Questions about the causes, intensity and duration of pain during and after treatment of caries are, perhaps, one of the first places among the popular questions to the dentist-therapist. The treatment of deep caries is generally the most difficult manipulation among the treatment of other carious lesions, therefore, unfortunately, pain is not always complete without pain.
According to the classification of the depth of the carious process, the following types of caries are distinguished:
- Elementary;
- Surface;
- Average;
- Deep.
The last stage of the development of the carious process suggests the proximity of the destroyed and infected tooth tissues to a healthy pulp (“nerve”). As a result, in the diagnosis there is always a risk of confusing deep caries and the beginning complications in the pulp of the tooth when a carious infection penetrates into it. Therefore, in such cases, treatment should be carried out only after a detailed diagnosis of the process stage.
Factors of the appearance of deep caries
The causes of caries in general, including deep, are directly related to the activity of cariogenic microorganisms in the oral cavity. In the process of fermentation of carbohydrates, bacteria of the Streptococcus mutans type (and some others) produce organic acids that cause the emergence of the initial forms of enamel destruction (caries of the spot) with a gradual transition of the pathological process to the dentin tissue.
When this occurs, the dentin softens due to the release of mineral components (calcium compounds, phosphorus, fluorine), followed by the dissolution of organic matter (collagen) under the action of bacterial enzymes. The formation of a cavity by the type of medium caries with softened infected dentin, remaining without treatment, inevitably leads to a deepening of the pathological process and an increase in the area of destruction. If at this stage the treatment of deep caries is not carried out, time can be lost, and a complication will arise with the transfer of infection to the unprotected tissue of the pulp (“nerve”) inside the tooth.
Unfortunately, not everything depends on the person himself. There is another important factor that some people face.when it comes to a problem tooth: the secondary occurrence of caries under the filling with various violations in it or under it. If some stages of the treatment of deep caries for various reasons were performed with an error, then deep caries appears under the filling. This is especially true for defects and chips of poorly delivered fillings.
On a note
Unfair treatment of deep caries by a dentist is usually associated with the following factors:
- With poorly cleaned carious cavity from infected and softened dentin, when the seal can not simply stick on the soft tissues of the tooth.
- With poor isolation of the working area from saliva, gingival fluid and blood. Often, when working, the necessary means of isolation and preparation for sealing are not used, and most of the materials for the seals, as is known, are not sufficiently firmly fixed in a moist environment. For long-term results, this results in the loss of all or part of the filling, spalling, cracks, abnormal fit, etc. In any case, the process of tooth decay often continues after such treatment.
- In violation of the instructions to the selected filling material or with the wrong choice of material in a given clinical situation.Due to the variety of modern fillings, errors are possible at the stage of setting the material, often associated with the doctor’s limitation in time. Any little thing for modern "light" fillings is especially important and determines their warranty and durability.
Localization of cavities with deep caries
Today, for the convenience of treating deep caries, doctors apply the classification of carious cavities according to Bleck, depending on their location on the chewing and front teeth.
Class I. Localization of the carious process in places of natural holes and fissures of small, large molars and incisors.
Class II. Localization of lesions on the contact (side) surfaces of molars and premolars (large and small molars).
Class III. The location of the carious cavity on the contact (side) surfaces of the canines and incisors while maintaining the cutting edge and corners of the crowns.
Class IV. The location of the carious process on the contact (side) surfaces of the canines and incisors in violation of the cutting edge and corners of the crowns.
Class V. Localization of carious lesions in the neck of all groups of teeth.
It is interesting
The classification of cavities was introduced by Black as early as 1896 to standardize the methods of preparation and filling of cavities and exist to this day.However, modern "light-cured" materials, which are based on the principle of "chemical bonds" with tooth tissues, make it possible not to adhere to the rules and techniques of preparation according to Bleck. Despite this, dentists actively apply it in various clinical situations in order to properly treat deep caries.
It is also noteworthy that after the death of the author, another 6th grade was added, which they began to officially call “after Bleck”. It includes cavities on the cutting edges of incisors and canines and knolls of molars. Most dentists are of the opinion that this class was mistakenly attached to the main classification, since the author did not give consent to this.
Main symptoms for deep caries
Before the treatment of deep caries, the dentist carefully examines the patient's complaints, since it is at this stage that the diagnosis can be either confirmed or refuted.
If you collect statistics from the histories of diseases with deep caries, then among the most frequent complaints and their features you can select the following:
- Aesthetic imperfection or deformation of the tooth.
- Pain from temperature irritants (hot and cold), chemical (mostly sweet) and mechanical (when penetrating solid food into the cavity).
- Short temper pain. The pain quickly passes after the removal of the stimulus.
- Violation of the filling (spalling, displacement, prolapse) and the associated caries, flowing or asymptomatic, or - with the above short-term pain syndrome, when the tooth periodically aches.
Criteria for selecting a filling material before treatment
After the diagnosis, treatment of deep caries is carried out according to the accepted protocol. Before preparation (processing) of the cavity, the dentist determines in advance the approximate set of filling materials needed in this clinical situation.
Now let's talk about which basic materials and in which case are preferred.
The obsolete type of filling materials is amalgam (silver and copper). They can not be used in the front teeth, as they are not aesthetic, therefore the area of their use is classes 1, 2 and 5 according to Blek, as well as for the teeth covered with crowns.
It is interesting
For the treatment of deep caries in the 20th century, amalgams have been an indispensable filling material that is still found today. Virtually no filling, except for amalgam, which can boast a 20-30-year-old prosperous existence in the tooth. Silver amalgam is a metallic filling with an active antibacterial effect of silver (and mercury). The possibilities of holding it are almost endless.
Unfortunately, in Russia it was hastily canceled due to the likelihood of contamination of the body with mercury, since silver powder was mixed on it. American dentists have successfully proved the opposite: they conducted a number of studies and did not reveal the possibility of mercury poisoning even for staff, while observing the safety standards. According to the latest data, since 2000, American dentists have been conducting annual amalgam production on several million teeth. In Russia, amalgam is almost never used, although the treatment of deep caries with their use is quite effective.
A more modern type of filling materials is the so-called glass ionomer cements (JRC). Most often, the JRC is used in the treatment of deep caries as a lining material for fillings or restorations made of composites of almost all Blek classes (it all depends on the type of material),for filling all classes of milk teeth, sealing fissures, fixing crowns, etc.
The doctor may give preference to this material in the following cases:
- terrible oral hygiene;
- multiple caries on the teeth;
- the location of the cavity below the gum level (under the gum);
- the impossibility of isolating the working area from moisture.
Another type of filling material is composites. We will not dwell in detail on their forms, we note only that there are composites of chemical and light curing.
Modern clinics prefer functional and aesthetic light-cured materials, well-proven in the treatment of deep caries. They are placed on carious cavities of any class, convenient to use, easily and firmly connected with the tooth tissues, are durable enough for accurate execution of the technical details of the production.
Unfortunately, each company produces composites with a set of properties that can have both positive and negative points. The price of such materials also differs. In any case, it is undesirable to use them in case of subgingival deep cavities, when it is not possible to isolate them from moisture.Such treatment of deep caries may not be effective.
Stages of treatment for deep caries
The treatment of deep caries consists of a series of steps carried out by the dentist in the order required for the clinical situation.
- Anesthesia. This is an important stage of pain relief for loss of tooth sensitivity during the treatment phase. It allows the patient to feel comfortable and not to experience fear.
- Mechanical treatment of the cavity from carious tissues (preparation), drug irrigation with antiseptics.
- Calcium hydroxide-based therapeutic pad is sometimes used in the treatment of deep caries and is placed on the bottom of the cavity to prevent the risks of pulpitis (inflammation of soft tissues). Its antibacterial activity is known for a long time.
- Overlay insulating gasket. Sealing with amalgam or a composite (except for glass ionomer cements) requires isolation of the material from dentin in order to prevent the toxic action of the components included in the filling composition. For gaskets in the treatment of deep caries are used: zinc phosphate cements, glass ionomer cements,compomers (combine in themselves the properties of JIC and composites), etc.
- And, finally, the formulation of the seal, selected according to the characteristics of the cavity being filled.
The following video shows an example of treatment for deep caries:
So, in fact, there is a treatment of dental caries (from drilling to installing a seal)
Expert comment
Most experts have concluded that the use of medical pads for deep caries, followed by closure of the cavity with a seal in one visit is an unreasonable risk for the long-term perspective. The fact is that the disappearance of the pads based on calcium hydroxide for a short time has been proven. Dentin actively absorbs the gasket to form a space under the seal. This, in turn, shrinks and damages the seal, leading to infection of the tooth tissues through microcracks.
Researchers agreed that it is better to either use a medical pad under the temporary seal, and only after some time (5-14 days) to install an insulating pad and a permanent seal without it, or not to use the pad at all, even with deep caries.In most cases, this does not affect the quality of treatment while adhering to modern technologies.
Possible complications after treatment
Sometimes a person has a rather tangible pain after treatment for deep caries, or a tooth aches. Almost always - it is the result of certain errors on the part of the attending physician. Normally, there should be no pain.
In some cases, the pain goes away within 1-2 weeks. It is called postoperative (post-filling) sensitivity, which is characterized by:
- pains with pressure on the filling;
- sensitivity from temperature stimuli (more from cold);
- sense of discomfort.
If after treatment of deep caries you have a tooth, then you should definitely consult a doctor. It is especially important to immediately appear at the reception after placing the seal in the following cases:
- Acute pains (paroxysmal and spontaneous).
- Pronounced aching pain, not removed even painkillers.
- Reactions from the gum near the treated tooth (edema).
- Clear signs of overestimation of the filling and reaction to a traumatic factor.If, for some reason, the dentist did not completely finish a bite on the bite, which prevents the teeth from closing and chewing, then pain soon arises and a reaction to the traumatic factor develops with the subsequent occurrence traumatic pulpitis or periodontitis. There is no point in waiting for the filling to “get cleaned up”, as some patients believe, it will not happen by itself. A visit to the attending physician is required.
Such pain after the treatment of deep caries often speaks of its complications: pulpitis, periodontitis, periostitis, or even acute or chronic trauma of the tooth on the background of overestimation of the filling.
Timely assistance can not only prevent serious consequences for the tooth, but also save it after adequate treatment for life. The help that the dentist can provide at the reception with complications of deep caries:
- Replacing gaskets and seals for other options (for post-filling pains).
- Treatment of the tooth in the canals with the subsequent formulation of the seal in the second visit.
- Correction of fillings in case of its overstatement, if there are no serious consequences from such an injury.
- Treatment of tooth canals and additional surgical procedures (incision, root resection, hemisection, etc.) to save all or part of a tooth in a well by the combined method.
To summarize: if you experience a pain in the tooth after the treatment of deep caries - no need to endure and wait for the consequences, it is always better to seek advice from your doctor.
Questions to the dentist
Hello! Three days ago I was at the dentist, and he bore my tooth so deep that it hit the nerve, although the tooth did not hurt. I didn’t feel anything, because a prick was made in the gum. I ask you to answer two questions: why did the doctor decide to remove a nerve from a living tooth, but he was not sick, and also explain the reason for the short pains that arose after treatment, when chewing on a tooth, especially meat and fruit?
Alexander, Moscow
Dentist-therapist: Hello, Alexander! Unfortunately, patients often come up with problems so late that it is not possible to treat the tooth according to the diagnosis “deep caries”. This is due to the strong destruction of the tooth with the involvement of the "nerve" in the infectious process. Therefore, in order to prevent a tooth from getting sick under the filling, the doctor depulses it (removes the “nerve”), and then after a certain time (less often - immediately) sets the filling.In some cases, in the first days after treatment, postoperative (post-filling) pain or sensitivity may occur due to the processing and sealing of the canals.
This is due to the manipulations in the channels themselves and, less frequently, to errors in their implementation. Usually, the pain disappears within 2-5 days. If the pain lasts longer - you should consult a doctor for consultation before the scheduled visit to a permanent seal. You should also immediately contact your dentist after the appearance of:
- High temperature;
- Edema in the canal-treated area;
- Severe and unbearable throbbing pains in a filled tooth;
- Numb feeling in jaw after treatment.
Price treatment characteristics
The price of deep caries treatment depends on many factors:
- the number of visits that you make to the clinic;
- applied materials;
- clinic status;
- the level of training of the doctor;
- and even the clinic’s marketing costs.
Treatment of deep caries is a complex of complex manipulations, so the price will also be determined by the localization of the carious cavity according to Bleck: for example, fillings on the front teeth are more often assessed more expensive than on the root ones.This is due to the requirement of form and aesthetics. You have to use expensive materials to create an exact copy of the tooth.
Take care of your teeth and be healthy!
Interesting video: preparation of the carious cavity of class 1 according to Bleck
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Hello! If there is a strong caries on the back tooth, but it does not hurt, and a tooth has broken off from the inside, what actions will be taken during treatment at the doctor? Do not need to put the crown?
Good evening, three weeks ago, the sixth upper tooth was sealed up. Nerves were not removed, the hole was small and on the side, but the doctor cut down almost the floor of the tooth, only the back wall and a little of the front remained. For a week, the tooth did not hurt. I ate drying, and fell on this tooth, after which the tooth periodically began to hurt, what could it be?
Hello! I think that we are still talking about the standard post-filling pain, which simply was minimally expressed before getting hard on the tooth. It is hardly possible to displace or damage in the form of a crack (microcrack) fillings, but it is worth checking out by contacting your doctor. In principle, at the moment there is no reason not to trust your dentist (even with a visually small carious lesion during preparation of the tooth, it is often necessary to clean out significant amounts of caries softened tissues). Thanks for asking.
Hello! Tell me, can a tooth react to cold and sweet, if a medical pad of calcium is placed under the seal in order not to kill the tooth?
Hello! No, this is almost impossible. Most likely, we are talking about the fact that the causative tooth was never found. That is, next to, in the neighborhood, or on the opposite jaw, there is a tooth with a carious cavity, which reacts to an external stimulus (cold, sweet) with short-term painful sensations. I recommend to go to the dentist and jointly try to find the causative tooth.
Good day! A month ago she turned to a dentist, reworked a defective filling, there was caries under it (it was done by a completely different doctor, and before that there was an old filling on the same tooth, and there was also caries under it). The hole was deep, and after treatment the tooth reacted to everything: to water, to juice from fruits, to chewing. She turned again, the doctor said that secondary dentin should be formed, and this usually occurs within two months. The second one already passes, the tooth no longer reacts so strongly to pressing and almost does not react to water, juice, but the sensitivity to cold and hot has not completely disappeared.Tell me, is it worth reworking the seal? Since there is not enough that I am afraid of doctors (the fourth one is already treating this tooth), there are still suspicions that they didn’t put a gasket on me - they poured something, but I don’t know that. And they made a deep hole for me, and the seal itself is not completely polished, I feel roughness. The color is different from the color of the tooth, darker, beige.
Hello! It is possible that you were simply afraid to polish the filling due to your complaints about previous fillings with a deep, as I understood, caries. Since the dynamics are clearly positive, judging by your description, you should not redo the seal yet. You can try to fluoridate the edges of the enamel near the seal. It is short in time and inexpensive: usually 2 sessions are enough. It is necessary to abandon the whitening paste (if used) for 1-2 months, and focus on the paste containing fluoride, at least at the level of 1500 ppm, and without the bleaching effect. You can add and fluoride rinse in agreement with the dentist. Since I do not see how well the seal itself was installed from the point of view of the marginal fit,then my advice concerns precisely the post-sealing sensitivity and (possibly) slightly excessive grinding of the tooth walls near the filling with boron, when its height along the bite was corrected.
As for the “deep fossa”: with a high probability we can say - there is no doctor’s fault that there were so many carious tissues that had to be cut to avoid recurrence of caries or even the occurrence of its complication - pulpitis.
Good evening, Svyatoslav Gennadyevich! This is Elena, I wrote to you. I am currently in Moscow, and brought a snapshot of the tooth with me. If there is an opportunity to consult or somehow contact you, share your contacts, if possible. Happy New Year! Thank.
Hello! I do not live in Moscow, but I can quite well advise on a tooth image - you can send it to the site’s mail, and I will describe you as it is after a while (without embellishment, as doctors sometimes do in clinics).
Hello, today I treated two teeth with deep caries by a doctor. After the anesthesia had gone, all the teeth that had come under anesthesia began to whine.I called the dentist, the doctor said that it was because they did not kill the nerve, said something about secondary dentine and that the pain should pass in 3-5 days. She offered to come tomorrow at the physio laser, for free, just a few minutes.
Under the seals put a medicinal gasket, I do not know which one.
Can you comment on something, should I worry, or is this normal? The pain is strong enough, but tolerable, gives to the temple, to the front two upper teeth, although only the two lower ones, the farthest, were treated.
Hello! With pains in the lower teeth, the pain may radiate to the temple and the upper teeth - from the point of view of innervation, this is quite normal. If you have spontaneous pains and hold on for a long time, aggravated by other irritants, then, unfortunately, there is a very high probability that one of the two teeth will have to be pulped. The biggest difficulty: to decide which tooth has a problem with the pulp in response to the treatment. And was there any deep caries at all - maybe there were signs of incipient or chronic pulpitis? He just has no pronounced symptoms - the doctor could miss this moment.
Now a few words in case the pain does not pass (that is, if pulpitis is confirmed).If the dentist insists on depulping both teeth, it is worth getting help at the clinic, where there is EDI. In many cases, it is otherwise problematic to find out what kind of tooth hurts: well, if only the stage of the inflammatory process inside the canal does not come to that form, when you can accurately point to the tooth, or the doctor can “grope” something using the instrumental examination method. Electroodontodiagnostics (EDI) is not done in all clinics, but both are depulped, so as not to read chamomile - blasphemy.
Hello, Svyatoslav Gennadyevich! Yesterday I treated the top five for deep caries, the tooth was not depulped. Now it hurts to press a tooth. This is normal? Or should you go to a doctor?
Hello! This can be either standard post-filling pain or damage to or infection of the pulp. The first option can be quite harmless - as a rule, every day the pain decreases. There is no exact time when the pain should completely pass: a number of doctors believe that it is advisable to wait no more than 2-3 weeks despite the fact that the symptoms diminish and new ones do not appear (severe pain, throbbing, from hot, cold, night and .d.)
If there is EDI in the clinic, then you should apply now, otherwise you can check whether the doctor has made mistakes or not by observing the treated tooth. If it becomes easier to press a tooth from 3-4 days, then it is quite possible to wait a while and watch. If the pain symptoms increase - run to the doctor.
Hello, Stanislav Gennadievich. Today I changed the filling, returning home, found that the dental floss now does not pass. I called my doctor, she said that it was thought that it was necessary, that she made such contact, was very convincing. I do not even know how many times I heard and read that this should not be. The doctor was experienced (the head doctor of the clinic), there were no problems before, her fillings have stood for more than 12 years, one still as new. And I do not know what to think. Trust the doctor and stop worrying, or still insist on re-packing (which I don’t want to do). What do you advise? Thank.
Hello! From the point of view of standards, this work is not considered quality. The thread should be inserted into the interdental gap with little effort.The absence of a gap is not the norm, although not in all cases such “dense” fillings are a big problem. Rather, such fillings are a danger for the future due to subsidence on the gingival papilla. Often, while chewing, sooner or later, spontaneous “wedging” of the teeth can occur, and a gap will appear, and the benefits of such a moment for the future will be questionable.
After the restoration of the side surface of the tooth, it should be perfectly smooth, have a characteristic shape for this tooth with the possibility of adequate hygiene without injuring the gingival gap. From the point of view of the work of the doctor, I can say that sometimes it is difficult to recreate such a gap that meets all the criteria of quality. That is, sometimes this contact point can be recreated, according to the protocol, for a number of reasons, only in an orthopedic way: with a tab, crown, etc. There is also a combined method of making an impression and imposing a photopolymer on a prepared cavity with the help of special matrices that eliminate possible problems with a bad interdental gap.
Before insisting on pereplambirovo, it is important to knowis it possible to do it at all at this doctor in another way It is possible that you will need to change the doctor and clinic.
Today I treated the tooth, the doctor thought that I had pulpitis, but it turned out to be superficial caries. During treatment, the tooth began to periodically hurt (three times anesthetized). When anesthesia has passed, the tooth continues to just hurt for no reason: not much, but unpleasant. Should I run back to the doctor?
Hello! If during treatment, anesthesia did not work well, then this means that the doctor is most likely either not to have quality anesthesia techniques or does not have an imported anesthetic available. As for post-filling pains - the reason they may have is different. If during treatment there were no serious complications, then such pains disappear without a trace, usually within 3-10 days. If you wish, you can send a snapshot of the tooth to the site mail - I will comment on it in more detail.
Hello! Is it necessary to remove wisdom teeth?
Hello! Not necessarily, but often have to do it for certain reasons.The fact is that wisdom teeth in many people (most often in the female sex) do not fit in the jaw during eruption, therefore they either erupt “crookedly” or cannot erupt at all, which causes severe pain, inflammatory processes, up to osteomyelitis. In a preventive manner (for prophylaxis), wisdom teeth that are normally oriented in the jaws should not be removed, since with their proper eruption they often participate in chewing and even (periodically) come in handy in a difficult situation for fixed prosthetics (with bridges, for example). That is, wisdom teeth are removed only if they threaten human health or interfere with orthodontic or orthopedic treatment. In other cases, it is advisable to try to save them.
Hello. More than a month ago I was treated with deep caries (in one visit) in different places, and it still hurts to press on both teeth. Today I called and the doctor said - probably the nerve is close there, we’ll make an x-ray. If so, you have to remove the nerve.
Is it justified to kill a healthy nerve (without pulpitis) because of the proximity of the filling? I read about such a pain - that it is an undersized or dried out tooth.Is a different way possible then removal of a nerve? And is the doctor obliged to fix the problem now for free, if he gave a guarantee for a year?
Due to improper installation of a seal, caries formed under it. The doctor offers to remove the tooth and immediately begin preparing for implantation. Are there any other options? Will it be possible to remove the tooth now, and then put the implant in a year?
Hello, Anastasia. And why the doctor immediately offers to remove the tooth? If there is only caries under the filling, then it can be eliminated and a new filling can be inserted, or a tab or crown, depending on the degree of damage to the tooth.
As for the removal of the tooth and subsequent implantation, it is better to do it all at once, if the condition of the bone tissue allows (thickness and height of the ridge). Either postponed, 4-6 months after removal. If you walk for a long time without a tooth, then atrophy of the bone tissue and displacement of the teeth in the direction of the defect occurs (Popov-Godon syndrome).
Good evening! 4 days ago they were treating 6 with deep caries. They did everything without anesthesia, they knocked - everything was fine.Came home, began to whine a little. The doctor said that there could be such a reaction to the material that she laid. She advised me to drink antihistamines for a couple of days and Nimesil. The aching pain has passed. Now reacts when biting ... Is this the norm? Is that possible? And yes, sort of, it reacts to the sweet. And sometimes it twitches a little there ...
Hello! Post-filling pains occur in patients are not so rare, especially after the treatment of deep caries. It is necessary to observe, and with an increase in pain, take an x-ray to clarify the causes of pain. The tooth may be disturbed during the month, but the pain should gradually decrease. If, on the contrary, it increases, the tooth reacts to hot and cold - this means that, most likely, it will be necessary to depulp the tooth (remove the “nerve”).