Black pit of despair

January 24, 2006 2:37 AM

Is it alright to leave a dental cavity unfilled?

I recently went to a dentist for the first time in years, and found I had some cavities. He's filled most of them, but there is one obvious one left. He said 'we'll just keep an eye' on my teeth now, and to rub sensodyne into the spots where I get twinges.

He's a good dentist, but being UK national health I'm suspicious that he may have his own reasons for not doing the work now. To my mind, it would be best to fill it so it can't get worse. It's not huge, but it is a little black hole.

What do you think? I could try and make them do it, or get it done privately. On the other hand, I am brushing really well now, and if it's okay to leave it a lot of hassle would be saved.

posted by lunkfish to Health & Fitness (21 answers total)

Umm, in general if it was "ok" to leave cavities as-is, wouldn't they just leave them ALL? My opinion is that a small cavity is pretty much guaranteed to turn into a big one. Why *not* fill it now, rather than having it become worse down the road and require possibly more painful work?
posted by antifuse at 3:09 AM on January 24, 2006

My dentist has done the same thing. He filled all except one, which is actually rather big. Thing is, though, I'm private, so he makes a reasonable amount of money from me. I've pressed him on it and he assures me it doesn't need doing.
posted by wackybrit at 3:23 AM on January 24, 2006

Just back from the dentist myself and same thing... two fillings and one they mention every time but never fill. The cavity I have has been untouched for a couple of years now and has nver got any bigger or caused any problems. I'd say they are just being practical.... why fix it if it isn't a problem?
posted by twistedonion at 4:10 AM on January 24, 2006

Don't you have to make a cavity bigger in order to fill it? Perhaps that's the issue if it is near a nerve or the edge of a tooth?
posted by A189Nut at 4:28 AM on January 24, 2006

That might make sense as mine is at the edge of a molar
posted by twistedonion at 4:34 AM on January 24, 2006

My dentist has been "watching" two cavities that I have ... he said that if they don't get any bigger that it is not a big deal. (And I pay for my dental services out of my own pocket.)
posted by tastybrains at 4:48 AM on January 24, 2006

What you think is a "cavity" might actually just be a "pit". I've got one that looks like huge (one full mm in diameter) but is just a pit. I had it sealed preemptively a long time ago but that's it.
posted by intermod at 4:54 AM on January 24, 2006

If your cavity is in a wisdom tooth, it might not be worth filling if the tooth has to eventually come out.
posted by Brittanie at 5:24 AM on January 24, 2006

I just turned 31. I have had two fillings - one in my teens, one in my twenties, and several very small open cavities that I've literally had for ten years.

Avoiding coffee, soda, and doing that brushing/flossing/cleaning thing your dentist tells you to do goes a long, long way in preventing cavity growth
posted by mrmojoflying at 6:19 AM on January 24, 2006

It may just be an off-color spot or a pit as others have said. I have a spot on one of my teeth that definitely looks like it could be a cavity, but isn't. Does your dentist poke at your teeth to check for soft spots? I hate that test since the probe will stick in an actual cavity and it gives me the shivers, but I'd assume your dentist has checked over the tooth. Some newer offices (in my part of the US, at least) now have a machine that can detect levels of decay through some sort of light.
posted by mikeh at 7:00 AM on January 24, 2006

It also depends on where the cavity is in terms of which tooth and where on the tooth. I have had a small cavity for years on the gum-facing side a back left molar. 3 different dentists have opted just to keep an eye on it, each saying that it should be fine.
posted by Verdant at 7:02 AM on January 24, 2006

I'd go to another dentist. When I had a spot that might or might not have been decay, mine opened it up & filled it just to be sure. And it's not a money thing: they know I'm poor and are just letting me carry an interest-free balance until whenever. (In fact, when I was putting off an appointment because I felt like I owed them too much, they called and were like, don't worry, just come in.)
posted by dame at 7:13 AM on January 24, 2006

I have actually had a filling come out 5 years ago... it had been drilled into the side of a molar and widened out. I have kept it clean and brushed it good and it has never given me any trouble. Not that it won't, but I'm kind of surprised it's been so dormant.
posted by zek at 7:13 AM on January 24, 2006

FWIW, my coworker's husband is a dentist, and "dental inconsistency" came up in conversation a few years back. She said that there is a continuum of dentists, from cautious dentists who will fill anything that even LOOKS like a cavity, who are really into braces and fixing things and the whole lot, to really laissez-faire dentists who take a more "wait-and-see" approach. Dentists can disagree on treatments and sometimes even disagree on what counts as a cavity-worth-filling (cavity counts in the same mouth can vary depending on the dentist you see, which was the question that started the conversation in the first place).
posted by unknowncommand at 7:54 AM on January 24, 2006

I had a totally hollow tooth for about fifteen years, from where an incompetent dentist (again in the UK, later struck off) had drilled completely through the top of a tooth into the root to drain an abcess, and not bothered to fill it after. The tooth was quite literally doughnut shaped for that whole time, with a hole running straight down into the root canal.

Having said that, it was actually fine, and apart from being a slightly manky colour I had no problems with it for that whole time, before eventually having the root canal filled when I plucked up the courage to go back to a dentist about 2 years ago.

I also went to the dentist after a large gap (although I am not NHS). I think it's pretty usual for them to adopt a watching brief between your first and second visit: they take notes on the extent of any decay or softness, and I think if they detect a significant change between visits they will act. This is what they did with me for a couple of soft spots that he found at the first visit, but only arranged to fill after the second had shown they were growing.
posted by bifter at 9:00 AM on January 24, 2006

alls i'm sayin' is, you guys better not complain anymore about how the british mangled-teeth stereotype is just a stereotype.

get it filled. cavities are cavities and they are problem because they expose the soft material of your tooth that is normally covered by the enamel. the only thing that can happen is that it can get worse. you can deal with it now and save yourself pain and a probably-more-expensive procedure later, or leave it and gamble.

for me it's a no-brainer - every time i am in pain because of some dumb medical thing i let slide, i curse myself for being such an idiot and not dealing with sooner.
posted by sergeant sandwich at 9:09 AM on January 24, 2006

So I asked my father-inlaw (who is actually a professor of dentistry) this question some time ago. He indicated that cavities can go back and forth and in fact this occurs over the course of the day... bacteria etc. leech structure off your teeth and then later your body (based on saliva make-up I think) gets its chance to put minerals and structure back. This is the reason why he recomends eating in big chunks instead of little snacks (or sips of soda) through the day. I know I am missing something about why that follows but some how it does.

Anyway... the big picture is that you can have an imbalance for a while that allows tooth decay, but if it doesn't get too far your body can halt that decay or even in some cases reverse it. That at least is what he told me as best I can recall.
posted by lucasks at 9:48 AM on January 24, 2006

If you're sure it's a cavity, and you can actually see it, then yes, of course it should be filled. As someone who's had dozens filled, trust me when i say they're better filled when small than when bigger. Anything you can see with the naked (untrained) eye is on the large size. But... what looks like a cavity to you might not be. Does it hurt when you eat sugar in that area? Is it more sensitive to cold/heat in that area then the rest of your mouth? Then it might be a cavity. If not, maybe it isn't. Only a professional (and perhaps an xray) can really tell for sure.

On the other hand, I trust my dentist completely and totally. We've been though a lot together. And even with my long history of dental troubles, she won't fill the really small ones, they're just on a watch list as well. Some end up getting filled eventually, some don't. I've always wondered why - lucasks, thanks for that tidbit, that makes sense!
posted by cgg at 10:02 AM on January 24, 2006

My understanding is, if a cavity hasn't moved into the dentine (the layer below the enamel) then you don't need a filling but if the cavity extends into the dentine you should get a filling. If it hasn't breached the enamel you might try asking the dentist about a fluoride treatment to help re-mineralized the teeth to help strengthen that area.

btw what seems like a tiny hole to us is a massive cavern to bacteria. When you eat something the bacteria in your mouth attack it and create acids, which is what breaks down the enamel and causes the cavity. Brushing will help but you would need to flush your mouth every time you put something in it.
posted by squeak at 12:15 PM on January 24, 2006

Response by poster: Thanks for the answers. Doesn't seem to be a clear yay or nay, but the information has helped. I think it will probably be okay to keep an eye on it at least until my next checkup and ask the dentist how it's doing.

Yes I am kicking myself for not going to the dentist for 11 years and inheriting our national curse.
posted by lunkfish at 12:38 PM on January 24, 2006

I had a cavity on the front of one of my canines. It was there for maybe 7 years... It never hurt, and I was scrupulous about keeping it clean.

Finally one day the dentist decided it was time to fill it, but I suspect that I could have kept it from growing indefinitely.
posted by tomble at 5:45 PM on January 24, 2006