Expert: Mark Bornfeld DDS - 2/2/2005

Question
    Thanks first for your time.  I am very confused after just visiting my dentist yesterday for a routine cleaning, xrays, and exam.  This was my first visit with this dentist, but my husband has been seeing him since he was little.  He has no past record or xrays and this concerns me because of his diagnosis.  I haven't seen a dentist in a few years due to relocating.
    I was told by the woman who cleaned my teeth that my teeth look very good and she only wrote down 2 notes on 2 teeth for the dentist to look at.  While he was checking my teeth, he noted on almost every one of my molars and said that they needed filled.  He said when the "pick" sticks into my tooth that that shows a soft spot.  Is this true? I have had cracks and deep tracks in my molars for my entire life.  Could he have been sticking the pick in those cracks which is why it was sticking?  He said that the cracks are normal and that sometimes when molars form they don't come together completely.  He also told me that probably only one of my "cavities" showed up on the xray.  Is it possible to diagnose about 11 minor cavities that don't even show up on an xray?  I always assumed that if it doesn't show on an xray than it isn't a cavity yet.
    Also i have no pain in any of my teeth.  The only thing that i believed going out of there was that i have a minor case of gingavitis(not sure of the spelling).  

Answer
Dear Angie,

To do justice to a proper oral diagnosis, many different forms of diagnostic information must be gathered. Depending on their orientation and position, some areas of decay can be detected by visual or tactile exploration and are at the same time not demonstrable on x-ray, and sometimes the converse is true-- that decay is detected on x-ray and not discernable visually or to exploration by a sharp instrument. That is why both radiographic and tactile modes of examination are used; one without the other is incomplete, and risks failing to find some areas of decay.

That is not to say that the finding of a sticky occlusal groove or pit necessarily means decay. It is true that during embryonic development, the various lobes of a tooth don't always fuse properly, and the areas where the lobes contact frequently do manifest open pits and grooves that will feel sticky to a sharp explorer tip even without the presence of decay. Unfortunately, these areas will always be more susceptible to decay than they would be without the fissured grooves, and a dentist must be vigilant and intervene when obvious deepening signals the beginning of decay. The problem is that the point at which a dentist can distinguish between a mere enamel fissure and true active decay is a subjective judgement. This becomes all the more troublesome when a change of dentists causes a change in treatment philosophy, where the point at which a dentist chooses to treat a fissured groove changes as well. This can be perplexing to a patient.

Nonetheless, you have no reliable way of knowing whether your new dentist is being overzealous, or perhaps your previous dentist was too relaxed about treating what may indeed have been the beginning stages of active decay.

In any case, the absence of obvious decay on x-ray is, as I stated previously, insufficient to rule out decay. If you have doubts as to the judgement of your new dentist, you might wish to seek a second opinion, if only to confirm your trust, or (hopefully not) confirm your doubts.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY