavity so as to prevent bacteria from entering
After removing the decayed tooth while leaving as much healthy tooth tissue as possible, the next step is to fill it in order to prevent bacteria from entering. If bacteria causing problems in the oral cavity get into the surgical field, there is a high possibility that the treated tooth will develop problems in the future.
In addition, the oral cavity is moist due to the presence of saliva. The dental composite resin used in caries treatment can increase its adhesive strength to the tooth by keeping it clean and dry. To do this, a sheet called a rubber dam must be placed over the tooth to be treated, creating the optimal environment for treating the surgical field.
By using a rubber dam, we can fill the cavity more precisely. In our precision caries treatment, we use dental composite resin, which is strong and aesthetically pleasing. We select the most suitable material for each case.
4. Create a cleaning environment that is easy to brush.
In the case of adjacent caries between teeth, it is necessary to make the adjacent shape ideal after treatment. Let's think about the history of tooth decay. Tooth decay occurs because it is the perfect place for bacteria to grow. Therefore, even with natural teeth, if cleaning is not done properly, bacteria will grow and cause tooth decay.
Dental composite resin is plastic, so it is more susceptible to plaque buildup than enamel. In order to prevent the treated area from developing cavities again in the future, it is important to eliminate as much unevenness as possible between the tooth and the resin, and to create a shape that is easy to clean and pass through with interdental brushes and floss.
To achieve this, it is necessary to fill the adjacent surfaces as smoothly as possible without creating any gaps, while making full use of special materials and tools. The appropriate material is selected according to the case, such as a flow-type resin with fluidity or a paste-like resin. After filling, the filling is polished to achieve an even smoother shape.
Flow of our precision caries treatment
Treatment period and frequency
Cost (The cost varies depending on the symptoms and condition.)
List of associated treatment costs (costs will be incurred as necessary during the above root canal treatment)
If you undergo prosthetic treatment such as ceramics in the future, additional treatment costs will be incurred.
Risks and Side Effects
-
If a tooth fracture that was not detected during pre-treatment diagnosis is discovered during treatment, we will consider ways to preserve the tooth as much as possible, but there is a possibility that the tooth will need to be extracted in the future.
-
Even during precision root canal treatment, nickel-titanium files can break inside the root canal.
-
If the inflammation is severe, the pain may not disappear with the first treatment alone. In that case, it may be necessary to use painkillers in combination or resume the next treatment sooner.