Treatment of Dental Cavities
The standard treatment for a dental cavity involves removal of infected dentine, followed by restoration with an appropriate filling material to restore tooth function and prevent further decay.
Diagnosis and Assessment
When evaluating a dental cavity, consider:
- Extent of decay (size and depth)
- Location of the cavity
- Symptoms (pain, sensitivity)
- Patient's overall oral health
- Risk factors for future caries
Treatment Algorithm
1. Minimal Intervention Approach
For early or small cavities:
- Remove only infected dentine while preserving as much healthy tooth structure as possible 1
- Consider remineralization for very early lesions that haven't progressed significantly through enamel
2. Cavity Preparation
- Access the lesion by removing enough enamel to reach infected dentine
- Remove infected dentine completely 2
- Preserve affected dentine that can potentially remineralize
- Follow minimal extension principles to maximize preservation of natural tooth structure 3
3. Restoration Selection
Based on cavity location and size:
- Anterior teeth: Composite resin for aesthetic results
- Posterior teeth with moderate-sized cavities: Composite resin or amalgam
- Large cavities or those with significant loss of tooth structure: Consider indirect restorations (inlays, onlays, or crowns)
4. Restoration Placement
- Apply appropriate bonding systems for adhesive restorations
- Place restoration material in increments (for composite)
- Ensure proper contour, contact points, and occlusion
- Polish to minimize plaque accumulation
Special Considerations
Deep Cavities
- If close to the pulp, consider indirect pulp capping with calcium hydroxide or MTA
- Monitor for signs of pulpal involvement
High Caries Risk Patients
- More frequent recall appointments
- Enhanced preventive measures (fluoride varnish, sealants)
- Dietary and oral hygiene counseling
Prevention of Future Cavities
After restoration, emphasize:
- Regular brushing with fluoride toothpaste
- Daily flossing
- Regular dental check-ups
- Dietary modifications to reduce sugar intake
- Consider supplemental fluoride for high-risk patients
Evaluation of Restoration Quality
Restorations should be evaluated for 4:
- Marginal adaptation
- Anatomic form preservation
- Protection against recurrent caries
- Color match (for anterior restorations)
- Absence of margin discoloration
Common Pitfalls to Avoid
- Over-preparation of the cavity, removing excessive healthy tooth structure
- Under-preparation, leaving infected dentine that could lead to continued decay
- Poor isolation leading to contamination during restoration placement
- Inadequate bonding procedures resulting in restoration failure
- Failure to address occlusal issues, leading to premature restoration failure
The goal of modern cavity treatment is to extend the lifetime of restored teeth with minimal intervention while effectively removing disease and restoring function and aesthetics 1.