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Dentistry/cavities or no cavities ?

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Question
I went to a new dentist for my every 6 month cleaning and got some information that is either incomplete or suspect.  X-rays all normal showing no cavities ( I haven't had any for over 30 years). Then they used some kind of dental video camera and looked at all my fillings and showed me what they suspected was a superficial cavity, but it looks like a vertical fissure in the tooth to me (asymptomatic). Then they said I should take out the amalgam filling and repair that fissure. When I got to the front desk they had a quote ready for EIGHT cavities, all the teeth I have had previously filled. additionally, they are advocating "deep cleaning" in the left lower quad for a single molar having a 5 mm recession but with NO gingival disease, "to make the gum and peridontal ligaments grow back".  My gums never bleed, even when I got some heavy duty cleaning on that molar. Is there any benefit to xylitol rinse and calcium phosphate paste to repair superficial radiographically invisible cavities? I am a medical person but this tag team approach between the hygienist and dentist at the office had my head spinning.  Any input you might have greatly appreciated.
Anne

Answer
Dear Anne,

Your letter has inspired me to write a more detailed answer than usual.  I write with the purpose of helping you to save your teeth AND your money, with the hope that you will spread the news.

The news is that there are many dentists filling teeth that don't need it.  That is to say drilling and filling teeth where it is not medically necessary..  There have been studies showing how pervasive this over treatment is.  Here are examples which point to the over treatment problem.  You may have to cut and paste

http://www.ncbi.nlm.nih.gov/pubmed/9140335

http://www.ncbi.nlm.nih.gov/pubmed/8478124

As you may know, over treatment in medicine is a problem we live with.  But dental over treatment is particularly egregious.  For example, when a child's tonsils are removed needlessly, it is over and done with after a few weeks of recovery.  But if a child's permanent tooth is filled, the assault stays with her the rest of her life.  That filled tooth will be continually undergoing the process of breakdown and repair because re-mineralization is hampered by the junction of filling and tooth..  The constant recurrence of decay results in ever larger fillings and eventual crowns and root canal treatments.  The average cost over a lifetime has been shown to be thousands of dollars per tooth, and that's just the money part of the suffering.

The most likely time to be caught in the over treatment trap is when switching to a new dentist.  This is when the patient is most vulnerable because of traditional authority and trust that goes with the title, "Doctor".

Now let's finally look at your case Anne. Disclaimer:  Let me first say that since I haven't seen your teeth or your x rays,  there could be something I don't know or see, that your dentist knows or sees, which would trump anything I write here.

Since you are in the medical field, I hope you will be interested in the medical details of my thinking about your case.  My thinking is based on risk analysis and I will detail that.

One validated risk factor for cavities is having a cavity or filling in the previous 3 years.  Your history of no cavities for 30 years is that much more dramatic.  Furthermore you are the type of person who cares for your health and teeth.  Also, you have been seeing a good dentist who helped you stay free of cavities or fillings.

In short, I doubt that you need any fillings at all.  The deep cleaning appears to be more over treatment.  To answer your last question, yes, xytitol appears to help somewhat in re-minerealization.  The calcium phosphate paste doesn't appear to have any advantage over fluoridated paste.  More concentrated fluoride paste is available by prescription - I doubt that you need it.

If you would like to pursue this matter further, please contact me by e mail for further discussion.  I would like to look at your x rays some time for my own education.

Larry Burnett DDS
Lburnett2@comcast.net.

Dentistry

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Larry Burnett DDS

Expertise

Preventative Dentistry. Conservative Periodontal Therapy

Experience

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.

Organizations
ADA

Publications
RDH Magazine. Numerous articles

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

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