Dentistry/Pit and Fissure staining
QUESTION: Hello Dr. Burnett
I was wondering if you could help me or offer me some advice? I know you can't really diagnose anything unless you look into my mouth, but I will explain my situation as best as I can. I will also give you a short summary of my dental health.
I am a 22 year old female and I have 2 silver filling. I got them when I was fairly young. I got one when I was about 6 or 7 and the other when I was about 11 or 12. I haven't had a cavity since then and I'm not really counting the small hole that I detected recently. This hole was so small that it must have been the width of a really thin needle. I had no pain and there wasn't any brown or black stuff in or around the hole.
I went to my dentist, who I have been going to since I was 8 years old. I told him about the hole and he took a look. This hole was so small that my dentist couldn't even see it. He had to take out a magnifying glass in order to see it. He then stuck his probe in it. He asked me if that hurt and I said no. He said that it wasnt bad at all and that it was really shallow. That it didn't reach the dentin at all.
He then took out some composite. He said that he was going to clean it and seal off the hole with the same composite he uses for deep fillings. I asked if he was going to drill and he said that there was no need. So he sealed off the hole and said that this should prevent the whole from progressing.
After that, he looked at my bottom molars and said that they were pretty deep and that I had some staining on them. He said that this staining could turn into a cavitated lesion. That right now it was non cavitated incipient lesion. He asked if I wanted to seal them. I wasn't so sure but I trusted him so I let him do it. He cleaned off the fissures (no drilling) and sealed them off with the same composite he uses for fillings. I was confused because I thought that sealants were normally flowing but I figured he knew what he was doing.
I then left the dentist and thought to myself that I made the wrong choice and I shouldn't have sealed off my pits and fissures. I had so many questions and concerns but I didnt want my dentist to think I didn't trust him. I did ask him if could take it off and he said yes but didn't recommend it because I already had some staining.
Here are my questions/concerns:
1) Was it okay for him to seal off that tiny hole? Could I have prevented it from progressing on my own?
2) Was it okay for my dentist to seal off my pits and fissures even though there weren't any cavities just staining? If there were some decay would it arrest it because food and fluids can't get inside the fissures?
3) Is it normal to use the hard composite resin instead of the flowing kind to seal fissures?
4) Would I be more susceptible to decay or get a cavity under the composites since I cannot brush the sealed of portion of my teeth? I am afraid that the brown staining will turn into a cavity since it is sealed off. My dentist said that even if I did have a cavity (which I didn't) it would arrest because of the anaerobic environment. Is that true?
5) My dentist said he could remove the composite on my teeth. Is there a safe way to do this without any danger of removing any part of my actual tooth by mistake?
So there you go Dr. Burnett, I apologize for the really long email and I know you have actual patients to attend to. I just thought I would try to ask because I am freaking out and my dentist can't seem to give me a straight answer. Any help is greatly appreciated!
ANSWER: Dear Victoria,
Relax, you appear to be in better than excellent hands with this dentist. Even though I can't see your teeth, every word in your clearly written note suggests to me that you are in the hands of a dentist intent upon saving your teeth AND your money. He has treated you based upon evidence that you are at low risk of getting new cavities. He is using the most modern dental prevention techniques known.
1. It was more than OK. You may have been able to prevent from advancing on your own, but there is no assurance of that.
2. Yes it is OK. If there were some early decay it would arrest from the anaerobic environment and also from fluoride that may go from the sealant to the surface it covers. If the material is something that looks like tooth filling plastic, it might be a glass ionomer material that acts as a fluoride implant for further re-mineralization of the enamel.
4. The tooth will become less susceptible to decay, that will continue even after the sealant is gone.
5. You wouldn't want to do that. But the dentists offer to do it shows that he is really sensitive to what his patients want as opposed to insisting to do what he thinks is best.
Many other dentists would have been more aggressive and drilled all those other teeth and maybe even more. That would have left you with fillings destined to break down and be repaired over your lifetime with ever larger fillings and crowns.
Non aggressive Dentists like yours don't get rich and they don't receive the admiration they deserve. So you might want to bring him this communication and tell him I said "good job buddy"
Larry Burnett, DDS
P.S. Continue to use a fluoride tooth paste twice a day. The way you will likely never get another filling except for repair of recurrent decay on your present filling. This assumes you don't change dentists.
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QUESTION: Dr. Burnett
Thank you very much for taking time of your day to answer my question. You have put me much more at ease. I called my dentist and asked him about what kind of composite material he may have used. He said that it was a regular composite filling material. I am a little concerned because you said that it should be a flouride releasing material to prevent decay.
Also I was reading some research conducted on sealing fissures with staining and it said that the number one problem is the sealant leaking especially if it is high viscosity. The staining then becomes deep decay and it sometimes does the opposite of what it was supposed to do.
This composite that my dentist used was like a thick paste. He used his metal instruments to put it on my teeth. I thought the composites used for sealing teeth were in syringes and were flowable. That way the sealant can get down into the deep grooves and protect it from debris. I did ask him about that and he said that those kinds come off eventually and that the one he used doesn't wear off.
Well I am hoping for the best and I will make sure to get an xray every six months to check to see if any decay is forming underneath the composites. I just hope that this preventative measure doesn't backfire on me and damage perfectly healthy teeth.
Thanks again Dr. Burnett. I will update you if I have any problems or if I decide to take them off and put in a flouride releasing sealant. Have a wonderful day.
ANSWER: I would want those sealants to be glass ionomer in my mouth. Especially if there were early demineralization that needed to be remineralized. I think your plan to watch with an x ray every year or two so would be a good idea. But definitely not to worry. If it did worry you, you could always get him to change as he offered.
Larry Burnett DDS
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QUESTION: I see, I will make sure to mention this to my dentist when I see him for my check up in May. One last question, is it possible to remineralize the stains that were covered by the composite even though they have been covered? I'm not sure if that question makes any sense. Basically I brush with regular Crest cavity protection paste, then rinse with listerine, and lastly rinse with Act Flouride Rinse. I also chew 100% xylitol gum between meals. Will the Flouride in the toothpaste and Act Rinse help remineralize the fissures under the composite? Or does it not matter because the teeth are sealed and are not exposed to the flouride or the antibacterial qualities of the listerine and the xylitol.
Again I apologize for all the questions, but you have been a great help. I am glad that I was able to find this website and find such a knowledgable person. Thanks again and enjoy your weekend.
Sorry for the delay. Regarding remineralizing the stains; They probably don't need it. The stains in those grooves are often the result of those areas having remineralized themselves previously. Colored material gets trapped in the new enamel. If this is the case, those stains are more resistant to decay then the original enamel because of the fluoride ion that now is part of the enamel. I just tell you all this because I sense that you want to know as much about it as you can. Too bad so many dentists are not aware of this staining process. But some stains are different and are associated with decay.
Any how you answered your own question amazingly well. Everything you mentioned is correct. The area is sealed so that demineralization can't occur - no bacteria - no acid -no demineralization. And all that fluoride further protects you further. I wouldn't change the sealants if I were you. I would have the dentists check their integrity each time you return to the office.
I think the only way you will ever get a new cavity is if someone drills in error. Your preventive program and risk status is that good.