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Cavities |
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To the right is a good example of a large cavity. Picture A shows a tooth with a small cavity on the chewing surface, but picture B shows that the small hole is just the tip of the iceberg- there is much more decay present under the surface of the tooth. Picture C shows what we see once opening up the small hole, and picture D shows that once all the decay was removed, the nerve of the tooth was exposed. This tooth will now need a root canal and a crown in order to keep it in this patients mouth. This is also a good example of why early detection is so important because this cavity was once just a small problem which could have been easily restored with a small filling. An important concept to learn is that cavities are a bacterial problem. When we remove cavities and place fillings, we are only repairing the damage that has been done by the bacteria. To lower your chances of getting cavities we have to deal the bacteria which are responsible for the breakdown of tooth structure. Being bacterial in nature, cavities are also transmissible from person to person during intimate contact, so if you are kissing someone with lots of cavities, you are putting your teeth at risk to cavities as well. Another important fact is that any tooth with a cavity left untreated will eventually result in an infected nerve, leading to a root canal and a crown as is shown in the pictures above. Teeth which have developed extensive cavities which have spread below the gum are usually unsalvageable and need to be removed and replaced with an implant.
Prevention is the best treatment... The best treatment against cavites is to not get them. This may sound dumb, but there is really no substitute for a healthy, disease-free tooth. Fillings, inlays, onlays and crowns are excellent for restoring and rebuilding teeth damaged by cavities, but they do have a finite lifespan and will require replacement from time to time. Proper hygiene, flouride, diet, regular dental exams, sealants, and the CariFree system are all preventative treatments which can lower or eliminate your risk of developing cavities. Keeping your teeth clean and using a flouride toothpaste is one of your best defenses against cavities. Clean teeth eliminate the food source for the bacteria and flouride is beneficial because it binds to the enamel, making it less likely to demineralize. Avoiding excess sugar is also important in preventing cavities because sugar is quickly and easily converted by bacteria into lactic acid.
CariFree is a system which was developed by a company called Oral BioTech and is used widely in our practice. This product is designed to lower and hopefully eliminate the cavity causing bacteria in your mouth. It is a series of mouthrinses which are designed to first eliminate all the bacteria in our mouths and then to encourage the growth of only non-cavity causing bacteria. The human mouth is home to hundreds of different types of bacteria, and it is only a handful of them which cause cavites. If we can establish a population of only beneficial bacteria in our mouths, the likelihood of the cavity causing bacteria moving in is greatly decreased. For more information on CariFree, click here to go to the CariFree section of our website.
Next to prevention, early detection and treatment is best ... If you do get a cavity, it is important that is is detected and treated as early as possible. The smaller the cavity, the easier it is to repair the damage done, many times without the need for anesthetic using either air abrasion or a hard tissue laser. Routine check-ups and x-ray examination of the teeth is the best way to catch cavities when they are small. We cannot treat what we cannot see, and x-rays are the best diagnostic tool we have to diagnose cavities forming inbetween teeth. For cavities on the chewing surfaces of the teeth we use a tool called a Diagodent. The Diagnodent uses a small laser to probe the grooves of the teeth for signs of decay by measuring the amount of demineralization which has occurred. It is quick and easy to use and we have found it to be extremely accurate in detecting small cavities. The picture below demonstrates how a traditional dental explorer gets caught in the narrow groove of a tooth, preventing the tip from getting to the cavity at the base of the groove. In the past a dentist would use this instrument to feel for soft spots which were the result of demineralized tooth structure; it is obvious from this diagram that cavities can easily be missed by this type of exam.
This next diagram shows how a Diagnodent can detect this cavity since the laser light can penetrate the smallest of grooves easily. The only disadvantage to the Diagnodent is that is is only capable of detecting cavites on the surfaces of the teeth; cavities which are forming inbetween teeth require x-ray to be diagnosed. There is a Diagnodent being developed to detect these types of cavities, but as of now it is not yet available to the dental community.
The Diagnodent unit
Restoring teeth which have cavities... Restoring a tooth which has a cavity involves removing the decay and replacing the missing tooth structure with an appropriate material. Small cavities are usually restored with a composite filling, while larger areas of decay may require an inlay, onlay or a crown. If the cavity has gotten deep enough, a root canal may be necessary also. If you have any questions about cavities, our doctors would be happy to answer them for you. Call us at (408) 402-0900 to schedule an appointment. Here is a link to the patient education section of our website which you may find helpful. There is a lot of information there for you to browse through and to answer any questions you may have, and was designed by a dental education company whose tools are used in our office to help our patients understand their treatment options. Some of the information there may be a bit outdated because the dental field is always evolving, but the general concepts of dentistry are nicely described and illustrated. Some of these pages require Adobe Acrobat to view them. If you do not have this installed on your computer, download and install it here for free.
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Sealants are another effective way of preventing cavities. They are small resin fillings which are placed in the deep nooks and crannies in teeth where cavites are likely to start. These small grooves are areas in our teeth where plaque accumulates and are so deep and narrow that even the bristles of a toothbrush are not able to clean them effectively. Sealants are only useful for preventing cavities on the chewing surfaces of the teeth which is why regular flossing is neccessary to prevent the formation of cavities inbetween teeth. To the right is a before and after picture of a sealant on a tooth, you can see how the little grooves are completely covered up preventing the accumulation of plaque in them. 
