ARE YOU A TOOTH-WATCHER?

by Pentti J. Nupponen, DMD, MAGD, FIND, AIAOMT

A little girl named Susan went to her very first dental appointment. Her teeth were cleaned, X-rays were taken, and fluoride was applied to her teeth. Then she had a good, thorough examination. As her dentist examined each tooth, he noticed a questionable area on one of Susan’s back teeth. Nothing appeared on the X-rays. There was no crack obviously large enough for the pick to get stuck in. The dentist told Susan’s mother that he was going to "watch" that tooth.

At Susan’s next checkup, the tooth had the tiniest of pits in the questionable area. It was only six months since the last X-rays, so none were taken. Again, the dentist told Susan and her mother that they were going to have to "watch" that tooth.

Susan came back six months later for another cleaning, fluoride treatment, X-rays, and checkup. This time, there was a definite shadow on the X-rays. The tiny pit had become a hole large enough to catch the end of the pick. Everyone agreed that the tooth should be repaired.

When the small hole had been enlarged and the underlying hidden decay had been removed, a very large hole remained to be filled. The tooth had become so damaged that it was permanently weakened. The dentist was careful to restore the tooth with a bonded resin rather than a mercury amalgam, which has been shown to break down and cause teeth to fracture.

• Wouldn’t it be healthier to detect dental disease sooner and remove diseased areas before they become so extensive that teeth have been permanently weakened?

• Wouldn’t it be more cost effective to treat teeth sooner, rather than to wait until they are severely damaged, requiring expensive root canal treatment and crowns?

• Wouldn’t it be less painful to treat teeth sooner, when cavities are smaller and less close to the nerve?

• Wouldn’t it be more convenient to take care of dental disease at a time of your own choosing, rather than waiting until a tooth is completely broken down, the pain is excruciating, and your dentist has just left on vacation?

Today there are methods and materials available which will enable a dentist to find dental disease at earlier stages of progression and to restore teeth to their normal appearance and strength with minimal discomfort to the patient. And yes, it is possible to treat dental disease, when detected early, with no drills and no needles.

New diagnostic tools for early detection of dental disease include intraoral video cameras and new cavity detecting solutions. Intraoral video cameras probe into areas which may be difficult to otherwise visualize, and the magnification makes it possible for both the dentist and the patient to see areas in which dental disease is lurking. Cavity detecting solutions may be painted on the teeth, where they stick in the tiny cracks and crevices of incipient decay where teeth are starting to break down.

When detected early, dental disease can be removed with a device which is recently becoming more available in dental offices, the micro-particle accelerator or dental "sand blaster." This device does not cause the painful heat and micro-fracturing associated with conventional drilling. It is also more conservative, tending to remove only the decayed area in all its nooks and crannies.

The use of modern flowable composite restorative materials makes it possible to conserve healthy tooth structure, since the material is actually bonded to the tooth. This is in contrast to the use of mercury amalgam, which does not bond to the tooth, and which is held in place after hardening by the physical shape of the hole. In preparing a cavity for the placement of mercury amalgam, it is often necessary to remove some healthy tooth structure in order to form a hole of the proper shape in which the material will be held in place when it hardens. Of course, this weakens the tooth. Furthermore, mercury amalgam does not respond to changes in temperature in the same manner in which teeth are affected. With time, they have been shown to cause teeth to fracture and split from the constant "freezing and thawing" effect.

Of course, the intraoral video camera and the cavity-detecting solution may be used to analyze existing mercury amalgam fillings to detect leaking margins, microfractures, and incipient decay long before traditional methods would indicate a problem and long before more precious tooth structure had been lost.

If you are now "watching" a tooth, what are you waiting for? Are you waiting for it to become really painful, really expensive, really inconvenient? Why wait?