It’s a scenario that can surprise even the most diligent dental patient: your dentist removes an old crown, and beneath it lies a significant amount of decay. This decay, often hidden from view and undetectable through regular dental X-rays, can pose a serious threat to the tooth’s structure and health. When this happens, several treatment options must be considered based on the extent of the decay, the location of the tooth, and various patient-specific factors.
The Discovery of Hidden Decay
The discovery of hidden decay under an old crown typically occurs during the removal of the crown for replacement or due to discomfort reported by the patient. The decay might have developed due to a poor fit of the old crown, inadequate oral hygiene, or other factors. When a dentist uncovers extensive decay, immediate steps must be taken to address the damage and decide on the best course of action.
Evaluating the Extent of Decay
Upon discovering the decay, the dentist will assess the extent of the damage. This evaluation is crucial to determine if the tooth can be saved or if extraction is the most viable option. Factors that influence this decision include:
Amount of Remaining Tooth Structure: If there is insufficient healthy tooth structure left, saving the tooth might not be possible.
Location of the Tooth: The position of the tooth in the mouth can influence the treatment choice. Front teeth have different functional and aesthetic considerations compared to molars.
Patient Preferences and Health: Patient’s overall health, preferences, and age also play a significant role in deciding the treatment plan.
Treatment Options for Extensive Decay
Crown Lengthening:
Crown lengthening is a procedure that involves reshaping the gum and bone tissue to expose more of the tooth’s structure, providing a stable base for a new crown. This can be a viable option if there is enough tooth structure to support the procedure.
Case Example: Recently, a patient with extensive decay under an old crown on tooth #31 opted for crown lengthening. The old post was removed, a new post was placed, and a new buildup was done. The use of a CO2 laser facilitated the process, making it efficient and precise. The tooth, being out of the esthetic zone, allowed for a focus on functionality over aesthetics.
Extraction and Replacement Options:
If the decay is too extensive, the tooth may need to be extracted. Post-extraction, several replacement options are available:
Ridge Preservation and Guided Tissue Regeneration (GTR): These procedures help maintain the bone structure and prepare the site for an implant. Ridge preservation involves placing bone graft material into the socket immediately after extraction to prevent bone loss. GTR may involve the use of membranes to guide the bone regeneration process.
Dental Implant: Implants are a popular and effective solution for replacing a missing tooth. They provide a permanent, stable replacement that looks and functions like a natural tooth. The success of implants depends on the amount of available bone and the patient’s overall health.
Dental Bridge: A bridge is another fixed option for replacing a missing tooth. It involves placing crowns on adjacent teeth and a false tooth in between. Bridges can be a good alternative if implants are not feasible.
Removable Partial Denture: Although typically less popular, removable partial dentures are a cost-effective solution. They can be taken out and cleaned easily but may not offer the same comfort and stability as fixed options.
Why Address Hidden Decay Even If Asymptomatic
Many patients might wonder why they need to address decay if they don’t feel any pain or see visible problems. Here are some crucial reasons:
Prevent Further Damage: Untreated decay can continue to progress, leading to more severe damage that can compromise the entire tooth or even adjacent teeth.
Avoid Infections: Decay can lead to infections, which might require more intensive treatments like root canals or extractions.
Maintain Oral Health: Treating decay early helps maintain overall oral health, preventing more complex and costly dental issues down the line.
Aesthetic and Functional Integrity: Even if a tooth is out of the esthetic zone, maintaining its functional integrity is vital for chewing and overall dental alignment.
Long-Term Savings: Addressing dental issues promptly can save money in the long run by avoiding more extensive procedures.
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Discovering extensive decay under an old crown is a challenging situation, but modern dentistry offers several viable solutions. The chosen treatment depends on the extent of the decay, the location of the tooth, and patient-specific factors such as health, preferences, and financial considerations. By evaluating all options, your dentist can help you make an informed decision that ensures the best possible outcome for your dental health and overall well-being.
If you suspect any issues with your old crowns or have concerns about your dental health, consult your dentist. Addressing problems early, even if asymptomatic, is key to maintaining a healthy and functional smile.
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.
Forget fancy gadgets and serums, the secret to a dazzling, lifelong smile lies within ourselves, nestled around our pearly whites – tooth enamel! This powerhouse mineral, stronger than bone, shields our teeth from daily wear and tear. But how do we keep this natural wonder strong and shining without relying on traditional methods like fluoride?
Enamel Empowerment:
Food for Champions: Embrace calcium-rich heroes like leafy greens, sesame seeds, and dairy products. These power-up your enamel with building blocks for resilience.
Hydration Heroes: Water is your enamel’s best friend! Swig it regularly to wash away food debris and neutralize acidic foes.
Brushing Brigade: Brushing after meals with a gentle, non-fluoride toothpaste is key. Choose options with xylitol, a natural sweetener that fights bacteria. ️
Flossing Force: Don’t underestimate the power of daily flossing! It removes plaque and food particles hiding between teeth, where brushing can’t reach. ️
Dental HQ Patrol: Regular visits to your dentist are essential for early detection and treatment of any enamel concerns. Think of them as your smile’s pit crew!
Stress-Busting Techniques: Grinding your teeth at night? Stress can be hard on enamel too. Explore relaxation techniques to calm your mind and protect your smile.
Bonus Pro-Tips:
Say Cheese (in moderation): Believe it or not, cheese can help neutralize acid after meals. Enjoy a bite, but remember, balance is key!
Sugar Savvy: Limit sugary treats and acidic beverages. Opt for natural sweeteners like stevia or monk fruit in small amounts.
Say No to Smoking: Smoking weakens enamel and stains teeth. Ditch the habit for a healthier, brighter smile!
Remember, a strong enamel foundation starts with small, mindful choices. By prioritizing natural sources of calcium, maintaining good oral hygiene, and managing stress, you can pave the way for a dazzling, resilient smile that lasts a lifetime! ✨
Many people believe that since they aren’t experiencing dental symptoms – like tooth pain or bleeding gums – then all must be well.
Unfortunately, a sizable number of dental problems, including cavities and periodontal disease (bone loss around your teeth), just don’t produce obvious symptoms in their early stages. At least not symptoms that tend to be obvious to patients.
In fact, by the time people the average person experiences pain, his dental issue is typically pretty far along. And all too often, by then, the problem can also be quite expensive to handle.
It might amaze you to discover the types of problems your average dentist encounters every week, many of which you would expect to be painful, but they just aren’t. They can still result in tooth loss though.
Pretty much anyone who has ever worked in a dental office for any length of time will tell you this is so. And they will tell you that you can inform some people that they have a problem, but unless it is “real” to them, they just won’t do anything about it.
They may come back a few years later (or maybe sooner) – usually with an emergency – desperately wanting to save the tooth that you told them about earlier. Of course, by now, it may be too late. And very often they will have forgotten it was ever discussed at all, because it was never a realistic problem for them to begin with.
Human nature can be funny that way.
So, keeping that in mind, it’s generally a good idea to get checked out by a dentist. Regularly.
The best news you can hear is that everything looks great.
But sometimes getting a confirmation that you don’t have cavities or gum disease is not the only reason to get a dental exam. Over the years, I have detected cancer (not just oral cancer) – as well as a host of other non-dental problems – that might have been overlooked had the patient not scheduled an exam. Obviously, we refer patients to an appropriate specialist for treatment when we discover medical problems outside the scope of dental practice.
Other benefits of getting a dental exam: I can recall many patients who told me that what they thought were unrelated health problems simply resolved when their oral problems were gotten under control. These have included digestive problems, low energy problems, elevated blood cell counts, hypertension, and more.
Over the years, some people have told me they don’t want to get a dental exam because they don’t want to discover they have any problems. I guess that works.
Just maybe not too well.
Your overall health is connected to your oral health. Take a look at this infographic. Then think it over. . . .
So it’s always gratifying when a patient can leave my office joking and smiling after the experience, such as happened in my office two days ago.
In fact, another patient, actually gave me a big hug after her extraction the following day.
And that got me to thinking about this entire area. . . .
No one (usually*) wants to lose teeth. And we, as dentists, don’t want people to lose them either, but sometimes there is little choice if a tooth has been allowed to get bad enough, or if periodontal disease is so advanced that there is no hope of reversal. [*Though, I did have a young boy actually request a tooth extraction last week — but I’m pretty sure he was really hoping for a visit from the tooth fairy. ]
Nevertheless, I see many people really work themselves up over the thought of the procedure. In fact, the first patient I mentioned actually rescheduled her original appointment when she learned she needed the extraction. She had a hard time confronting the idea of removing her tooth.
Trust me. I get it.
But, to her credit, she did show up for her appointment and when we were done – as I have heard so many times before – she said: “I can’t believe I worked myself up for that.”
Even with her tooth being so badly decayed that there was barely anything to get a hold of, her experience was pretty quick and painless.
So, her worry was just stress on top of stress.
My first piece of advice on this point is try not to need an extraction. Toward that end, try to keep up with regular dental visits, eat a healthy diet, and don’t forget — you control your home care. But, if you do need to have a tooth removed, talk to your doctor about your concerns.
In most cases, your anticipation of what is to come will be far worse than the experience. Still, delaying the inevitable is seldom a good thing. It can make it harder for the doctor too. So why not just make it easier on everybody?
Common sense. Does it seem to you that this has become a rare commodity nowadays? Possibly, then, it is really uncommon sense that we should be talking about.
The latest example of an affront to logic – at least for me – lies in the latest media challenge to oral health. This morning various news agencies including The New York Times, suggested that maybe flossing is really overrated. Apparently, “officials” have never researched the effectiveness of regular flossing.
Now, millions of people are likely to jump on this as a justification for not flossing. But, in reality, the new media sensation is probably not going to change very much at the end of the day. Why? Because I can confidently tell you – based on more than 25-years of personal experience – most people don’t floss anyway. About all this latest “research” will promote is the possibility that some people will feel just a little less guilty about what others with any sense (common or uncommon) already understand is a pretty good idea.
But, it makes for good press. Doesn’t it?
Just for the sake of argument, let’s assume that flossing doesn’t remove plaque. Heck. Some people fail to remove plaque with a toothbrush. That doesn’t mean either fails to benefit the patient, if done properly. I can think of several reasons why flossing helps, though:
Passing floss between the teeth sweeps out the contact point between them – meaning the points where they touch. That’s a source of about 30% of all tooth decay. Your toothbrush typically doesn’t reach those areas, unless you have gaps between your teeth. Floss does reach those areas.
Flossing stimulates blood flow in the gums. One of the body’s first-line mechanisms of defense is to increase blood flow to an affected area. You are effectively helping your body do this in a controlled manner by flossing.
A number of the bacteria under your gums are anaerobic bacteria. That means they don’t grow in room air. So what is a person introducing into the gum pocket when they pull back their gums by flossing? Could it be . . . air? Is it possible that the oxygen in the air could kill some of those bacteria as well?
Think about it.
If we can set aside this newly created question of doubt for just a moment, I would propose that you ask yourself the following question:
“Have I ever flossed consistently?”
By this, I mean every day, and it would have to have included doing so for at least two weeks.
This question is particularly directed to someone if they ever had a gum problem like gingivitis or periodontal disease. Sure, one needs to get rid of tartar and control bacteria as well, but for patients that make the effort to floss (and with only a few qualifications that I can think of), it is almost a sure bet that their gums got better as a result of the daily exercise. First of all, the gums probably bled less afterward. Not in the beginning – to be sure – but after about two weeks of flossing every day, we typically see positive change. Breath improves too. An overall sense of well-being is not out of the question either.
When it comes to flossing sporadically, I agree. It doesn’t help much. It’s kind of like exercising once or twice a month. And let’s face it, that’s where most of the population lives when it comes to flossing — once in a blue moon. Is regular exercise effective, though? What does your common sense tell you?
Why would I hold on to this idea in the face of “new evidence”? Well, I have seen flossing help too many times to just call it a coincidence. Hard core scientists might say “Oh, well, that’s just anecdotal evidence. It doesn’t stand up to real scientific scrutiny.” OK. Then survey practicing dentists. Let’s see if I’m the only one with that observation and experience. I doubt it.
I’m not saying flossing is the only thing you need to do to have healthy gums. It isn’t. Diet and good nutrition are paramount. A healthy immune system doesn’t hurt either. But for Pete’s sake, flossing is cheap, really not all that hard to do once you have practiced it for a while, and it can end up saving you a lot of money in the long run. With health care costs being what they are, I can’t think of too many actions a person can take that bear as much fruit and keep money in their pockets.
But, if the media has just succeeded in making you feel better about not flossing, then OK. Bully for them. (Heaven knows, they do a top notch job spending most of their time getting people to feel less than great.)
And, I suppose there are other ways to handle tooth loss – which, by the way, happens a lot more from gum disease than tooth decay.
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. . . .”
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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