The treatment modalities in dentistry could confuse many, as it involves a lot of strange instruments and materials. It sometimes even confuses us, dentists, i.e. the wide array of instruments and materials. But each of these has a specialized function or an indication of its own. Likewise, the treatment modalities that we choose for the patient are various and dependent upon the extent of decay and also the patients wish. In this post today, I would like to elucidate you upon the various modalities of treatment that you may face. A simple explanation of each and the decision making you and the dentist have to go through.

 

• Caries not involving the Pulp – Simple decay involving the Enamel and Dentin but not the Pulp of a tooth. This will be seen as a discolored tooth and in some cases be sensitive when food gets lodged into the decayed portions and generally will not have pain.

  Treatment  – Please go to the dentist ASAP, since if this gets deeper it might involve the pulp, which might bring you or your child a lot of discomfort, pain or even swellings. The dentist will fill you or your child’s teeth with filling materials necessary after excavating the entire decayed portion and thus stop the carious process. So, hurry up if you or your child has decay or any discolored teeth. It might save you a lot of time and money if you move early.

 

• Caries involving the Pulp– This condition comes after the decay reaches the pulp of the teeth and might bring along mild to severe pain due to the irritation of the pulp or even the death of the pulp followed by accumulation of pus adjacent to the root of the teeth (i.e. forming an abscess) which might appear as a swelling of the gums adjacent to the teeth.The pain can range from continuous dull pain on taking hot/cold food, night pain to severe pain which will preclude you from even closing your mouth.

  Treatment – This calls for more than just a simple filling. If pus is present we have to find a way to drain it. In case of a primary teeth of a child who is very young and the successor teeth below this tooth has some time left to erupt, the tooth has to be saved by undergoing a procedure called Pulpectomy and likewise in a permanent teeth we have to go for a Root Canal Treatment (RCT). Both procedures are almost similar. These procedures will result in multiple appointments and multiple times the cost than a simple filling of the same tooth. Sometimes, antibiotics have to be prescribed to the patient. In case the permanent tooth below this tooth is almost erupting, the teeth might be extracted as per the judgment of the clinician and the parent’s wish in cases of children.Extraction can be the option in both the children and adults but you will then face a difficulty of having to replace the teeth or leave the space as it is compromising the chewing function and esthetic requirement of your mouth. And believe me when I say that replacing the teeth is not as easy or cheap as many people might think. It’s always best to try and save your teeth for the long run.

 

• Caries involving the pulp and resulting in a big swelling of the face – This big swelling of the face due to caries of teeth is called Space Infections and results due to pus accumulations into many fascial spaces of the face and neck. This might be because of increased virulence of the bacteria involved, decreased immunity of the patient himself or some anatomical predispositions of the individual. This is a severe condition, which if left untreated might lead to serious complications.

  Treatment – Drainage has to be established for the pus to come out and pressure relieved by starting the Pulpectomy/RCT/ Extracting the tooth. Sometimes in case of very big swellings Extraoral drainage may have to be attempted, which may be a very painful procedure if not under general anesthesia and might leave a scar on the face. Antibiotics have to be prescribed to control the infection. The tooth is either saved as mentioned above by doing Pulpectomy or RCT or it might be extracted as per the judgment of the clinician or the patient’s wish.

 

All this talk points out to a simple answer, “going to the dentist early, i.e. regular checkups will actually save you a lot of time, money and discomfort whereas the later it gets, the more time, money and distress you are going to face.”

 

(This is a simple explanation on the common treatments modalities for caries as per the extent of decay. There might be various other uncommon ramifications for the treatment not mentioned above. If you have any queries regarding your oral health please post a comment. I would be glad to answer anything that my knowledge and experience will allow me to.)