The treatment of dental cavities goes back centuries, but it was not until 1875 that Dr. G.V. Black first described an organized approach to their treatment. His systematic methods are still used today, primarily for the placement of (silver) amalgam dental fillings. Dr. Black advocated removing the decayed part of the tooth and extending the tooth preparation to include certain grooves and other surfaces. This process is considered prudent because it provides the tooth with some protection from further decay in the future.
The goal of treating cavities involves two basic principals: Removing the decayed and damaged portion of the tooth, and rebuilding the missing tooth structure with a filling material. The dentist usually begins the procedure with an injection of local anesthetic. The tooth is then isolated from the rest of the mouth, and in most cases, either a high-speed dental drill or an air abrasion wand is needed to remove the tooth decay and prepare the tooth for the filling. The dentist will vary the tooth preparation depending on which material is used to fill the tooth.
After the tooth has been prepared, a liner is often used to reduce tooth sensitivity. Common liners include gluma, copalite varnish and dycal. In deeper fillings, a base is sometimes used in addition to the liner. Common bases used under dental fillings often contain resin reinforced glass ionomer cement or zinc phosphate cement. 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, but the most common are resin (white), amalgam (silver), porcelain or gold. These materials are layered on top of the liner or base to finish the process of rebuilding the tooth.
After a tooth has been filled, it is not unusual for the tooth to be sensitive for a day or two. In general, the deeper the cavity, the more likely the tooth will have prolonged sensitivity, especially to cold foods or beverages. Most fillings should feel completely comfortable within two weeks. In some cases, if the filling is built up too high, a second appointment is needed to shave down the filling to a comfortable level. If sensitivity lasts more than two weeks, it may indicate that there is a space under the filling. Prolonged discomfort may also indicate a tooth that has an infected pulp, and requires root canal therapy.
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