Consider this article a public service announcement. I really dislike it when patients lose their teeth unnecessarily. My practice philosophy is that if a person has a dental problem, the goal is to handle that difficulty first, but then empower the patient with the correct knowledge that will keep him out of trouble from there on out. Ideally, my hope is that most future visits to my office will only be for routine maintenance.
Unfortunately, and all too often, I encounter new patients with teeth that are so badly decayed there is little hope of salvage. Possibly just as frequently, I find these patients scheduling a checkup – usually after a long absence from dental care – who are surprised to learn that they have any cavities at all. Sometimes they will think they lost a filling when, in fact, a piece of their enamel has broken away.
Why are they surprised? The common denominator seems to be the idea that cavities are supposed to hurt.
Well, sometimes they do hurt. But most of the time – especially in the early stage – they don’t.
In fact, by the time a tooth does start to hurt you it’s usually pretty bad. More often than not, it is so bad that a dentist is evaluating whether it can be treated with endodontic (root canal) therapy or whether it needs to be extracted. A little understanding of basic dental anatomy is helpful here.
Take a look at the illustration below:
The outer layer of the tooth is comprised of enamel. This is the hardest substance in your body. It breaks up your food and is designed to last you a lifetime.
And now, here is the important part for you to understand: it doesn’t contain any nerves.
It is more than ninety-five percent mineral. Water and organic materials make up the balance. And because it doesn’t have nerves, it doesn’t have feeling. This is actually quite practical since it wouldn’t do to have pain every time you bit into something. On the other hand, it also means that it can be decayed without giving you a warning.
In fact, decay can also travel into the supporting layer – the dentin – and still not cause you pain. It usually has to travel pretty close to the inner layer that contains the blood vessels and nerves – the pulp – before you feel it. Of course, by then, the tooth has generally undergone considerable destruction.
Another factor that makes spotting decay difficult is the way it spreads. I have drawn two black triangles into the enamel above. Notice that the narrow point is on the outside of the enamel. The broader base faces the inside of the tooth. This is how decay usually travels. Sometimes, it will undermine the interior of the tooth while the outer, harder enamel still maintains its form . . . until it eventually crumbles because the underlying supporting dentin has been eaten away by decay.
Many cavities also form at the contact point between two teeth. These are areas that you simply cannot see. Even the dentist needs an x-ray to spot these cavities in most cases.
So what does all this really mean? Spotting decay is not always that easy. As dentists, we use visual examination, but we also rely on probes, x-rays, and even laser detection devices to locate cavities. Even then, it can be difficult to find cavities under existing fillings.
Don’t rely on pain to tell you if you have a cavity in your tooth. If you do, you can be assured that your treatment is likely to be more uncomfortable, expensive, and may even result in the loss of a tooth that could have been treated much more easily earlier in the game.
If you have a loved one, who still has their teeth and hasn’t seen a dentist in a while, have them read this article. You may be saving them from quite a bit of discomfort – not to mention time and money – if they catch potential problems before they are hopeless.
Some of you may be thinking, “No big deal. If it’s that bad, I’ll just pull it.” OK, sometimes that is necessary, but therein lies a lesson for another day.
Not long ago, I heard something from a patient that really surprised me. Now, that in itself is significant, because after practicing dentistry in Philadelphia for over 20 years, I thought I had just about heard it all. This patient, who up until recently had a great record of regular follow-up visits for cleanings and check-ups had been missing in action for about a year and a half. After we caught up with her and found out what was behind her unusual lapse in dental care, I learned that, among other things, she had been listening to a friend who had asked her: “Why do you want to go to the dentist? He’ll just find things that are wrong with you. And it’s so expensive.”
Wow!
Quite apart from the fact that this patient usually left her checkup without a need for any additional treatment, I thought to myself “With friends like that, who needs enemies?”
Well, here’s one to chew on: Let your oral health go and sure it may be expensive. That is, if you choose to get back into shape. Maybe even really expensive.
But, take care of yourself and – unless you have a serious accident – it’s very unlikely.
Statistically, I have found that patients who keep up with their bi-annual visits, have far less treatment that needs to be done. At times, an old filling or two may require replacement, but usually not a lot beyond that. That’s just normal wear and tear.
People who grind or clench their teeth often experience a higher need for dental work due to added stresses on their teeth, but we have solutions for this too.
All-in-all, having regular check-ups keeps the bulk of your hard-earned money in your pocket and not mine. Think about it. It’s just common sense.
While I believe you can find many useful tips on this site to help you improve your dental health, if there were only ONE thing I might impart to you that may help you achieve a more desirable oral condition – it would be to gain an understanding of the role your diet plays in the formation of tooth decay.
Over the years I have seen patients with good oral hygiene experience little decay and patients with poor oral hygiene experience the same. Conversely, I have seen several patients with excellent hygiene still experience problems with tooth decay. And of course, there are those patients with poor oral hygiene who, as one might expect, experience difficulties. Maybe it is all a matter of your genes, then?
If so, what about my genetically identical patients (twins)? One has virtually no tooth decay, whereas, the other has had a cavity in almost every other tooth in her mouth.
The difference, in virtually all of these cases is diet.
Patients with a tooth-friendly diet experience less decay than those who consume foods that are not good for your teeth. And, frankly, a tooth friendly diet is a body-friendly diet. So this begs the question: is tooth decay a problem of bacteria, or diet?
I believe both play their role. But you can control your diet and, to that degree, what you eat is most likely the very key to your dental health. Click on the links above to read about foods that are good for your teeth and those that are not.
Chances are that you have met someone with a dental implant and didn’t even know it. Completely natural looking, they have saved countless beautiful smiles. Dental implants are on the leading edge of technology and use special biomaterials – and they can be placed in only one or two office visits!
You may be a candidate for dental implants. In our office, we coordinate treatment with a periodontist who handles the first step of the procedure.
Implants are basically artificial tooth roots which anchor to surrounding bone and to which replacement teeth are attached.
The periodontist handles the first part of the procedure, which is placing the tooth root. Once that step is completed, I complete the second step which involves making the replacement tooth.
Permanent replacement teeth can be made translucent like natural enamel and are framed by your natural gum tissue.
Implants are long-lasting and reliable – and actually, quite cost effective. The cost to replace a single tooth with an implant is comparable to making a dental bridge. But, unless you’re 125 years old, most bridges will have to be replaced after several years. (Five to fifteen is the national average.) Implant crowns can last considerably longer because there is no natural tooth structure beneath them that can decay and if the crown comes loose, it is usually just a matter of re-cementing the crown.
Implants can replace one tooth, rebuild an entire jaw of missing teeth, or be used to secure dentures.
Cosmetic dentistry isn’t always just about good looks. Many of these treatments can improve various oral problems, such as correcting your bite. They are also not necessarily restricted to the teeth. Some people encounter problems with gum pigmentation or uneven gums. Periodontal procedures exist that address these difficulties as well.
Generally, cosmetic dental procedures include whitening, bonding, crowns, veneers, and the reshaping and contouring of teeth. If you have a cosmetic concern, it is a good idea to have heart-to-heart talk with your dentist and ask lots of questions. Among them:
What can I expect the changes will look like?
What should I experience throughout the course of treatment?
What type of maintenance will be required by me or by the dentist?
Television has certainly popularized cosmetic dentistry with such shows as Extreme Makeover and, at times, it can be as complex as a total smile reconstruction. At other times, cosmetic dentistry may be as simple as correcting the appearance of a single tooth. In short, it is what is right for you, what fits your budget, and makes you feel better about your smile!
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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You may be a candidate for dental implants. In our office, we coordinate treatment with a periodontist who handles the first step of the procedure.
