Root end surgery

Treatment of tooth decay

How does tooth decay happen?

The most common cause of dental tissue damage is tooth decay. It can be caused by bacterial infection, dental plaque or poor oral hygiene. Sometimes it is also conditioned by the quality of dental tissues, which is related to the patient’s health condition and genetic background.

What are the types of tooth decay?

Depending on the speed of the process, tooth decay may be acute, chronic or stopped. Furthermore, we distinguish between enamel, dentin, and cementum tooth decay, which are hard tooth tissue. While in the case of children, tooth decay especially affects the tooth’s chewing surfaces, in the case of adults it is mainly the so-called interdental caries, which is caused by the non-cleaning of the interdental spaces. Untreated tooth decay leads to tooth marrow damage and, in later stages, to the formation of an infectious bone lesion in the area of the root apex.

How to treat tooth decay?

In the treatment of tooth decay, the rule is the earlier, the better. The treatment of tooth decay is all the more complicated if/when the dental tissue is destroyed. The dentist will determine the appropriate method of tooth decay treatment based on a physical examination. Nowadays, early tooth decay can be treated without the need for “drilling,” by using concentrated fluorides or ozone. Such treatment is absolutely pain-free. Treating the advanced stage of tooth decay consists of removing it by drilling and filling the formed area with a filling or so-called dental filling. However, if tooth decay is at an advanced stage and has reached the dental pulp, it is necessary to treat the tooth’s root canal system. All of these procedures are done painlessly in our dental clinic using local anaesthesia.

Amalgam or “white” filling?

The type of tooth filling is chosen based on the dentist’s assessment with respect to the patient’s wishes. As a rule, there is a choice between the uncharged, free amalgam and the charged “white” dental filling (composite). Amalgam is the strongest material but has a number of disadvantages such as toxicity (it contains harmful mercury), volume expansion (in cases of insufficient thickness, the tooth wall can be broken), poor adhesive quality (bond to the tooth) and the fact that it is impossible to use in areas visible when you smile. A composite tooth filling is highly aesthetic, has better adhesion quality, and in particular, does not contain mercury. Composite tooth fillings may be chemical or light curable.  Light-curing dental fillings (photo composites) make it possible to achieve top-quality results.  Chemically curing dental fillings are considered to be of a lesser quality and cannot be colour layered.

Endodontic therapy

What is endodontics?

Endodontics is the dental specialty concerned with the study and treatment of dental pulp, which is the living connective tissue filling out the pulp chamber and the root canals of a tooth. Dental pulp is rich in both capillaries and nerve networks, which nurture the tooth and facilitate its growth.

Age matters

Endodontic therapy is most often performed in adult patients. This stems from the fact that dental pulp has barely any regenerative capacity in adulthood. In the event of its death, the connection to the cardiovascular system is severed and the white blood cells therefore cannot stop any potential infections from spreading. Endodontic therapy, in other words root canal treatment, aims to remove infected dental pulp and purify the root canal system to make it possible for it to be hermetically sealed.

When is it necessary to undergo endodontic therapy?

Endodontic therapy is necessary in the case of any cavities reaching the dental pulp itself. Through high quality root canal treatment, we often succeed in healing the infected dental tissue and thus preserving the tooth.

How is endodontic therapy performed?

The goal of the entire endodontic therapy procedure is to treat the root canals of the tooth in their entire length, which is measured both through X-ray and digital scanning. The basis of root canal treatment is purifying the infected root tissue and subsequently filling the root canal, which must be sufficiently widened and has had all the infected dental pulp remains removed. This is facilitated through a special disinfection chemical and an endodontic motor. Another important step is the hermetic sealing of the root canal. Most often it is performed by filling the root with gutta-percha points and a special paste (sealer), which solidifies in the root canal over time. This makes the root canal impenetrable by bacteria and infections will no longer be able to enter the centre of the tooth.

Is it a simple procedure?

Root canal treatment is very intensive regarding the equipment, tools and materials used, and at the same time it requires a high degree of dexterity and precision from the dentist. To ensure maximum quality, the procedure is performed with the aid of a dental operating microscope. Due to the need for a clean operating environment, sterile single use instruments are used along with a dental dam, which is a rubber sheet used to isolate the tooth from the rest of the mouth, to prevent the root canal from being contaminated by saliva or blood.

Why undergo a high standard procedure?

Endodontic treatment through the central point method is a considerably archaic approach. That is why we offer endodontic therapy to our patients exclusively through the condensation method, which is considered to be a high standard procedure, and thus is not covered by health insurance. In our dental office, we make sure to inform our patients of the costs involved in this high standard procedure, which the patients have to cover themselves.

Dental hygiene

The health of your teeth and gums depends directly on the quality of oral hygiene.

Where does tartar build-up and tooth plaque come from?

Dental plaque is a soft, sticky, colourless, and to a certain extent, invisible layer on the crown of the tooth. Dental plaque is composed of soft food residue and microorganisms. The presence of bacteria in dental plaque supports the development of tooth decay and gum inflammation. Dental plaque mineralization results in a sediment, called tartar.

Controlling the amount of plaque can be straightforward – mechanical and chemical disruption and removal of plaque within oral hygiene or indirect – diet adjustment.

What is dental hygiene?

Dental hygiene is preventive care performed in a dental clinic that aims to remove tartar, plaque, and other grime. Dental hygiene reduces the number of bacteria in the oral cavity, thus reducing the risk of infection, periodontitis (set of inflammatory diseases affecting the tissues surrounding the teeth) and tooth decay. In addition to professional oral care, dental hygiene at SofiDent includes home care training and counselling.

How often should dental hygiene be done?

Dental hygiene should be done at least once every 6 months, at least twice a year. Classic tooth cleaning, even with the use of dental floss and interdental brushes, is not enough. A patient is usually not able to easily get to the back teeth at home. Therefore, as a general rule, it is necessary to undergo dental hygiene every six months, where all interdental deposits might be removed.

How does dental hygiene work?

Dental hygiene takes place in several stages. First, the dental hygienist performs an initial examination of your oral cavity. This is followed by the tooth cleaning phase, during which the tartar and dental plaque are removed from the surface of the teeth. If your gums do not bleed, the cleaning is performed using manual instruments or by ultrasonic scaling instruments. After the teeth are cleaned, they are further polished using a rotating polishing device.  A protective paste is used to make your teeth polished and smooth. To reinforce the tooth enamel, fluoride is applied. Finally, the correct tooth cleaning technique and the necessary instruments will be explained. The whole process usually takes 60 minutes.

If your dental hygienist discovers that your gums are inflamed and bleed, or that your dental pockets are deeper than 3 mm and you have exposed tooth roots, you will need special care. Dental hygiene is then performed on sections of the denture and is more time-consuming.

What is tooth sandblasting (AirFlow)?

AirFlow is a widespread mechanical dental cleaning method in dental hygiene. This is a gentle removal of tartar and dental plaque, even in heavily cleanable interdental spaces. The AirFlow principle is based on a focused jet of compressed air, water, and bicarbonate particles to gently polish away any surface staining from the teeth. AirFlow is a painless method.

Pediatric dentistry

Care of children’s teeth

The responsibility for the child’s teeth is usually borne by their parents. It is very important not only to regularly visit the dentist, but also to teach children how correctly take care of their teeth and oral cavity. Proper care of the oral cavity from the child’s birth can prevent the development and subsequent treatment of tooth decay. Our dental hygienists and our dentist, who is focused on paediatric dentistry, will tell you about the principles of prevention of tooth decay and child tooth care. They will be happy to provide you with information on proper nutrition, hygiene, fluoridation and how to remove various bad children´s habits.

Complete initial examination for children

The objective of the initial examination for children is to determine the condition of the hard and soft oral cavity tissues, and to obtain information from the parents about how they observe dental hygiene and their child’s eating habits. This examination includes the following:

• Digital panoramic X-ray OPG (orthopantomogram).
• Detailed digital RVG images, eventually Bite-wing images for control of interdental spaces and spaces under the back teeth fillings.
• Detailed examination of teeth and gums with magnifying glasses, eventually intraoral cameras.
• Assessment of the quality of existing fillings and determining the level of the child’s dental hygiene.
• Assessment of the position of teeth and jaws within orthodontic prevention.
• If necessary, preparing a treatment plan with the cooperation of parents.

Fissure sealing (so-called sealing)

What is a fissure? It is a small groove in the tooth. Therefore, bacteria can get inside. These grooves are located predominantly on the chewing surfaces of the back teeth and premolars. Fissure sealing is a preventive procedure that is mostly done in children to protect freshly cut teeth before tooth decay develops. The ideal time for sealing is the period as soon as possible after the cutting of the tooth. At that time, there are not so many bacteria, which cause tooth decay, in the grooves, and therefore sealing has the greatest chance of long-term success in paediatric dentistry. The sites most prone to tooth decay are covered with a special sealing material that closes access to these difficult to clean parts of the tooth to dangerous bacteria.

Analgosedation

Any performance (from tooth decay removal to dental hygiene) can be performed in analgosedation, which is sedative analgesic anaesthesia. While general anaesthesia means that the child completely falls asleep, analgosedation causes insensitivity and the brain stops perceiving pain. Small patients in this state can breathe themselves while they sleep but they do not remember the treatment process. In analgosedation, we use a safe and effective inhaled analgesia, Entonox, known as “laughing gas”, which has the necessary rapid onset and offset of effect.

Periodontology

Periodontology concerns itself with treating and preserving the tissues responsible for providing support for your teeth and ensuring they remain firmly anchored to the jawbone. The professional term for these tissues is periodontium. Periodontal diseases are the second most common cause of tooth loss after cavities.

Is it a matter of genetics?

Periodontal diseases primarily form as a result of long term dental plaque and calculus build-up. In other words, there are no genetic predispositions at play; the main factor is insufficient oral hygiene. A contributing factor towards plaque build-up can also be overhanging dental restorations and crown edges.

How can I identify a periodontal disease?

The main symptoms of periodontal diseases are bleeding gums and bad breath. Dental plaque contains bacteria which produce a number of toxins which irritate the gums. Red and swollen gums signal an infection. Gums that remain swollen for a longer period of time react to any mechanical stimulus.

Periodontium loss manifests first through gum recession, then the formation of periodontal pockets, and in the final stage by exposed tooth roots. Gum recession causes temperature sensitivity in teeth. Pockets are caused by the space between the gums and the teeth deepening.

Bad breath is caused both by bacteria and periodontal pockets, which serve as a reservoir for food remains to build-up in.

Affected teeth can start to loosen, and if you do not start to remedy the situation, the teeth will have a minimal chance of remaining attached.

Periodontitis or periodontosis?

Both periodontitis and periodontosis are periodontal diseases. Periodontosis shares many symptoms with periodontitis. Just like with periodontitis, periodontal pockets are created and teeth begin to loosen, yet infection is not amongst its medical signs.

How are periodontal diseases treated?

We are able to cure peridontal diseases, but the most important aspect of the treatment is perfect oral hygiene, which not only includes the use of a toothbrush, but interdental brushing and flossing as well. During periodontal disease treatment, we employ a wide range of supplements which can greatly aid the treatment. The supplements include chlorhexidine mouthwashes, gels and bacteria suppressing toothpastes.

The goal of the treatment is to return the affected tooth surroundings, primarily the gums and the jawbone, to their original condition. This can be fully attained only in the case of a gum infection (Gingivitis). In the case of periodontitis and periodontosis, the loss of tissue tends to be permanent – in that case the primary goal is to stop the disease from advancing.

 Phases of treatment

We divide periodontal disease treatment into multiple phases, which do not necessarily have to follow a linear progression (it is commonplace to take the patient from the Initial therapy phase directly into the maintenance phase without any surgical procedures).

• Initial therapy

The goal of the initial therapy is to remove any gum infection, and to create and maintain a plaque and calculus-free oral environment. After the initial oral hygiene procedures, we will explain the correct ways to take care of your teeth to you. Correct and regular oral hygiene is a necessity for further treatment.

• Surgical treatment

If the initial therapy proves to be ineffective and the disease cannot be stopped, it is appropriate to employ surgical treatment. There are different types of surgical procedures, all of which share the same goal – to reduce the depth of the periodontal pockets, remove infection, secure the loosened teeth and stop the dental plaque from building up (thus preventing any calculus from forming). The amount of visits needed depends on the number of affected teeth and the extent of the disease. Our patients usually require about 6-12 visits.

• Maintenance phase (recall)

This phase is the last step in periodontal disease treatment. Its goal is to maintain the healthy condition where the gums show no signs of infection or bleeding, the teeth are cavity and calculus-free, and devoid of any improperly fixed bridges, restorations or implants, which could serve as places for plaque to build up or irritate the gums. Depending on your condition, the dentist will create a schedule for you, which could be potentially time consuming in the initial months. During each visit, the quality of your oral hygiene along with the amount of any potential gum bleeding will be assessed, and your teeth will be professionally cleaned. If the condition does not begin to worsen, you will be able to visit the dentist only twice a year.