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by Jeffrey Gross, DDS, FAGD of The Healthy Smile
I met this lovely lady yesterday who came to me for a second opinion. Her dentist told her that the upper left cuspid, also known as the eye tooth, needed a root canal followed by a crown. Her dentist does not do root canal therapy and referred her to someone else. She told me that she reads my column frequently and wanted my opinion. She shared her age with me and as a ninety-year-old, was agitated that she needed this procedure and had to spend money on it. I took an x-ray, and a conversation ensued. I want to share some of the topics that we discussed and elaborate on some of those topics.
When I looked at her x-ray, I immediately agreed with her dentist. The tooth in question showed a serious area of decay on the back side. The decay was deep and extended into the center of the tooth where the nerve resides. Often at the age of 90, the nerve shrinks away which would explain why she did not have any discomfort associated with that tooth. The lack of pain is not an indicator as to which treatment is warranted. Pain is our body’s way of telling us something is wrong. However, things can be wrong without pain. Either the pain is around the corner, or it is simply not present and never will be.
Her decay was unique in the fact that it started just a little above the gum but soon moved and submerged below this gum area. Cavities of this type are very difficult to find, and they are mostly hidden. When the decay gets very large, it starts to peak up above the gum and the dentist can catch it. I’m sure that many of you are asking about x-rays. We take dental x-rays to allow us to see hidden areas, such as below the gum area or in between teeth. Could this cavity have been found earlier? I can’t answer that question, but one thing to remember is the following.
We take x-rays of the back teeth at the annual or semi-annual checkup and nothing more. My patient’s decay appeared in a front tooth and would not appear on a routine exam. This fact of only seeing the back teeth is why we instituted pictures of the front teeth when we do back teeth x-rays.
Let’s get to the crux of her question once we have accepted the fact that she has a large cavity on this tooth. Fillings whether they be silver or white all have indications and limitations. When I place a filling, it is moldable and responds to my shaping and contour creation. When I am satisfied with the shape, I can harden it at will or let it set chemically on its own. If a tooth has a very large defect or one that extends below the gum, a filling is not an option. Simply put, the filling, in that case, cannot be placed well. If it is not placed well then it will be a source of future decay and breakdown.
Also, if the area of decay is close to the nerve, placement of a filling so close to that area will result in much pain, inflammation, or even infection. Those cases with a cavity so close to the nerve, require a root canal treatment first followed by a crown for strength and for the creation of the proper shape and surfaces of the tooth.
Not every tooth that has a cavity is a good choice for a filling. Your dentist needs to carefully examine and analyze each situation individually. Where indicated, the most conservative treatment is always our first choice. However, if we sacrifice quality while seeking conservatism, that is not a good direction in which to move. If you need to hear another thought or opinion on your proposed treatment, please feel free to call me at 440.892.1810 and set up a visit. I look forward to hearing from you.
Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.
The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com
