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

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.

Dentures: Holding On or Letting Go?

Dentures: Holding On or Letting Go?

I’m willing to bet that many people have a favorite pair of shoes – worn, comfortable, familiar. But what if those shoes start causing more harm than good? The same can be true for dentures, especially when we cling to them long after they’ve overstayed their welcome. In my years as a dentist, I’ve seen countless patients holding onto ill-fitting dentures. Often, the only reason they were I my office at all is that they were brought in by concerned family members who noticed that their dentures looked more like dancing puppets than teeth.

Holding on to dentures for too long is like driving a car with bald tires. You might convince yourself it’s okay, but the risks lurk beneath the surface. Over time, dentures lose their fit as bone recedes, causing instability and potentially painful sores. And let’s not forget the impact on digestion and even your appearance. That sunken profile you’ve gotten used to? A new, properly fitted denture can restore it, sometimes even shaving years off your look.

The American Dental Association recommends a refresh about every five years. That could be a reline or a remake, to keep your dentures in harmony with your changing mouth. Some scoff at that, claiming their ten-year-old choppers are doing just fine. But here’s the secret: small, incremental changes are much easier to swallow than a giant leap many years down the line. When you update regularly, the transition is seamless, like slipping into a well-worn but freshly polished pair of shoes. When you wait fifteen, twenty, or twenty five years before replacing dentures, getting use to the new set can seem impossible.

Implants offer a revolutionary option for some, anchoring dentures like sturdy roots. But not everyone can or wants to go that route. For them, the choice boils down to two paths: hold on to the familiar, wobbly comfort, or take a leap of faith with new dentures.

Today, I wear a different hat. Experience has taught me to read the situation, to gauge whether my efforts will truly benefit the patient. If stubbornness trumps logic, it might be time to let go of the case, especially if it doesn’t appear that any help will be well received. But for those open to rediscovering the joys of proper fit, improved digestion, and a revitalized smile, I am ready to guide them on that journey.

Holding onto old dentures, like those worn-out shoes, can be tempting. But remember, comfort shouldn’t come at the cost of your health and well-being. Talk to your dentist, explore your options, and embrace the possibility of a brighter, healthier smile. After all, sometimes, letting go is the best way to move forward.

When was the last time you had a dental exam?

When was the last time you had a dental exam?

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. . . .

Do Dental Implants Make Financial Sense?

Do Dental Implants Make Financial Sense?

Because tooth-loss so often creates long-lasting and generally negative effects for personal health and, not infrequently, appearance – the entire array of tooth replacement options has long been an important subject in the dental field.  Dentists not infrequently discuss which options are best for their patients, given different circumstances.  And if there is any debate in the profession at all, you can be sure the public will also question which options make the most sense for them.

The truth is there is no one right answer.  Each person’s circumstances differ – whether the reasons are anatomic, functional, emotional, or financial.

But the question is still an important one to ask, because patients face new realities when they lose even one tooth.  These changes include (but are not limited to):

  • Difficulty chewing
  • Altered speech
  • Food impaction
  • Jaw pain
  • Drifting teeth

And, then there are the secondary effects:

  • Poor health resulting from a changing diet
  • Compromised appearance
  • Self-consciousness/embarrassment
  • An inability to wear dentures
  • Financial challenges created by the need to address these problems

It is this last point that I want to touch upon here, because I have observed a good deal of confusion surrounding dental implants.  As a dentist, I am obligated to review all options with an individual when discussing their tooth replacement options – regardless of affordability.  I can’t, and don’t, pre-judge anyone financially when discussing their choices.

Commonly, though, when I raise the subject of dental implants, I get an immediate reaction along the lines: “Oh, forget it. I could never afford that.  How about a bridge?”

Now, I’m not going to try to convince you that implants are cheap. Restore a full mouth with dental implants and it is likely to be costly.  Nevertheless, cheap is relative.  For some of my patients, even a small filling can be perceived as expensive.  For my wealthy patients, they might be prepared to spend any price for what they perceive will serve them best.  Lucky them.  Right?

What I hope to do here, however, is to show you when an implant may make the most sense for a person. And — at least, when when it comes to replacing a single tooth — a dental implant may just be the way to go.

But first, permit me to remind you again – there is no one right answer for everybody.  Your choices may be very different depending upon whether you are 25 or 85 years old, for example.

I’m sure you can fill-in still other reasons that affect your decision-making process.  But for now, let’s consider the following scenario:

A patient loses one tooth.

For the sake of argument, we’ll call it a lower right first molar.   Suddenly, the patient realizes this is annoying.  Their bite is changing; their gums are sore.  They feel the need to do something.  Now.

Here are a few options. I’m just going to list the main ones, but there are sub-sets to some of these:

  1. Do nothing anyway.
  2. A removable denture.
  3. A non-removable bridge,
  4. A dental implant.

For the purposes of this discussion, the patient has already decided that doing nothing isn’t working for them.

So, the next option is a removable denture.  I usually get “the face” on this one.

And with good reason.  Food gets caught around partial dentures every time you eat.  You will have to remove the appliance after EVERY meal and clean it separately from your own teeth.  Certain foods will also cause it to dislodge as you eat, allowing some of the food to get caught between the denture and your gums.  The cost – depending upon what kind of partial you have made – will typically range between $750 and $1,500. The recommended replacement time: every 5 to 7 years.  The reality – people replace them roughly every 15 years.  Sometimes more.  The longer they put off the replacement though, the more issues they may face with the replacement.

Bottom line:  Removable dentures are potentially uncomfortable.  Average lifetime replacement cost if you are 25 years old, (based on an average life expectancy of about 79 years, and an average 10-year replacement rate – not adjusting for inflation) is going to be nearly $7,000.

Next, we’ll take up considering a “bridge.”  It’s called a bridge because it spans a gap (like a bridge spans a body of water) with a fake tooth, or teeth, in between the ones that are still there.  The trouble is that you must shave down the supporting teeth to little stubs so that the result will look natural and be strong enough to take the force of daily chewing.  For the most part, bridges look, and can often feel like, your natural teeth; but you do have to floss under the fake tooth after every meal.  Food will get caught under there, whether you perceive it or not.  If you don’t clean it regularly, the life expectancy of your bridge will be shorter.

Now, the cost on this option can really be widely variable, because some teeth need to have fillings replaced before they can be used as supports for the bridge.  In other cases, the teeth may end up with root canals if the process of shaving them down results in lingering sensitivity.  This doesn’t always happen, but it is a risk.  If the tooth needs that additional treatment it will cost you more.

The average cost to replace a single tooth with a bridge is about $3,500.  Again, that can be a little more, or less, depending upon what part of the country – or even what part of a city, you live in.

If, on the other hand, you also need to place or replace fillings on the teeth being used as supports, and you need to do root canals as well, it could be as much as $7,000.

Roughly, double.

The average lifetime replacement cost with the same parameters given above (25 years old with an average life expectancy of 79 years and a 10-year average replacement rate) is going to be: $31,500.  And that assumes that the underlying teeth will be strong enough to survive that many replacements.

That brings us to dental implants.

Here is the breakdown:  The average implant cost in many metropolitan areas is around $1,800 – $2,200.  If you end up needing a bone graft before the implant can be placed, though, add another $550.  (Basically, a graft is adding bone to your jaw when you don’t have enough for the implant.) So far, these costs are just for the implant.  It doesn’t include the cost of the crown.  Add about another $2,100 for the parts needed to make up what supports the crown above the gumline, and the crown itself.  If your tooth is short, and there isn’t enough tooth height to which your crown can be easily cemented, you might need something called a UCLA abutment — it lets your dentist screw down the crown instead of cementing it.  That could cost you more.  How much depends upon the lab your dentist uses, but $500 more wouldn’t be unusual.

On the low end, one implant may cost $3,900.  On the high end, let’s round up to $4,900.

So, what about the average lifetime cost?

$4,400.

That’s less than either partial dentures or bridges!

Why?

Because, unless you bite into a rock, grind your teeth uncontrollably, or have some serious illness that causes you to lose bone around the implant – any of which can happen to you with the other options as well – you will probably have your implant for life.  Still, no one can guarantee this because, sometimes, plain ol’ dumb luck will factor into any equation.

But, you can’t get a cavity on an implant.  On the other hand, you still can get a cavity on the teeth that support your partial denture, or bridge (and crowns, for that matter).

So, do the math.  Look at your circumstances, and decide what is right for you.  But when your dentist starts talking to you about dental implants, hear them out.  It just might be more cost effective than you realize.

[Note: The prices mentioned here are just averages in US Dollars at the time of this writing.  Actual costs could be more, or less, depending upon where you live.]

Tooth Extraction Stress

Tooth Extraction Stress

In my experience, extractions freak people out.

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?

And relax.  It’ll be ok.