I have little doubt that some patients who visit a dentist and are told they have decay, but don’t experience any symptoms, are convinced that someone is trying to pull the wool over their eyes. There are probably several reasons for this. Possibly, they had been to some unscrupulous person in the past who suggested they had a problem, when they really didn’t.
I can see how that might create skepticism. I mean, it’s conceivable that sort of thing could happen.
But even if that were the case, I sincerely don’t believe it represents the behavior of a majority of dentists. Most of the dentists I know genuinely care about what they do and the people they treat. So maybe these skeptics are just people who don’t trust anyone. I don’t know.
The reality, though, is that these patients will eventually be in for a big surprise when the you-know-what hits the fan. Or – and let’s keep this a family column — when the decay hits the nerve.
But that could take a while.
And I believe that could be where some of the problem lies. A patient tries to use this to their advantage — they want to buy some time. After all, it’s not really being a “problem” for them in that they don’t perceive anything as being different. When the problem eventually does occur, I usually hear: “I never thought it would happen to me.”
A doctor detecting treatable decay usually recommends that the patient handle it at their earliest opportunity.
Why? Well, the patient can catch the problem when it is small, when it is less likely to cause post-operative discomfort, and when it will generally cost them a lot less.
But, first, let’s back up a little and explain why it’s possible to have a cavity – several in fact – and have absolutely no symptoms.
Most decay starts on the outer surface of the tooth called the enamel. It’s roughly 97% mineral in consistency and does not contain nerves. That means it has no feeling. Practically zero. Your dentist could DRILL on that part of the tooth and most of the time you won’t feel it.
Notice that in the earlier paragraph I mentioned “treatable” decay. Well, when would decay not be treatable right away? I can’t speak for other dentists, but I typically won’t treat decay when it is confined to the enamel. Why? It has the potential to re-mineralize. In other words, it has the capacity to fix itself – that is, if you don’t continue to do the things that led to the cavity in the first place. Usually, this is related to your diet, but it can be affected by hormones, or even medications.
Why not mention home care first? Isn’t that important too? Of course it is. It just may not be the most important factor.
Another time a dentist might not treat a cavity could relate to the age of the patient. For a much older patient, there are times when the pain or infection are not likely to come up before the patient passes. Of course, your dentist doesn’t have a crystal ball on that point. (Well, probably not.) But, it wouldn’t make sense to recommend treatment in the majority of those cases.
And this takes us back to the nature of a cavity. They often take a long time to get bigger. (But not always…. Again, no crystal ball here.) The reason has to do with the hardness of the enamel itself. Enamel, for you trivia lovers, is the hardest substance in your body. It’s harder than bone, and that property, along with the lack of sensation, can be problematic.
Here’s why: a cavity is often quite small on the outside of the tooth. It’s actually difficult for decay to work its way through that hard enamel. Most of the time it burrows a narrow channel down to the dentin (only a couple of millimeters away) and then it really starts to spread. Because dentin is softer than enamel, it’s just easier for it to spread more quickly there. By the way, this additional, and deeper, decay – very often still doesn’t hurt – as long as it is far enough away from the nerve.
Meanwhile, your enamel is, for the most part, continuing to hold its form. That stuff is hard. But things are generally hollowing out on the inside of the tooth now — out of sight and out of mind — as the decay continues to spread. Painlessly.
Eventually, your tooth can become very much like an eggshell.
Then one fine day you bite on something, and the hard enamel that was still doing its job holding the form of the tooth caves into the hole below. It just got too thin.
Now, at this point, does the skeptic understand that he got a cavity? Sure. Some of them finally get it. But for others –no! It’s more like: “Hey that blowhard dentist was obviously wrong because he talked about me having cavities years ago, and look – I did fine until now. In fact, I probably just lost a filling! Jeez, this hole just came out of nowhere. It’s probably the fault of some earlier dentist.” (Um, Mr. Skeptic never got the filling though. Remember?)
“Hey doc, how much is this going to cost me? $2,400?!!! (For a root canal, buildup and crown.) Are you insane? Just pull it.”
Now you are going to be missing a tooth, and may lose even more teeth as a result. Yet, when the doc first mentioned it, that cavity was only going to cost $150. How can it suddenly become sixteen times more expensive?!
“Rip-off artist. Seems you can’t trust anyone. . . .”
This is a reprint of a column I recently wrote for our office newsletter. While it is only mailed to existing patients, it contains sentiments I wanted to share more broadly. Hopefully, it will help you consider a few things about your dental health and maybe even save you some trouble down the road. While this was directed to the patients in my practice, if you aren’t a patient of mine and haven’t seen your dentist in a while, please reach out to him at your earliest opportunity. Read on and I think you’ll understand why. At least I hope so.
You can save your teeth. How do I know this? After more than 25 years in practice, you get to see a few things.
The two main reasons people give for not taking care of their teeth are time and money. Typically, people will swear they have neither.
I believe that they believe it.
But, here’s the funny thing: when the emergency happens (and it will given enough neglect) most of these same people find the time and the money to handle their problem. Sometimes, it even costs more than it would have to prevent the problem to begin with.
So, what’s that about?
It’s actually pretty simple. One patient summed it up concisely: “I never thought it would happen to me.” You see, I know that most people — deep down — really understand that neglecting their dental health can lead to trouble. But a couple of other things come into play.
First, is this classic error: “If I don’t have dental pain, then everything must be OK.” Here is why that’s just not true. Cavities usually start on tooth enamel. Tooth enamel — being about 97% mineral and not containing any nerves — doesn’t feel pain. Trust me on this. Once you actually do feel pain, it’s bad.
Second, the number one cause of tooth loss (worldwide) isn’t even cavities. It’s periodontal disease. More than half of American’s have it and most don’t have any clue that they do.
Sometimes the first symptom they notice is that their teeth are getting loose.
I can’t tell you how many times a new patient has come in and told me, my front tooth just fell out. (Naturally, it was loose for a while, but that’s the thing — they expected that maybe it would get better or, if they didn’t think about it, they could just ride things out a little while longer — or … they just didn’t think it would happen to them.)
One panicked lady absolutely had to leave the office with all her problems handled that day. After all, she couldn’t let people see her with missing front teeth. It didn’t matter that she let it go for years.
It doesn’t work that way. But you can take care of your teeth. Ask us for help. That’s why we’re here.
Millions of people worldwide wear full dentures. While we often associate this aging, wearing full dentures is not just limited to older adults. Illness, accidents — sometimes even pregnancy — can contribute to tooth loss and, in a number of cases, this affects younger individuals as well.
Young or old, the psychological consequences of losing teeth can be severe.
Several studies have suggested that a smile is very often thefirst thing people notice about another person. So, losing one’s teeth can be devastating in a variety of ways.
Toothlessness may affect digestion. This, in turn, can influence nutrition and health. There can be issues with self-esteem, intimacy, and a host of other areas most people wouldn’t normally take the time to consider.
This is stressful enough. But having to now replace the teeth can also become stressful for some.
Many people worry about whether they will be able to eat with their dentures. Will people notice that they are wearing them? Will they sound funny when they speak? Will it hurt to eat with the dentures? Will they be able to chew their food? How will the dentures affect the ability to taste food? Will the dentures slip when they talk? What can they afford?
These are natural concerns, but for the first-time wearer, they add up to a lot of unknowns.
The truth is that no two situations are alike. But almost all denture challenges have solutions.
Another thing to consider is that there are many ways to go about addressing total tooth loss. The solutions depend upon a person’s preferences, financial options, and — frankly — anatomy.
If a person were building a house and they decided to hire an architect, the architect would undoubtedly first gather a lot of information about the project. For example: Where is he going to be building? What does the client want: a log cabin or a mansion? What does the foundation look like? What is the client’s budget?
In some ways, restoring a person’s smile is not too dissimilar.
For the person without teeth, they may be surprised to learn that there are multiple ways to go about replacing the teeth. The length of time will vary with each approach, as well as the cost.
To help clarify the options and give some sense of the costs, I put together a report that helps discusses different levels of care, from simple to more complex. Included is a sense of the pros and cons of each approach, and a general price range at today’s rates. Of course, this can vary widely from area to area and doctor to doctor.
There is no cost or obligation to download the report. We just hope it helps to clarify some of the questions many people have about dentures. Click on the pulsing button (the one on the right) in the picture below to download your free report. Have questions and want to set up a consultation? Click the pulsing phone button on the left.
As readers of my blog may know, I have long been an advocate of dietary supplements. While the ideal form of nutrition is always a healthy diet, today’s food is simply not the nutrient-rich, non-chemically altered, or non-genetically engineered food our grandparents ate.
While that might just be a topic for another discussion, I want to point out that whereas supplements have their place, it is always prudent to understand what you are consuming and what potential effects it may produce. This advice holds equally true for vitamins and herbs as it does for medications.
While the side-effects of supplements are typically far less dire than those encountered with many common medications, there can be side-effects nonetheless — especially when used in combination with medications.
As dentists, we are particularly interested in knowing what herbal medications a patient takes that may cause drowsiness, excessive bleeding, cardiovascular problems or that interfere with other drugs.
Here are a few examples:
St. John’s Wort, used as a mood enhancer, can interfere with the effectiveness of many heart and blood pressure medications, as well as blood thinners. On the other hand, garlic, ginseng, ginger, chamomile and gingko, to name a few, can cause bleeding after surgery.
A patient given sedatives by a dentist or oral surgeon before surgery who is also taking Valerian root and kava may experience an interaction that causes excessive drowsiness.
Ginseng has been associated with an increased chance of arrhythmias (irregular heart beats. Patients who take ginseng and also get a local anesthetic with epinephrine (commonly used for fillings and many other dental procedures) may be putting themselves at risk for cardiovascular complications.
Echinacea, while it is widely considered to be an immune system enhancer, may inhibit wound healing and increase the risk of post-surgical infection.
This list is by no means exhaustive, and the simple message here is just because an herbal remedy is considered “natural” doesn’t mean you should neglect to inform your dentist that you are taking them. Neither he nor you want to risk negative effects or complications that can come about as a result of interactions.
More likely than not, your doctor will simply ask you to stop taking a particular supplement before surgery or modify the anesthesia accordingly.
Good communication is the key.
Here is another example of this point. Not uncommonly, patients take “baby aspirin” as a blood thinner. Of course, this is not an herb, but many people feel it is not worth mentioning because it is just a “baby” aspirin. That is, until they fail to stop bleeding after an extraction.
You should always be sure to tell your doctor about ALL of the substances you are taking, including prescriptions and over-the-counter drugs. Even doctors aren’t always fully aware of every potential interaction between herbs and drugs, as new drugs are constantly being developed and introduced into the market. It is in your best interest to let your doctor “know before you go.”
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.