Cabinet Dentaire du Bourg
Cabinet Dentaire du Bourg · Savigny-le-Temple

Treating tooth decay

How tooth decay forms, the warning signs and the possible treatments. Restorative dentistry at Cabinet Dentaire du Bourg, Savigny-le-Temple.

Tooth decay is caused by bacteria in dental plaque, which turn sugars into acids. These acids attack the enamel, then the dentine.

DecayEnamelDentinePulpGumBone
Spot
1/3Decay attacks the enamel: no painTop view: a small spot in a groove, often hard to see
Decay
Cavity
2/3It reaches the dentine: sensitivity to cold and sweetThe enamel gives way: a cavity opens at the bottom of the groove
Decay
Pulp
3/3It reaches the nerve: pain, root canal treatment neededThe cavity is large and exposes the pulp

What causes it

Poor brushing, snacking and sugary or acidic drinks throughout the day, smoking, a dry mouth.

Where it starts

In the grooves of the teeth, between the teeth and near the gum. In children, fissure sealants protect the molars.

Deep grooveGumToothPulpBone
Deep groove
1/3In section: the groove is narrow and deep, the brush cannot reach itOn a permanent molar, deep grooves trap plaque: this is where decay often starts
Flowable resin
Flowable resin
2/3The flowable resin runs to the bottom of the groove, without drillingA flowable resin is applied in the grooves, with no drilling and no anaesthetic
Sealed groove
Sealed groove
3/3The groove is sealed: plaque can no longer settle in itThe grooves are protected. Sealants are mainly recommended when the risk of decay is high; they are checked at every visit

The signs

Early decay does not hurt. Sensitivity to cold or sweet things is a reason to see us. Don’t wait for pain: the earlier it is treated, the simpler the treatment.

Treatment

The decayed part is removed, under local anaesthetic if needed, then the tooth is rebuilt with a tooth-coloured composite filling. If the tooth is badly damaged, a ceramic inlay or onlay strengthens it. If the infection has reached the nerve, root canal treatment is needed (see root canal treatment).

Keeping the tooth alive

When decay is deep but the pulp is still healthy, we try to avoid root canal treatment. After removing the decay, we place Biodentine, a bioactive calcium silicate cement, at the bottom of the cavity. It helps a bridge of dentine to form that protects the pulp: the tooth stays alive. This is only possible if the pulp is not too badly affected; the decision is made after examination and sensitivity tests.

Deep decayHealthy pulpGumToothBone
1/4The decay is deep, but the pulp is still healthy
Decay removedHealthy pulp
2/4The decay is removed without touching the pulp
Biodentine
3/4Biodentine, a bioactive cement, is placed at the bottom of the cavity
RestorationBiodentineDentine bridge
4/4The tooth is restored. The pulp stays alive and protects itself with a dentine bridge

Sources: HAS, caries risk and fissure sealants · HAS (French National Authority for Health), strategies to prevent tooth decay · European Society of Endodontology (ESE), deep caries and the exposed pulp, 2019

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