What are cavities? How do you get rid of them? What should you do if you have a cavity?
First of all, what is a cavity? Back in the olden days, we used to think it was something that ate a hole in your tooth. They called them tooth worms, and we even joke about that today, but that's not a thing. There's no tooth worms. What a cavity is, is when the acid from the outside of a tooth starts to harm its hard shell and that breaks down that shell, it's hurting it, and eventually a hole forms in that tooth. So it takes the outside world, the acid erodes the outside of the tooth, the tooth breaks away, and then it gets to the inside of the tooth, which is a lot softer and it can't resist acid. That whole process is called a cavity, but that's where the simplicity ends.
How do we check for cavities?
There's everything that you're used to. It's looking inside. We just do a checkup. We can tell a lot of times visually if you have a cavity. We take x-rays when you're in. A lot of times we can find the early stages of a cavity before it's actually caused a hole or a big black spot. We can see those in x-rays first. That's something that a visual exam can't show you. And then there's the more sophisticated ways of finding cavities, whether it's AI or it's fluorescence or there's a couple different light sources that we can use to pinpoint cavities. The point isn't how we find the cavities, but once we discover that they're there, if that's something that's going to progress and it's going to harm the tooth, it'll get deeper, it'll form a hole and cause you pain or discomfort, what are we going to do about it?
How does the dentist check for cavities?
Well, after the clinical exam and after we have x-rays, we look at those two together. A lot of times we can just tell visually by the surface of the tooth that something's going on. Whether there's a big black opening and a hole in the surface of the tooth, well, that's pretty obvious. But if it's something that's not quite that bad yet, what if it's brown? What if the surface hasn't crumbled? What if this is just a spot that actually looks white? All of those can be early signs of cavities, just before it's caused the hole that opens into the center of the tooth and we need to do something about that too.
What are the different stages of a cavity?
One of the earliest stages is no cavity at all. Let's say the pH goes down. Let's say you're eating lots of sweets or candies. There's things that are damaging the surface of the tooth. Well, day one, you're not going to see anything. But as time goes by, that low pH, that acid, is going to hurt the surface of the tooth. It's going to cause the enamel to thin, to get more porous. You might notice some sensitivity. It can even look like a white spot lesion. And doesn't that seem weird? Your tooth is being damaged, but it gets more white. Don't we want our tooth white? Well, not in this scenario. This scenario means the enamel's being harmed. It's being damaged. It's getting thinner. It's getting more porous. And those are the stages right before it either turns a dark color or crumbles into the surface.
Can a cavity spread to other teeth?
It can and it does. If you have something going on with the environment of your mouth, the kind of bacteria that live in there, and the diet that you choose, all of those things, if it can harm one tooth, it can harm the rest of the teeth. So what you can assume is anything going on with one tooth is very likely already going on with the tooth next to it. It might just be in earlier stages before you can see it, feel it, or notice it yet.
Is it possible for cavities to go away?
Absolutely. In fact, the earlier stages that we can find a cavity, we have stronger and stronger recommendations to not do anything to that tooth directly. What we need to do is set a better environment and remove all of those things that are causing harm, whether it's the acids in the diet or the lack of remineralizing structures. Let's change those before we go directly to doing something to the tooth, whether that's a filling or a crown, something like that. In the earliest stages, especially when the tooth is not yet crumbled in the surface, when the surface is just turning white or maybe a different color, but it hasn't collapsed in yet, that's the best time to do something that's preventative, that can stop that process, and then we don't have to do something invasive.
How do we stop a cavity from progressing?
As I mentioned earlier, you can do things like remove the acid from the surface, change your diet habits. You can do things that can strengthen the outside of the tooth. The most traditional is fluoride, but there's others. You can do something that brings more of the minerals to the surface of the tooth. Usually, that's something like calcium and the other associated minerals. All of those things together, reducing the acid, bringing more building blocks, strengthening the surface of the tooth, changing the kinds of acids and the exposure time of acids. When those are all done together, we can have a pretty significant effect on cavities. One that reduces the rate and sometimes even reverses early stage cavities to the point that they've stopped. They're not progressing anymore, and then you don't really need any direct treatment at all. You just need to continue the prevention.
How long is a filling going to last?
Let's say that you had a cavity, and it was severe enough that you needed a filling. I think most people have had a filling. It's pretty rare to meet someone who hasn't. At probably 10 to 15 years, we got about a 50% survival rate on those, so nothing man-made lasts forever. I'd much rather you keep your natural tooth structure, but if you do need to get something fixed, it's going to last a good long while. 50% chance it's still going to be there after a decade. That's pretty good for something man-made, put in a hostile environment that we use all day long.
What's the deal with cleanings? Don't cleanings prevent cavities?
The answer is they can, and they do already. If you get rid of the biofilm, that's the scuzzy layer on the surface of the tooth. That's the biofilm that holds acid. That acid is harming the surface of the tooth. The better you can disrupt that and remove that and replace it with things that increase the pH, things that protect and remineralize the tooth, if you're getting the bad stuff off and more exposure to the good stuff, then you've short-circuited the cavity process and you've actually turned down the rate of your cavities already. What most of us don't know is by getting that regular cleaning, by disrupting that biofilm, we're already doing something that's really good for our teeth, but you just have to supplement it the rest of the day. If you go home and you go back to, I know the diet that I keep isn't the best, and you're doing all those things that you know you shouldn't do, then you're not supporting the good process that happened during the cleaning. You need to make sure that you're sticking with it all throughout the time in between your cleanings as well.
What should I do if I suspect that I have a cavity?
By all means, ignore it. It'll probably go away on its own. No, of course not. That process, once it's started, tends to progress. It's very rare that a cavity would stop on its own with no intervention whatsoever. We talked about earlier, if we do find something in the very early states, and it could be even just a white spot along the edge of your teeth, that's the most opportune time to stop the process from continuing. That's the right time to find it. That's the right time to put in all these interventions that we talked about, whether it's increasing the pH or decreasing the acids, disrupting the biofilm, getting something on the tooth that can rebuild those building blocks. Once we change all of those things, that's your best shot at not needing the filling, not needing the crown, not needing that advanced work. Don't let the surface crumble. It's going to happen all of a sudden. The second you suspect something's going on, and really before you have any sign that there's a cavity, that's the right time to check for it because that's when our success rates are the highest, and that would be the best for your teeth too.