Risk Category II:    Tooth Structure:

Some people still get ‘cavities’, while others do not, regardless of diet, and how well we clean our teeth. Some people have many teeth, ‘heavily restored’ with large silver amalgams, crowns, posts, and root canals, while others, do not. These combine to give me an evaluation of the likelihood of your teeth lasting your lifetime, based on tooth structure.

During our initial examination we document the size and condition of existing restorations, decay (cavities) that may be present, and the evidence of weakening of remaining tooth structure. A consistent part of my initial exam includes the loss of tooth from a rubbing together contact, brushing, erosion, and bite forces. I also try to determine how or why, teeth may have been lost in the past from these factors. This can be accomplished by visual examination, viewing x-rays and dental photography, and a thorough review of one’s dental history.

Considerations to treatment may include how often and on what locations of a tooth decay starts. If a filling is greater than one-third the width of the tooth, it is only 50% as strong as a non-restored tooth.  In situations where the remaining tooth is thin, cracked, or decayed, some form of a restoration which covers more of the tooth will last longer, reducing the risk of early failure. Placing a crown below the gum line will reduce the chance of decay starting again, lowering the risk of tooth decay. For unusually high frequency of decay, we may culture for specific bacteria, and include a rinse program to reduce bacterial count, in conjunction with repeated applications of a fluoride ‘varnish’.

I frequently hear someone say to me, ‘let’s fill it’, or ‘can’t we just fill this?’ The answer is much more involved than that. ‘Fillings’ don’t solve everything, any more than Penicillin cures all illnesses. I will consider such things as age, diet, brushing habits (including the amount of toothpaste), the presence of adjacent restorations (side to side, and up and down), what part of the tooth is weakening by either decay or fracture, and more.

There are times when we need to realize, ‘teeth aren’t for everyone’, and our best efforts will be seen wasted in a short period of time. Removable teeth or fixed teeth with the use of dental implants are becoming an increasingly better option. I have yet to see a ‘cavity’ on a dental implant! There’s risk reduction……