Dental Hygiene/Cavity

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Question
I had a dental appointment two weeks ago and got told I had one cavity as it was sticky but all my other teeth were perfect. For the past three days, I have noticed a second sticky tooth on the same side (not sure if it is top or bottom as I only notice when I put my teeth together). I have avoided all drinks except water and have been brushing my teeth regularly. I have also completely avoided any food on that side. Is there anything else this could be but another cavity? How could a cavity come so quickly without any food or drinks touching it? I also heard cavities, at there early stages, could be treated by fluoride toothpaste and was wondering if that is true. If so, is Colgate good enough and did I catch this second one in time?

Answer
Hi Danika,

Sorry for the delay.  I spent some time trying to find the enclosed article. I want you and hopefully some others to have access to this kind of information.  It was written to help teach dentists so it is all the more valuable to you.  It is all directly related to the very important questions you raised.  Its a good thing you took the time to ask.  i think we can save you a lot of trouble and expense.

First lets clarify some things. Am I correct if I assume that you have no other fillings in your teeth?   When you say that your tooth was "sticky" that means the dentist stuck a sharp little probe into the grooves on the chewing surface, and the probe seemed to sort of stick in there when he went to pull it out.  If it is stcky, he may diagnose it as a cavity that must be drilled and filled.  But the diagnosis could be inaccurate.

When you talk about the other tooth being sticky a few days later, that must be something else that has nothing to do with new decay.

And yes, you can treat early decay with the fluoride in any toothpaste including your Colgate.  You must start applying it with a toothbrush to the affected area every time you eat or snack.

You will also learn below that sticking that probe in to find a cavity can convert an easily reversible early enamel decay, into a hole which needs to be drilled and filled.  And once you get that filling, whether you needed it or not, it is destined to a lifetime of breakdown and repair costing thousands of dollars per tooth filled, on average.

Were x rays taken?  If the decay doesn't show on x ray, don't let anyone drill it without a second opinion.

Larry Burnett DDS









BY George Stookey, Ph.D.

USE OF AN EXPLORER CAN LEAD TO MISDIAGNOSIS AND DISRUPT REMINERALIZATION.


For at least the past 50 years, the conventional procedure for the clinical detection of dental caries has involved a visual-tactile examination of the tooth surfaces supplemented with the use of radiographs. As described in 1968 by Radike,1 a critical factor supplementing the visual inspection was the tactile feel of tackiness and force of withdrawal associated with the insertion of the dental explorer into the suspicious area. Thus, dental students were taught literally to attack the suspicious area with the sharp explorer to determine if the area had the traditional feel of a carious lesion. Since many of the suspicious areas resisted the explorer, the clinician was expected to use pressure on the probe. However, an increasing amount of research is indicating that that long-standing approach may no longer be the best.

The results of several studies indicated that use of the dental explorer was of limited value for the detection of occlusal caries.



THE EXPLORER, REMINERALIZATION AND FALSE DIAGNOSES
The caries process is a known continuum beginning with demineralization beneath dental plaque and progressing through various stages that include a so-called "white spot" and eventual cavitation. Since the 1966 report by Backer Dirks2 documenting that white-spot lesions could be reversed completely and "disappear" clinically, many scientists have investigated the physicochemical dynamics of the caries process. Among the conclusions from these numerous studies is the fact that even though the white-spot lesion reflects the loss of mineral through the outer one-half of the enamel thickness, the lesion may be remineralized as long as the surface layer remains in place. Once the surface layer is broken, plaque acids diffuse into the lesion and the extent of the lesion progresses much more rapidly. Thus, an intact surface layer is considered essential to the reversal of the caries process, and penetration of this surface with an explorer converts a subsurface lesion into a frank cavity.3,4

This realization, coupled with the observation that the use of the dental explorer in the historical manner resulted in an unacceptably high proportion of false-positive diagnoses on occlusal surfaces,1,3 led a number of clinical scientists to re-examine the value of the use of the dental explorer as a probe for caries detection. The results of these studies indicated that this use of the dental explorer was of limited value for the detection of occlusal caries. For example, Lussi5 investigated the ability of faculty dentists and dental practitioners to diagnose fissure caries and determined that only 42 percent of the fissures were diagnosed correctly. In terms of reproducibility, a good level of which is expected to have a  value approaching 0.75, faculty dentists had  values of 0.21 using the explorer and 0.25 using only a visual examination. For dental practitioners, the  values for the examinations were 0.24 and 0.23 with and without the aid of an explorer, respectively. Lussi also observed sensitivity and specificity values of 62 and 84 percent, respectively, indicating that practicing dentists were more likely to fail to treat carious fissures than to restore sound fissures.

Generally similar results of an unacceptably high number of false-negative diagnoses of fissure caries using the dental explorer have been reported by a substantial number of investigators.3,4,6.  As noted by Anusavice,19 many clinical decisions to place occlusal restorations are based on the inappropriate use of the dental explorer to determine the softness or tackiness of the fissure or the amount of resistance to the removal of the explorer from the fissure. Thus, Anusavice concluded that there is strong evidence to support the elimination of the use of the dental explorer in the historical manner.

The tip of the explorer should be moved gently across the surface of any noncavitated area to determine the presence or absence of surface roughness.



However, as noted by Kidd and colleagues,20 the dental explorer continues to be an indispensable component of the caries diagnostic armamentarium. With the recognition that the caries process is a continuum and the caries process, if detected before cavitation, can be reversed or arrested with various professional and home-use fluoride measures, it is apparent that the mission of the clinical caries examination has changed from simply the identification of well-advanced lesions requiring restoration. Instead, the mission of the examination now includes the identification of lesions or demineralized areas at the precavitation stage that may be reversed or arrested if the thin surface layer covering the demineralized area remains intact. Thus, the use of the dental explorer in the traditional manner must be avoided, because it will fracture the surface layer and eliminate the possibility of reversing the caries process.



THE USES OF THE EXPLORER, PRESENT AND FUTURE The primary uses of the explorer are to remove dental plaque from the examination area and to determine the roughness of the surface of noncavitated lesions (white spots). Since dental plaque is essential for the development of dental caries, its presence is a clear indication that the area beneath the plaque needs to be examined carefully. The plaque biofilm may be removed gently with a scraping action of the explorer򳠳haft or by the use of the explorer򳠴ip in fissures to expose the underlying enamel surface.

In addition, the tip of the explorer should be moved gently across the surface of any noncavitated area (white spot, brown spot) to determine the presence or absence of surface roughness as an indication of whether the underlying demineralized area reflects an active lesion. In the absence of imaging technologies, which still are evolving, the use of the explorer in this manner coupled with the visual examination appear in several studies to be the most effective means for the diagnosis of clinical caries and the identification of the most appropriate approach for caries management.4,9,21.  These studies have demonstrated clearly that the use of the dental explorer in this manner does not diminish the clinician򳠡bility to detect accurately more advanced lesions requiring restoration on both occlusal and smooth surfaces. Moreover, this procedure permits the detection of precavitation-stage lesions and the determination of whether these areas are active. This latter assessment of the precavitated lesion or demineralized area permits the clinician to identify the appropriate professional and home-use treatments to reverse or arrest the process and to monitor the success of the treatments at subsequent examinations. Thus, while the dental explorer continues to be a critical component of the clinician򳠤iagnostic armamentarium, its use as a probe in the historical manner for a tactile examination of the tooth surface is contraindicated.



CONCLUSION There is an increasing body of scientific data indicating that noncavitated incipient lesions may be remineralized if the surface layer covering the demineralized area or lesion (the white spot) remains intact. Because the use of the probe generally has disrupted this surface layer and prevented the possibility of reversing the noncavitated area through remineralization, the use of the probe to determine the softness or tackiness of the noncavitated lesion is contraindicated.
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Dental Hygiene

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Larry Burnett DDS

Expertise

I can answer questions about prevention, elimination of, and non surgical treatment of periodontal diseases and early tooth decay. I can't answer questions concerning dental insurance payments.

Experience

Taught hygienists in a major dental hygiene school for about 20 years. Taught hands on courses concerning these categories to Dentists and Hygienists throughout the US and Canada including repeat lectures at the Annual Scientific Sessions of A.D.A. and A.G.D over several years. Personal hands on delivery of preventive hygiene services to disadvantaged children through a mobile school based prevention program.

Publications
RDH Magazine, Parkell, Dental India and some places of which I'm not aware.

Education/Credentials
Medical College of Virginia ( VCU) School of Dentistry.

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