Are These Stains or Cavities? Do They Need Fillings or No?

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.