Do Cavities Have Holes In Them?

What is a cavity? What does it look like? Is it supposed to hurt? What happens when your tooth has big hole in it? 

Although this young person hasn't been to the dentist in 5-7 years, overall she has good teeth, healthy gums, and no pain at all. However, can you point out to me which teeth have cavities? Do you think these need to be treated as soon as possible? How deep do you think they are? Do you think there are cavities in between teeth as well? What would happen if this patient delays treatment?

Do all cavities have holes in them? It's okay for you to guess. Dentists are not guessing which of your teeth has a cavity or caries when they tell you that you have a cavity. It takes many years of reading X-rays, looking for signs of a cavity, and past experiences to diagnose them properly. When diagnosed, treatment should be done as soon as possible to receive the best prognosis and saving more of your tooth! You will be glad you did!

Cavities, sometimes called tooth decay, or caries, develop from breakdown of your enamel and soon the softer dentin layer of your teeth. Most of us blame cavities on eating too much sugars and candies, but it's only half true. Bacteria, normally present in your mouth environment, are the ones that feed on sugars and carbohydrates, and make acid as their waste product. The acid not only irritates your gums, causes gum bleeding, it also breaks down your teeth. Not all cavities have "holes" in them. You may have a cavity or decay under your existing fillings, or crowns. White fillings can turn black from recurrent decay or failure in bonding as they get older and stressed from daily use. Some older fillings break because they have decay underneath. When you can actually see a hole in your tooth, the decay is too big and you need to have that treated as soon as you can to prevent more damage. When your cavities are too big, you may not be able to do a filling anymore, you may need a root canal (when the cavity is too close to the nerve), a large buildup, and/or a crown. 

So could you point out which teeth have cavities here? We just finished the treatment for this patient. We will have taken out the wisdom teeth that had cavities in them. See the new photos. 

Close up view of the finished new white fillings.

Here's a picture of a very deep cavity in a molar. It doesn't really have a hole in it for you to feel that it is there. Though this patient is not aware of it because it is not sensitive or hurting yet, it is very advanced and even involves the contact areas between teeth that can be detected on X-rays called the Bitewing X-rays. Treating a cavity as soon as possible can prevent the need for root canal as the deeper cavity reaches close to the nerve inside. Flossing will prevent future problems in the restorations or fillings and ensure they will last much longer. 

Here I was using a different camera, and I have increased the contrast setting in these images to show the failed white filling that had significant amount of decay or softness underneath once the existing filling was removed. You can also see the crack line in the third image. The dark dentin was good tooth structure so that was not removed. We masked the darkness and filled the rest of the cavity, checked the bite, and made sure that all the margin was sealed tight. Failing filling or restoration treated early, more often than not, can prevent the need for root canal, which many people dread. Though this cavity was significantly much deeper, the patient reported no sensitivity. He was quite pleased to see that they all blended in nicely without the dark lines. No root canal! 

This series of pictures shows what appeared to be a small cavity turned out to be very deep! These types of cavities are often missed during the exam when the grooves are not cleaned out, or the criteria used by one dentist are different from another. Some dentists may not consider this a cavity that needs treatment yet. To make matters more complicated, when a dentist diagnoses a cavity, patients may hesitate to get the treatment right away, and over time have forgotten that they ever have a cavity. 

As you can see, when these grooves are opened, the cavity looks very bad. By first opening the grooves, and using a slow speed handpiece and round bur (a safer way to remove the softer decay tooth than a high speed drill), Dr. Vuong cleaned out and checked for any remaining decay. Once cleaned out, a new filling can be done and verified that all the margins are sealed properly. When the bite is checked and proper steps are observed, this patient should experience little or any post-operative sensitivity at all. 

As shown in the examples above, the sooner the cavities are treated, the better it is, and you may avoid pain, sensitivity, or even root canal treatment. 

Alternative Treatment Option To Root Canal or Tooth Extraction

Are you having a toothache that needs root canal but tight on funds? Dr. Vuong can help! With mutual agreement, partial root canal treatment called a pulpectomy can be done to relieve pain, so that you can save money and complete the procedure in the near future, preferably within 4-6 months period. The sooner you can finish the procedure to seal the tooth from bacteria and re-infection, the better!  And it is important to restore the broken tooth with a crown to protect it from fracturing.  Even when the best root canal procedure is completed, but the patient fails to follow up with restoring it, the prognosis of that tooth decreases tremendously.

Understandably, pulpectomy is rarely presented to patients as a treatment option because it can be considered not a standard of care.  In some cases, pulpectomy may not completely alleviate pain or swelling, or it may cause more complication for which the dentist would have to continue with the treatment.  Or the patient simply fails to follow through.  With trust and mutual agreement between the patient and the dentist, and with the understanding that this treatment option is a temporary relief for pain, it would be a great benefit to someone in pain, who is motivated to save the tooth, and wants to work out a payment arrangement to get the treatment completed properly.  

When proper steps are taken and followed up, pulpectomy could be a good alternative solution rather than taking the tooth out, which will cost more to replace in the future. Of course, pulling that tooth out is the less expensive option if you still want to go that route. We can do that too!

The Importance of Keeping Children's Teeth Healthy

Did you know that many children do not lose all their baby teeth until they are about 10 or 11 years old? And that the first adult tooth to erupt is when they are around 6 years old? 

Look at the chart below, you can see that the presence of many baby teeth is crucial to keep adult teeth erupting in the right place, as mother nature has intended. When a child loses a baby tooth too soon, spaces may be lost, and adult teeth coming in at the wrong place. Sometimes, the bite can become quite complicated that will require many years of braces to correct. 

Source: Ash, M. Wheeler's Dental Anatomy Physiology and Occlusion 7th ed W.B.Saunders

Imagine a 5 years old child who has a toothache, and it is his first dental visit to the dentist. To the dentist's disappointment, the child has an abscessed baby tooth, let's say the upper 2nd baby molar that will require extraction. (In the above chart, the first blue tooth on the left of the upper arch at age 7 is the 2nd baby molar). What do you think will happen as a consequence for that early tooth loss? The adult molar will erupt and invade the space for the premolar tooth to erupt in its proper place!

When we take X-ray images of baby teeth and put on our big screen monitor, many kids get so excited to see their own adult teeth forming! Unfortunately, it wasn't the case here. This child came to us with a lot of pain and huge swelling for a few days! He had a big cavity in the baby tooth, which was not treated and became abscessed. It was not ready to come out yet, either on its own or for us to remove it.

Due to circumstance that the tooth could not be saved with baby root canal treatment, we took the tooth out. Care was taken not to damage the adult tooth underneath. Abscessed baby tooth can also damage the adult tooth underneath if it was not removed. 

Now what do you think will happen to the tooth (which is the adult molar) on the right side of the image? Will it tilt over and prevent that adult premolar tooth underneath to come out? So what can we do to prevent this from happening?

Keeping baby teeth healthy is very important for the health of adult teeth. Treating cavities early on to prevent abscess and the need to take out baby teeth is one way. However, the best way is to prevent cavities all together!

Dr. Vuong Provides 6 Month Braces

Dr. Vuong provides the 6 Month Braces for adults who seek alternative solution to crooked teeth without porcelain veneers or traditional longer termed braces with metal brackets.  You can have straighter teeth and a beautiful new smile by your next cleaning visit after 6 months!

Our patient has always wanted a nicer smile, but traditional braces take too long up to 2 years.  She didn't want to wear a mouthful of metal brackets.  6 Month Braces is a lower cost solution to enhance her smile without porcelain veneers, which could require extensive tooth reduction to correct crowding.