Dental filling - stages, technologies and materials

The more a person is afraid of dentists, the more closely he eventually has to interact with them and the longer the dental treatment will be for him - a simple and banal truth, but, unfortunately, not all people take note of it. If caries treatment is not carried out in a timely manner, the infection gradually spreads “inward”, capturing more and more new territories and reaching the pulp chamber. Pulpitis develops - an extremely painful and unpleasant disease, which is popularly called “inflammation of the dental nerve.” This is where most people don’t just go to the dentist, but run – because the pain prevents them from sleeping, eating, or working normally. And if the patient has already begun to have inflammation of the tooth canals, treatment will require quite serious and lengthy treatment: cleaning the tooth canals from infected and dead tissue, their special antibacterial treatment, careful filling of both the canals themselves and the dental crown with the cavity.

Almost everyone knows about such a dental procedure as treatment and filling of dental canals, and many people have encountered it from personal experience. But most people usually don’t know the intricacies of the process, how exactly such treatment takes place, why it is needed and what it gives in the end. So what are the standards for filling canals, why and how exactly is this procedure carried out, and what can a poorly filled canal threaten a patient with? Dentist-therapist at the 32 Dent clinic Larisa Aleksandrovna Kravtsova will help you get reliable answers to all these questions.

Is caries treatment painful?

Many people are convinced that caries is painful to treat, and therefore are afraid to go to the dentist. The problem goes back to the recent past, when anesthetics were not used in dentistry. Just a few decades ago, no one could even imagine that it was possible to treat teeth with anesthesia, and all manipulations were performed “live.”

In this article

• Is caries treatment painful?
• Is it painful to treat dental caries with anesthesia?
• Is anesthesia always necessary?
• How to treat caries with an injection step by step?
• Is it painful to treat caries on the front teeth?
• What anesthesia is used in the treatment of caries?
• Who is contraindicated for anesthesia?
• Conclusion

Of course, with this approach it was very painful to treat deep caries and other stages of this disease that affected the sensitive parts of the tooth. Fortunately, dental treatment methods have changed, modern safe anesthetics have appeared, and it has become easier to treat with an injection.

Is it painful to treat dental caries with anesthesia?

If you treat caries with an injection, anesthesia will be given at one of the first stages of treatment. Once the tooth is frozen, it will no longer hurt. Thanks to anesthesia, tooth sensitivity will noticeably decrease, and even with deep and complex caries there will be no pain. You will feel the touch of dental instruments, perhaps minimal discomfort, but not pain. When the treatment is completed and the anesthesia wears off, your gums will hurt a little for a while after the injection. But this feeling is tolerable and will soon pass.

There are people with intolerance or allergic reactions to anesthesia for whom injection pain relief is not suitable. This does not mean that they will have to endure pain when treating dental caries. For such patients, modern dentistry can offer an alternative painless treatment method - for example, using chemical dissolution of the affected tissue or using a laser.

Is anesthesia always necessary?

When treating caries, there is not always a need for an anesthetic injection. It depends on how badly the tooth is damaged and the individual sensitivity of the patient.

Superficial caries.

For example, early caries on the surface of the teeth resembles a whitehead and can be treated in a non-invasive, painless way. To do this, a procedure is carried out to remineralize the enamel. It is coated with special protective compounds and electrophoresis is performed with fluorine or calcium ions. This method of treating teeth does not hurt at all, so the doctor does not even offer pain relief with an injection.

Average caries.

At this stage, the carious process reaches the upper part of the dentin - the connective tissue under the tooth enamel. At this stage, drilling may be painful, but for many it is tolerable. Therefore, treatment of average caries can be carried out both with and without an anesthetic injection - it depends on the individual threshold of sensitivity and the wishes of the patient.

Deep caries.

This is the most complex form of pathology. If the caries is deep, then the dentinal tubules with nerve endings are involved in the process, and any touch causes pain. It is very painful to treat teeth without anesthesia at this stage, so in most cases the area around the affected tooth is numbed with an injection.

In addition to the degree of tooth decay, the intensity of pain can be influenced by the location of the caries. The lateral one is located on the side of the tooth, away from the neck and, as a rule, does not cause severe pain. The contact tooth is located at the junction of two teeth, and the severity of pain is comparable to average caries. To endure or to give an anesthetic injection depends on the patient’s choice. Cervical caries is located in the most sensitive root zone of the cervix, where many nerve endings are located. Almost always, cervical caries is treated with an anesthetic injection.

What to do if your tooth hurts after filling?

If a tooth begins to hurt due to a filling being placed, but its condition does not require additional dental procedures to relieve severe pain, the doctor may prescribe:

• painkillers ; most often these are drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs); Ketoprofen (Ketonal) has the best analgesic properties; in case of severe pain, it is enough to take a long-acting capsule of 150 mg - these will relieve pain for a day; instead of Ketonal, you can use the rectal suppository Diclofenac - 100 mg; both drugs are contraindicated in the presence of a gastrointestinal ulcer; in such cases, it is better to take a nimesulide tablet (Nise) - it has almost no negative effect on the gastrointestinal tract;
• physiotherapeutic procedures - to reduce pain, electrophoresis with novocaine is prescribed; for swelling, it is better to use hydrocortisone instead of novocaine; Magnetic and laser therapy are also used; the number of procedures depends on the patient’s condition;
• a one-time injection of an antibiotic solution into the periodontal tissues - for problematic traumatic treatment to prevent infectious inflammation and pain.

There are many folk recipes for relieving severe post-filling toothache:

• rinsing the mouth with a decoction of oak bark; Pour 2 tablespoons of crushed bark into a glass of water, bring to a boil, boil for 15 minutes, add boiled water to the original volume, strain and rinse your mouth several times a day; when a tooth hurts, it relieves inflammation, swelling and associated pain well;
• applying a small piece of salted (but not smoked) lard to the gum - this application is especially helpful for pain associated with tissue swelling: salt draws fluid from the tissue, swelling and pain go away;
• a reflex method of pain relief (used in folk medicine for a very long time): grate a clove of garlic on a fine grater, place it in a thin napkin, apply it to the inside of the wrist of the hand opposite the painful tooth, fix it and leave it overnight.

How to treat caries with an injection step by step?

At other stages of caries, teeth are treated approximately according to the same scheme, which includes several stages:

• Cleaning teeth.

The doctor removes tartar and plaque from the surface of the tooth being treated.

• Selecting the shade of the filling.

The dentist selects the material for filling, focusing on the natural color of the enamel of the damaged tooth. To do this, he uses the so-called Vita scale - a plastic strip with samples of different shades.

• Anesthesia.

Anesthesia injections help make the procedure painless and reduce discomfort during the treatment of caries. The type of drug and dose are selected taking into account the age and individual characteristics of the patient. The anesthesia usually lasts from 40 minutes to several hours. Sometimes the gums hurt a little after the injection, but this does not compare with the pain when treating deep caries without anesthesia.

• Isolation of the tooth before treatment.

It is performed by placing a small plate - a rubber dam - on a row of teeth. As a result, one or more necessary teeth are completely isolated from the others. This allows the dentist to do a better job and prevent blood and saliva from getting on the cleaned surface, which guarantees its reliable connection to the filling in the future.

• Preparation of a carious cavity.

Cleansing the tooth of all tissues that have been damaged by caries and parts of the tooth enamel above the carious cavity. If you leave the caries at least partially and install a filling, after a couple of months the problem may recur. And in the future complications may develop - pulpitis and periodontitis.

• Formation of a carious cavity.

The doctor creates the best conditions for installing the filling by forming special support points. It makes indentations, notches, irregularities in the cavity, and smoothes the edges of the enamel. This is required for the filling to fit tightly to the walls of the tooth.

• Washing the cavity.

After the above procedures, the carious cavity is washed and sprayed with a stream of air to remove dentin sawdust.

• Medical treatment of carious cavity.

It is produced using antiseptic solutions to prevent the new development of caries. Then the doctor dries the cavity well so that drops of moisture do not interfere with the close contact of the filling with the tooth tissues.

• Acid etching.

It is performed so that the adhesive, which is applied after etching for a stronger fixation of the filling material, can penetrate deeper into the dental tissue. To do this, use a special gel with phosphoric acid. After etching, the gel is washed off well and the tooth is dried.

• Application of adhesive.

It is applied to the tooth to firmly fix the light-curing filling material; after absorption, it is illuminated using a special lamp.

• Application of a therapeutic and insulating pad.

This step can be performed either before or after acid etching. Spacers are an intermediate layer between the dentin or pulp and the filling material. Therapeutic pads protect the tooth from external adverse influences and help stop inflammation; they are most often used to treat deep caries. Isolating gaskets protect the pulp, the soft connective tissue of the tooth, from the negative effects of filling materials.

• Placing a filling.

The doctor takes turns, layer by layer, applying filling materials and drying each of them with a dental lamp.

• Grinding, polishing.

The restored tooth with filling is ground and polished to perfect smoothness and evenness. This gives it a natural shine and eliminates the smallest imperfections and gaps that cause inconvenience. At this stage, caries treatment ends. Thus, anesthesia with an injection is given at the very beginning of dental treatment, and all other stages are absolutely painless for the patient.

When you need to urgently go to the clinic

Occasionally, a filling can create serious problems that require immediate attention to your dentist:

• gum pain after tooth filling; if the pain does not increase, then this is a variant of the norm; but often the pain syndrome is accompanied by redness and swelling of the mucous membrane, the appearance of pus when pressing on the gums, which indicates the presence of an inflammatory process; it could be a burn to the gum tissue, an allergy to the filling material, or an infection; in any case, you need to contact a specialist;
• a toothache and a sharp rise in body temperature to high numbers or a slight increase lasts more than three days, a severe headache appears;
• the cheek on the side of the filling became swollen and pain of any nature, increasing in intensity, appeared in the tooth or periodontal tissues.

Don't put off visiting the dentist if your cheek is swollen or you have a fever!

Is it painful to treat caries on the front teeth?

Due to their location and structural features, caries on the front teeth is more difficult to treat. If the damage is severe, it is not always possible to put a filling, and then you will have to resort to prosthetics.

There are other features:

• The front teeth, compared to molars and premolars, have thinner and more sensitive enamel. It is easily destroyed, opening access to sensitive dentin, so the central incisors are more sensitive to pain.
• The front teeth, which are used for gripping and cutting food, are subject to high stress and wear out more quickly.
• A large cavity is often hidden under a small chalk point. And often caries is detected already at the stage when it is difficult to cure without pain. Therefore, in most cases, anesthesia is used in the treatment of caries of central incisors.
• Increased aesthetic demands are placed on the front teeth, so the filling must be placed not only reliably, but also beautifully.

That is why the condition of the front incisors - teeth with a small chewing surface area - must be monitored especially carefully.

If caries affects the front teeth, due to the thin enamel and dentin, it very quickly passes into the middle and deep stage, affecting the sensitive pulp. If you do not know whether it is painful to treat deep caries of the front teeth and doubt whether you need anesthesia, we recommend that you definitely agree to an anesthetic injection. Of course, in the absence of contraindications to the anesthetic. Because treating caries on the front teeth is painful.

Aesthetic correction

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Does it hurt to put a filling on a tooth? Many do not believe that this can be endured easily and calmly. They are even more surprised when they find out that sometimes they fill a tooth without caries or pulpitis. This is necessary when you need to make an aesthetic correction. We are talking mainly about the front teeth, the edges of which have been slightly worn out or chipped off. This procedure is also performed if there is a spot of fluorosis. In order not to sacrifice a healthy tooth and not install a crown, they choose a simpler option - restoration with a filling.

What anesthesia is used in the treatment of caries?

To remove tooth sensitivity and treat it painlessly, the dentist selects the appropriate type of anesthesia for each patient.

The most common are three types - application, infiltration and conduction:

• Application involves pain relief without injections. A gel or solution of an anesthetic is applied to the oral mucosa, which reduces the sensitivity of the tissues in this area. Most often, topical anesthesia is performed when treating or removing baby teeth. It is also used to numb the injection site.
• Infiltration is anesthesia with an injection of an anesthetic, which is injected relatively shallowly and affects the peripheral nerves. This type of anesthesia is often performed in the treatment of caries and pulpitis. After the injection, the patient does not feel pain and feels comfortable in the dental chair.

• Conduction anesthesia acts on large nerve canals and trunks. With its help, you can remove the sensitivity of half the jaw. It can be used for caries, which is complicated by a serious inflammatory process, during surgery.

The type of anesthesia, as well as the drug used to numb the teeth, is selected by the dentist.

Who is contraindicated for anesthesia?

There are three main contraindications to the use of local anesthetics during dental treatment in the clinic:

• Pathologies of the cardiovascular system (stroke and heart attack, after which less than six months have passed).
• Endocrine diseases in the stage of decompensation - thyrotoxicosis, diabetes mellitus. It is recommended that patients of the first and second groups treat caries and other dental diseases only in a hospital.
• Allergic reactions to anesthesia and anesthetic components. In this case, it is recommended to conduct allergy tests and find out which drugs you are allergic to. If it is selective, caries can be treated with an anesthetic injection - but only one to which you are not allergic. If the tests show a reaction to all anesthetics, you will have to treat your teeth without pain relief or look for alternative options. Sometimes the solution for allergy sufferers may be sedation, which puts a person into a state of half-asleep and partially disables reactions. In this state, the pain is felt much less.

About temporary filling

There are quite a few cases where, after this filling has been placed, the patient continues to complain of prolonged pain in the tooth area. This phenomenon is most often considered normal, but only if the installed filling was actually temporary and not permanent. Many patients who have delayed dental treatment for too long may encounter this problem, since in advanced cases, the medication installed under the filling cannot immediately cope with the pain. In this case, a second visit to the dentist is recommended.

Installing a medication under a temporary filling is simply necessary for certain serious diseases of the oral cavity, for example, pulpitis, periodontitis or widespread advanced caries.

Sometimes a person experiences discomfort after having a temporary filling installed.

Most often, the presence of mild persistent pain after the placement of a drug under a temporary filling is absolutely normal, as the tooth is subjected to drug therapy. At this time after the procedure, the nerve roots inside the tooth pulp still tend to react to external stimuli, which is why in the first time after the procedure the medicine and the filling mass tend to cause mild pain.

Pain that occurs during the first time after the procedure is normal, but there are cases when the pain continues to persist after the end of dental therapy. In this case, the patient needs to contact a specialist again, because the presence of such a symptom may indicate any errors made during treatment. If you do not consult a doctor for re-treatment, then the patient runs the risk of serious complications.

Important ! The main causes of pain after the filling has been installed are insufficiently tight installation of the filling material, incorrect or insufficient disinfection during the procedure, incorrect treatment or the occurrence of re-infection after the procedure. If such a problem exists, the patient should immediately consult a doctor, and in no case self-medicate.

Pain may indicate improper treatment