How exactly will my dentist fix these cavities?

January 8, 2009 8:49 AM

Cavities: I have one in both of my two front teeth, one of which is fairly significant. Both of them are on the outside edge of the respective teeth, and thus sandwiched between my front teeth and the teeth next to them. How will a dentist fix this?

As a touring musician, hygiene sometimes takes a backseat. I know this is not acceptable, and it also has much to do with a significant lack of 'enforcement' about dental hygiene when growing up. Now that I have dental insurance, I've resolved to have my teeth fixed and to take care of them moving forward. As dentists make me nervous however, I would like to know what to expect in having these two cavities addressed.

Of my two front teeth, the one on the right (the #8 tooth) has a pretty significant cavity on the right side, which has also done a small bit of damage to the #7 tooth as well. There is absolutely no pain or sensitivity in this cavity (or the other for that matter), but it is quite embarassing and clearly needs to be addressed. I am quite certain that both of these cavities are due to infrequent flossing.

As I understand it, a dentist will clean this out or something and fill it, but I can't imagine how they will do that thoroughly with the #7 tooth hindering access somewhat, and also how they will repair the small amount of damage to the #7 tooth; once these are both addressed, will the repair look natural? Also, my #9 tooth has the exact same problem, but it hasn't quite created a hole yet. However, the dark discoloration is there and it is clear that a significant cavity is forming. With their not being a hole to fill there, will the dentist have to drill out the damaged portion of the tooth in order to fill it? Also, my #10 tooth was chipped quite severely a few years ago, so they extracted what was left of it and put a post and a crown in place which looks/feels great. As I assume that is somehow bonded, will they remove that crown in order to allow for easier access to the developing cavity on my #9 tooth.

My question is fairly broad in that I'd like to know what to expect as far as exactly how they will address these cavities, and what kind of pain and timeframe will be involved. I'd like to have it taken care of as soon as possible. I'm sure I have a few other cavities in my back teeth and such, and I'm probably long overdue for a cleaning, but if I request that my dentist address the front cavities first, will they oblige? Is there any chance that they could just knock me out and take care of these all at once?

Thanks, MeFites!

posted by anonymous to health & fitness (14 answers total)

[IANADentist, NYdentist and all that] A good dentist will get rid of the rot, match white fillings to the surrounding tooth, standard stuff that. Snazzier versions available - cosmetic dentistry is being advertised everywhere these days. Difficult access to tight corners? They do it all day long. I've never heard of someone removing a good crown to access another tooth.
Only your dentist can tell you the time plan for your treatment. Could all be surface stuff, or not...

When I look not at what you ask, but how you ask it, it seems to me that you'll want to find a dentist who is sympathetic to people who are a bit afraid of the whole enterprise. This is a widespread phenomenon. Some dentists are especially trained to cope with it, and they do marvelous things in the soothing department. Look for that and everything else will solve itself.
[not too fond of my annual visit either]
posted by Namlit at 9:30 AM on January 8, 2009

When my cavities were taken care of, I wasn't knocked out. I was also completely fine a few hours later. Your situation is much more complex, so I can't really give you too much perspective. But that's what I know, if it helps.

Also, there are specialty dentist offices that cater to people who really, really get terrified at the thought of going to the dentist. I'm not certain, but I suspect that if your regular dentist is hesitant to unnecessarily knock you out for a set of procedures that don't require it, you might be able to go to one of these dental spas (I think that's what they're called) and be put fully under without a problem.

(And/or listen to Enya in a really comfortable chair while the work is being done.)
posted by Nonce at 9:32 AM on January 8, 2009

Dentists are used to getting in all kinds of tight places. I had a root canal on #8 after a bike accident that almost knocked the tooth out (I pushed it back in place during the 8 hr ER wait) and broke #7 off just below the pulp line. They just drill in through the back.

When time came to re-surf #8 and build up #7 for cosmetic purposes, I actually fell asleep in the dentist's chair. It's that little of a deal.
posted by notsnot at 9:42 AM on January 8, 2009

While you seem to have a fair number of cavities, none of them seem serious, and a dentist should have no problem fixing you up.
posted by KokuRyu at 9:50 AM on January 8, 2009

Like others have said, modern composite fillings will be pretty much invisible if they match the color properly. If you smoke or drink alot of coffee, over time (years?) you might find that your natural tooth discolors but the filling doesn't, and the filling becomes more noticeable. I suppose you could have tooth whitening done at that point.
posted by cabingirl at 9:53 AM on January 8, 2009

I had similar work done on my two front teeth years ago. My dentist filled the cavity with a composite that was bonded to my tooth with a laser-light type apparatus. I lost the 2nd front tooth and he created a partial plate for me that I wear to this day so that I am able to smile naturally. My dentist is very accommodating to those with fears or low pain tolerance and makes sure that his patients are comfortable during procedures. I hope that this is your experience, also, because it's worth the inconvenience to regain a nice-looking smile. Good luck!
posted by Lynsey at 10:06 AM on January 8, 2009

I know where you're coming from. I avoided seeing a dentist for a long time, many years, and was embarassed and anxious when I finally went to a dentist. Fortunately I had a recommendation for a fantastic dentist in San Francisco and he took care of me gently and now I go regularly for cleanings and have a healthy mouth. It's worth it.

I had a cavity exactly like you described. It wasn't so awful you could see it from the front, but once the dentist removed all the rot there was a significant gap there. He filled it beautifully with some sculpted filling and unless you look really close you can't see or feel the difference. He warned me that it would probably need to be replaced in about ten years as fillings change colour differently than teeth. But in the meantime I never even think about it, the tooth is just fine.

I can tell from your questions about cleaning and knocking out that you're anxious about going to a dentist. Don't be embarassed about that, it's perfectly common. My dentist classifies particular patients as "anxious" and treats them specially, with the gentlist / kindest hygeinists and lots of explanation. They're also glad to use Nitrous Oxide, which while not as fun as cracking whippets does take the edge of having someone poking in your mouth. When you call for your appointment tell them you haven't been to a dentist for many years and are uncomfortable, they should take care of you.

Your first visit will probably be an evaluation from the dentist, some x-rays, then a recommendation for treatment. In my case the recommendation was a combination of some cavities being filled and root planing. Root planing is a deep cleaning process. Honestly it's not much fun, my first time I used heavy nitrous and headphones to block it out, but I'm really glad I got it done because the results are great. And once that was out of the way the regular upkeep is a simple light cleaning, not bad at all.

The dentist isn't pleasant, but avoiding it means things will only get worse. Good luck!
posted by Nelson at 11:09 AM on January 8, 2009 [1 favorite]

Cabingirl,

My dentist says you should not do teeth whitening if you have composite fillings on visible surfaces. The fillings are not affected by the whitening and if they were matched to a darker shade will stand out as dark spots on your newly whitened teeth.

ps. the procedure is totally painless.
posted by Gungho at 11:28 AM on January 8, 2009

i've had this done before, not on the front two teeth, but between teeth nonetheless. it's really no big deal, and dentists deal with it all the time. if you have a good dentist, you won't even be able to tell there are fillings there (from a cosmetic standpoint) and the teeth won't be "connected" so that you can still floss between them.

if you're super nervous about getting the cavities filled, let your dentist know so that s/he can modify her process as necessary (giving more explanation, taking more breaks, etc.).

and after you get your fillings done, be sure to brush and floss like you're supposed to!
posted by misanthropicsarah at 11:29 AM on January 8, 2009

Offered as reassurance: I have a filling along the outside edge of my #8 tooth, on the side that borders #7. It was done probably more than 30 years ago, by a dentist who was nowhere as good as the one I have now, and it is still virtually invisible. You have to know where to look, and then realllllly look.

Know your insurance options, so that you can change dentists if the first one you see suggests a treatment plan you aren't comfortable with.

Good luck! Soon this will be behind you.
posted by sageleaf at 11:46 AM on January 8, 2009

I had three small fillings done in between my almost-too-close-together-to-floss molars and while it took some tricky maneuvering, my dentist had no problems. They do it all the time- lots of people don't floss. Be prepared to spend some significant time and money at the dentist, though. They'll probably want to fix your teeth in stages. If you can, don't scrimp on this and skip getting the fillings you need. Think of it as a new lease on life for your teeth (and brush accordingly)!
posted by MadamM at 11:53 AM on January 8, 2009

I just did this. It sucked and was painful, and they had to match the tooth twice before it was perfect, but they're perfect now. I had sensitivity to cold and heat and sugar for about two weeks. Don't be surprised if you have a little blood the first two times you floss; brush as normal. Don't pick between those teeth with anything sharp afterward. I once picked a filling out thinking I had something stuck between two teeth and it HURT.

After you get them fixed, DO NOT DRINK POMEGRANATE JUICE. My dentist had to replace one filling because I was drinking it every week and it stained the edges of the filling reddish-pink, which made it look like I constantly had a piece of tomato stuck in my teeth.
posted by Unicorn on the cob at 12:23 PM on January 8, 2009

I am a dentist, and by and large the advice you've gotten thus far is fairly accurate. Several details might help you understand your first visit if you haven't been in a while.

First, while it is entirely possible to have your front teeth fixed on the first visit, a visit to a modern dentist is not quite like going to a repair shop. The examination will look at the problem you describe, but will also include some evaluation of your overall dental condition in order to make a diagnosis, which will guide treatment. Your bite, the condition of your gums, and how clean your teeth are to start with will have an effect on the outcome of fillings in visible teeth like your top front ones.

Once the severity of the condition has been determined and those other factors have been weighed, the decay has to be removed. If you are nervous you may wish to be premedicated with a sedative, or be distracted by watching a movie or listening to tunes. For simple (by our professional standards) procedures, it is usually cost prohibitive to be 'knocked out', as it requires an anesthesiologist or someone similarly trained and that adds considerably to the cost.

Topical anesthetic is placed with a q-tip, and then we distract the heck out of you in order to gently administer a dose of local anesthetic (novacaine, but not novacaine). This is the part most folks are most anxious about, but it's virtually unnoticeable if done correctly.

Once you are feeling numb a modern dentist will use either an erb;yag laser or the conventional high speed handpiece (drill) to remove the decay. We have a myriad of tips to allow access to any sort of space without damaging unaffected nearby surfaces. We will not remove the neighboring crown to gain access.

Here's the rub: front teeth aren't very thick, so even a smallish seeming cavity can get pretty close to the pulp of the tooth (where the nerve is). It's like taking the brown spot out of an apple; we go until the brown is gone and if there is sound tooth beneath we insulate and fill, if we reach the core (pulp of the tooth) we have to core the apple (remove the pulp, which is called a root canal) so an abscess does not ensue. My point here is that you should have this done asap so the cavity doesn't get any bigger than it is now, perhaps avoiding this last step.

Composite fillings (tooth colored) come in a wide palate that is matchable to most any shade of tooth, but again clean teeth are what we would want to match to.

Pain during the procedure should be a non-issue once the local is in, but post-op pain varies with the severity of the decay and is very subjective. Most docs will have no problem managing post-op symptoms with otc or prescription pain meds. Temperature sensitivity is the most likely symptom. Teeth don't love cold to begin with, which is why you don't bite an ice cream sandwich the same way you bite a pastrami sandwich, but again this is manageable.

My advice to you would be to seek out a dentist with a reputation for communicating well with his/her patients; someone who will take the time to answer questions and explain the ins and outs of the process. I find most folks like to know what's happening, it ain't magic.

good luck and get this taken care of post haste.
posted by OHenryPacey at 1:19 PM on January 8, 2009 [3 favorites]

What Dr. (OHenry)Pacey said! I'd reiterate that it would be a very good idea to have a comprehensive exam as a first visit. The dentist will want a general overview of the condition of all of the oral structures. Then he/she can triage the importance of the work needing to be done. Of course you will have the final say in how to proceed, insisting on the front teeth to be done first is a pretty reasonable and common request. From our perspective as dental care providers, we like to see good esthetic results that patients are delighted with. Front tooth restorations accomplish that, and the dramatic change help stimulate the patient to become better at their homecare. Win/Win all around.

I would not worry about the actual mechanical details of fixing the teeth. It is what the dentists has spent years and years in training and in practice to do. I would make sure that the dentist you choose is someone you are comfortable with on a communications level.

There are many Metafilter threads asking for recommendations for dentists in various cities around the US, I know several good ones in Seattle or Orlando areas..
posted by Jazz Hands at 11:58 AM on January 9, 2009