Dentist refer to deep caries as: “caries profunda”. This term defines a certain stage or depth of tooth decay (caries). The end phase of an untreated case of caries is the death of dental pulp. In vernacular speech, dental pulp is also referred to more simply as the nerve. However, before bacteria reach the nerve, they have to eat their way through the different layers of the tooth. To achieve this, bacteria convert sugars into acid. This slowly destroys the hard tooth substances, creating a deep hole. The closer this dental caries comes to the nerve, the more likely you are to experience severe tooth ache as a symptom. What are the layers of the tooth that the bacteria need to work their way through?
1. Tooth enamel
2. Enamel-dentine junction (relevant to treatment)
4. Pulp (synonyms: nerve, pulpa)
The tooth enamel is the hardest layer of the tooth. It covers the entire outer surface of the tooth, and is what people see when you smile. This layer shines a crystal-white if it is well looked after. It protects the tooth from any and all substances from the outside world that the mouth comes into contact with. Beneath this layer, the significantly softer dentine layer can be found. It is brownish in colour and has small channels that reach down to the nerve. These channels make the tooth sensitive and cause pain when they are exposed. Beneath the dentine, the pulp can be found which contains blood vessels, tissues and the nerves of the tooth.
In summary: Areas of tooth decay that advance through the enamel, the deep layers of dentine, and right up to the area approaching the pulp are termed “caries profunda”.
Filling options with their advantages and disadvantages
If deep caries are not recognised and treated then tooth loss is a real threat. In early stages, the dentist is able to reliably rescue the affected tooth by removing the caries with a drill and closing the tooth using a filling. In the later stages, a special type of treatment is required. The regions immediately surrounding the nerve are treated and covered with special materials and medicines. A conventional filling is then applied on top of this. Here is a list of some options with their advantages and disadvantages:
1. Ceramic inlay, the highest-quality filling: stable, sealed, beautiful.
2. Gold inlay: very durable, sealed, danger of tooth material fracturing, not aesthetically pleasing.
3. Amalgam fillings: form a tight seal, disadvantages include possible intolerance, poor aesthetics and susceptibility to fracture.
4. Composite filling: for the front tooth areas. In the side teeth, however, this filling type often has significant shortcomings.
Dental caries (tooth decay) and how they form
Caries are formed by plaques: a sticky, white biofilm that forms on the tooth surface. This tough substance contains bacteria and nutrients. In terms of which bacteria cause the most damage, Streptococcus Mutans takes the gold. Until the areas in the mouth affected can become pathogenic (i.e. harmful), this biofilm must form for around 24h on the surface of the tooth in specialised layers. If these layers are regularly removed by cleaning away of the plaque, no caries can form. For this to be effective, the biofilm does not necessarily need to be removed 100%. Just disturbing the structure of the film is enough, disrupting the bacterial arrangement. Poor oral hygiene, however, combined with poor diet can lead to severe damage to both teeth and gums. Go to the “gum damage” section to read our articles on inflammation of the gums and periodontal disease.
Our dentists and dental hygienists can help you to recognise hard-to-reach places and give you advice on how to clean in these areas more effectively.
If the pathogenic bacterial arrangement is formed for over a 24h period, the bacteria can finally form organic acids from sugar. In this case, these acids are the cause for loss of tooth material in the enamel, leading to the formation of a hole. The hole in the enamel then serves to provide the caries with additional protection and for that reason must be treated by a dentist before it reaches the nerve. After the caries has been removed, the hole is closed with a sealed filling to keep bacteria out.
Treatment of deep caries
When are follow-up treatments necessary?
Frequently asked questions
How do I know if I have tooth decay or deep caries?
Areas affected by caries tend to be difficult to identify as they tend to develop in areas that are difficult to see. Even if you can see brownish spots, these are not necessarily tooth decay. Spontaneous tooth ache can be an indication of very advanced caries existing. However, there are many other causes that may be attributed to this kind of pain. A clear diagnosis can generally only be made by a dentist.
Why does tooth ache occur?
Due to the protective layer covering the tooth being penetrated, irritants can be directed towards to pulp of the tooth via small dentine channels. Irritant stimuli can include cold and warm temperatures. Chemical and mechanical stimuli may also, however, cause the pains to appear.
Do fillings or crowns protect the tooth from subsequent bacterial infections?
No, damage may continue to occur on the border areas of any fillings and crowns if oral hygiene is not sufficiently maintained. Damage to the filling material directly, however, is not possible.
Which are the most common sites for dental caries to occur?
Between the teeth, as it is here that only special cleaning tools can clean effectively. For example, dental floss, or better still, interdental brushes.
Which filling type do you recommend for the front teeth, and which do you recommend for the side teeth?
For side teeth, we recommend metal-free ceramic inlays. These can endure high chewing forces and do not change their shape. For that reason, they can maintain a tight seal for a lifetime. In the front teeth, we recommend composite materials. For smaller volumes and areas with reduced chewing forces, composite materials are suitable. Additionally, they can create an aesthetically pleasing finish.