Cariology – tooth decay treatment in Varna

Our tooth decay treatments

What is cariology?

Cariology is the branch of dentistry devoted to dental caries – its prevention, diagnosis and treatment, and the restoration of the tooth tissue it destroys. In practice it answers the question of how to save as much of the natural tooth as possible: by finding lesions early, cleaning out only the affected tissue with minimally invasive techniques, and placing a restoration that brings back the tooth’s shape, function and appearance. When patients search for “tooth decay treatment” or “a filling”, this is exactly what they are looking for.

How tooth decay develops – the four stages

Caries does not appear overnight. Bacteria in dental plaque turn sugars into acids that gradually break down the hard tissues of the tooth. The earlier we step in, the less of the tooth we need to touch.

• Enamel demineralisation – the only fully reversible stage. It shows as a matt white spot. At this point the tooth can be saved with remineralisation therapy and fluoride, without drilling and without a filling.
• Enamel caries – there is now a real defect in the enamel. It usually does not hurt, but the process will not stop on its own. Treatment is a small, conservative filling.
• Dentine caries – the decay has passed beneath the enamel into the softer dentine and spreads quickly. Sensitivity to sweet, cold and hot appears. This is where a classic composite filling is placed.
• Pulp involvement – the bacteria reach the nerve. This is when the tooth starts to ache on its own and at night. A filling is no longer enough – root canal treatment is needed to save the tooth.

Types of caries we treat

Not all caries looks the same or is treated the same way. Its location determines both how it is found and how the tooth is restored.

• Fissure caries – in the grooves of the chewing surfaces of the back teeth. The most common type in children and teenagers; it is prevented with fissure sealing.
• Approximal (interproximal) caries – between two neighbouring teeth. It cannot be seen with the eye and is almost always found only on a bitewing X-ray. The first sign is often food getting stuck or floss tearing.
• Cervical caries (at the neck of the tooth) – at the gum line, where the enamel is thinnest. Typical with exposed tooth necks and overly aggressive brushing.
• Root caries – on the exposed root surface when the gum has receded. It develops quickly because cementum is far softer than enamel.
• Secondary (recurrent) caries – under an old, worn or leaking filling. From the outside the tooth looks restored, while the damage continues hidden underneath.
• Hidden caries – a small entry point in the enamel with a wide cavity in the dentine beneath. It is found only on X-ray or with laser caries detection.

Symptoms: how to tell you have tooth decay

Early caries almost never hurts – which is why a preventive check-up every 6 months remains the most reliable way to catch it in time. See a dentist in Varna if you notice any of the following:

• A matt white or brown spot on the enamel
• Sensitivity or a short, sharp pain with sweet, cold or hot
• Food getting stuck between two teeth where it didn’t before
• Dental floss tearing or fraying in the same place every time
• A rough edge or small hole you can feel with your tongue
• Darkening of the tooth or of the edge of an old filling
• Persistent bad breath with no other explanation
• A dull, spontaneous ache that gets worse at night – a sign the process is already close to the nerve

How we make the diagnosis

Half of all caries cannot be seen in an ordinary visual check. That is why our diagnostics combine several methods – so we miss neither hidden decay between the teeth nor secondary caries under old fillings.

• A thorough clinical examination charting all teeth and existing restorations
• Bitewing X-ray – the standard for detecting decay between the teeth and hidden caries
• Panoramic X-ray (OPG) when an overall picture is needed before more extensive treatment
• Transillumination – examining the front teeth with directed light, without radiation
• Intraoral camera – you see on screen exactly what the dentist sees before you decide
• A written treatment plan with priorities: what is urgent, what can wait and why

How the treatment works, step by step

A visit for uncomplicated caries takes between 30 and 60 minutes. Here is exactly what happens in the chair – no surprises.

1. 1

   Examination and treatment plan

   We agree which teeth will be treated today, which material we will use and what it will cost. We only start once you are happy with the plan.

2. 2

   Painless anaesthesia

   We apply a numbing gel before the injection itself, so you do not feel the needle. With small, shallow cavities anaesthesia is often not needed at all.

3. 3

   Isolating the working field

   We isolate the tooth with a rubber dam or with cotton rolls and a saliva ejector. A dry field is not a formality – the adhesive bonds firmly only to dry tooth tissue, and that is what decides whether the filling lasts for years.

4. 4

   Gentle removal of the decayed tissue

   We remove only the softened, infected dentine and keep every healthy part of the tooth. A minimally invasive approach means a stronger tooth ten years from now.

5. 5

   Disinfection and protecting the pulp

   We clean the cavity and, with deep caries, place a protective liner over the nerve so the tooth stays alive and root canal treatment is avoided.

6. 6

   Adhesive preparation and layered build-up

   We apply the adhesive and build up the tooth in thin layers of composite, each cured with a light. The layering technique reduces shrinkage of the material and prevents cracks and post-operative sensitivity.

7. 7

   Shaping, bite check and polishing

   We restore the anatomy of the chewing surface and the contact point with the neighbouring tooth, then check the bite with articulating paper. The final polish leaves the surface smooth – and a smooth filling collects less plaque.

8. 8

   Aftercare instructions

   We explain when you can eat, what is normal to feel over the next few days and how to look after the restoration. We remain available if anything worries you.

Filling materials – which for which tooth

There is no one universal material. The choice depends on which tooth is being restored, how large the defect is and how much load the tooth bears when chewing.

• Nanohybrid composite – our main material. It is light-cured, colour-matched to the neighbouring teeth and practically invisible. Suitable for both front and back teeth.
• Fibre-reinforced composite – for larger defects and teeth after root canal treatment, where extra resistance to fracture is needed.
• Glass ionomer cement – releases fluoride and bonds chemically to the tooth. Used for baby teeth, cervical defects and as a liner under the main filling.
• Ceramic inlay, onlay or overlay – when the defect is too large for a filling but the tooth does not need a crown. Made in a laboratory and bonded into the tooth; it lasts considerably longer than a large direct filling and restores the shape of the chewing surface precisely.
• Why we do not use amalgam – grey amalgam fillings require removing healthy tooth tissue to hold them in place, do not bond to the tooth, discolour it over time and are being phased out in the European Union. All our restorations are metal-free and tooth-coloured.

Painless treatment – what we do for your comfort

Fear of the dentist is real and far more common than people admit. We work so that the visit is manageable even if you have put it off for years.

• For anxious patients – we tell you in advance what we will do, work in short stages and stop immediately when you raise your hand. Nobody rushes you and nobody blames you for not coming sooner.
• Numbing gel before the injection, so you do not feel the needle itself.
• For children – a gentle approach and explanations in words they understand. The first visit is often just getting to know us, with no procedure.
• During pregnancy – treating caries is not only possible but recommended, because an untreated infection is a greater risk than the treatment itself. The second trimester is the best time. Tell us you are pregnant so we can adapt the anaesthesia and X-rays.
• With a strong gag reflex we work with you sitting more upright and in shorter intervals.

What happens if tooth decay is ignored

Caries does not heal by itself and does not stop on its own. When the bacteria reach the pulp, pulpitis develops – a severe, throbbing pain that gets worse at night and is not lastingly relieved by painkillers. If that is ignored too, the infection spreads through the tip of the root into the bone, leading to periapical periodontitis, a granuloma or an abscess with facial swelling. At this stage the tooth can still be saved, but now with root canal treatment followed by a crown – many times more expensive and time-consuming than a filling. In the worst case the tooth cannot be saved and has to be extracted, followed by an implant or bridge so that the rest of the teeth do not shift. That whole chain starts with one small hole that did not hurt.

Prevention: how to avoid needing a filling

The best treatment for caries is the one that is never needed. A few things noticeably change the odds:

• A preventive check-up every 6 months – cheaper than any filling
• Fissure sealing for children as soon as the permanent back teeth come through
• Fluoride and remineralisation therapy at the first signs of white spots
• Cleaning between the teeth every day with floss or interdental brushes – a toothbrush does not reach where caries most often starts
• A 1450 ppm fluoride toothpaste and a brushing technique suited to your teeth
• Limiting how often you have sugar, not just how much – each separate intake triggers an acid attack lasting about 20 minutes
• Professional tartar removal once or twice a year

Frequently Asked Questions