But it does not hurt…
I feel it is critical to address this question that I hear all the time:
“Dr. Hahn, I want to wait on treatment for that tooth. I understand it has a little decay in it, but IT DOES NOT HURT. Let’s watch it and see how it feels next time.”
If I had a quarter for everytime I hear this…Anyhow, here is “my” philosophy on dental decay. Do as you please, but realize what you are doing and what the consequences are!
DECAY: Decay is decay. It starts out small, then continuous to grow until it eventually encompasses the entire tooth. There is no such thing as “a little decay”. Decay is decay. The tooth is rotten and will continue to get worse.
IT DOES NOT HURT: This is a good sign, most of the time. Once a tooth hurts you are looking at extensive and expensive treatment to try to save the tooth! The chances of success are directly proportional to the extend of the decay. Once it hurts you probably need a root canal treatment, rebuilding of the core of the tooth and a crown. Expensive and not very good for you or your tooth.
LETS WATCH IT: Ok, let’s watch it get worse. If you had large, spreading infection on your leg and your doctor told you that it is spreading, would you watch it spread? Probably not. Watching decay get worse without recommending treatment is what I call supervised neglect. Dentists exist to help you have a healthy mouth and consequent healthy body. Our only purpose is to watch out for you, remove decay and bacteria from your mouth and make your smile pretty. Watching is decline and get worse is not part of the job description.
I understand the restrictions of life, including finances. I am human as well. For that reason I am extremely proactive with my approach towards dental decay. It is a thousand times easier and cheaper to treat a small area of decay than wait for it to “hurt”. I aggressively treat to causes of decay such as poor oral hygiene. I do whatever I can in my power to avoid root canals, extractions and dental infections in general. Every patient is treated the same way I treat my family:
1. Treat Dental Infections: Infections affect your whole body health, which comes first. So, cleaning your teeth, removing infections in the bone as well as infected teeth, should come first. Once this is completed, move to number 2.
2. Treat Dental Decay: Decay only affects the tooth until it results in an infection of the bone. So, decay comes second. Treat decay at its earliest onset! This will be better for you, your tooth, and your wallet. Decay will grow into a full blown body infection eventually. I check teeth very thoroughly for incipient or early decay. This can often be treated painlessly without shots! We call it minimally invasive dentistry.
3. Elective/Aesthetic Dentistry: Once the foundation is sound, let’s make your smile beautiful! This is the last step, not the first. Too often I see new patients that had aesthetic dentistry done but the foundation is poor. Kind of like building a house on house on swamp land.
To summarize: Decay does not hurt until it gets pretty large. On x-rays decay can be 50% larger than what we see, which means that we are missing a lot of decay that is present but does not yet show up on x-rays. The dental “pick” instrument has been shown to be 25% accurate, which means that once again, decay needs to be pretty large to respond to the pick. I prefer to treat decay before any of these traditional methods detect the “large” lesions. I use 4.5 times magnification loops and a laser to help me find early decay. This decay can be removed with much greater ease and comfort, avoiding the “pain” from decay! Why would you want to wait until it hurts? That would result in more aggressive, expensive and uncomfortable procedures.