All of the dark staining in these teeth are cavities! And the black spots between the white filling and tooth can be easily repaired at this early stage by resealing the filling edges…painfree!

When I was in dental school (a long time ago!), we were taught to “just watch and wait” in cases of early suspected cavities unless our dental pick really “got stuck” in a darkened pit in the tooth.  At the time, the only materials we had to fill these teeth (silver amalgams or gold) had to be a certain depth and thickness to be strong enough to be long-lasting, and treating teeth in the earlier stages of cavity meant to remove a lot of healthy tooth just to make a strong-enough filling. So, we noted dark, stained grooves in our patients charts, and months or years down the road when those very small areas became big, we could fix them with the materials we had.

Many dentists no longer use silver amalgam or gold to fill teeth, but composite resins and porcelain instead (like in our office). This gives us the chance to treat teeth in a very conservative way, only removing the diseased and infected part of the tooth and replacing that with something strong and beautiful.

Did she say “infected and diseased”?

Media aimed at patients has long taught that the bugs in our mouths use the sugar we eat to chew holes in our teeth. It was explained that way to be very simple to understand, but with much research we have a clearer picture of what actually happens. The bacteria causing cavities is called Streptococcus Mutans, and this uses the food left behind on your teeth to create acid. It is this acid which weakens the tooth and allows the bacteria to go deeper into your tooth. Once the outer layer of the tooth (enamel) is infected with this bacteria, the infection will spread to the inner, softer layer of tooth (dentin). Once deep into the tooth, the infection and acid spread much more quickly, creating a great deal of destruction of the healthy tooth.  Like any other area of infection in your body, it can spread to neighboring teeth or anywhere else in the mouth.

Can early cavities be reversed?

Of course every patient wants to be able to correct this problem without another dental visit! The answer to this question is…yes, and no. If the infection in the tooth shows on the smooth surfaces of the tooth on the cheek side or tongue side of the tooth, using a prescription toothpaste or a prescription high-fluoride gel can strengthen the enamel and hold the progression of this disease at bay…IF the patient changes diet habits and oral cleaning habits. However, there is no scientific research to date supporting the use of these medications to reverse cavities starting on biting surfaces of the teeth.  There has been some promising research on the use of specially-formulated xylitol (a plant-based sweetener) products, and there are many gums and other products containing this compound. At this point, our office recommendation is…it can’t hurt! But we do recommend against using xylitol products as a means to avoid dental work.

The last dentist didn’t find these cavities…

Laser cavity finder helps patients.

The laser can “see” into a tooth way farther than the dental pick can reach, helping us diagnose cavities much earlier!

To be honest, most dentists really don’t want to find anything wrong with your teeth, especially when you don’t have any pain. However, our job is to tell you about everything we see, and recommend how to best treat it. So…why didn’t that dentist who saw you last year see these cavities? How did that dentist “look” for cavities? The typical “dental pick” misses early cavities more than 75% of the time! X-rays only show cavities on the biting surfaces of the teeth when they’ve destroyed more than 1/3 of the surface…do you want to wait that long? Many dentists now use a variety of diagnostic tools in addition to the dental pick, including magnifying lenses, extra-bright lights, photography, and even lasers to help us find these cavities when they’ve destroyed the smallest amount of tooth.

If the cavities are so small, do I have to get them fixed?

Of course, the decision to treat should lie with each patient. However, you came to the dentist because you wanted to have a healthy mouth, and your dentist has given you advice on how to achieve that goal! Treating early can mean less discomfort and more conservative treatment now (which can also be less expensive) vs. the possibility of more discomfort and less conservative treatment (which can be more expensive) later. Which sounds better to you?

Dr. Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario. If you have dental questions, you can call her at 613.271.7091.