Patients often come into our office and ask if the stains on their grooves on their back teeth and around their existing fillings are cavities and do they need fillings immediately or can they wait and see how the progress is. I am sure many of you have had this experience where you had a second opinion and got different answers that either confused you or made you doubt one of the doctors. It is a very common scenario that all dentists face from time to time. The decision of filling cavities in teeth is based on several factors and the dentist eventually makes a judgement call based on these factors.
1. Clinical exam with x rays : This method is the
most commonly used technique to diagnose cavities, combined with x
rays. But, not all cavities are visible on the x rays . They have to
be deep and bigger to be actually visible on the x rays. Waiting for
the cavities to be visible on the x rays before filling them,
eventually results in a bigger filling by removing more decayed tooth
structure. This can be prevented by early detection and treatment.
2. Close monitoring over a period of time : If the
stain on the grooves remains unchanged in size, texture and depth,
over a period of few months or years, it is probably best to wait. But
if changes are observed in the nature of the stain, then it should be
treated immediately.
3. Newer tools like lasers and light reflecting tools
can aid in diagnosing cavities at an early stage , thus helping to
promote preventive dental treatment. Smaller cavities are easier to
treat and relatively painless as compared to bigger cavities which
pose a high risk of extending to the nerve of the tooth.
4 Individual patient factors : Individual patient
factors contribute significantly to the treatment decision. Some of
these factors include oral hygiene, overall health of the patient,
(any medical risk factors that may increase chances of cavities )
family history of the patient( yes, surprisingly,
heredity is a significant decision making factor-some people simply
have a greater tendency to having decay), patient motivation to
maintain good oral hygiene and regular dental appointments, patient’s
age, and whether the patient is wearing braces or any other form of
orthodontic devices which can make good oral hygiene challenging and
time consuming.
So, eventually, the dentist will make a judgement
call depending on all these factors , and outweigh the risks and
benefits of the treatment that will be recommended . Ultimately, it is
upto the patient to decide whether they want to make cavities treatment or wait after your doctor makes his diagnosis.
