When most (nearly 99%) dentists look at an x-ray with decay close or touching the nerve, the knee jerk reaction is one of the most dreaded statements a dentist can make: “You need a Root Canal”. And they wouldn’t be wrong, in light of ordinary conventional dental techniques.
Placing liners or bases in deep cavities to protect and soothe the nerve is nothing new in dentistry. However, advances in modern dental materials and technology has made it possible to perform “pulp caps” in a much more predictable way.
The first step is to determine if the nerve is healthy. The trouble is, there is no technology available today that can see inside the nerve and determine how much bacteria is in it and if the body can handle the bacterial load. The best test we have is a simple cold test. Placing a frozen cotton pellet on a tooth should give a cold response lasting 2-4 seconds. If intense pain is felt or the cold lingers, that is not a good sign and root canal becomes the only predictable option for saving the tooth.
If the tooth tests normal to cold, we can assume the nerve has a chance to heal. It’s a 50/50 chance. This is when a vital indirect ozone pulp cap is utilized in our office in order to have the best chance in avoiding root canal therapy.
Traditionally, all the decay must be removed from the tooth. In fact, when dentists leaves decay in teeth, they are considered sloppy careless or “bad”. However, studies show if the decay in close proximity to the nerve, there is no need to remove it if the decay can be sterilized and re-mineralized (hardened). We remove 90% of the decay leaving some in the deep areas of the tooth next to the nerve. This is important since removing all the decay and violating and exposing the nerve has a much poorer prognosis.
Following partial decay removal, the decay is fully sterilized using ozone gas, which kills 100% of all germs. Ozone, a cousin of oxygen, can selectively kill bacteria while never harming any human cells. This is conformed by a new technology that gives a color as well as numerical values that translate to how much live bacterial is in the tooth. The gas is applied until all the bacterial is killed. The sterilized decay is then covered by a new class of material called Resin Modified Calcium Silicate (RMCS). The material aids in re-hardening the dentin by supplying the tooth with the necessary building block and allows the nerve to heal in a non-toxic environment. This novel product has 10 years of research backing up its efficacy and is made by one of the best dental material companies in the world. Once the decay is dealt with and covered by a liner of RMCS, the tooth is restored with materials that closely mimic the natural tooth. Biomimetic reconstruction of teeth, allows the filling and tooth to work in harmony with each other. This prevents early failure of teeth and fillings.
We did everything we could to help your tooth nerve heal. We have provided the tooth with the right environment and building blocks, now its up to your body to heal. Maintain a nutritious diet, including foods rich in vitamin C.
If you have any questions, please feel free to speak to Dr. Shvartsman directly.