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I am relatively new to my area, so after moving away from my dentist of 27 years, I had to find a new dentist. I have seen 4 dentists in this area, in an attempt to find a good dentist I trust. They are all considered top dentists via various sources.
I had full mouth exams with all of them, with no x-rays.
I have not had a cavity in 15 years, so I was surprised when two of them said I had a cavity in a particular tooth.
But the other two said I had no cavities. How is this possible that dentists can disagree on what is a cavity or what is not? They all have between 10 and 40 years of experience as dentists.
Should I get a fifth opinion? After my recent horrible experience with dental work, I am hesitant to get this filled if there is such disagreement on what it is. One dentist said the "cavity" was tiny and shallow and that I wouldn't even need novacaine to fill it.
I'm surprised you didn't get xrays. That's the first or second thing they usually require. But I know what you mean about dentists...I also decided to find one in the town where I live. After this little experience I'll be looking for another one. Some are really big on sales pitches and I don't need or want that.
Um...Look at the x-ray yourself? My dentist explained to me the cavity and I knew there was one there after "the hook" (ugh..hate the hook) But I could also see darkness on the x-ray. I would just keep an eye on it and be aware of sensitivity issues. If it gets bigger/gets sensitive, go back. What about asking around at work for what dentist people go to? Thats what I did..I made a bee-line for the woman with the perfect teeth. LOL
A cavity is a softening of the enamel and/or dentin to the point where remineralization (rehardening) cannot occur. So why is it so difficult to agree on it? Because it's a biologic process. With any bodily function, it isn't as clear as yes/no. It requires interpretation of the limited number of signs viewable that do not fully express what is happening on a microscopic level.
Bacteria in plaque release acids as a byproduct of sugar metabolism. These acids cause a chemical reaction in the enamel to release minerals (hydroxyl, calcium, and phosphate ions) which soften the enamel. If the superstructure of the enamel remains intact, the tooth can remineralize, especially with fluoride around (i.e. toothpaste). However, when the damage is so bad that the superstructure is degraded, the tooth cannot remineralize and a "cavity" forms. Because the damage cannot be repaired, plaque and bacteria will penetrate this defect and continue the process of breaking down the enamel and dentin. So as you can see, a cavity is a microscopic process---you'd need to extract your tooth, cut it up into slices, and view it under a high powered microscope to see what's really going on.
But the reality is that this can't be done. So dentists are limited to detecting cavities using macroscopic processes---e.g. visual, x-rays, instruments, and diagnostic devices such as a Diagnodent. How accurately do these "tools" reflect what's going on at the microscopic and histologic level? When the cavity is small, it's not that accurate. So why don't we get something more accurate to use? Well, no one has developed such a device. It's also not likely that one will be developed because of the limitations of current scientific technology.
In summary, because none of the dentists can see at the microscopic level, you're never going to get 100% agreement on whether you have a cavity or not, unless the tooth has a big hole in it. But then you wouldn't need a dentist to tell you that you have a cavity.
A cavity is a softening of the enamel and/or dentin to the point where remineralization (rehardening) cannot occur. So why is it so difficult to agree on it? Because it's a biologic process. With any bodily function, it isn't as clear as yes/no. It requires interpretation of the limited number of signs viewable that do not fully express what is happening on a microscopic level.
Bacteria in plaque release acids as a byproduct of sugar metabolism. These acids cause a chemical reaction in the enamel to release minerals (hydroxyl, calcium, and phosphate ions) which soften the enamel. If the superstructure of the enamel remains intact, the tooth can remineralize, especially with fluoride around (i.e. toothpaste). However, when the damage is so bad that the superstructure is degraded, the tooth cannot remineralize and a "cavity" forms. Because the damage cannot be repaired, plaque and bacteria will penetrate this defect and continue the process of breaking down the enamel and dentin. So as you can see, a cavity is a microscopic process---you'd need to extract your tooth, cut it up into slices, and view it under a high powered microscope to see what's really going on.
But the reality is that this can't be done. So dentists are limited to detecting cavities using macroscopic processes---e.g. visual, x-rays, instruments, and diagnostic devices such as a Diagnodent. How accurately do these "tools" reflect what's going on at the microscopic and histologic level? When the cavity is small, it's not that accurate. So why don't we get something more accurate to use? Well, no one has developed such a device. It's also not likely that one will be developed because of the limitations of current scientific technology.
In summary, because none of the dentists can see at the microscopic level, you're never going to get 100% agreement on whether you have a cavity or not, unless the tooth has a big hole in it. But then you wouldn't need a dentist to tell you that you have a cavity.
Thanks for your post, this was very helpful. What would you do if you had two dentists saying you had a cavity (although a tiny one), and two saying you did not? I really don't want to get any unnecessary dental work done, even for something as minor as a cavity.
Let me throw in another monkey wrench. Where was the cavity located? Probably in one of the grooves in your teeth? A tooth forms by "buds" that coalesce. If you look at your cusps, they look like bubbles and they join together. The places where they join form grooves. Depending on the anatomy of that groove, it can be shallow or deep. One of the primary means of detecting a cavity is the "stick" test. If your dentist uses a sharp instrument to push in the groove and it "sticks", then it's presumed to be a cavity. As you can imagine, there are false positives with this method, especially when dealing with small cavities. On the whole though, it's pretty accurate. Does this help explain why a cavity may or may not be a cavity?
To answer your question, you may need to do a little self diagnosing.
1. How is your oral hygiene? BE HONEST. If poor, get the dental work. If excellent, wait.
2. How many fillings/crowns/root canals/missing teeth do you currently have? The more prior dental work, the more likely you want to fix problems earlier.
3. How is your diet? If you consume lots of sugar and acidic foods, better to do the work.
4. How often do you get checkups and cleanings? The longer the wait, the earlier you should have intervention.
5. What is your risk tolerance? If it truly is a cavity, then it will grow (slowly) and you didn't catch it when it was smaller. If it's not a cavity, you fixed an imaginary problem.
After the self-assessment, you can try to answer this for yourself.
Should I get a fifth opinion? After my recent horrible experience with dental work, I am hesitant to get this filled if there is such disagreement on what it is. One dentist said the "cavity" was tiny and shallow and that I wouldn't even need novacaine to fill it.
That's not uncommon to not need anesthetic if it's really tiny, we do that a lot, they're just trying to save you from the discomfort of the shot and being numb for a bit if the drill is going to hurt less than that because it's just on the surface of the tooth and it's going to take like one second of work. As for so much disagreement, did the others say it was just stain? Was it a bit 'sticky' when they examined it? I would just get it done but that's really weird to hear so many different things I feel like, it must be really small if it is one.
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