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Dentistry/Cavities,but not on x-rays


Tooth Analysis
Tooth Analysis  
QUESTION: Thank you for your time. I recently visited a new dentist after a 3-year lapse. She diagnosed me as having 8 cavities( and 2 refills?), though she was surprised to find them because they did not show on the digital x-rays. (She also diagnosed me as eventually needing 2 crowns due to acid erosion on my first,bottom molars, and she wants to remove my wisdom teeth,just in case.)This seems like a long list of ailments, considering that I have never had dental work beyond several shallow fillings.

I am concerned that she wants to fill cavities that could otherwise be monitored, because they were too shallow to show on x-rays. Do you believe that I should get a second opinion? Does a "cosmetic dentist" generally tend to have a different philosophy of practice that a general dentist? Your opinion is much appreciated!

ANSWER: Hi Claire,
I only have time for a short answer now, but If you want more detail please send me some follow up questions.  For now, I'll just say you definitely should get a second opinion.  I would love to see copies of your x rays.  This treatment plan seems rather aggressive for a patient with your history.  Were your wisdom teeth causing you any problems.

I would suggest that you postpone any treatment until you have a second opinion.  if it is anything like this opinion, I would then suggest a third opinion.  I can't know because I can't examine you, but this treatment just doesn't seem appropriate for the information you have provided.

Larry Burnett

---------- FOLLOW-UP ----------

QUESTION: Dr. Burnett- Thank you for your quick reply! I do not have a copy of my x-rays but, for what it's worth, before looking at my mouth she remarked how nice they looked,apart from some tartar, and that she didn't expect to find anything. She also remarked after the exam that she was surprised to find any cavities. I'm not denying that they might be there. My concern is that she wants to drill into cavities that might re-mineralize, given good home treatment and time. Am I wrong to make such an assumption?
My wisdom teeth have yet to cause me any pain, only one has erupted and I'm 34. The only reason indicated for removal was that they might cause decay and subsequent bone loss, due to food getting stuck between them and the second molar. I don't want to have that surgery unless absolutely necessary. Also Dx were spots of acid erosion on the first,bottom molars, from possible silent reflux. Is it possible that there would only be a few spots on just these molars, and not any of the others?
I sincerely appreciate your time and expertise. - Claire

If you can't see the decay on x ray they are too shallow to need drilling.  If they are there at all they can be remineralized when they are that shallow.

We are slowly coming to the consensus that wisdom teeth should not be extracted unless and until they cause a problem.  This is because of the expense and the frequency of damage to the patient by the extraction process.

I repeat my suggestion that  you get a second opinion.  It would be most helpful that the second opinion be given by someone who has no financial interest in the treatment.  A hygienist would be fine. Take your x rays from the first dentist.  Don't tell whoever is giving the second opinion what first opinion was.  I would be interested in hearing your results.

Larry Burnett DDS  


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Larry Burnett DDS


Preventative Dentistry. Conservative Periodontal Therapy


National lecturer on conservative treatment of periodontal diseases and elimination of tooth decay. Former adjunct professor of oral microbiology at a Leading school of dental hygiene. Former investigator for State Board of Dentistry. Retired from private dental practice.


RDH Magazine. Numerous articles

Graduate of Medical College of VA School of Dentistry. 20 years teaching hygienists at NOVA

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