Tooth decay (dental caries) is one of the most common oral health conditions in the world today. It is a costly problem to treat, and may result in toothaches, pain, infection and tooth loss.
The best way to avoid the oral health complications of tooth decay is to prevent it through proper oral health care and hygiene.
If you already have minor tooth decay, there are still “non-operative” ways of managing the condition. You can thoroughly clean tooth plaque through brushing and flossing, follow a healthy diet (avoiding foods high in sugar and refined carbohydrates) and use fluoride oral care products. The combination of these techniques can help to slow down or even stop the progression of the decay.
It’s when your decay has progressed to a more advanced stage, that “operative” treatment is required. That’s when you have a filling treatment at your dental clinic. Your dentist prepares and fills in the holes left by decay, restoring your tooth to its original form and function.
But there’s more to it than that.
Traditionally, a complete caries removal (CCR) method is used. That’s when all of the tooth decay is removed with dental tools before a filling is placed. Not all tooth decay is suitable for treatment via this dental method, especially in cases of people with deep caries lesions.
The potential risk with the complete removal of all of the tooth decay (caries) is that other parts of your tooth can be affected by the procedure – resulting in pulp exposure, tooth nerve exposure and damage, toothache and/or a weaker tooth structure.
If a complete excavation of your tooth decay could result in oral complications, such as pulp or nerve exposure, your dentist may recommend a stepwise excavation (SW) or partial caries removal (PCR) of your tooth decay as a suitable alternative “operative” treatments (before more complex tooth restorations such as inlays, overlays and crowns are required):
- Stepwise excavations (SW) are a decay removal method that removes the tooth decay in two sessions.
The interval of a few months between visits, allows recovery time for the dental pulp to repair and strengthen itself by laying down dentine, before the second visit to remove the remaining decay. This two-part method does involve additional costs and discomfort.
- Partial caries removal (PCR) excavates part of the decay. Then your dentist seals the residual decay permanently – preserving much of the original structure of your tooth before restoration. There is also less nerve damage to both baby and adult teeth if part (or all) of the decay is preserved.
Research studies have also found that PCR treatment resulted in better pulp survival rates and improved pulp vitality, compared to CCR and SW treatments. PCR also had a lower risk of treatment failure as a result of pulpitis and pulp necrosis.
“Operative caries management in adults and children.”, Authors: Ricketts D1, Lamont T, Innes NP, Kidd E, Clarkson JE. Cochrane Database Syst Rev. 28 March 2013;(3):CD003808. doi: 10.1002/14651858.CD003808.pub3
“Randomized trial of partial vs. stepwise caries removal: 3-year follow-up.”, Authors: Maltz M1, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD. Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. Published: Sep 14, 2012.