The treatment of dental cavities goes back centuries. But it was not until 1875 that @G.@V. Black, a dentist at @Northwestern University Dental School, first described an organized approach to their treatment. His methods are still used today. Dr. Black removed the parts of the teeth that were decayed. He then extended the tooth preparation to include not only the cavity, but also certain other grooves and surfaces. This process, "extension for prevention," is considered prudent because it provides the tooth with some protection from further decay in the future.
Most cavities discovered during a dental examination will need to be treated. In general, if a cavity has broken through the enamel and is into the underlying dentin, or if it is able to be penetrated with a dental instrument, requires treatment. Early dental cavities -- ones that have not spread to the dentin -- can simply be re-mineralized with fluoride or filled with amalgam. If the decay has spread further into the tooth structure, it can lead to gum disease. This needs to be treated more aggressively, with scaling and planing, flap surgery, or even a root canal.
The goal of treating cavities involves two basic principals: first, removing the decayed portion of the tooth; second, rebuilding the missing tooth structure with a filling material. The dentist usually begins with an injection of a local anesthetic. The tooth is isolated from the rest of the mouth. Then a high-speed dental drill is used to remove the decay. Next, the dentist will prepare the tooth. A liner is often used to reduce tooth sensitivity. In deeper fillings, a base is used in addition to the liner. The main purpose of the base is to insulate the tooth from temperature changes in the mouth. The dentist and patient can then choose a number of different materials to fill the tooth. The most common are silver (amalgam), white (resin), porcelain, or gold. These materials are layered on top of the liner or base to finish the process of repair.
After a tooth has been filled, it is not unusual for the area to be sensitive for a day or two. In general, the deeper the filling, the more likely the tooth will be sensitive. Most fillings should be completely comfortable within two weeks. In some cases, the filling will be built up too high, causing a rough area or an improper bite. In these cases, a second appointment will be needed to shave down the filling to a comfortable level. If sensitivity lasts more than two weeks, it may indicate that there is an abscess under the filling; an x-ray will show the abscess as a space. Prolonged discomfort may also indicate a tooth that has an infected pulp; more extensive work, such as a root canal, will have to be performed.
The easiest way to prevent cavities is by brushing and flossing your teeth, removing plaque before it builds up.
