Tooth preservation is one of the most important areas of contemporary dentistry. In many cases, dental treatments are not only aimed at alleviating discomfort. An important aim of many measures is also to preserve the existing tooth substance for as long as possible.
Methods of tooth preservation are used both preventively and therapeutically:
- preventive means that prophylactic measures prevent serious problems from occurring in the tooth in the first place.
- Therapeutic means preserving a diseased tooth as far as possible instead of extracting it.
Ideally, the development of tooth and supporting apparatus diseases is prevented so that it is not necessary to intervene therapeutically at a later stage.
Conservative dentistry is dedicated to the preservation of teeth. It primarily deals with plaque-related diseases of the teeth as well as carious and non-carious damage. These diseases pose the greatest threat to tooth preservation.
This area of dentistry therefore includes
- dental prophylaxis,
- caries therapy,
- periodontology (treatment of bacterial diseases of the periodontium) and
- endodontics (treatment of other inflammatory diseases of the periodontium and dental pulp).
Almost everyone in Western Europe comes into contact with this broad field of dental conservation medicine during the course of their lives. Dental prophylaxis begins in childhood and in Germany includes two check-ups per year.
Regular check-ups at the dentist are an important part of tooth preservation © Andriy Bezuglov | AdobeStock
The most common reason for tooth preservation treatment is tooth decay. Tooth decay affects more than 98 percent of people living in Western Europe. Tooth decay is a disease of the tooth substance caused by bacteria found in the biofilm that surrounds the teeth. These bacteria metabolize sugar molecules into acids, which in turn attack the tooth substance. Over time, this creates holes in the tooth enamel.
Another common reason for tooth preservation treatment is periodontitis. This is a bacterial disease that leads to the breakdown of the bone and gums that hold the teeth in place. Warning signs are the formation of plaque and inflammation of the gums, some of which also develop into periodontitis. These two phenomena are therefore also often the reason for tooth preservation treatments.
Other reasons for tooth preservation therapies are
- Inflammation of the dental pulp, which can be caused by bacteria, but also by mechanical, chemical or thermal irritation, as well as
- Damage to the tooth due to other environmental influences.
The methods of tooth preservation differ just as much as the reasons for the treatment. A basic distinction is made between preventive and therapeutic approaches.
When it comes to prevention, it is primarily the individual who is responsible: efficient dental hygiene is the best way to prevent dental damage. Dentists teach their patients effective tooth brushing techniques. Professional dental cleanings can also help to minimize risk factors.
Even greater differentiation is required when it comes to therapeutic approaches. The best known is filling therapy, which is used to remove carious lesions. The lesion is removed using a drill, which creates a hole in the tooth structure. This hole is then filled with filling material so that the tooth can be fully loaded. This also prevents bacteria from penetrating the inside of the tooth.
In the past, amalgam was generally used as a filling material. Today, dentists are increasingly using ceramics and composite resins.
In the case of incipient caries in certain areas of the tooth, a new type of therapy can also be used that does not require drilling. In this case, a plastic infiltrates the lesion and seals it.
Periodontitis is often treated in several stages. After removing visible plaque, a curettage of the inflamed gum pockets is carried out together with the tooth root: The inflamed tissue is scraped out. In addition, antibiotics are sometimes used to reduce bacterial colonization.
If the pulp is inflamed, root canal treatment is necessary. This involves opening the root canal to remove the inflamed tissue. The canal is then sealed with filling material.
In addition to the methods described, other methods are used in oral surgery. Surgical dental treatment is primarily required after accidents and other traumatic damage to the teeth. They also serve to preserve teeth, but are not considered part of conservative dentistry.
Aftercare depends to a large extent on the type of treatment. In any case, however, it is important to know the basics of dental hygiene and to apply them after treatment. In this way, you can prevent further diseases of the teeth and the periodontium.
This includes regular and effective tooth brushing and the use of antimicrobial mouth rinses. Furthermore, dietary changes towards a less sugary diet are sometimes useful and are recommended by dentists.
There is no general answer as to whether it is necessary to protect the affected tooth after treatment.
After cement fillings, for example, it is necessary not to chew on the tooth for at least a day and to clean it very carefully, as the filling must first harden. However, this does not apply to ceramic or composite fillings.
It is generally advisable not to eat anything after local anesthesia until sensation is fully restored. Otherwise, injuries - such as unnoticed biting of the tongue or cheek - are possible.
Complications can occur during all therapeutic measures for tooth preservation. For example, there is a risk of unintentional damage to healthy tooth substance during treatment. The penetration of bacteria into the interior of the tooth and the root canal is also possible with certain treatments. However, these risks are reduced by a professional approach on the part of the dentist.
The prognosis for diseases that endanger the tooth substance depends primarily on
- the timing of the start of treatment and
- the aftercare
depends. The sooner treatment is started, the more likely it is that the loss of the tooth can be averted. For this reason, it is advisable to take advantage of the preventive dental check-ups paid for by the statutory health insurance companies.
Periodontitis is a special case: The degradation of the periodontium that has occurred can generally not be reversed, or only to a limited extent. It is therefore particularly important to start treatment in good time.
