Cavities Clarification

[icekitsune]

Hi there,
I'm a pharmacist, the other day I had a patient come in asking about prescription fluoride toothpaste and a whole bunch of questions that I didn't know the answers to. I tried to search online about this topic but got alot of vague answers so I told her to talk to her dentist. However, I was kinda curious and I wanted to educate myself on these topics so I hope this thread is acceptable. So patient had bitewing xray which the dentist said something about faded color on one of her tooth on two surfaces, its btw two teeth. The color looks a little different but it doesn't hurt and there seems to be nothing that indicates a cavity from the visual eye.

Dentist states that it was a cavity due to lack of flossing and it needs to be filled not asap but within 3 months time. There was alot of information regarding reminerization and fluoride toothpaste that I found online (oil pulling?). Even on the gov website, it states that a cavity can be reversed. So in practice, can a cavity be reversed by fluoride therapy and change in habits? If a cavity is located in the enamel part only(since no pain), does that mean a filling will not be necessary since the enamel can be reminerized? I also read how teeth can reminerize and become white spots where parts were deminerized then reminerized. Correct me if I'm wrong but isn't a bitewing xray shows spots of deminerization and changes in density of tooth structure/gum changes? If someone could send some articles or sites, that would be great too.

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[suarez 7]

Caries can be reversed if it's limited in enamel only, and use of fluoride, flossing, etc will help remineralize the decalcified enamel, whether its on a proximal or chewing surface. However, not all dentists believe in this idea. Some will fill all lesions even if it's on enamel.

Also caries can still be in dentin and the patient can be asymptomatic. There are different stages of caries, which ultimately leads to cavitation and irritation of the pulp, thus causing symptoms.

Correct me if I'm wrong but isn't a bitewing xray shows spots of deminerization and changes in density of tooth structure/gum changes?

Yep

 

[icekitsune]

Caries can be reversed if it's limited in enamel only, and use of fluoride, flossing, etc will help remineralize the decalcified enamel, whether its on a proximal or chewing surface. However, not all dentists believe in this idea. Some will fill all lesions even if it's on enamel.

I'm a bit confused. Caries is the same as a cavity isn'i it or is caries leads to a cavity? If the cavity is in the enamel but not the surface of the enamel but the inside i guess, kind of like a light bulb shape.. saliva won't get in there as much, would fluoride still be able to reminerize the enamel thats a little deeper/?

 

[7 Iron]

"Caries" is what dentists call tooth decay... most patients know it as "cavities" so yes they are the same thing.

Tooth decay limited to enamel sometimes can be remineralized with better habits, oral hygiene, flossing, and fluoride. Some people have lots of incipient caries (i.e. cavities limited to enamel) across many different teeth. In this case a high-fluoride toothpaste is a great option and many dentists take a "watch and wait" approach. Decay that goes into the dentin (the tooth layer under the enamel) will not remineralize on their own, so they need to have fillings placed.

Also, decay can be far into dentin and still the patient will not have pain. This is why radiographs are important.

 

[Screwtape]

There is a lot of information about this kind of stuff so I will try to keep this simple and to the point. Caries is the process of tooth decay. A cavity (to dentists) is an actual breakdown of tooth structure. You can have a carious lesion without cavitation. Tooth decay is a process that starts with demineralization of tooth structure without any loss of tooth structure-- this is what we call a non-cavitated carious lesion (AKA white-spot lesion). These early forms of decay can be reversed by remineralization, however once the decay process has advanced to an actual cavity (loss of tooth structure), that structure will never come back naturally-- so we fill it.

Hope this helps.

 

[icekitsune]

"Caries" is what dentists call tooth decay... most patients know it as "cavities" so yes they are the same thing.

Tooth decay limited to enamel sometimes can be remineralized with better habits, oral hygiene, flossing, and fluoride. Some people have lots of incipient caries (i.e. cavities limited to enamel) across many different teeth. In this case a high-fluoride toothpaste is a great option and many dentists take a "watch and wait" approach. Decay that goes into the dentin (the tooth layer under the enamel) will not remineralize on their own, so they need to have fillings placed.

Also, decay can be far into dentin and still the patient will not have pain. This is why radiographs are important.

I read that white spot lesions are actually lesions that was previously deminerized but was able to reminerize again. So basically once the decay has reached any part of the dentin even slightly, there is no going back and a filling has to be done. Looking at what is available online, fillings are usually the composite resin and they have a life span of 5-10 years (idk how true that is).So having a cavity at the borderline enamel/ dentin, isn't that a downward spiral toward tooth loss? When a filling falls out say in 5-10 years,it gets replaced and more tooth structure gets loss in the process of filling and cleaning, eventually isn't there no tooth left? In theory, having a filling, doesn't that increases the chance of having more decay in the border between the filling and actual tooth?

 

[bigstix808]

I read that white spot lesions are actually lesions that was previously deminerized but was able to reminerize again.

sometimes. kids with a history of having braces with white spots afterwards, this is likely the cause. also, the white lesion can not be assumed to remineralized based on look alone. a skilled dentist can typically make that diagnosis for you. some white spots can develop before the tooth erupts in which it is typically the result of too much fluoride during development. those white spots are softer in nature and actually more prone to breakdown and caries prone.

So basically once the decay has reached any part of the dentin even slightly, there is no going back and a filling has to be done.

theoretically, yes. manual removal is the only option to correct the damaged tooth structure. if OH can be maintained then advancement of the cavity can be slowed down and filling can be put off, but thats not with out risks also. it is up to the dentist as if he feels a cavity needs to be restored or not. there is ample anecdotal evidence that states that if only minimal dentin is affected (gauged almost entirely by radiographs), AND the surface structure is in tact, then remineralization is a viable option - increased OH and F therapies (there is some literature stating this too, but the verdict is still out)

Looking at what is available online, fillings are usually the composite resin and they have a life span of 5-10 years (idk how true that is).So having a cavity at the borderline enamel/ dentin, isn't that a downward spiral toward tooth loss? When a filling falls out say in 5-10 years,it gets replaced and more tooth structure gets loss in the process of filling and cleaning, eventually isn't there no tooth left?

this is the conversation i have to have with pt's every single day. most restorations these days are tooth colored, and/or some variation of a composite resin. amalgam (silver fillings) is still a tried and true restorative options, but due to the "scare" of mercury as an ingredient in the material and the esthetic concerns, its being used less and less. the literature will tell you that the life span of a filling is 5-10 yrs, however, there are a myriad of conditions that can make that lifespan much much less, and much much longer. OH, DIET, # of previous cavities, age of pt, location of the filling, dentist technique in placing the filling (i.e.: rubber dam vs no rubber dam), systemic medical health, size of filling, para functional habits (grinding teeth, etc), and the list goes on.

i personally have composite fillings over 15 yrs old in my mouth, and i see its with silver fillings 40+ yrs old. i had poor OH when my fillings were placed. i stepped it up and maintained it so i haven't had a filling in 10+ yrs. just keep routine check ups to check their integrity. only your dentist can make the distinction if he/she feels that a filling needs to be replaced.

In theory, having a filling, doesn't that increases the chance of having more decay in the border between the filling and actual tooth?

yes. read above explanation about said answer. once tooth structure has been removed it can never be replaced. our restorative options are getting better and better, but they will never be as good as the original product. of course teeth with fillings are more susceptible to have a new cavity in the future, its not a death sentence for a tooth. all those parameters i mentioned above all play a part in that risk.

 

[icekitsune]

OH, DIET, # of previous cavities, age of pt, location of the filling, dentist technique in placing the filling (i.e.: rubber dam vs no rubber dam), systemic medical health, size of filling, para functional habits (grinding teeth, etc), and the list goes on.
.

Thank you very much. I appreciate you taking the time to explain, bigstix and others. I noticed you bolded diet as a large factor in life of a filling. Are we talking about drinking acidic drinks and eating candy that can decrease the life of a filling?Are there diets or certain vitamins (fluoride therapy) that can increase the life of a filling or help facilitate reminerization like milk or calcium? Though i don't think vitamins will have any large impact on teeth since the structure is already there.Several sites promote the low carbs, I believe Paleo diet?, that claims can harden teeth due to low sugar content

 

[bigstix808]

Thank you very much. I appreciate you taking the time to explain, bigstix and others. I noticed you bolded diet as a large factor in life of a filling. Are we talking about drinking acidic drinks and eating candy that can decrease the life of a filling?Are there diets or certain vitamins (fluoride therapy) that can increase the life of a filling or help facilitate reminerization like milk or calcium? Though i don't think vitamins will have any large impact on teeth since the structure is already there.Several sites promote the low carbs, I believe Paleo diet?, that claims can harden teeth due to low sugar content

the bacteria eat the carbs to produce acid … that is what leads to tooth decay. if you limit the amount of simple sugars mainly (candy, sweet tea, soda --this is a double treat being acidic and sugar filled, etc) then you reduce the risk of a cavity. that coupled with good oral hygiene is paramount in the success of a filling. i don't condone any "fad" diet but simply recommend a balanced one with little to no simple or processed sugars.

some general things i tell pts about diet etc:
-if you drink a soda or sweet beverage, limit them to meal times. the continual onslaught of sugars creates a "perma-acidic" environment which will cause demineralization/tooth damage
-if you want to have a soda, then drink some water and wait about 10-15 min bf brushing afterwards as your enamel is "soft" temporarily due to the pH dropping below 5.5. your mouth needs some time to get the pH back up and your tooth brush will work like sand paper
-stay away from hard candies … they break teeth, and coat the whole mouth with sugar
-chew gum frequently, or at least after meals if you can't brush right away.

and since you mentioned it, no diet will "harden" teeth … and oil pulling is a bunch of garbage