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Why do patient’s think that all cavities cause pain? I think you have to look at the history of preventative dentistry to understand how this myth got started. The prevention of dental disease is a relatively new science. Dental insurance wasn’t common until the ’70’s and fluoridation of drinking water was widely instituted at about the same time. Prior to the ’60’s or ’70’s, it was uncommon for patients to see their dentist every 6 months for cleanings and exams (preventative care). Patients rarely made an appointment to see their dentist unless they felt pain. And, in most cases, this pain was caused by a deep cavity. Extraction of the tooth was usually the treatment of choice at that time because root canals were not commonly done.
You notice I said the pain (toothache) was caused by a deep cavity. If the patient had seen the dentist before the pain started, the tooth could have been saved with a filling. But patients didn’t see the dentist”until it hurt”. When they saw the dentist, he/she said the pain was from a cavity. Thus the association of pain with a cavity. The fact is that patients in those days were walking around with millions and millions of painless cavities. The only ones they knew about were the deep, painful ones.
Of course, preventative dentistry is more widely practiced and utilized these days. Technology for the detection of small cavities has improved immensely. A patient who sees the dentist regularly should never suffer from a cavity so large that it causes pain. Of course, if a patient goes several years between dental visits, they may develop cavities large enough to cause pain. However, the type of cavity that we find on routine check up exams is painless and can only be detected using our newer detection tools.
It’s a little unfortunate that small to moderate cavities don’t hurt. If they did, patients would get them taken care of before they became large and costly. The sale of junk food would drop also because people would begin to associate junk food (a major cause of cavities) with pain!
In my next blog, I’ll explain a little of the physiology and anatomy that causes deep cavities to hurt but small to moderate cavities to be painless.
I’ve now been involved in Dentistry for over 35 years. For some strange reason, it has taken me that long to realize that 99% of all the patients whom I’ve had contact with over the years have been misguided in their dental decision making process by a belief based on an “old wife’s tale”. Their misguided belief is that CAVITIES CAUSE PAIN and, therefore, they will know when they have a cavity. Due to this belief, patients fail to follow up on preventative care, fail to take the advice of their dentist and treat cavities when they are small, and distrust their dentist when he/she tells them they have a cavity when they have no pain.
Most patients seem to trust their bodies to tell them when they have a cavity. So, many times, new or emergency patients come in to see me because they have a mild sensitivity in a tooth and they think they have a cavity. Most often, this mild pain is not caused by a cavity, but by some other minor problem. However, many times, a thorough exam to determine the cause of the pain reveals small to moderate cavities in other areas of the mouth which are absolutely painless.
For all these years, I really thought that it was obvious to most people that only “really big” cavities caused pain. Recently, I mentioned to my wife of 30 years that patients don’t understand that SMALL TO MODERATE CAVITIES don’t hurt! They don’t even hurt just a little- they don’t hurt AT ALL! Her own shock and amazement at this fact has finally made me aware of how widespread this false belief really is. After all, she is a highly educated woman who has been involved in a dental practice for 34 years. If she doesn’t understand the painless nature of most dental cavities, how can I expect a normal patient to understand this fact. And, after doing a random poll of several other friends and acquaintances, I realized how widespread this false belief is.
Of course, over the years, I have been continually asked by patients why they didn’t feel any pain from the cavities I had just diagnosed in their mouth. I always patiently explained that cavities usually do not cause ANY pain until they get huge! In fact, many patients have told me they thought their previous dentist “ripped them off” because he/she did some filling on teeth that they weren’t feeling any pain in. I only recently realized how common this belief is and how much extra money and time it is costing patients. It costs a lot less to treat dental decay when it is small vs when a cavity gets large enough to hurt!
Even though I was so slow to realize how widespread this false belief really is, I’m pretty sure I understand why it exists. I’ll elaborate on that in my blog tomorrow.
Many recent studies have linked gum disease to other health problems. Pregnant mothers are always very concerned with improving their chances of giving birth to a healthy baby. Here’s a simple way to do so.
A University of Pennsylvania study of 160 pregnant women with gum disease found that successful treatment lowered the rate of premature delivery from 23 percent to just 7 percent. In other words, expectant mothers with gum disease have a much better chance of avoiding premature birth if they keep their gums healthy.
Gum disease releases bacteria that can lead to early labor. Having regular professional cleanings removes these bacteria. It’s really that simple.
A recent article in the June, 2010 edition of The Journal of The American Dental Association, discusses the use of tooth bleaching agents to improve the oral health of patients with special care needs. Basically, we are talking about patients who are unable to brush and floss their teeth properly due to physical or mental issues. These patients may also be highly prone to decay due to low salivary flow (dry mouth) caused by age and/or medication side effects.
Tooth decay occurs when the pH of dental plaque and saliva reach a certain level of acidity. In a healthy patient with good salivary flow and good oral hygiene, decay is not a problem because plaque does not sit on the teeth long enough to cause cavities and the saliva neutralizes the acid and helps to wash it away. Patients with poor oral hygiene or poor salivary flow are very susceptible to tooth decay (cavities).
It now appears that certain tooth bleaching materials may actually reduce cavity rates and improve gum health.
The most commonly used tooth bleaching agent is a chemical called carbamide peroxide. Besides causing the teeth to lighten, one of the side effects of a 10% carbamide peroxide bleaching gel is to decrease the acidity of dental plaque and saliva. Carbamide peroxide breaks down in the mouth into urea and hydrogen peroxide. The release of urea is what changes the pH of saliva and plaque. The hydrogen peroxide which is released delivers the antimicrobial effect.
Some bleaching agents contain only hydrogen peroxide. While they are effective for tooth whitening, they do not have the same decay preventing effect as carbamide peroxide because they do not release urea. Urea is the chemical that reduces the acidity which causes decay..
The safety and effectiveness of tooth bleaching by means of application of 10% carbamide peroxide using a custom tray are thoroughly documented. Long term use has also been shown to be safe and effective. The only known negative side effect is occasional tooth sensitivity. This is usually easy to control and causes no long term problem for the teeth.
While more research is needed, it appears tooth bleaching (using carbamide peroxide) may have a dual beneficial effect for decay prone patients. Of course, for those patients considering tooth whitening for it’s cosmetic effects, it’s nice to know that bleaching has beneficial secondary effects.
These days almost every dentist calls him/herself a “cosmetic dentist”. It’s the glamour job in dentistry. I’ve actually been performing cosmetic procedures since the 70’s. Before I left my practice in Ohio 4 years ago, I was performing cosmetic cases almost exclusively because I had developed a reputation for that type of work there. Since I basically started my practice from scratch in Boulder, my reputation for excellence in cosmetic dentistry is taking a while to develop here.
However, the other day, I was reminded why I love to do that type of work. We had a patient in for a follow up appointment a few weeks after completion of some cosmetic treatment. We’ll call the patient Bill (not his real name). Bill had simply had two old crowns on his two upper front teeth replaced. The originals were done 30-35 years ago and didn’t match and were too bulky looking. They also had dark areas at the gumline. Bill had developed a certain way of smiling that hid the teeth he didn’t like. In addition, his left eye tooth was too small and made his smile too narrow for his face. On my suggestion, we placed a porcelain veneer on the eye tooth to widen his smile. I forgot to mention that Bill also bleached his teeth before we started this treatment.
When Bill came back for his follow up appointment, he told me several times that he was VERY satisfied with the results of his treatment. We did some minor adjustments on his bite and took some after pictures of his smile. My assistant, Jessica, took his after photos. Two days later, out of the blue, she mentioned to me how Bill’s reaction to his new smile had made her feel really good that she had been part of his treatment. Her comment made me realize why I have always enjoyed doing cosmetic cases more than any other type of dentistry, even though the cases are more time consuming and stressful than routine dentistry.
When we viewed the after photos of Bill’s smile compared to the before photos, there was an obvious difference. It’s hard to explain, but you could tell that Bill felt much better about his appearance. He looked more confident and exuberant. His smile was bigger and brighter. Both Jessica and I felt proud that we had helped improve Bill’s quality of life. It was easy to see that a smile comes to his face easier now than it used to.
Over the years, I have always noticed that what I call “smile therapy” can make a huge difference in a patient’s life. If you want to see what I mean, click on the “Before and After” photos on my Home page. Notice how the patient’s face always looks a little strained in the “before” picture but more relaxed in the “after” picture. When someone doesn’t like a certain aspect of their smile, they develop an unnatural way of smiling to cover it up. When I make changes in a patient’s smile that allows them to smile more easily, I feel really good about what my professional skills have given me the ability to do.
