Pain in children’s milk teeth caused by extensive decay: we examine the best ways to treat the dental pulp

Tooth decay is one of the most common diseases in children. Tooth decay in the primary or milk teeth tends to progress rapidly, and it often reaches the pulp. Dental pulp consists of nerves, tiny blood vessels and connective tissue that make up the centre of a tooth. Symptoms of this extensive tooth decay include pain, swelling and abnormal tooth movement.

Dentists often have to perform one of three pulp treatment techniques to resolve the problem:

  1. Direct pulp capping: where a healing agent is placed directly over the exposed pulp. The most common materials used for direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive resin, placed directly over the tooth’s nerve.
  2. Pulpotomy: removal of a portion of the pulp. After a pulpotomy, one of four materials is generally used to fill the cavity: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate.
  3. Pulpectomy: removal of all of the pulp in the pulp chamber and root canal of a tooth. After a pulpectomy, a material is put into the space created by pulp removal.

This review looks at the three techniques, and the effectiveness of different materials (known as medicaments) for pulp capping, pulpotomy and pulpectomy. Continue reading

Teeth restored using atraumatic restorative treatment may be more likely to fail, but evidence is low quality

Dental caries (tooth decay) has been considered the most common global disease. Conventional methods (drill and fill) involve the use of electric drills to clear away decayed areas of tooth before filling. Local anaesthetic (painkiller) is normally injected to prevent pain during the procedure. Conventional treatments require highly trained dental health personnel, access to electricity, appropriate tools and are more expensive. These factors may limit access especially in underdeveloped regions of service provision. Atraumatic Restorative Treatment (ART) is an alternative approach for managing dental decay, which involves removal of decayed tissue using hand instruments alone, usually without the use of anaesthesia (injected painkiller) and electrical equipment. Continue reading

Metal-free materials for making crowns and bridges

Teeth in the foreground

Fixed prosthodontic treatment is a routine dental procedure in which one or more missing or severely damaged teeth are replaced by artificial substitutes. The material used to make the prosthesis may be made of a metal framework with a veneering of an aesthetic material (ceramic) or entirely in metal or it can be made with different non-metal structures (metal-free materials). There is still uncertainty regarding metal-free long-term performance compared to metal-based crowns and bridges. Continue reading

Lining the cavity to protect the tooth pulp: what’s the evidence?

Tooth decay is the most common disease affecting children and adults worldwide. If left untreated, acid produced by bacteria in the dental plaque or biofilm forms cavities or holes in the teeth. A number of techniques and a variety of materials can be used to restore or fill teeth affected by decay. One of these materials is tooth-colored, resin-based composite or RBC. This material is increasingly used as an alternative to amalgam (a mixture of mercury and metal alloy particles).

Since the 19th century liners have often been placed in cavities in the teeth under the filling material. The liners are thought to protect the living pulp of the tooth from filling materials themselves and also from their potential to allow more heat or cold through than the natural tooth would. Although RBC filling materials are thought to be similar to the natural material of teeth in terms of how they conduct heat, sensitivity to temperature change is sometimes still an issue for people after treatment.
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Evidence is lacking on adhesive bonding for amalgam fillings


c. Spectrum Family Dentistry, under CC Licence

Tooth decay is a common problem affecting both children and adults. Cavities form in the teeth by the action of acid produced by bacteria present in dental plaque or biofilm. A number of techniques and a variety of materials can be used to restore or fill teeth affected by decay. One of the most commonly used and comparatively cheap filling materials is dental amalgam (a mixture of mercury and metal alloy particles). The review authors sought to evaluate the added benefit of using an adhesive to bond amalgam to tooth structure to see if bonded fillings would last longer and perform better. Continue reading

Preformed crowns for managing decayed primary molar teeth

Close-up of fused ceramic corona, three elementsTo stop further damage and restore function of primary molar teeth that are decayed or malformed, a dentist will usually use a filling (a soft material that is placed in the cavity and hardened) to restore the tooth to its original shape. Alternatively the dentist may place a crown over the tooth to cover it. This usually requires an injection in the gum to numb the tooth before trimming it down (conventional technique). These crowns are pre-made (i.e. preformed) in a variety of sizes and can be metal or white, with the correct size being chosen to fit the trimmed down tooth. The Hall Technique is an alternative method for fitting metal crowns, where there is no need for an injection or tooth trimming as the crown is simply pushed over the tooth. Preformed crowns are recommended by specialists in children’s dentistry for the management of baby back teeth (molars) when they are affected by moderate to advanced tooth decay, or where the enamel has malformed during development or the tooth has had to have root canal treatment. Continue reading

Micro-invasive treatments for managing dental decay on adjacent tooth surfaces in children’s and adults’ teeth


Photo copyright Conor Lawless, via Creative Commons Licence

Decay on tooth surfaces that are next to each other (proximal surfaces) is common. Usually it has not progressed into late stages of decay and the tooth surface does not yet have a cavity. Different methods are used to manage proximal dental decay. A common method is drilling the affected tooth tissue and inserting a plastic or metal filling. However, a lot of sound tissue can be removed in the process and this method is regarded as invasive). Another non-invasive methods in use include dental practitioners applying fluoride varnish or advising people to floss regularly. These non-invasive methods do not require removing any tooth tissue. More recent approaches (micro-invasive treatments) involve preparing (conditioning) the tooth surface with an acid and then either placing a sealing (cover) on top of the surface or ‘infiltrating’ the softer demineralised tissue with resins. These newer methods work by installing a barrier either on the tooth surface or within the demineralised tissue to protect it against acids and avoid the further loss of minerals from within the tooth. This, in theory, should stop the decay. This approach can be performed by a dentist or other dental practitioner and involves the loss of a few micrometers of tooth tissue because of the need to condition the tooth surface with acid. There is still uncertainty as to how effective micro-invasive treatments are for managing proximal decay. It is also unclear which if any of these techniques are better than others. For example, a stronger acid is needed to infiltrated porous tissue with resin than when the tooth surface is simply sealed or covered. While infiltration might be a more effective method of protecting the tissue than sealing it, the use of a stronger acid also means losing more tissue. The aim of this review was to investigate the best approach for managing such decay in adults and children. Continue reading

Should you use a crown or a filling to restore a root-filled tooth?

0244 Rosario Van Tulpe

Photo by Rosario Van Tulpe, reproduced under Creative Commons licence

Root filling is a fairly routine dental procedure in which the injured or dead nerve of a tooth is removed and replaced by a root canal filling. However, the restoration of root-filled teeth can be quite challenging as these teeth tend to be weaker than healthy ones. A dentist may use crowns (restorations made outside of the mouth and then cemented into place) or conventional fillings (direct filling with materials such as amalgam or composite/plastic resin). Although crowns may help to protect root-filled teeth by covering them, conventional fillings demand less in terms of time, costs and removal of tooth structure. Continue reading

Treating tooth decay in baby teeth

pulp treatmentTooth decay in the milk (baby teeth) of children tends to progress rapidly, often reaching the dental nerve (or pulp, the nerves in the centre of the tooth). Dentists normally have to do one of three things:

1. pulp capping – placing a medicament over the exposed tooth pulp
2. pulpotomy – removal of some of the tooth pulp
3. pulpectomy – removal of all of the tooth pulp.

With direct pulp capping and pulpotomy, some of the nerve in the tooth is left and therefore the filling material has to be put into contact with the living pulp tissue. The most common materials used in direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive which allows a filling material to adhere to the tooth. After a pulpectomy, no nerve is left inside the treated tooth, but a filling material is put into the space created by the removal of the pulp and this must not stop the development of the permanent, adult tooth. After a pulpotomy, one of four materials is used to fill the space: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate. This research investigates the success of these dental nerve treatments in milk teeth. Continue reading

Amalgam fillings versus resin composites


Photo copyright Jeffrey Dorfman, released under the Creative Commons Attribution-Share Alike 3.0 Unported license.

There is some controversy over the best materials to use when restoring or filling holes caused by tooth decay in permanent teeth at the back of the mouth. Amalgam fillings are cost effective and have been used for over 150 years. However, their use has declined over recent years, partly because of the way they look and because of the perceived risk from the mercury they contain. Tooth-coloured (composite resin) fillings are frequently used in the front teeth and in the teeth at the back of the mouth. But which is better overall? This Cochrane review compares the two restorative materials in adults and children with permanent teeth. Continue reading