An Enigmatic and Catch 22 Situation for the Dentists – What to do in Deep Cavities – Fill (Sandwich) or Deep Drill (RCT)
Enamel is the outer or first layer and Dentin, the middle or second layer of any tooth. If the cavity or decay is restricted to enamel or dentin, a restoration, be it any; silver, composite, alkasite etc. is good enough to restore it. If the middle or second layer, dentin is slightly more involved, it is always preferable to give a liner and/or a base below the restoration. If the decay or bacteria traverses through to the third layer, the pulp a.k.a. the nerve tissue, then the tooth might or usually does need a root canal therapy. The pulp of the tooth contains nerve fibers along with many smallest arteries, veins, lymph tissue along with some loose connective tissue. When the pulp seems to have become infected or inflamed due to a deep cavity, the blood supply to the
tooth may have been lost and the tooth pulp may have died in all probability, as it may seem, but internally, it may be partially alive, yearning for a chance to be saved or at least, be given a fair and square chance. This ‘inflammatory’ stage usually causes some pain and pressure while chewing, eating or drinking hot or cold foods and liquids along with a nagging pressure on
biting down or sometimes, just a lack of pressure on the tooth even with full force. However, a word of caution, as this stage can be ‘infection’ also. This stage is however, the trickiest to decide for any clinician; to decide between the ‘inflammation’ and ‘infection’ stages, whether the tooth is actually infected or just a bit inflammed because inflammation is reversible whereas
infection is not. The decision at this stage has to be strictly based on experience, clinical judgment and your own instinct rather than any other correlated clinical findings. This situation often lands up the clinician in a dilemma of whether to go for Root Canal Treatment or restore the deep cavity with a proper protection underneath with a good liner followed by a base and then the
restoration following a proper sandwich technique. The unfortunate aspect here is that in the initial stages of tooth decay (before the patient arrives in the clinic before this situation), there won’t be any pain. Hence, complacency creeps in and the patient delays or postpones the visit to the dentist. When an excruciating or sometimes even more than little pain happens, the patient
immediately runs to the dentist and the radiograph, clinical scenario and the symptoms sometimes make it seem like a Catch 22 situation for the clinician – An enigma for the dentist whether to do a Root Canal treatment in that deep cavity or not to do a Root
Canal treatment and restore it with the conventional or contemporary means via a Light cure Composite restoration and sandwich technique followed beneath.