dental disorders
Caries
Treatment of Caries
Restorative therapy Sometimes a root canal and crown Remineralization of teeth with incipient caries (which is confined to the enamel) is usually attempted with improved home care (brushing and flossing), cleanings, prescriptions for high-fluoride toothpastes, and multiple fluoride applications at the dental office. Other topical products promoted for remineralization contain calcium and phosphates but are less effective in remineralizing caries than fluoride. Silver diammine fluoride (SDF), commercially available in the United States since 2015, can arrest and remineralize carious lesions. However, because SDF permanently stains caries black, it is applied primarily on deciduous teeth. The primary treatment of caries that has entered dentin is removal by drilling, followed by filling of the resultant defect. Fillings for occlusal surfaces of posterior teeth, which bear the brunt of mastication, must be composed of strong materials, including Silver amalgam Composite resins 40 years. Amalgam is a highly durable material with annual failure rates lower than that of composite resins; therefore, amalgam restorations last longer and are more resistant to secondary caries than composite restorations ( Treatment reference ). Amalgam use is decreasing for 2 main reasons: The results are not as aesthetically pleasing as those achieved with either composites or glass ionomers. There are environmental concerns about the removal and disposal of the mercury content of amalgam. Although concern has been raised about "mercury poisoning," the number of amalgam fillings a person has bears no relationship to their blood mercury levels. Replacing amalgam is not recommended because it is expensive, damages tooth structure, actually increases patient exposure to mercury, and requires the use of amalgam separators to prevent disposal of its mercury content into the environment. Because of recent environmental concerns about the disposal of the mercury content of traditional fillings, there is a trend toward using dental materials other than amalgam. Composite resins,which have a more acceptable appearance, have long been used in anterior teeth, where aesthetics are primary and the forces of chewing are minimal. Many patients request them in posterior teeth as well, and they are now commonly used there. Early-generation composite resins under high occlusal stress generally lasted less than half as long as amalgam and tended to develop recurrent decay because the composite resin shrinks when it hardens and expands and contracts with heat and cold more than the tooth or other filling materials. The current generation of composites more closely simulates enamel hardness, does not appear to have the same incidence of recurrent caries as earlier materials, and may also last longer. Use of bonded composite resin restorations allows for more conservation of tooth structure compared to amalgam preparations. Glass ionomer,a tooth-colored filling, releases fluoride when in place, a benefit for patients especially prone to tooth decay. It is also used to restore areas damaged by overzealous brushing. Glass ionomer is not as aesthetic as composite and it should not be used on chewing surfaces because it has a high wear rate. Resin-modified glass ionomer materials are also available and provide some improved aesthetics compared to conventional glass ionomers. If decay leaves too little dentin to retain a full or partial coverage restoration, a dentist replaces the missing dentin with cement, amalgam, composite, or other materials. Sometimes a post must be inserted into one or more roots to support a gold, silver, or composite core, which replaces the coronal dentin. This procedure necessitates a root canal filling, in which an opening is made in the tooth and the pulp is removed. The root canal system is thoroughly debrided, shaped, and then filled with gutta-percha. The outer tooth surfaces (what would have been the enamel) are then reduced so that an artificial crown, usually made of metal, porcelain, or ceramic can be placed. Crowns for anterior teeth are made of, or covered with, porcelain or ceramic. 1.Moraschini V, Fai CK, Alto RM, et al: Amalgam and resin composite longevity of posterior restorations: A systematic review and meta-analysis.J Dent43(9):1043-1050, 2015. doi: 10.1016/j.jdent.2015.06.005 