Civitali Dental and Prosthetic Center srl

Deep caries, pulpitis and tooth destruction


Deep caries are a tooth destructive process affecting the whole thickness of the crown dentine, the tissue the crown is made of. The crown is lined by very hard tissue, the enamel. Dentine below is a far less hard and less demineralized tissue.

For this reason, when caries pass through the enamel and reach dentine, they develop rapidly affecting mainly this softer tissue, which is less demineralized and more prone to assault of bacterial acids.

Often, as in the clinical case presented, a nearly total destruction of the inner part of the tooth (dentine) is observed, while the enamel – the outer layer – shows only a small hole or fissure.

Demineralization of dentine occurs rapidly and leads to its complete destruction. During this phase the tooth becomes symptomatic. Pain is caused by different stimulations (hot, sweet or salty food) and caries move rapidly towards the pulp.

The pulp is a soft tissue located in the depth of the crown. It contains blood vessels and nerve endings. When caries get in proximity of the pulp, bacterial toxins cause pulp to inflame and produce an irreversible effect: pulpitis.

Pain becomes spontaneous, incessant, overwhelming and worse when the above mentioned stimulations are present or if the patients lays. Pain is not respondent to analgesics and must be treated with urgency through pulpectomy (that is the beginning of devitalization).

Pre-surgical picture

Caries affect the pre-molar and the two molars

Teeth are isolated with the rubber dam

Caries extension is quite wide

Caries-affected tissue is removed manually

After complete caries removal, pulp exposition can be observed

The probe shows the caries depth: 5 mm from the tooth surface

Pulpar chamber appears after pulp removal

At greater magnification

Caries removal at the adjacent tooth

Intermediate medication: a cotton pellet is positioned in the pulpar chamber

After opening an access cavity, softened and caries-affected tissue can be observed

Caries is removed by the second molar, adjacent to the devitalized one

Teeth are filled with composite material