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have been created by Dr. Jeffrey Dorfman, Director of The Center for Special Dentistry
Decay tooth, teeth cavity, dental caries, cavities, carious lesion
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How to remove tooth decay. These nine photos should be viewed from left to right and then top to bottom. Notice that sometimes the dentin looks smooth and intact until touching it with an explorer shows it to exhibit a diseased, oatmeal-like consistency. The dental pulp (tooth nerve or root canal) can been seen in the last photo in the middle of the preparation through a thin layer of dentin.
How to remove tooth decay pictures: 1) Dental bonding an upper premolar tooth where the buccal cusp has failed adjacent to a large old silver filling amalgam. 2) Silver filling removed. Don't try to bond to this amalgam since its foundation is not very strong and decay is frequently beneath it. 3) Decay removal. 4) Final tooth bonding.
Dental caries removed and teeth bonding from the palatal side of the upper two central incisors. 1) Pre-op palatal photo of #'s 8 & 9. 2) Interproximal decay. 3) Decay removed. 4) Final bonding.
Pictures show how to remove recurrent tooth decay. 1) Old white filling composite. 2) Composite removed, exposing recurrent tooth decay. 3) Pulp chamber with decay present. 4) The old composite came out in one piece because it was not bonded or glued to the tooth. This old composite was not premium dentistry. 5) Decay removed and tooth drilling into the root canal orifices for dental bonding retention. 6) Depth of preparation into pulp chamber. 7) Bonding is in place before tooth preparation. 8) Tooth preparation and gingivectomy; note the occlusal retention groove.
Photo of recurrent tooth decay. There is recurrent decay under this silver dental filling. Drilling on the buccal - cheek side - of a tooth is frequently more sensitive after a dental visit than removal of occlusal - biting surface - decay. Decay is still present. Root canal and crown is most predictable.
Removal of tooth decay and near exposure of the nerve - root canal. Treatment choices: 1) Dental bond only; 2) Dental bond and porcelain crown; 3) Root canal and a porcelain crown.
Retaining a wisdom tooth in the mouth longer than recommended can cause tooth decay in the adjacent second molar. This wisdom tooth is growing at an angle directly into the adjacent tooth causing a big cavity.
Deep tooth decay under a small silver dental filling. Apparently small cavities can grow much larger inside a tooth where the bacteria colonize.
Dental bonding technique showing tooth decay removal using a dental drill and an indirect pulp cap - near nerve exposure - that is very close to needing root canal.
Tooth decay removal and crown buildup technique with bonding into root canal orifices after drilling away a little gutta percha. Notice the crown margin finish line ends on tooth structure not the buildup.
A large cavity was created in the adjacent second molar by the wisdom tooth - third molar - growing into it. The patient did not feel oral pain. Treatment: Root canal and dental crown - notice the crown covers the site where decay was removed.
A big dental cavity can be seen extending into the nerve - red blood vessel - after removal of a broken silver tooth filling. This tooth needs root canal therapy; bleeding is visible from the nerve, the root canal.
Two lower premolar teeth that had large dental caries (#28 & 29) following root canal therapy. The occlusal photo first shows cavit in place and then the initial preparation into the pulp chamber reveals extensive teeth decay. The final photo shows decay removed from both teeth. This is photo #1 of a series of 3 photos.
Tooth decay and dental stain removal following removal of a silver dental filling.
Tooth decay under a fractured silver amalgam dental filling. Dental bonding may be seen in the final photo.
Extract this tooth. Tooth decay extends through the pulp chamber into the furcation. The prognosis is much less predictable than replacement with a dental implant.
There is a cavity in this tooth under the silver dental filling. The initial crown preparation has a supragingival shoulder to later help retain the endodontic clamp. The final crown margin finish line should have a chamfer or a bevel.
These photos show the tooth cavity and stain drilled away during removal of the silver filling.
Teeth decay noted under an old dental bridge that had dental cement failure, leakage.
This silver dental filling was removed during tooth decay drilling and was replaced with a white filling.
Arrows point to a horizontal black line which represents tooth decay entering through the distal contact (dotted black lines). You must prepare a distal box and remove this black line at its source.
This is a cavity! This is a lingual photo of a lower molar tooth. This tooth decay can be seen as a black crack line with white tooth decalcification around it and going deeper under the silver dental filling.
Diagnosis of tooth decay. Be suspicious of "little" cavities ... they can become quite deep. If ignored they may soon need root canal therapy!
Tooth decay is removed by drilling and then filled with tooth colored bonding.
These pictures show dental decay being drilled away in a tooth that has a large cavity. A white tooth filling, dental bonding, is then placed. The last sentence reads: 4. Bonding. "The white in photo #2 is decalcification."
This patient presented with severe mouth pain. Tooth decay - cavity - removal is shown. This tooth is being prepared for root canal therapy and a dental crown - teeth cap. Before and after pictures are shown.
This patient presented with oral pain. These pictures show the initial tooth cavity and after it has been drilled away. This tooth will receive root canal therapy and a dental crown.
Dental caries in a molar tooth. This tooth decay has been removed before referring the patient for crown lengthening gum periodontal surgery so the periodontist knows how much gum tissue must be removed.
Interproximal decay - a cavity between the teeth - can be seen in these photos while removing an adjacent dental crown. Preparation into this stain clearly shows the teeth decalcification and tooth decay present.
Tooth decay - dental cavity - removal between two front teeth. 1) Teeth decay can be seen in this photo. 2) Decay being removed. 3) Tooth decay removed. 4) The white fillings cannot be seen because they blend in with the teeth.
Emergency oral pain in the lower right jaw. 1) X-rays showing big teeth cavities in the second premolar and first molar and smaller cavities in both the second and third molars. 2) There was also a large periapical radiolucency around the apex of the second premolar tooth. 3) Photo of the second premolar and first molar teeth. 4) Radiograph - xray - of the second premolar and first molar following root canal therapy. The patient felt better immediately following this. Note: these teeth were treated following a careful differential diagnosis. It would not be surprising, if in another patient, the mouth pain came from a tooth with a less apparently severe problem.
How to pictures show the removal of a large silver amalgam filling and tooth bonding. Photo 1) Fractured disto-lingual cusp. Photo 2) Amalgam filling removal. Photo 3) Tooth decay removed. Photo 4) Bonded restoration, a white tooth filling.
Pictures show tooth decay removal and how to drill out a crack. During removal of tooth decay from under a large silver filling a fracture crack line is noticed. 1) Large silver filling showing a mesial interproximal crack line. 2) Amalgam removal still shows the presence of the crack line. 3) This mesial crack line is now seen to be continuous through the middle of the tooth and out towards the buccal. 4) The crack line has been removed as much as possible without invading the pulp chamber. Root canal therapy and a crown would be the most predictable method to keep the mesio-buccal cusp from further fracture and the patient was informed. Dental bonding would be a good second choice because the bonding actually glues the cusps together to help prevent further cracking - particularly if the mesio-buccal cusp was reduced occlusally and the bonding overlayed. A non-bonded silver filling would probably exacerbate the fracture over time.
This patient presented with mouth pain in the lower right jaw. Both teeth had cavities in them. Root canal therapy, crown buildup and dental crown preparation was performed for both the molar and premolar. The premolar is the focus in this series of photos.
Patient presented with severe oral pain in her lower jaw focused on two teeth. Both teeth had dental caries extending into the pulp chamber. Root canal therapy, crown buildup and dental crown preparation was performed for both the molar and premolar. The molar is the focus in this series of photos.
Pictures show how to treat a tooth fracture. 1) The entire lingual cusp of this upper premolar fractured and can be seen separated from the tooth decay around the silver filling. 2) The lingual cusp is being lifted away from the tooth. 3) The fractured cusp of the tooth. 4) The tooth after the removal of the fractured cusp. The black line indicates the anticipated extent of crown lengthening periodontal gum surgery that will be needed.
Tooth Cavity preparation. Photos 1 - 3) Note how big the tooth cavity is even though the silver filling initially appears clinically intact. Photo 4) The black line indicated by the arrow is a crack extending from the mesial box that probably was the source of a lot of the cavity. This crack must be completely removed.
Proper tooth cavity preparation requires the removal of crack lines that could contribute to recurrent tooth decay. 1) The arrow points to a crack line extending interproximally. This crack line can be either white or black. 2) Preparation of a mesial box still shows the presence of the crack surrounded by white decalcification. 3) Appropriate removal of the crack. 4) The arrow points to a crack line adjacent to visible decalcification in the adjacent tooth. Reevaluate your bite-wing radiographs; this tooth should probably also be treated. Note: sometimes it might be necessary to prepare a narrow channel with a 169 carbide steel bur to just remove a crack without unnecessary tooth preparation. This tiny channel could be filled with flowable composite resin.
Final tooth preparation - dental caries removal - before placement of direct-bonding material in a lower molar. 1) - 2) Final tooth preparation. 3) Placement of chemically-cured flowable bonding material. Note the presence of several spheres of slightly different-colored bonding material within the flowable bonding material. These are spheres of light cured dental bonding material - bonding balls - that are used to condense against. 4) The final tooth bonded white filling.
Pictures show how to treat tooth decay in a maxillary lateral incisor adjacent to a palatally-displaced supernumerary tooth. Photos 1) - 2) Initial presentation. Note the broken, decayed lateral tooth and the palatal location of the adjacent supernumerary tooth. Photo 3) Close up of the broken, decayed lateral and the adjacent palatally-displaced supernumerary tooth. Photo 4) X-ray. Photo 5) The same tooth after electrosurgery and initial tooth preparation. Photo 6) Placement of the temporary crown. Note that acrylic was extended from the temporary on the lateral to the supernumerary to provide initial stability of the temporary until root canal therapy and a cast post and core was placed. Photo 7) X-ray of the final root canal therapy, cast post and core and dental crown. Photo 8) Final result.
Treatment of severe tooth decay in a molar that had root canal therapy with only a large bonded filling restoration. 1) Neglected lower molar that had an adequate root canal yet very decayed amalgam silver filling. 2) View of the extent of the decay after removal of the silver filling. 3) Tooth decay removed. Note the gutta percha coming out of the three orifices. 4) The bonded restoration, a white tooth filling. The point here is that a bonded restoration can be placed even when a crown is obviously indicated. The crown will be placed after the patient completes orthodontics, braces.
Teeth decay - dental caries - under a dental bridge that was repaired. 1) - 2) Patient had a two-unit bridge on an upper canine abutment tooth, lateral incisor pontic and palatal wing attached to the distal of the central incisor. The patient presented with the bridge out. 3) Initially it seemed that there was external resorption on the facial surface of the canine near the gingival margin. 4) Initial x-ray. Photo #1 of 3.
Teeth decay - dental caries - under a dental bridge that was repaired. 1) X-ray after root canal therapy. The root canal itself did not seem subject to external resorption. 2) Gingivectomy with electrosurgery. Note the still unusual look of the facial dental decay. 3) Following tooth decay removal. Note the communication to the gutta percha. 4) The dental bonding restoration. Photo #2 of 3.
Diagnosis of radiographic decay - x-rays of tooth decay. Teeth cavities can be difficult to identify on x-rays. Dark shadows can be seen in the outer (whiter) tooth enamel.
Tooth decay cavity identification, cavity removal and dental bonding fillings in two upper jaw molars. Photos #'s 1, 3, 5 and 8 show the first molar; Photos #'s 2, 4, 6, 7 and 8 show the second molar. Photos #'s 1 and 3 show the initial cavity. Photos #'s 3 - 7 show the steps in cavity removal. Photo # 8 shows the final dental bonding white fillings.
Tooth decay diagnosis interpretation and removal in two molars. Image #'s 1, 3, 5 and 7 show the first molar; Image #'s 2, 4, 6 and 8 show the second molar. Image #'s 1 and 2 show the initial cavities. Image #'s 3 - 8 show progression in the still incomplete cavity removal in both teeth. For the second molar note how the decalcification and decay spread laterally from the buccal surface all the way into the mesial box in image #'s 2, 4, 6 and 8.
Dental caries diagnosis identification and removal in two lower molars. 1) The interproximal tooth decay was identified in x-rays; the teeth looked ok intraorally. 2) - 3) Initial teeth cavity preparation into the proximal boxes. Notice that in the proximal boxes, the mesial of the second molar shows a zone of teeth decalcification (increased whiteness) and the distal of the first molar shows a black crack line. Both should be removed. 4) Note that tooth cavity removal shows the continued presence of teeth decalcification and decay on the lateral (buccal) edges of both proximal boxes. 5) Complete dental caries removal.
An x-ray of dental caries. Radiographic tooth decay. A tooth cavity can be diagnosed by visual clinical examination and/or by xray diagnosis.
An x-ray showing tooth decay. A radiograph of dental caries. A tooth cavity can be diagnosed by visual clinical examination and/or by xray diagnosis.
An x-ray showing tooth decay in multiple teeth. A radiograph of dental caries. A tooth cavity can be diagnosed by visual clinical examination and/or by xray diagnosis.
Tooth color can be an indication of tooth decay. 1) Be suspicious when tooth color is different than what you would normally expect. 2) There was a large tooth cavity in this case.
A hopeless tooth that should be extracted. 1) Photo of tooth #18 shows gum tissue growing into the space previously occupied by tooth structure. 2) X-ray shows significant tooth decay extending below the gum line to the level of the jawbone.
1) - 2) Two x-rays showing a lower wisdom tooth impacted on an angle and pushing into the adjacent second molar causing a large area of dental caries. 3) X-ray shows the wisdom tooth was removed and the second molar following root canal therapy with the large distal tooth cavity still present. 4) Cast gold post and core and crown in place. Note the distal crown margin completely covers where the distal dental decay was removed.
These photos show preparation of the second molar to remove the distal dental caries after root canal therapy was performed on it and the wisdom tooth was removed. 1) - 2) Tooth Decay is present in the distal area of the second molar. Temporary dental filling material is visible in the occlusal opening following root canal therapy. 3) Dental Decay removed. 4) Temporary filling material removed showing gutta percha in root canal orifices prior to cast post and core preparation.
1) X-ray showing a lower angular impacted wisdom tooth pushing into the adjacent second molar causing dental caries - a large dental cavity. 2) Tooth decay is present in the distal area of the second molar tooth. Temporary tooth filling material is visible in the occlusal opening following root canal therapy.