Cavities, dental caries or tooth decay, is the destruction of your tooth enamel, the hard, outer layer of the teeth. Around the world, 60–90% of school children and nearly 100% of adults have dental cavities. This makes cavity treatment one of the most common procedures dentists do on a day-to-day basis.
Here, Dr. Chris Johansson answers the 10 most commonly asked questions patients ask about cavities and how they are treated.
SEE ALSO: Tooth Decay & Oral Health: Fact Sheets
None of my teeth hurt, does that mean I’m cavity-free?
Unfortunately, there isn't any clear relationship between cavity size and pain. There can still be cavities even without any symptoms. Whilst smaller damage to the teeth (initial caries) that still haven't developed to cavities can give sensitivity and discomfort, we can have other problems with our teeth than cavities. Extensive tooth brushing, grinding of teeth or abrasive food can damage the teeth with or without any symptoms.
Minor pain or sensitivity is often treated without drilling. Your dentist can easily address your case and give you advice to prevent further damage to your teeth. But if you put your dental checkup in backseat, your risk of developing cavities increases and this can put your pulp at risk.
If a minor sensitivity is neglected for a long period of time it can suddenly get worse and cause intensive pain, tenderness, swelling of the gum and even fever. To avoid damage to the tooth and pulp, we usually recommend checkups every 6-12 months. Always come for a checkup if you suspect something might be wrong. It's better to treat something in an early stage before it gives you more problems.
What happens inside the tooth that has a cavity?
A cavity never shows up suddenly from nowhere. It always starts with a surface damage in the enamel that gradually grows deeper. This damage is caused by certain kind of bacteria in our mouth which use sugar or carbohydrates in the food that we eat to produce acids that gradually dissolve the enamel. It usually takes a long time for a surface damage to develop into a cavity. There is still time to prevent a cavity during this initial stage.
Many patients are surprised when we take X-rays on their teeth and find deep cavities even when they haven't felt the slightest of pain, sensitivity or discomfort.
If the surface damage grows deeper it will develop into a cavity. At this point, we have to clean the tooth from bacteria and do a filling before the pulp is damaged. If the bacteria comes too close to the pulp, we will get an immune response where the body is trying to battle the invading bacteria. This is when symptoms – sensitivity to hot, cold or sweet food and drinks, tooth become tender when biting down – start to present.
It's not always easy to find a cavity. It might be difficult to find a cavity if it's located between the teeth. That's why we use the X-ray to reveal caries or other pathologies that can't be detected easily.
Is it possible for a decayed tooth to heal by itself?
A cavity is an infection that will never heal by itself. There is only one right thing to do when we have a cavity and that is to get your dentist’s help to clean out the bacteria as soon as possible and protect the tooth before it's too late. If the patient for whatever reason decides to wait with treatment then the risk increases for the infection to spread into the pulp and damage more of the structure of the tooth.
If this happens then we have to remove the nerve in the tooth and do a root canal treatment before we build up the tooth with a filling or a crown. If the tooth has been damaged beyond repair then we have to remove the tooth.
How does a dentist treat cavity?
The main principle is to clean the tooth from bacteria, usually with a burr. Where there is a risk for pain during the procedure, we will apply anesthesia. Sometimes we use an anesthetic gel to numb the gum prior to numbing with the needle. It takes a few minutes before the tooth will be numb.
Anesthetic shots take a few seconds to be administered in such a way that there’s a little to no discomfort. We have to remember that we use anesthesia to avoid pain and make the treatment more comfortable for the patient and thereby making it easier for the dentist to carry out the treatment.
We use a burr to clean away the bacteria and when the cavity is thoroughly cleaned, we do the filling. In the past we used amalgam fillings but today we use white filling materials, usually composites. Fillings are either self-curing (hardens by itself) or are cured with a light. It will be shaped and adjusted to the right height so you can bite properly.
Does it hurt? What does the dentist do to alleviate the pain?
We always try to relieve the pain with topical numbing gel and anesthetic injection. You shouldn't be worried about feeling pain during the procedure. Your dentist will try to make it as comfortable for you as possible. But it's always important to inform the clinician if you should feel any discomfort. It's important that the clinician is aware of the patient’s anxiety, take a gentle approach, listen and let the patient know what to expect.
A cavity is an infection that will never cure itself. It will spread and grow bigger by the minute. The longer we wait the bigger the damage.
Can the treatment be done in one appointment? How many hours is an appointment? What if I have more than one cavity?
A normal filling usually takes 20-30 minutes. Smaller fillings can be done in a few minutes while bigger fillings may need an hour.
The amount of fillings that can be done at the same time depends on how long the patient can keep his/her mouth open and how big the filling is. Patients with muscular pain or other jaw problems that prevent them from opening their mouth longer periods of time will be better off with shorter appointments, and thereby avoiding any discomfort.
If there is more than one cavity on the same side then we try to do a few fillings at the same time. If there are many cavities in different places then it's important to make a proper treatment plan. We start the treatment on the teeth that have higher priority.
Crown treatments always needs two or more appointments. The first visit usually takes an hour where we numb the patient and prepare the tooth for a crown. Impressions are taken and a temporary crown is placed. One week later the new crown will be ready for placement. Usually half an hour is booked for this.
It's very important to go through the treatment plan with our patients and make them understand and agree to the suggested treatment plan. I always ask my patients the kind of experience they have had before and if they need any special requirements. If I book longer appointments, I also make sure that my patients know that they, at any time in the middle of a treatment, can always take a short break. It's important to listen to the patients. That's one of the secrets to success in our profession.
Will I need a filling?
Smaller fractures of a tooth doesn't always need a filling. Polishing and minor reshaping of the tooth might be enough. Bigger fractures or cavities on the teeth needs fillings or crowns.
Will the filling be as strong as natural tooth?
Small and medium fillings are usually strong enough and can be an alternative to a crown when restoring a damaged tooth. Bigger damages on a tooth may need a crown to get enough strength. Teeth that are further back in the mouth is under more pressure when we bite and need to be protected in a suitable way. A big filling in this location may work well but will be under tremendous stress and might break. If this happens, the tooth may be even more damaged than before. That's why the dentist sometimes recommends crowns, onlays or veneers instead of fillings.
How long does a filling last?
Statistics show that amalgam fillings have an average survival rate of 12 years and composite fillings 8-10 years. Crowns and veneers can survive for 10-20 years and even longer depending on the situation. This doesn't say so much on individual basis. We see crowns that still works fine after 30-40 years and we can see fillings that is in a good condition even after 8-12 years.
There are a few things that increases the outcome.
- You have to maintain a good oral hygiene. Brush twice daily with a soft brush, using dental floss and rinse with a fluoride mouthwash on a daily basis.
- See a hygienist for a dental cleaning every 6 months and also have your dental checkups at the same time.
- People with a hard bite or those who grind their teeth may need a mouthguard to protect both teeth, fillings, crowns or veneers.
- Avoid bad habits like biting on nails, hard caramels, ice cubes, nuts or other hard items might jeopardize the survival rate of a filling or crown.
- A high sugar or carbohydrate intake also increases the risk for cavities. In combination with a bad oral hygiene this might be disastrous. If the bacteria start to damage the area around a filling or crown then there is a risk for further invasion of the bacteria and the filling or crown will no longer sufficiently protect the tooth and have to be replaced.
The dentist must be familiar with the treatment he does. There is a big difference between placing an amalgam filling compared with a composite filling. If the dentist isn't familiar with the new generations of materials or the treatment he is doing then the result can be a filling or a treatment that will fail and cause future problems. It's very important to use a good material to get a good result. There are no shortcuts.
Do I expect soreness or pain after the treatment?
When we have been drilling on a tooth you might feel minor discomfort for a few days. Usually, the symptoms is getting less after a few days.
If the cavity has been very deep then the tooth may be more sensitive than usual. We usually monitor the tooth for longer periods of time in such cases. Most often these symptoms becomes less after a while, but sometimes we have to schedule a follow-up. In a few cases the tooth won't get better unless a root canal treatment is performed.
That's why it's important to come regularly for the dental checkups and always call when something doesn't feel right. It's also important to come to the scheduled appointments to avoid any risk for further problems.
To avoid damage to the tooth and nerve, we usually recommend checkups every 6 months. Always come for a checkup if you suspect something is wrong. It's better to treat something in an early stage before it gives you more problems.