The question of whether a dentist can fix a “rotten tooth” is a common one, and the answer is overwhelmingly yes, provided the damage has not progressed past a certain point. What is often referred to as a rotten tooth is medically termed dental caries, a disease process where acids produced by mouth bacteria break down the hard tissues of the tooth: the enamel and the underlying dentin. This breakdown creates a cavity, and the treatment approach a dentist uses is entirely dependent on how deep the decay has traveled. Timely intervention is a significant factor in saving the natural tooth structure, as earlier treatment is less invasive.
Treating Mild to Moderate Decay
When tooth decay is in its early or moderate stages, meaning it is confined to the outer enamel and has not penetrated too deeply into the dentin, the treatment focuses on removing the compromised structure and sealing the area. Dentists typically use visual inspection and dental X-rays to accurately diagnose the extent of the decay. If the decay is shallow, sometimes a concentrated fluoride application can even help remineralize the enamel.
The most common procedure for moderate decay is a dental filling, where the decayed material is first removed with a drill. The resulting clean space is then restored with a durable material to prevent further bacterial invasion and restore the tooth’s shape. Dentists frequently use composite resin, a tooth-colored material that bonds directly to the tooth structure for an aesthetically pleasing repair. Alternatively, some situations may call for dental amalgam, a durable metal mixture, particularly in back teeth.
For larger areas of decay that still do not require a full crown, a dentist may opt for an inlay or onlay, which are custom-made restorations. An inlay is placed within the cusps (the raised points) on the chewing surface, while an onlay covers one or more of these cusps. These custom-fit pieces offer a stronger, more precise restoration than a traditional filling when a significant portion of the tooth’s structure needs support.
Repairing Internal Damage
Decay that is left untreated will eventually pass through the dentin and reach the pulp, the innermost chamber of the tooth that contains nerves and blood vessels. Once the bacteria infect this soft tissue, it often results in significant pain and can lead to a severe infection. In this scenario, the procedure necessary to save the tooth is root canal therapy, a form of endodontic treatment.
The objective of a root canal is to eliminate the source of the infection by removing the inflamed or necrotic pulp tissue from the chamber and the root canals. The endodontist or general dentist cleans, shapes, and disinfects these tiny canals using specialized instruments. Once completely sterilized, the canals are filled with a biocompatible material called gutta-percha to seal them off permanently.
A tooth that has undergone root canal therapy is often significantly weakened due to the loss of structure from decay and the necessary access for the procedure. To prevent the tooth from fracturing, especially a back tooth that withstands considerable chewing forces, a dental crown is typically placed. This crown, or cap, covers the entire visible portion of the tooth, providing the necessary strength and protection to allow the tooth to function normally for many years.
When Extraction is Necessary
Despite all efforts to save a natural tooth, there are situations where the decay is too extensive, making extraction the only viable option to prevent further health complications. A tooth may be deemed unsalvageable if the decay extends far below the gum line, if the tooth is fractured vertically into the root, or if an infection has severely compromised the surrounding jawbone. Removing the tooth eliminates the source of infection and prevents it from spreading.
Leaving a gap in the mouth after an extraction can lead to other dental problems, as the adjacent teeth may shift and the jawbone beneath the missing tooth will begin to deteriorate. Therefore, a dentist will immediately discuss replacement options to restore function and maintain the alignment of the remaining teeth. The gold standard for replacement is a dental implant, which involves surgically placing a titanium post into the jawbone to act as an artificial root for a new crown.
Other methods include a fixed dental bridge, which uses the adjacent teeth as anchors to support a prosthetic tooth that spans the gap. For multiple missing teeth or as a more economical choice, a removable partial denture can be used. Choosing a replacement is an important step that ensures the stability of the bite and preserves the overall health of the entire mouth.