When Fillings Alone Can Eliminate Pain

Patient presents with pain on his lower left molars.  He only feels pain when he is eating or drinks something cold.  We took X-rays of the teeth to confirm that there was some decay on the top surfaces of the teeth.  I also tested the teeth with cold and they were sensitive but not overly painful.  This is a good sign as we can fix these teeth with fillings and will not need to perform root canals.  The photo below shows these teeth before any work was done.  Notice the top tooth has a white filling and stain round the margins.  The bottom tooth has deep groves and stain.  When feeling with an explorer (pointy instrument), there is a “sticky” hole that can be explored.

I drilled out the bulk of the cavity (decayed tooth) and below is what the teeth looked like.  Notice there is still some decayed tooth structure.  Tooth decay usually works its way towards the nerve or pulp of the tooth.  This is because the bacteria are drawn to the source of nutrition

The photo below shows the teeth with the decay removed.  Notice there is still some dis-colored tooth remaining.  I am getting close to the nerve.  I disinfected the tooth at this point with Sodium Hypo-clorite (good old bleach) and then placed a fluoride base over the areas.  The fluoride base is slow release and services two purposes.  One is that is helps reduce sensitivity and second it is antibacterial.  The photo below and to the right shows the teeth after the base has been applied.

 

After this step the tooth is ready to fill.  Below are the before and after pictures of these teeth.

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