Understanding Why Cavities Don’t Hurt Until It’s Too Late

Understanding Why Cavities Don’t Hurt Until It’s Too Late

It’s a scenario many of us have experienced: You visit the dentist for a routine check-up, expecting a clean bill of dental health, only to be told you have a cavity. But wait, you think, I didn’t even feel anything! How could this be?

The truth is, cavities often don’t cause pain until they’ve progressed to a point where significant damage has been done to the tooth. This phenomenon can be attributed to the structure of our teeth and the nature of tooth decay itself.

In the early stages of tooth decay, which typically begins in the enamel—the outer layer of the tooth—there is seldom any pain. This is because enamel is primarily composed of minerals and contains very few nerve endings. As a result, when decay is limited to the enamel, there are no nerves present to signal pain.

However, as decay progresses and reaches the deeper layers of the tooth, such as the dentin or pulp, where nerve endings are more abundant, pain may develop. By this point, significant damage has likely occurred, and the decay may have advanced to a stage where a root canal or extraction is necessary.

This delayed onset of pain can lead to a false sense of security for patients, who may delay seeking dental treatment until symptoms become unbearable. Unfortunately, by the time pain develops, the decay may have already caused irreversible damage to the tooth.

In many cases, dentists aim to intervene at the earliest signs of decay, typically opting for conservative treatments such as fillings, inlays, onlays, or crowns to restore the tooth’s structure and prevent further damage. These treatments are often successful in halting the progression of decay and preserving the tooth’s function.

However, there are instances where decay may be more extensive, and the decision to attempt restoration without a root canal may still be made. This decision is based on several factors, including the extent of decay, the condition of the tooth, and the patient’s overall oral health. While the goal is to preserve the natural tooth whenever possible, there are cases where restoration without a root canal may not be successful, leading to the need for additional treatment down the line.

Unfortunately, some patients may perceive the decision to attempt restoration without a root canal as inadequate care, especially if they experience pain or discomfort following the procedure. If the restoration doesn’t produce pain, this perception typically doesn’t arise in the patient’s mind. It’s important to understand that dentists carefully weigh the risks and benefits of each treatment option and make decisions based on what they believe is best for the patient’s long-term oral health.

By understanding why cavities don’t typically hurt until it’s too late and the factors involved in treatment decisions, patients can make informed choices about their dental care and work collaboratively with their dentist to achieve optimal outcomes. Prevention, early intervention, and open communication are key to maintaining a healthy smile for life.

I Never Thought It Would Happen to Me

I Never Thought It Would Happen to Me

I have little doubt that some patients who visit a dentist and are told they have decay, but don’t experience any symptoms, are convinced that someone is trying to pull the wool over their eyes.  There are probably several reasons for this.  Possibly, they had been to some unscrupulous person in the past who suggested they had a problem, when they really didn’t.

I can see how that might create skepticism. I mean, it’s conceivable that sort of thing could happen.

But even if that were the case, I sincerely don’t believe it represents the behavior of a majority of dentists.  Most of the dentists I know genuinely care about what they do and the people they treat.  So maybe these skeptics are just people who don’t trust anyone.  I don’t know.

The reality, though, is that these patients will eventually be in for a big surprise when the you-know-what hits the fan.  Or – and let’s keep this a family column — when the decay hits the nerve.

But that could take a while.

And I believe that could be where some of the problem lies. A  patient tries to use this to their advantage — they want to buy some time.  After all, it’s not really being a “problem” for them in that they don’t perceive anything as being different.  When the problem eventually does occur, I usually hear: “I never thought it would happen to me.”

A doctor detecting treatable decay usually recommends that the patient handle it at their earliest opportunity.

Why? Well, the patient can catch the problem when it is small, when it is less likely to cause post-operative discomfort, and when it will generally cost them a lot less.

But, first, let’s back up a little and explain why it’s possible to have a cavity – several in fact – and have absolutely no symptoms.

Most decay starts on the outer surface of the tooth called the enamel.  It’s roughly 97% mineral in consistency and does not contain nerves.  That means it has no feeling.  Practically zero.  Your dentist could DRILL on that part of the tooth and most of the time you won’t feel it.

Notice that in the earlier paragraph I mentioned “treatable” decay.  Well, when would decay not be treatable right away?  I can’t speak for other dentists, but I typically won’t treat decay when it is confined to the enamel.  Why?  It has the potential to re-mineralize.  In other words, it has the capacity to fix itself – that is, if you don’t continue to do the things that led to the cavity in the first place.  Usually, this is related to your diet, but it can be affected by hormones, or even medications.

Why not mention home care first?  Isn’t that important too?  Of course it is.  It just may not be the most important factor.

Another time a dentist might not treat a cavity could relate to the age of the patient. For a much older patient, there are times when the pain or infection are not likely to come up before the patient passes.  Of course, your dentist doesn’t have a crystal ball on that point.  (Well, probably not.) But, it wouldn’t make sense to recommend treatment in the majority of those cases.

And this takes us back to the nature of a cavity.  They often take a long time to get bigger. (But not always…. Again, no crystal ball here.)  The reason has to do with the hardness of the enamel itself.  Enamel, for you trivia lovers, is the hardest substance in your body.  It’s harder than bone, and that property, along with the lack of sensation, can be problematic.

Here’s why: a cavity is often quite small on the outside of the tooth.  It’s actually difficult for decay to work its way through that hard enamel.  Most of the time it burrows a narrow channel down to the dentin (only a couple of millimeters away) and then it really starts to spread.  Because dentin is softer than enamel, it’s just easier for it to spread more quickly there.  By the way, this additional, and deeper, decay – very often still doesn’t hurt – as long as it is far enough away from the nerve.

Meanwhile, your enamel is, for the most part, continuing to hold its form.  That stuff is hard.  But things are generally hollowing out on the inside of the tooth now — out of sight and out of mind — as the decay continues to spread. Painlessly.

Eventually, your tooth can become very much like an eggshell.

Then one fine day you bite on something, and the hard enamel that was still doing its job holding the form of the tooth caves into the hole below.  It just got too thin.

Now, at this point, does the skeptic understand that he got a cavity?  Sure.  Some of them finally get it.  But for others –no!  It’s more like: “Hey that blowhard dentist was obviously wrong because he talked about me having cavities years ago, and look – I did fine until now.  In fact, I probably just lost a filling!  Jeez, this hole just came out of nowhere.  It’s probably the fault of some earlier dentist.”  (Um, Mr. Skeptic never got the filling though.  Remember?)

“Hey doc, how much is this going to cost me?  $2,400?!!! (For a root canal, buildup and crown.) Are you insane?  Just pull it.”

Now you are going to be missing a tooth, and may lose even more teeth as a result.  Yet, when the doc first mentioned it, that cavity was only going to cost $150.  How can it suddenly become sixteen times more expensive?!

“Rip-off artist.  Seems you can’t trust anyone. . . .”

You CAN Take Care of Your Teeth

You CAN Take Care of Your Teeth

The idea that losing teeth is an inevitable part of aging is a common misconception. While it’s true that tooth loss occurs more frequently among older adults, it’s not a foregone conclusion. With proper oral care and preventive measures, you can keep your natural teeth healthy and strong well into your later years.

Why Tooth Loss Occurs

Tooth loss can be caused by various factors, including:

  • Gum disease: This is the leading cause of tooth loss in adults. Gum disease is an infection that affects the soft tissues around the teeth, eventually destroying the bone that supports them.
  • Tooth decay: This is caused by bacteria that build up on the teeth and form plaque. Plaque produces acids that can erode the enamel, the hard outer covering of the teeth. If left untreated, tooth decay can lead to cavities and eventually tooth loss.
  • Trauma: Injuries to the mouth or teeth can also cause tooth loss.
  • Other health conditions: Certain medical conditions, such as osteoporosis and diabetes, can increase the risk of tooth loss.

Preventive Measures

The good news is that you can take steps to prevent tooth loss and maintain healthy teeth for a lifetime. Here are some key strategies:

  • Practice good oral hygiene: This includes brushing your teeth twice a day for two minutes each time, flossing daily, and using a mouthwash.
  • Visit your dentist regularly: For professional cleanings and checkups.
  • Eat a healthy diet: Limit sugary foods and drinks, which can contribute to tooth decay.
  • Quit smoking: Smoking increases the risk of gum disease and other oral health problems.

In addition to these general recommendations, there are some specific things you can do to protect your teeth as you age:

  • Use a toothbrush with soft bristles: Hard bristles can damage your gums and enamel.
  • Consider using an electric toothbrush: Electric toothbrushes can be more effective at removing plaque and bacteria than manual toothbrushes.
  • Get regular fluoride treatments: Fluoride can help strengthen your teeth and prevent decay.

Myths about Tooth Loss and Aging

There are several common myths about tooth loss and aging. Here are a few of the most prevalent:

  • Myth: Losing teeth is a natural part of aging.
  • Fact: While tooth loss is more common among older adults, it’s not inevitable. With proper oral care, you can keep your teeth healthy for a lifetime.
  • Myth: You don’t need to see the dentist as often as you get older.
  • Fact: It’s important to continue seeing your dentist regularly for checkups and cleanings, even as you get older. Regular dental care can help detect and prevent problems early on.
  • Myth: There’s nothing you can do to prevent tooth loss.
  • Fact: There are many things you can do to prevent tooth loss, including practicing good oral hygiene, eating a healthy diet, and quitting smoking.

Losing teeth doesn’t have to be a part of aging. With proper care and preventive measures, you can enjoy a healthy smile for a lifetime. Talk to your dentist about ways to keep your teeth healthy and strong as you age.

Additional Resources

Full Dentures – Problems and Solutions

Full Dentures – Problems and Solutions

Millions of people worldwide wear full dentures.  While we often associate this aging, wearing full dentures is not just limited to older adults.  Illness, accidents — sometimes even pregnancy — can contribute to tooth loss and, in a number of cases, this affects younger individuals as well.

Young or old, the psychological consequences of losing teeth can be severe.

Several studies have suggested that a smile is very often the first thing people notice about another person.  So, losing one’s teeth can be devastating in a variety of ways.

Toothlessness may affect digestion. This, in turn, can influence nutrition and health.   There can be issues with self-esteem, intimacy, and a host of other areas most people wouldn’t normally take the time to consider.

This is stressful enough.  But having to now replace the teeth can also become stressful for some.

Many people worry about whether they will be able to eat with their dentures.  Will people notice that they are wearing them?  Will they sound funny when they speak?  Will it hurt to eat with the dentures? Will they be able to chew their food?  How will the dentures affect the ability to taste food? Will the dentures slip when they talk?  What can they afford?

Denture Profile

Dentures

These are natural concerns, but for the first-time wearer, they add up to a lot of unknowns.

The truth is that no two situations are alike. But almost all denture challenges have solutions.

Another thing to consider is that there are many ways to go about addressing total tooth loss.  The solutions depend upon a person’s preferences, financial options, and — frankly — anatomy.

If a person were building a house and they decided to hire an architect, the architect would undoubtedly first gather a lot of information about the project.  For example:  Where is he going to be building? What does the client want: a log cabin or a mansion?  What does the foundation look like?  What is the client’s budget?

In some ways, restoring a person’s smile is not too dissimilar.

For the person without teeth, they may be surprised to learn that there are multiple ways to go about replacing the teeth.  The length of time will vary with each approach, as well as the cost.

To help clarify the options and give some sense of the costs, I put together a free report that helps discusses different levels of care, from simple to more complex. Included is a sense of the pros and cons of each approach, and a general price range at today’s rates.  Of course, this can vary widely from area to area and doctor to doctor.

Dentists Need to Know Your Supplements

Dentists Need to Know Your Supplements

A friend of mine recently sent me the link to this video: Dentists Need to Know Your Supplements, and I found it somewhat timely.

As readers of my blog may know, I have long been an advocate of dietary supplements.  While the ideal form of nutrition is always a healthy diet, today’s food is simply not the nutrient-rich, non-chemically altered, or non-genetically engineered food our grandparents ate.

While that might just be a topic for another discussion, I want to point out that whereas supplements have their place, it is always prudent to understand what you are consuming and what potential effects it may produce.  This advice holds equally true for vitamins and herbs as it does for medications.Supplements

While the side-effects of supplements are typically far less dire than those encountered with many common medications, there can be side-effects nonetheless — especially when used in combination with medications.

As dentists, we are particularly interested in knowing what herbal medications a patient takes that may cause drowsiness, excessive bleeding, cardiovascular problems or that interfere with other drugs.

Here are a few examples:

  • St. John’s Wort, used as a mood enhancer, can interfere with the effectiveness of many heart and blood pressure medications, as well as blood thinners.  On the other hand, garlic, ginseng, ginger, chamomile and gingko, to name a few, can cause bleeding after surgery.
  • A patient given sedatives by a dentist or oral surgeon before surgery who is also taking Valerian root and kava may experience an interaction that causes excessive drowsiness.
  • Ginseng has been associated with an increased chance of arrhythmias (irregular heart beats.  Patients who take ginseng and also get a local anesthetic with epinephrine (commonly used for fillings and many other dental procedures) may be putting themselves at risk for cardiovascular complications.
  • Echinacea, while it is widely considered to be an immune system enhancer, may inhibit wound healing and increase the risk of post-surgical infection.

This list is by no means exhaustive, and the simple message here is just because an herbal remedy is considered “natural” doesn’t mean you should neglect to inform your dentist that you are taking them.  Neither he nor you want to risk negative effects or complications that can come about as a result of interactions.

Doctor & Patiet CommunicationMore likely than not, your doctor will simply ask you to stop taking a particular supplement before surgery or modify the anesthesia accordingly.

Good communication is the key.

Here is another example of this point.  Not uncommonly, patients take “baby aspirin” as a blood thinner.  Of course, this is not an herb, but many people feel it is not worth mentioning because it is just a “baby” aspirin.  That is, until they fail to stop bleeding after an extraction.

You should always be sure to tell your doctor about ALL of the substances you are taking, including prescriptions and over-the-counter drugs.  Even doctors aren’t always fully aware of every potential interaction between herbs and drugs, as new drugs are constantly being developed and introduced into the market.  It is in your best interest to let your doctor “know before you go.”