Why does one dentist tell me I have 8 cavities, while another says I have none?

incipient caries (4)

Before we begin, I’ll say that by using an electric toothbrush, the likelihood of both dentists telling you that you have 0 cavities will probably increase. I prefer either Sonicare or Oral B!

I’ve heard several frustrated people tell me that they didn’t trust a dentist because after being told they had several cavities, they’d visit another dentist who would tell them they didn’t have a single one. I wanted to write a short article explaining this situation.

The first thing you need to know is that neither dentist is necessarily wrong. The reason they give you 2 different diagnoses is often due to a form of caries called incipient decay. Incipient decay is a form of decay where the minerals in your tooth have been weakened by acidic bacterial residues, however the weakened minerals have not yet cavitated or extended past your enamel into the second layer of your tooth, the dentin. (See image on the left).

The differing diagnoses between dentists come because there is a window of progression where, with proper care, the tooth may remineralize. However, visual examination and x-rays are often not enough to give a definite answer as to whether or not the decay is still within the window of remineralization. One dentist may decide that it is within the window, while another could look at the x-ray and believe that the decay has penetrated the dentin.

After determining that the decay has not yet passed through the enamel into the dentin, a dentist may simply treat the decay with fluoride and sealant, and note the incipient decay on his charts for monitoring. The tooth will often remineralize in this situation. The advantage to this approach is that you may avoid having to have a tooth drilled and filled. The disadvantage is that if the tooth doesn’t remineralize, the decay will spread and the dentist will have to drill away more tooth structure than he would have originally, had he drilled out instead of hoping for remineralization. This one disadvantage, however, may take years to come to fruition.

If a dentist determines that the decay has passed into your dentin, he will elect to drill it out and fill it in order to avoid the risk of the caries spreading deeper into your tooth.

Without drilling into the tooth, it can be extremely difficult to determine whether or not the decay has reached the dentin. This further explains why you may get slightly differing diagnoses from one dentist to another. Any time a dentist recommends remineralization, it is crucial that he monitors the incipient decay very closely. This means that you are going to the dentist every 6 months so he can make sure that your tooth is not being destroyed.

Whether or not your tooth decay needs to be drilled, your dentist should be communicating with you and explaining his diagnosis as well as your treatment options. If you ever have a question or are confused about your diagnosis, don’t be afraid to ask your dentist what’s going on. If you are informed on your treatment it will be much easier to trust your dentist and maintain a positive relationship with your dentist and his office.

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Jake the Dentist: brushflossandmouthwash@gmail.com