Dental treatment - anesthesia, methods, complications

Modern dental treatment

Dental treatment of teeth is a set of measures aimed at eliminating the inflammatory process and restoring chewing functions. The most common disease is, of course, caries and its complications. The timing of dental treatment directly depends on the stage of development of the disease. Thus, installing a dental crown or implanting several teeth will take different times, depending on the number of specialist appointments. It is worth noting that regular preventive examinations allow you to notice pathologies at an early stage, allowing for dental treatment without extraction and significantly simplifying it.

If a patient comes to the clinic with acute pain, the task becomes much more complicated. Therefore, every dentist will tell you that the best dental treatment is prevention.

Photos before and after dental treatment

Photos Before and After treatment of chewing teeth.

Photos Before and After treatment of front teeth.

How to treat caries: stages

To get rid of caries, you need to make an effort, because although modern drills do not vibrate like hammer drills, they still make us wait for the sudden appearance of acute pain - while drilling out carious tissues. Fortunately, modern anesthetics allow the dentist to properly numb the teeth during treatment - unlike the ineffective novocaine and lidocaine that were widely used previously.

Proper treatment of dental caries in dentistry consists of a number of successive stages, each of which has a clear goal. But nevertheless, the most important thing is the complete removal of caries, because... if the removal of tissue affected by caries is incomplete, it will immediately develop under the filling and will certainly lead to the development of pulpitis and the need to remove the nerve from the tooth. Watch the video below to see how hard tooth tissues affected by caries are removed.

Treatment of dental caries: video 1-2

In detail about the stages of treatment of average caries -

But before we move on to drilling out the carious tissue, which you could see in the video above, you still need to perform a number of procedures to prepare the tooth for treatment, as well as anesthetize it with an injection of a local anesthetic. For those who like stronger anesthesia, there are methods of sedation and general anesthesia.

1. Cleaning a tooth from plaque (Fig.4) –

   
   Before starting treatment, it is necessary to hygienically clean the tooth, as well as neighboring teeth, from plaque and tartar. For this purpose, ultrasonic attachments are used to remove massive dental plaque, as well as special brushes and abrasive pastes to remove soft microbial and pigmented plaque.

2. Determination of tooth color using a special scale (Fig.5) –

   
   Hygienic treatment of the tooth also helps the doctor to accurately select the color of the filling material. In this case, the filling will match the color of the tooth, and will not stand out against the background of the tooth’s own tissues. This is especially important for teeth that are visible when you smile.

3. Anesthesia (Fig. 6) – is it painful to treat caries: for painless drilling of carious tissues if the tooth is alive, local anesthesia is necessary. Modern painkillers in dentistry, for example, ultracaine or ubistezin, make the intervention absolutely painless. Depending on the amount of anesthetic administered and the method of anesthesia, the anesthesia time can last from 40 minutes to several hours.

   
   The only pain that the patient can feel is the moment the needle is inserted into the gum, as well as the process of removing the anesthetic into the tissue. This process can sometimes be painful, which largely depends on the patient’s level of pain sensitivity, as well as on the speed at which the anesthetic is injected into the soft gum tissue. The faster the solution is administered, the more painful the injection.

4. Drilling out carious tissues – As can be seen in Fig. 7, enamel is always destroyed with average caries to a lesser extent than the underlying tissue (dentin). This is due to the fact that enamel is much, much stronger and harder than dentin. Therefore, the carious cavity usually expands in depth, and the entrance hole in the enamel can even be quite small.

   The dentist must drill out the edges of the enamel overhanging the carious cavity, and also remove all carious dentin. If you leave even a small amount of dentin affected by caries and put a filling on top of it, then very soon you can expect complications - the rapid development of caries under the filling and destruction of the tooth crown, with the subsequent development of pulpitis and periodontitis (24stoma.ru).

   In Fig. 8, the dotted line shows the approximate boundaries of tooth tissue removal. In this way, the cavity is given a relatively correct shape and the next stages of treatment can begin. It should be noted here that recently new methods of tooth preparation have appeared, which help to do without traditional drilling. Recently, it has become possible to remove caries with a laser.

5. Isolation of tooth from saliva – this is a very important stage! After the carious tissue is drilled out, and before filling the tooth, the doctor must carefully isolate the tooth from saliva and even the patient’s wet breath. These factors will greatly affect how long the filling will last. Previously, cotton balls and gauze balls were used for insulation, which were used to cover the tooth on all sides. It should be noted that this is a very unreliable and ineffective protection.
   For the last 10 years, “cofferdam” has been used for these purposes. The latter is a thin latex “scarf” in which holes are made for the teeth. This scarf is pulled over the teeth (Fig. 9-10), after which 1-2 special metal clasps are installed on the necks of the teeth, which hold the rubber dam against the gums. The edges of such a latex scarf are attached to a special frame (Fig. 11), and we see the result - a group of teeth is completely isolated from the oral cavity.

   Installing a rubber dam is quite labor-intensive. Some doctors refuse to use it on principle to save their time. The doctor’s use of a rubber dam in the treatment of caries indicates that the doctor is very attentive to the quality of his work, because the quality of the filling will be affected not only by the accidental contact of saliva on the tooth being filled, but also simply by the moist breath of the patient himself.

6. Medical treatment of a carious cavity - a cavity formed in the tooth during the removal of carious tissues - is treated with antiseptics.
7. Restoring the contact point between teeth – If caries is treated on the contact (interdental) surface of the tooth, then it is also necessary to restore the side wall of the tooth.
   This is a rather labor-intensive and complex task than simply treating average caries, for example, on the chewing surface of a tooth. In this case, another stage is added - the installation of special devices to restore the side wall of the tooth. Such devices include wedges (a) and matrix (b) in Fig. 12. Read more about the treatment of interdental caries in the article: → “Treatment of caries between teeth”
8. Etching the enamel with acid (Fig. 13) is necessary so that the adhesive (something like glue), which will be applied to the surface of dentin and enamel at the next stage, can penetrate deeply into the tooth tissue. For this purpose, a gel based on phosphoric acid is used. After etching, all the gel should be thoroughly washed off, and the tooth surface should be slightly dried.
9. Treatment of dentin and enamel with adhesive - for better fixation of a permanent photopolymer filling, enamel and dentin are treated with a special adhesive, which (after absorption) is illuminated with a photopolymerization lamp.
10. Applying a gasket under the filling (Fig. 14 b,c) - an insulating gasket, usually made of glass ionomer cement, is applied to the bottom of the cavity. The need for lining material under the filling is explained by the complex mechanisms of polymerization shrinkage of the filling material and other factors (we will not dwell on them).
11. Filling – dental filling is necessary to restore the shape of the tooth, its aesthetics, as well as to restore chewing efficiency. For this purpose, photopolymer composite materials are usually used. They are applied in layers and each layer is illuminated with a special lamp, which allows the material to harden.
12. Grinding and polishing of the tooth - after the shape of the tooth has been restored using filling material, it is necessary to grind and polish the filling, because it is rough and uneven. Final polishing gives the filling a shine and aesthetics comparable to that of tooth enamel. This completes the treatment of average caries.

→ Cost of treatment of dental caries

Filling a carious defect: video 3-4

Please note that dentists use special metal strips (matrices) and wedges to restore the side walls of teeth. In addition, tooth filling in both cases is carried out using a rubber dam.

Endodontic dental treatment

What is endodontic dental treatment? This is a procedure aimed at treating root canals, usually using a microscope. If you ignore the symptoms of caries for a long time, pulpitis, periodontitis and other complications develop. Endodontic treatment of teeth under a microscope will help eliminate acute pain and relieve inflammation. The help of an endodontist is indispensable when there is a suspicion of a dental cyst or granuloma. Often, after canal treatment, complications arise due to poor quality treatment or stuck pieces of broken instruments. In such difficult cases, they also resort to endodontic treatment of the tooth canal under a microscope.

Treatment methods

The treatment regimen and the scope of medical manipulations are selected according to the patient’s somatic status. The inflammatory process is eliminated, professional oral hygiene is performed, and antimicrobial therapy is prescribed. Treatment of mobility is aimed at eliminating the underlying cause that led to the weakening of the ligamentous apparatus. If it is periodontal disease, then infection and inflammation are treated; in case of malocclusion, orthodontic treatment is carried out; in case of injury, a temporary splint is applied.

Treatment includes various methods, including grinding crowns, normalizing occlusion, splinting, and prosthetics.

• Thanks to bite correction, the load on the periodontium is normalized, the teeth occupy a more stable position in the sockets.
• Wearing a special mouthguard that prevents clenching or grinding of the teeth will help strengthen loose teeth in the gums during bruxism or clenching.
• In case of physiological changes, hormonal levels and nutrition are corrected, vitamin therapy is carried out, and the immune system is strengthened.
• In case of injury, a special device is installed on the dentition - a splint, which helps to fix loose units and correctly distribute the load between healthy and injured teeth.

In some cases, it is impossible to save a loose tooth. Direct indication for extraction

is mobility of 3-4 degrees with loss of bone tissue by 70%, atrophy of the jaw bone by more than 50% with damage to the dental pulp. In such situations, it is advisable to remove the loose tooth, preserving the bone tissue for subsequent implantation.

Treatment without drilling

Dental treatment without drilling involves the use of minimally invasive procedures. Some of them have been mentioned above. In particular, lasers are actively used to eliminate caries. This type of dental treatment is performed for adults and children. Among the main advantages is a reduced risk of any infection, since contact of equipment with organs and tissues of the oral cavity is eliminated.

Also, dental treatment without a drill can be performed using the chemical-mechanical method. A special preparation is applied to the area of ​​the tooth affected by caries. It contains sodium hypochlorite and amino acids. Next, the specialist treats the affected area using special tools. Since only dead tissue is removed, the filling occupies a much smaller area, and it is also possible to preserve healthy areas as much as possible.

Another interesting technique was developed by German specialists. It is based on the bactericidal properties of ozone and is often used in pediatric dentistry. The gas used to treat teeth completely destroys microorganisms that cause caries.

The latest non-invasive methods

Before dental treatment, a specialist determines the degree of destruction of enamel, hard tooth tissue and dentin. In advanced cases, a granuloma forms around the root, which may subsequently increase in size. Modern methods of dental treatment make it possible to successfully combat the first signs of caries without the use of a drill. Among them:

• laser dental treatment;
• application of chemical-mechanical techniques;
• fluoridation – treatment of teeth with calcium;
• application of the air-kinetic method;
• ozone therapy.

Treatment of a tooth under a crown

After some time has passed after the installation of the prosthesis, subsidence of the gums and exposure of the neck of the tooth are often observed. All this contributes to the development of caries, and therefore pulpitis, periodontitis and other unpleasant diseases can appear even when the tooth is covered with a crown. Only a specialist can identify the problem and treat the tooth under the crown. If a disease is detected, the structure may need to be removed.

It is also the cause of problems - errors in the manufacture of the prosthesis: if the crown does not fit tightly around the neck of the tooth, bacteria can get under it. The specialist immediately removes such structures and carries out dental treatment. The crowns will subsequently be replaced, which will preserve the teeth and prevent the development of more serious diseases.

Anesthesia

Conventional local anesthesia is performed very often today. Patients with increased sensitivity of soft tissues and children can first be given topical anesthesia. Also in dentistry, painkillers are used for dental treatment. The type of drug and its dosage are selected individually - it all depends on both the patient’s health condition and the clinical situation. For example, pediatric dentists often treat teeth with nitrogen. Laughing gas causes a feeling of mild euphoria and is not hazardous to health. The patient relaxes, and the doctor can calmly perform all the necessary manipulations. But general anesthesia in dentistry is used only in the most extreme cases.

Anesthesia after dental treatment can last up to 3 – 4 hours. Everything here is very individual and depends on how much anesthetic was used.

Features of the structure of newly erupted permanent teeth in children.

As we have already said, newly erupted permanent teeth in a child have a number of anatomical features and differ from the teeth of an adult, namely:

1. They have fragile, not fully formed and mineralized enamel.
2. They have unformed roots that connect to the growth zone.
3. The root canals of such teeth are wide, with a funnel-shaped expansion towards the root apex.
4. The thin and fragile walls of the dental canals do not have secondary dentin; they are easily injured and destroyed.
5. There is insufficient mineralization of dentin in the roots of the tooth.

Therefore, when treating pulpitis of permanent teeth in children, there are a number of limitations and features that the pediatric dentist knows and must follow. Endodontic treatment (root canal treatment) of permanent teeth in children is complex and requires great care.

By the way, for this reason, it is better for adolescent patients to contact a pediatric specialist rather than an adult dentist-therapist.

Features of treatment of anterior teeth

Treatment of anterior teeth is associated with some difficulties. A characteristic feature of the incisors is their smaller size compared to other teeth. The work that a dentist has to do is truly jewelry. Only an experienced specialist can achieve a high degree of aesthetics.

In the process of treating and restoring the shape of a diseased tooth, a filling can be performed using light-curing polymer materials or veneers. Their shade is selected taking into account the color of the enamel of the patient’s healthy teeth.

The last resort is the installation of crowns. This method is justified only if the tooth is severely damaged. Treatment of lower teeth in the frontal zone is performed using similar methods and techniques.

Reason to see a doctor: symptoms that cannot be ignored

If a tooth hurts, treatment should never be delayed. Any delay is fraught with serious problems not only for the oral cavity, but also for the whole body. The sooner the source of infection is identified, the easier and faster dental treatment can be performed in the clinic. Symptoms that indicate serious problems:

• acute throbbing pain in the tooth;
• significant increase in sensitivity;
• bad breath during regular hygiene;
• bleeding and swelling of the gums;
• tooth mobility;
• difficulty opening the mouth;
• the appearance of a defect on a tooth, an area with uneven edges and pigmentation.

Degrees of mobility

• I
  – the tooth deviates back and forth from neighboring units
  by no more than 1 mm
  , there are no symptoms from the periodontium or gums;
• II
  – amplitude of swing back and forth and sideways
  by 1 mm or more
  , tartar and plaques are visible on the enamel, redness, swelling, bleeding and soreness of the gums are possible;
• III
  – the teeth swing strongly in any direction with slight pressure with the tongue or chewing, the amplitude of the displacements
  significantly exceeds 1 mm
  ;
• IV
  – the tooth shifts in all planes, rotates around its axis, and
  barely stays
  in the gum tissue.

Pathological mobility of any degree requires complex treatment. If the tooth is located in the gum, the periodontium and socket are intact, the process is reversible. Dental units begin to become very loose when periodontitis or periodontal disease is advanced. With deep periodontal damage, weakening and destruction of the ligamentous apparatus, bone atrophy, tooth extraction may be required, followed by implantation and prosthetics.

Stages of dental treatment

Despite the fact that modern methods involve virtually painless dental treatment, fillings and other procedures, many patients appear in the doctor’s office with acute pain and a whole “bouquet” of oral diseases. Treatment usually includes the following steps:

1. Diagnostics

   A specialist examines the oral cavity, identifies problems and draws up a treatment plan. Additional examinations may be ordered. At the same stage, the doctor conducting the consultation discusses the cost of services with the patient and selects the most convenient time for an appointment.

2. Professional oral hygiene

   It is advisable to begin dental treatment only after their surface is cleaned of hard and soft deposits.

3. Treatment

   The process of treating caries involves removing the affected tissue. The procedure is performed using local anesthesia, and the treated area is isolated from the rest of the mouth. Rubber dam or cotton swabs can be used for these purposes.

4. Seals

   Filling is carried out after cleaning the carious cavity. The final procedure is grinding the filling - this is necessary to eliminate the occurrence of discomfort during the process of chewing food.

Step-by-step treatment of wisdom tooth caries

If the dentist gave a positive answer to the question of whether to treat wisdom teeth, it is necessary to begin treatment as early as possible, before caries reaches a more advanced stage. The treatment procedure for third molars is slightly different from the treatment of other teeth in the upper or lower jaw, since due to the special arrangement of the teeth, the doctor cannot use all available technologies.

Treatment occurs in several stages:

• After anesthesia, the dentist carefully prepares the cavity and, using a drill and hand instruments, removes all tissue affected by caries.
• To prevent infection from entering the body, he treats the oral cavity and the tooth itself with an antiseptic solution.
• The dentist places a healing or insulating pad inside the cleaned cavity.

• A seal made of photocomposite material is installed on top of the gasket. It is applied in layers, and each layer is illuminated with a special lamp until completely cured.
• After filling, the tooth is adjusted to the bite, given the correct anatomical shape, ground and polished.

Why does a tooth hurt after treatment and what to do in this case?

Aching pain after treatment occurs quite often. However, its causes may be different, which means that the doctor’s actions to eliminate it are required different. Let's look at the most popular:

• Very often, after treatment, the tooth reacts to mechanical stress when chewing food. As a rule, minor pain appears after treatment of deep caries. This is due to the fact that the filling puts pressure on the pulp. Over time, the pain will pass.
• It is not uncommon for a tooth to ache after treatment and due to an individual reaction to the doctor’s intervention. The pain may persist for several days.
• Acute pain after dental treatment cannot be ignored. You must immediately contact a specialist. Unpleasant pain may indicate that there is inflammation after dental treatment.
• If you are sensitive to irritants such as hot and cold drinks, sweet or sour foods, then there is a high probability that the overhanging edge of the filling will injure the periodontal tissue in the gum area. This phenomenon leads to tissue inflammation and exposure of the tooth root, which is extremely sensitive to any irritants. Therefore, be sure to contact the dental clinic if your tooth aches after recent manipulations. The treatment was most likely carried out poorly.

How much does dental treatment cost in Moscow?

Taking into account the fact that therapy involves an integrated approach, the total cost of dental services will consist of the costs of individual procedures. Approximate prices for dental treatment in Moscow are presented in the table below.

Which filling is better to choose?

Option #1 - amalgam filling

One of the most reliable fillings is a silver amalgam metal filling. If the work is done correctly and the patient takes proper care of his teeth, it can also last for decades.

The biggest disadvantage of an amalgam filling is its unaesthetic quality, usually the dark or even black color of the metal. Although gold inlays are also noticeable to others, they look more aesthetically pleasing.

Option #2 - how a gold inlay allows you to restore the solidity of a tooth

Gold is a unique metal, absolutely inert and has antiseptic properties. At the same time, it is soft enough that you can roll it, grind it to the tooth tissues, there is no transition at all - a monolithic connection.

Properly made and installed inlays do not need to be replaced, and the teeth require additional treatment.