To fill or not to fill my laser-detected cavities?

March 21, 2012 9:16 PM

Should I get fillings of tooth cavities that have been diagnosed with a Diagnodent laser? If so, what number should I make my cut-off?

I've got cold feet and need advice. Appointment is in 11ish hours:

I have a dentist who seems all right. I'm not in love, but I'm not disenchanted enough to switch loyalties yet. I think. (I've had him since I moved about a year and a half ago.) But he uses a light laser thing which upon googling seems to be called a Diagnodent to find cavities, and I'm suspicious.

I'm scheduled to go in tomorrow morning to get three more cavities filled - I've already had two others filled by him, one of which evolved into a root canal and crown. None of these cavities hurt before detection and treatment. And the root canal and crown were expensive, time-consuming, and painful and were in a tooth I didn't even know had a problem. Then its first filling had an air bubble and the second kept hurting despite adjustments until it had to be crowned. I'm unsure if my cold feet are really based in resentment about that or not. I think it likely wasn't his fault, but how would I know?

Anyway, apparently all 3 new cavities are above a 55 on the Diagnodent scale. One's in the 60s and I think the other two are 80+. I have already paid my deductible for the year which in my plan started in August so if I'm going to get them done I should do it soonish so I can try to avoid paying anything next year.

So, what do I do tomorrow morning when I go in? Do I ask to see the cavities on X-rays they've previously taken before giving the go-ahead? Do I have them do only the cavities above 80? Option C?

posted by vegartanipla to health & fitness (8 answers total)

IANADDS, but my SO is. I'm not going to claim that this dentist is misleading you, however, skill can vary greatly from dentist to dentist. It's my understanding that root canals are particularly tricky, but a skilled dentist should be able to perform them well enough. I know you're not asking about root canals, but I'm just trying to illustrate that not all dentists perform at an equal level, or have similar experience, and then some are just sloppy.

DIAGNOdent lasers are accurate at detecting cavities, but the risk assessment of cavities falls completely on the shoulders of the dentist. Not all cavities necessarily need to be filled. If you are having misgivings, then you certainly are not being unreasonable in asking "why do these need to be filled," or even in getting a second opinion.
posted by erstwhile at 9:46 PM on March 21, 2012 [2 favorites]

Previously.
Your details are somewhat different, but my advice is nearly the same. If you trust your dentist then you should, by all means, have a dialogue about the need to fill these lesions; if you don't trust your dentist then seek another opinion.
posted by OHenryPacey at 12:18 AM on March 22, 2012

(UK based but using private dentist), if I had any doubts about my medical professional's conflict of interests between his income stream and my medical needs, I'd change medical professional. Based on your history I'd redouble that suggestion, he botched one treatment, why assume he knows how to read the X-ray imagery properly?

If you look at anything closely enough you will find something that needs attention (or may need attention in the future). Asking for a second opinion may assuage your doubts but will not help relations with the present dentist.
posted by epo at 2:48 AM on March 22, 2012

DIAGNOdent lasers are accurate at detecting cavities, but the risk assessment of cavities falls completely on the shoulders of the dentist.

This bears repeating.

I have at least one, possibly two (I can't remember: that's what dental records are for) incipient cavities which my dentist is keeping an eye on. They aren't getting any worse, so she hasn't done anything about them yet & if I'm lucky, the tooth material will recover.

Not all areas of decay need taking care of immediately. If you're unhappy with your current dentist, then there's no shame in getting a second opinion.
posted by pharm at 3:51 AM on March 22, 2012

My current dentist also has all of the "Star Wars" laser equipment, but he always falls back on the x-rays before doing any restorations. My hygienist is probably my best advocate - she believes in small increments and tends to talk him back down if she feels he is being too aggressive. This has happened twice. I also go in for cleanings four times a year, so nothing really ever has a chance to get started without being noticed.
posted by halfbuckaroo at 4:12 AM on March 22, 2012

None of these cavities hurt before detection and treatment.

That's a good thing--it doesn't mean they aren't there. Nothing you're saying about your dentist indicates he's not doing his job correctly. I suspect your "cold feet" is about something other than his dental skills. Maybe he's a bad communicator. Maybe he doesn't put you at ease. Maybe you would have this reaction to most dentists.
posted by Obscure Reference at 5:42 AM on March 22, 2012

I had a dentist that was filling happy and decided to get a second opinion from a highly recommended dentist and he told me I only had two that needed immediate Attention and a few that he would keep his eye on. The first dentist relied only on lasers and the camera, the second prodded at dark spots and used X-rays. I definitely felt as if the second dentist was an advocate for me rather than for his bottom line.

I'd go to a different dentist.
posted by ThaBombShelterSmith at 6:04 AM on March 22, 2012

I have at least one, possibly two (I can't remember: that's what dental records are for) incipient cavities which my dentist is keeping an eye on. They aren't getting any worse, so she hasn't done anything about them yet & if I'm lucky, the tooth material will recover.

This. I've had two cavities that haven't really changed since 2003. Every six months, I get my exams done at the local (top 10) dental school, usually by both a resident (or whatever the hell the dentist equivalent is) and a faculty member. The residents usually suggest filling them. When I ask the faculty members "so, what would you do if these were *your* teeth?" the faculty member always comes down on the side of just keeping an eye on them.

P.S. This is usually a good tactic, asking a health care provider what they'd do in your situation. You know, "so pretend you need that lump removed. who do you trust to do the work?" Always helps to humanize yourself a bit....
posted by pjaust at 1:35 PM on March 22, 2012