The
centre of the tooth is soft tissue, comprising nerve and
blood supply tissue. The outer surface of the nerve tissue
is similar, to you scholars, to a Medusa's head, with
millions of fine 'hairs' that are minute nerve ends. Each
'hair' runs up inside a single small tube with in the
dentine. So if you can imagine the dentine as an enormous
bundle of straws centred around a ball ( the nerve
tissue),
these hairs would run up inside each straw.
Covering
the outer ends of the straw tubes is the enamel which
is a very hard crystalline material. This outer surface
is the surface that takes all the abuse of the food
we eat, fluids we drink, and trauma when we bite and
chew, or get hit in the mouth during sports, brawls
and accidents. The reason that our teeth do not fracture
all fall apart after each knock is their unique design.
The dentine is 50% water, and the tubular construction
when wet with nerve fluids keeps this material flexible,
and able to absorb energy. So, you may well have many
fracture lines that you can see in your own teeth,
but the properties of the dentine bind the whole tooth
together and keep it intact and functional. The analogy
that I use to my Patients is a grass leaf. When wet,
it can be folded, knotted and woven. These processes
can be reversed, and the leaf returned to a single
leaf, usually without breakage. But once the grass
leaf dries to become hay, it is fragile and brittle.
If you attempted to fold, knot or weave it is this
dried state, it would probably break or fracture.
Nature has many other examples of this.
Now
once the acids and bacterial by-products gain entry
into the dentine, the rate of penetration and destruction
is increased by its unique 'straw-like' construction.
Depending on where the decay area started in the tooth,
and the shape of the advancing decay, structural failure
of portions of the tooth, or the whole crown, can
occur. Unless this stage is quickly stabilised, the
nerve tissue will die, leading ultimately to infection
within the supporting bone tissue.
Infection
in the bone tissue is not a reason per se to remove the
tooth, as many patients that we see have teeth where the
nerve tissue has been removed and the tooth restored once
the infection has been eliminated. This process is called
root canal treatment. However, reinfection can occur if
the technique in cleaning, sterilisation and filling of
the root system is poor, or some of the cheap, outdated
techniques are used.
Bacterial
toxins that are left in the dentine structure of the root
system can cause an area of infection to develop at the
tip of the root, and this occasionally can be controlled
by specialised surgical procedures to remove the root
tip and the area of infection. But even this extreme measure
will ultimately fail if the canal system still harbours
bacterial toxins. For a more predictable result, the canal
system should be opened, recleaned and sterilised, and
then filled whilst being able to access both ends of the
root system. If this fails at some time after, then I
personally feel the tooth should be removed with care
to preserve as much of the bone structure as possible.