Too Much Drilling? Not All Early Tooth Decay Needs a Filling
Some dentists are using newer technologies to help detect the beginnings of decay. The aim is to find out when the tooth begins to soften, before it turns into a cavity.
But if you have early decay, what should be done? Do you need a filling right away?
These days, dental decay is "a slowly progressing disease," says David A. Albert, D.D.S., M.P.H. Dr. Albert is an associate professor of clinical dentistry at the Columbia University College of Dental Medicine.
"From start to finish in the general population, it can take five years to go from early decay to full-blown involvement of the pulp," Dr. Albert says. The pulp is the center of the tooth, where the nerves and blood vessels are.
Early in the 20th century, decay could reach the pulp in a matter of months, Dr. Albert says.
Today, early decay doesn't always mean you need a filling. In fact, the decay often can be reversed. A tooth starts to decay because acid in your mouth causes minerals to leach out of the enamel. This makes the enamel break down.
Fluoride therapy, dietary changes and better oral hygiene habits can reverse this process. Minerals can build up in the tooth again, making the enamel stronger.
In some cases, a filling is a no-brainer. If you're in pain or have an obvious cavity (a break in the tooth surface), you need a filling. But, says Dr. Albert, "If there's no cavity and no pain, the tooth can fix itself."
"If I saw 100 patients [who had early decay] and decided to wait six months before treating them, it would be the right decision for 95 of them," he says. "I think we do more harm by overtreating, because there will always be complications of treatment."
For example, once a tooth has a filling in it, there is always a chance the filling will crack, break or fall out. A space left between the filling and the tooth is a hot spot for further decay. Eventually, the tooth may need endodontic (root canal) treatment or may even need to be extracted.
Dr. Albert says that using the new technologies in theory should lead to fewer fillings for most people. That's because early decay can be reversed with fluoride treatments or better oral hygiene habits. However, the reality may be different.
"Dentists who use these machines may actually do more fillings," he says. "For the general population, that's wrong. For some high-risk individuals, it's good to find [decay] early and treat it early. But if you're in a low-risk category, the treatment of choice is to do nothing."
So why don't most dentists watch and wait? They may be worried that the person won't return in six months for another checkup. Or they may worry that they will be perceived as indecisive or inexperienced.
Also, the detection devices aren't always right. "Some things look like cavities, but they're not," Dr. Albert says. "A dark discoloration does not mean a cavity."
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Reviewed by the faculty of Columbia University College of Dental Medicine