by Dr. Richard J. Walicki | Aug 28, 2024 | Dentistry
It’s a common scenario in dental offices: a patient comes in convinced they’ve lost a filling, only to find out there never was a filling in the tooth to begin with. Even more surprising, they learn that what they actually need is far more complex than a simple filling replacement. This post will explain why these misunderstandings occur and why they can lead to unexpected dental procedures.
The Hidden Culprit: Tooth Decay
Tooth decay can often go unnoticed, especially in its early stages. The outer layer of your tooth, known as enamel, doesn’t have nerves. That means that even as decay progresses, you might not feel any pain. This is why a cavity can sometimes reach a critical size or even affect the nerve without causing discomfort. On the other hand, when pain does occur, it can be severe—some even describe it as worse than childbirth. This is due to the type of nerve fibers (C fibers) in your teeth, which are primarily designed to transmit pain signals.
The Decay Dilemma: Misdiagnosed Loss of Filling
Many patients believe a piece of their tooth broke off because a filling failed, but in reality, it might be decay that has weakened the tooth structure to the point of breaking. When examining such teeth, it might appear, especially on x-rays, that the decay is dangerously close to the nerve (pulp) of the tooth. Attempting to remove this decay (caries excavation) often leads to the discovery that the pulp has been exposed, which necessitates further treatment like a root canal.
Complex Consequences: When Simple Fillings Aren’t Enough
If decay is extensive enough to warrant a root canal, the tooth will also likely need a crown to restore its shape, strength, and function. In some cases, if the tooth structure above the gumline is insufficient, crown lengthening might be necessary to properly anchor the new crown. These procedures, when combined, can be costly, which underscores the importance of regular dental check-ups to catch decay before it escalates.
Addressing Root Canal Concerns
One of the most common treatments for extensive tooth decay, where the decay has reached the nerve (pulp), is a root canal. However, some patients have fears about root canals, expressing concerns that they may be linked to systemic diseases, including cancer. It’s important to note that extensive research has yet to yield concrete scientific evidence directly linking root canals to any specific disease, but it must be acknowledged that it is difficult to conduct retrospective studies, and more research is needed. The idea behind root canals is to remove bacteria from the infected pulp, prevent reinfection of the tooth, and save the natural tooth.
Alternatives to Root Canals: Extraction and Beyond
For patients who remain hesitant about root canals despite current knowledge and practices, extraction is sometimes considered an alternative. It’s crucial for these patients to understand the consequences of tooth extraction, which include potential misalignment of the remaining teeth, changes in chewing function, and loss of jawbone density over time. If a tooth is extracted, options such as dental implants or bridges can be considered to restore function and aesthetics, though these solutions can often be even more invasive and costly than performing a root canal and crown.
Why Regular Dental Exams Are Crucial
During routine exams, dentists look for decay behind fillings, under crowns, and around bridge abutments—areas that are difficult to inspect without professional tools. Regular check-ups allow dentists to catch and address decay before it leads to more significant damage and more invasive procedures. Even with decades of experience, I’ve seen cases where the extent of decay under a crown or bridge wasn’t apparent until the restoration was removed, sometimes resulting in the need for an extraction.
Dental health can be deceptively complex, and what might seem like a minor issue can quickly escalate into something more serious. Understanding all available treatment options, including the benefits and potential risks, allows patients to make informed decisions about their dental health. It’s important for anyone concerned about the implications of dental procedures to discuss these worries openly with their dentist, who can provide evidence-based guidance and reassurance. Regular dental visits are essential for catching problems early, often before you feel any pain. Remember, maintaining your oral health is a critical part of your overall well-being.
by Dr. Richard J. Walicki | Aug 1, 2024 | Dentistry
Taking care of your oral health might seem unnecessary when you aren’t experiencing any pain or discomfort, but the truth is, many dental conditions are painless in their early stages. This contrast often leads patients to believe that their teeth and gums are perfectly fine, even when underlying issues may be developing.
The Silent Nature of Dental Problems
Most dental issues, like tooth decay and gum disease, begin without any noticeable symptoms. Tooth enamel, which is the hard, outer surface of your teeth, is predominantly mineral and the primary site where decay starts. Because enamel lacks nerves, it won’t hurt in the early stages of decay. By the time you feel pain, the decay has usually progressed to deeper layers of the tooth, often requiring more extensive and expensive treatments.
Similarly, bone loss, the leading cause of tooth loss, progresses quietly. You won’t feel bone loss happening, but it significantly impacts your dental health. Once bone is lost, it is almost impossible to regenerate it with the current state of dentistry. While some procedures like LANAP (Laser-Assisted New Attachment Procedure) offer promise for specific conditions, they can’t reverse horizontal bone loss.
Why Preventive Care is Key
Given the silent nature of these problems, it’s crucial to prioritize preventive care. Here’s why brushing after meals, flossing daily, and eating tooth-friendly foods are vital:
- Prevents Tooth Decay: Regular brushing and flossing remove plaque, the sticky film of bacteria that forms on your teeth. Plaque is the primary cause of tooth decay. By keeping your teeth clean, you can prevent decay from starting in the first place.
- Maintains Healthy Gums: Daily flossing removes plaque and food particles from between your teeth and under the gumline, areas your toothbrush can’t reach. This helps prevent gum disease, which can lead to bone loss and tooth loss if untreated.
- Strengthens Enamel: Consuming foods rich in calcium and phosphates can help remineralize your enamel, making it more resistant to decay. Drinking plenty of water and avoiding sugary snacks also support oral health.
Finding the Right Dentist for You
We recommend these practices not to scare you into the dental chair but because we care about your overall well-being. It’s important to find a good dentist who you feel comfortable with and who prioritizes preventive care. Regular dental check-ups are an essential part of maintaining oral health. During these visits, a dentist can catch and address issues before they become serious, helping you maintain a healthy, beautiful smile for life.
The Long-Term Benefits of Oral Health
Remember, a healthy mouth is a crucial part of a healthy body. Good oral hygiene habits can prevent a host of problems, from tooth decay to gum disease, and can even impact your overall health, reducing the risk of conditions like heart disease and diabetes.
By taking care of your oral health now, you’ll enjoy the benefits for years to come. Don’t wait for the pain to start—act today for a healthier tomorrow. Whether it’s brushing and flossing daily, eating a balanced diet, or scheduling regular dental check-ups, these simple steps can make a big difference in your oral and overall health.
Take Charge of Your Oral Health Today
Invest in your smile and overall health by adopting good oral hygiene practices now. Finding a dentist you trust can make a significant difference in maintaining your oral health and catching potential issues early. Remember, preventive care is the best care.
by Dr. Richard J. Walicki | Jan 29, 2024 | Cavities, Cavity, Communication, Prevention, Tooth Decay, Tooth Extractions, Tooth Loss
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.
by Dr. Richard J. Walicki | Jul 9, 2016 | Cavities, Cavity, Communication, Dentistry, Prevention, Tooth Decay, Tooth Loss, Toothache
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. . . .”
by Dr. Richard J. Walicki | Jun 17, 2016 | Cavities, Cavity, Communication, Dentistry, Periodontal Disease, Prevention, Tooth Decay, Tooth Loss
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
