The dental cavity treatment 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 fillings. Although he recommended amalgam fillings, which are rarely used today (the ones we remember, silver in color, which are a mixture of mercury and other metals).
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, then that tooth has undergone cavitation, and requires cavity treatment. Early dental cavities that have not spread to the dentin should be treated with fluoride.
There are two basic principals of treating cavities: removing the decayed portion of the tooth, and rebuilding the missing tooth structure with a filling material. With an injection of local anesthetic, xylocaine in most cases, and a high-speed dental drill, the decay is removed and this prepares the tooth for filling. In the past, fillings were silver (amalgam), or gold. These materials are layered on top of the liner or base to finish the process of rebuilding the tooth. Composites, resins and porcelain are being used today as alternate filling materials.
Porcelain is still sometimes used for dental fillings called inlays. The disadvantage is that they can be brittle and therefore susceptible to breakage. Porcelain costs significantly more than amalgam or composite fillings. Porcelain can also cause accelerated wear of the opposing tooth when biting. Still, it has many advantages.
After a filling, it is not unusual for the tooth to be sensitive for a day or two. The deeper the filling, the more likely the tooth will have prolonged sensitivity, especially to cold food or drink. However, fillings should be completely comfortable within two weeks unless they were built up too high, and need to be filed down. If sensitivity lasts more than two weeks, that may indicate a tooth that has an inflamed or infected pulp, and requires root canal therapy by an endodontist.
A good filling, done correctly, will last ten to 20 years and is the ideal treatment when a cavity is caught early. Bad cavities often lead to a root canal procedure, which is no longer a painful prospect. New advancements in root canal and endodontic technology have made this procedure quick and only producing slight discomfort. More on cavity treatment, fillings and lasers in our next article! Thank you for caring about your teeth, from your New York City endodontists.