Case Study – Close to the Nerve, Decay but still OK!
This is a” just in the nick of time”, situation. Decay feeds on the dentine of the tooth. The dentine consists of microtubules (micro tubes) the connect to the pulp (including the nerve). These tubes get larger as the approach the nerve meaning more space for the bacteria to invade the tooth.
Also, if there is a crack in the tooth, bacteria travel along the crack deeper in the tooth and not into the microtubules.
Fun fact: bacteria need to release chemicals to breakdown the dentine structure before itself, before it can digest it. So, the deepest layer of decay does not have bacteria in it.
The soft decay was removed, which is the digested dentine, leaving firmer decay. The remaining layer, with was carefully cleaned so as to not expose the pulp/nerve. A coating/lining of protective materials is placed to aid the nerve to make protective (calcified) dentine. It also has anti-bacterial agents.
There were minimal post-operative symptoms and the patient was initially not in much discomfort. This greatly favours the ability of the nerve to heal.
Remember PAIN IS TOO LATE.
It’s always amazing that if you give the body a chance to heal, it will. 15 months later there are no symptoms, despite the decay almost was inside the pulp/nerve.
The pulp can make 1mm of calcified dentine every six months if there is no inflammation. Pain is a sign of inflammation. Constant vigilance (regular examinations) and proper patient care is essential.
Happy mouth, Happy Life
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Easter 2026