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

What You Need to Understand About Cavities

What You Need to Understand About Cavities

Is it possible to have a cavity and not know it?

Understanding

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:Cavities

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.

Don’t Wait for Tooth Pain to See Your Dentist

Don’t Wait for Tooth Pain to See Your Dentist

Recently, I saw four new patients in my dental office during a given week. All four of those patients scheduled their visits because they perceived pieces of their tooth chipping away. In three out of four of those cases, the offending tooth was so badly decayed that the tooth couldn’t be saved. Yet only one of those patients came in with any discomfort.

The common thread in each of these cases is that the patient waited until the tooth was actually breaking apart to seek dental care. All too often, the trigger that brings people to the dentist is pain. Yet here, we had at least three cases where pain was not a factor and yet the tooth was decaying.

How is this possible?

A little understanding of dental anatomy helps here. The outer layer of teeth, the enamel, is the hardest substance in your body. Because its composition is predominantly mineral, it is possible to have decay throughout that layer without experiencing any sensation. In fact, it is even possible for your dentist to drill that part of the tooth (in most cases) without pain. The next layer under your enamel is called dentin. Decay can travel into the dentin – where it usually spreads more quickly, because it is not as hard – and a person still may not experience pain.

By the time a tooth that is decayed hurts, the decay has generally travelled so far that it nears the innermost layer – the pulp. The pulp contains nerves and blood vessels – so, naturally, pain becomes a factor. If a patient is lucky enough to have enough tooth structure remaining, chances are that the tooth will need a root canal if it is to be saved. Otherwise, extraction is the usual alternative.

One lost tooth can lead, in turn, to still other dental problems. Most notably these include shifting teeth, TMJ problems, periodontal problems, cosmetic difficulties or simply difficulty chewing. It may even lead to the loss of more teeth – not to mention the fact that tooth replacement options can become rather expensive.

Hopefully, just understanding that a lack of pain does not equate to a lack of problems will prompt some readers that haven’t seen a dentist in a long time to do so. Sometimes people fear learning that they have cavities that need to be treated, and so they put off the examination. Consider, however, that it is better to learn you have five teeth that need fillings, than to learn you have several that have to be extracted.

 

Why You May Have a Cavity (or Even Two, or Three) and Not Know It

Why You May Have a Cavity (or Even Two, or Three) and Not Know It

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 at the bottom of this post.

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.

Tooth Anatomy