Natasha Flake, DDS, PhD, MSD
Natasha Flake, DDS, PhD, MSD, president of the American Association of Endodontists and professor of endodontics and associate dean for clinical affairs, School of Dentistry, University of Washington, Seattle. AAE.org
Detecting cavities before they become serious can save you discomfort and money—and an early cavity may be fixable without filling. But what does a cavity look like when it first starts? And how does it feel? We asked American Association of Endodontists president and professor of endodontics Natasha Flake, DDS, PhD, MSD…
Known by dentists as a caries, a cavity is a hole that forms in a tooth. Bacteria in the mouth produce acids that destroy the enamel, the tooth’s outer layer. Eventually, this decay can extend through the enamel into the next level, the dentin, and finally to the tooth’s inner core, or pulp. Left untreated, the entire tooth decays, even possibly becoming infected, and must be extracted.
That depends on the cavity’s severity—cavities frequently cause sensitivity to cold and sugar. A severe cavity can cause a toothache.
You won’t be able to spot an early cavity on your own. They tend to form in hard-to-see places, such as back teeth and tight spaces where two teeth meet. The subtlety of early signs makes it extremely difficult for an untrained person to spot a cavity.
You likely will feel a cavity before you see it, in the form of sensitivity to sugar and cold. Unfortunately, by that point, the decay has reached the dentin and you’ll need a filling.
A dentist has the tools to detect cavities early. With bright lights and mirrors, professionals can spot the subtle shadowing on the enamel that indicates the start of a cavity. And of course, x-rays indicate early decay that would otherwise be invisible. That’s why it is so important to get regular dental exams.
Shallow cavities usually aren’t treated, because the enamel has the potential to repair itself. Dentists sometimes apply a fluoride varnish to help halt the cavity’s progression and counsel patients on home care, including brushing and flossing as well as personalized instructions if a patient has braces or a denture or limited manual dexterity that impacts his/her ability to brush and floss. Oral hygiene instructions also usually include information on diet or tobacco use tailored to the individual patient.
Deeper cavities must be drilled to remove the decay and then filled. If the decay is in the pulp, an endodontist will perform a root canal to remove inflamed and infected tissue. Then the tooth will be restored with a filling or crown.
We create the conditions for cavity formation by leaving food material on our teeth for too long. Flossing and brushing regularly with fluoride toothpaste is the best prevention strategy. Sugar and starches are especially damaging to enamel. You can consume them, but brush soon afterward.
After brushing at night, don’t eat or drink anything but unflavored water before bed. During sleep, you produce less cavity-preventing saliva.
Older people, especially those on certain medications, have drier mouths, increasing cavity risk. Ask your dentist about saliva substitutes…and be sure to drink lots of water.
If your teeth hurt, contact your dentist who may refer you to an endodontist, someone who specializes in the diagnosis and treatment of tooth pain. You can locate one near you by visiting FindMyEndodontist.com.
