Saving Teeth, Hero-dontics Optional

Any damage to teeth or gums can be the beginning of a long, downward spiral for the affected teeth. This is why we have such a focus on preventive dentistry in our practice. If we can prevent the cavity, prevent gum disease, prevent wear and tear, we know that natural teeth can last a lifetime.

Prevention, Minimal Intervention, Repair: A Modern Dental Approach

The modern approach to a newly-detected cavity is focused on repair (remineralisation) and minimal intervention. This is mainly because our understanding of the biology of teeth and gums has evolved, and the materials we have available to protect and restore teeth have improved dramatically.

Modern Fillings Can Be Tiny

In the past, metal alloys such as gold alloy and amalgam were the only materials available to fill teeth. These alloys don’t adhere or bond to teeth like our modern materials. So relatively large sections of a tooth need to be removed to hold these fillings in place.

This meant that when a tooth had a cavity, the filling often ended up being larger than the decayed area.

Today, because of modern tooth bonding technologies, we can treat spots of decay by placing tiny white fillings. We can even prevent cavities from forming by sealing vulnerable pits and fissures.

We Can Detect Dental Disease in Its Earliest Stages

New technology, such as digital x-rays and the Diagnocam, means that we can detect problems early, sometimes early enough to reverse the damage, potentially removing the need to place fillings. 

For example, if an image shows that the enamel between the teeth is starting to decay, the patient can increase (or start) flossing this area. This may well halt the decay in its tracks (because the cause of the damage, bacterial plaque, is now being removed on a daily basis). The enamel may be able to remineralise over time, sometimes with a little additional fluoride in the area.

If the gums bleed when toothbrushing, this again is a sign that early intervention is critical: regular professional cleaning supported by meticulous home care can do much to prevent the onset of gum disease and its companions: loose teeth and bad breath (halitosis).

When Dental Damage Is Severe

If teeth are deeply decayed or are so heavily filled that they become weakened or the nerve (pulp) inside is inflamed or infected, greater levels of treatment are needed. 

This is where we might recommend: 

• An indirect filling made of gold or porcelain (also called ‘onlays’, which fortify teeth)
• Dental crowns (which cover and protect the entire top part of the tooth), or 
• Root canal treatment (to remove the infected nerve, following which a crown may also be recommended). 

Dr Teo will thoroughly assess your mouth before discussing the treatment options available to you and provide recommendations that best meet your needs and desires.

What Happens if Heavily-Treated Teeth Become Compromised?

Teeth with large fillings or root canal treatment can weaken under stress over time. Sometimes conditions in a mouth are less than ideal:

• Some people have a heavy bite and may clench or grind their teeth at night whilst asleep. Under such heavy stresses, weakened teeth can chip, crack or break.
• If home care (brushing and flossing) is not done consistently and thoroughly, any tooth can get decay. This is as true for teeth with fillings, root canals and crowns as it is for untreated teeth. Decay (recurrent caries) can still occur in the tooth under a large filling or crown and further weaken and damage the tooth.
• Sometimes teeth are damaged by long-term exposure to an acidic environment. There are two main sources of acid in the mouth. The acids can come from the stomach (through gastric reflux, bulimia, morning sickness or similar conditions). They can also come from one’s diet (such as citrus fruits, sports drinks and wine). Acids dissolve and weaken enamel, the tooth’s protective outer layer. If the acidic environment in the mouth is not neutralised, serious damage can occur over time.

Teeth with a history of decay and damage can therefore deteriorate further and the tooth becomes more fragile. There comes a point at which the damage is so great that a standard filling or crown can no longer save the tooth. 

It is important to assess long-term risks and benefits and in close consultation with the patient, Dr Teo will propose a plan (and provide alternatives) that best suits her patients’ wishes, needs and long-term dental health.

Hero-Dontics Is Optional

If a tooth with a guarded prognosis can only be saved by heroic (and probably expensive) efforts, it can be helpful to consider other options. 

In such situations, Dr Teo will clearly and thoroughly explain the benefits and risks of each treatment option to her patients, listen to the patient’s points of view, and make recommendations. Dr Teo prefers only to undertake ‘hero-dontics’ if this is the patient’s express wish after the risks and potential outcomes have been considered.

If the patient agrees that hero-dontics is not worth the effort, the tooth can be extracted and replaced with a dental implant, bridge, or denture, or they may choose not to replace the tooth.

Your questions about this topic are welcome: please feel free to contact us at (03) 5298 1020.