I have been practicing dentistry for just over twenty years. In that time, I have had strangers, friends and family ask me questions about their dental problems. Maybe this question is one that has come up for you too. One of the more frequent queries I run across goes something like this:

“I recently went to the dentist and I was told I needed to have a filling done. It didn’t bother me before, but it does now – and what’s more, I’m being told I’ll probably need a root canal! Did I mention the tooth wasn’t bothering me? But now I’m looking at over $2,000 in dental bills, because once I’m done with the root canal I’ll have to put a crown on the tooth!”

Are you thinking, hmmm, that darned dentist probably should have just left the tooth alone?

Yeah, that’s usually what they are thinking too.

One of the first questions I then ask is: “Was there already a large filling on the tooth?” Invariably, the answer has been “yes.” In which case, my response is usually “Well, then, it’s really not that unusual.”

The first thing to understand is that the tooth was already treated before. The fact that it already has a large filling, suggests that either the original decay was extensive or it had to be replaced several times. Depending upon the location in the mouth, and severity of pressure placed upon the teeth, fillings do require replacement. Teeth are also not immune to new decay and larger fillings do not typically last as long as smaller ones.

So, picture a filling that originally came close to the nerve. Now, there is either new decay between the old filling and the remaining tooth structure – putting it even closer to the nerve – or there may be a fracture occurring between the tooth and filling because there is not enough enamel left to support the filling. Either way, the nerve is under assault.

The next comment is usually “Well, since it wasn’t bothering me, shouldn’t he have just left it alone?” Trust me, this is not a favorite situation for your dentist either. If he leaves it alone, the likelihood of it turning into a root canal is higher. Then the question becomes “why didn’t he tell me about it sooner?” And if it doesn’t turn into a root canal the patient risks losing the tooth if it fractures. So, really, the tooth’s chances of remaining calm are better if it is treated sooner.

Probably the biggest problem here is the omitted communication. Most of the time, the patient simply wasn’t told there would be a risk of post-operative sensitivity. While the dentist can’t entirely control whether the tooth will recover from a deep cavity or not, it helps when the patient knows there is a chance of later discomfort. The moral of the story: don’t put off your dental treatment. Small cavities conserve more tooth structure and seldom bother you afterwards. Large or deep feelings always put the tooth at risk of more treatment or greater discomfort.

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