What happens when they drill out a cavity?
June 24, 2005 1:10 PM   Subscribe

I'm going to have a cavity drilled on Tuesday. I've never had this done before and I'm terribly phobic of "procedures" (dental and otherwise), especially when I don't know what is involved. What exactly do they do when they drill out a cavity--step by step, what's involved?

In addition, I went on Wellbutrin 3 months ago. I've had perfect teeth up until now, but in my last visit to the dentist (admittedly after a hiatus of 3 years) he found two cavities and said that I grind my teeth. I brush very thoroughly twice a day and use listerine every night, which is much better dental hygeine than I have practiced up to this point, and I've never been told that I grind my teeth before. Could the Wellbutrin be at fault? Has anyone had a similar experience?
posted by fuzzbean to Health & Fitness (34 answers total)
How Cavities and Fillings Work.
posted by matildaben at 1:18 PM on June 24, 2005

First, they take a gigantic needle and stick it in your EYEBALL!!1!oneone MWAHAHAHAHAAA.

Just kidding. If you are very anxious about having this done, there are probably a few 'painless' dentistry branches around you, which specialize is doping you up while they work on you. They often cost more, since NitOx and others aren't covered by some insurance policies.

If your anxiety over the procedure is interfering with your dental health, you might want to consider it.
posted by unixrat at 1:23 PM on June 24, 2005

Well, insurance isn't the issue, as I haven't got any and can afford to get whatever done. And the three year gap isn't due to phobia - more to moving three times in three years and never really getting around to it. The one I've picked seems to be really good though not advertised as "painless". The question is more for my current mental health - I'm going to get it done Tuesday come hell or high water or large piles of marshmallow fluff choking the streets, but right now it's really stressing me out.

I guess what I'm really asking (I have googled this extensively and not found a decent answer) is, "what do they mean when they say, 'isolate the tooth'? How do you keep your mouth open? " What happens in plain English? (It's my top furthest back molars, if it matters.)
posted by fuzzbean at 1:29 PM on June 24, 2005

In my experience, and I have had a lot of fillings, it goes like this:
They swab on something on your gums that numbs them slightly. This is so the novocaine shot doesn't hurt. They wait a few minutes, then give you the novocaine shot in your gums. It pinches bad but just for a few seconds.
They wait for that to take affect.
Next they drill out the cavity, to get all the decay cleaned out. Next, they press in the filling material. My dentist then uses a UV light to harden the material. After it is hard, he shapes it as necessary, again with the drill. He may goes several rounds of shaping, having me bite down on some kind of inked paper to make sure the teeth are meeting correctly.
The most unpleasant part, and it is minor, is the smell when he is drilling. Like wood, plastic or anything else, when your teeth are being ground down, there is a smell to it. Very minor in my option.
I guess it is worth mentioning to the dentist if you have never had novocaine before, because a small percentage of people are allergic to it.
Actually, if the cavity is not very deep, he may give you the option of skipping the novocaine, and just tell you to let him know if it starts to hurt. I guess they have to go fairly deep before they hit a nerve and a shallow cavity may not need that deep of a drilling.
As far as isolating the tooth, they slide a metal sleeve over it. Again minor, but you feel the pressure. Imagine someone pressing hard on your tooth... it presses your head back into the chair. As for keeping your mouth open, they just say "Open wide" and you do.
posted by juggler at 1:31 PM on June 24, 2005

Here's my summary:

1. Topic anesthetic goo applied to gum
2. Novocaine injected into area numbed by topical anesthetic
3. Dentist drills into your tooth, drilling out the cavity. They will check with you to make sure you are not feeling pain and inject more Novocaine if necessary
4. Dentist fills tooth with, well, filling
5. Dentist shines light in your mouth to seal the filling
6. A little buffing, and little cleaning, and off you go!

Unpleasant moments:

1. Despite not really being able to FEEL the needle, you can feel the pressure of it. It doesn't hurt, but it's odd.
2. The sound of the drill is kind of obnoxious. Try not to think about it, or bring music to listen to on headphones (ask your dentist if this is ok)
3. Afterwards, your mouth and part of your lips and face will be numb. You'll get weird tingly sensations as the Novocaine wears off over the next few hours, but generally there's no lasting pain from the filling.
posted by arielmeadow at 1:33 PM on June 24, 2005

As someone with more than a few fillings, here goes:

They'll ask you to open your mouth really wide. If they have a problem with you keeping it wide enough or for more access, they may insert a little plastic wedgey thing. (Very untechnical here). You'll want to relax/pull your lips back.

If you've chosen Novocaine, they will give you a needle so big that you're surprised it doesn't go through the back of your head. This will numb the area and probably the lower quarter of your face where the tooth is.

If the cavity is where the teeth touch each other, they will insert a small spring-loaded 'spreader' between your teeth and slowly open it so that they can get at the problem spot. This is as painful as it sounds.

They'll pack the area with gauze to catch any blood, if that happens.

They will drill away the cavity part and some of the surrounding areas. This is the painful part. You will hear a high pitch grinding as well as feel bone fragments hit your tongue and cheeks. You may smell a 'burning bone' smell.

They'll mix a silver (gold/white) filling stuff and tamp/press that into the hole.

Then they'll wash everything out, remove all the doodads and send you on your way. It will be sore for about a day and the tooth will be hot/cold sensitive for up to a week.

posted by unixrat at 1:38 PM on June 24, 2005

Grinding your teeth is often caused by emotional stress and/or anxiety. Wellbutrin is taken for depression. I'd say the fact that you grind your teeth is no big surprise.

I have no idea what "isolate the tooth" means. You keep your mouth open the old-fashioned way, or they might stick this plastic thing in that does it for you. It'snot painful, doesn't gag you, I think just holds your lips open. Hardly remember because it was only used on me when I was a kid. I think most dentists trust adults not to chomp down on their fingers.

They will probably give you a needle in the gum near the tooth to locally anaesthisize. That's the worst part, IMHO. Once that's over, you won't feel much going on in there. The dentist will stick one of those spit sucker hoses in your mouth probably since you'll be producing a lot of saliva. No big deal. He will drill the tooth but you won't feel it, it's the sound of the drill that we are conditioned to be freaked by, but don't let it get to you. It may smell like something's burning and won't taste too good, but hey, no one said this was going to be super fun.

After the drilling, the dentist will fill the cavity with whatever they fill cavities with nowadays. Doesn't hurt a bit.

I could be forgetting details... But that's what I recall from having a cavity filled. And that was by a dental student at my school and I survived!
posted by amro at 1:38 PM on June 24, 2005

Well first they make sure they can get at the tooth. Mostly you keep your mouth open by just keeping your mouth open, but since this tooth is very far back, they will probably use a thingie that sort of stretches out your mouth to keep it open and let them get all the way back there.

Next they "isolate the tooth". This means get the other teeth away from it, probably because your cavity is in between teeth. So they take this metal thingie and put it between your teeth and sort of pry them apart and hold them there.

Next they need to keep the area dry. So they'll take some dental damn and position it accordingly.

OK....so now the drilling, which doesn't hurt, but kind of smells dusty and dry. They drill the cavity to get all the damaged part of the tooth out and to make room for the filling.

They wash out the tooth to get the dust out, then dry it with a tiny blow dryer thingie.

Now they mix the compound and put it in with one of their little pointy things (again, this doesn't hurt, they're just sort of spatula-ing it in there). Now for this stuff to set it needs UV light, so they'll shine a little light onto the tooth for 30 seconds or so. Then they might put another layer on and repeat.

ONce it's dry they sand it down so it's the same shape as your tooth. So they take their little dremel-kind of thing and sand it down. THey make you bit on a little piece of inked film to make sure the it's even (which presumably they can tell from the impression) and keep sanding and biting until it's good.

I think they then might polish it up or something (Again, with the dremel thingie).

And that's basically it...and of course before all that, they freeze your mouth.
posted by duck at 1:38 PM on June 24, 2005

The technical information is out there on the internet, but what really helps me, and may help you if your dentist is game, is having them explain what they're doing step by step as they're doing it.

For me, this makes the procedure pass more quickly, and let's the rational part of mind ("oh, now she's applying the etching agent, now she's sealing the pit, ok") quiet down the irrational parts ("what's going on, why is she cramming *that* thing in there, was that supposed to go 'crunch'?")

Of course, I'm completely needle-phobic, so that's the absolute worse part of any visit for me, after I've been stuck, she can't really do anything worse to me.


(on preview, my dentist "isolates the tooth" by punching a bite shaped set of holes in a rubber sheet, then putting these holes over my teeth, creating a cover over the mouth and throad (it's not even a little bit close to air tight, it's more so that decayed pulp and junk doesn't fall down your throat), then putting a little metal frame around the tooth so she can work on it with no chance of bumping in to other teeth)
posted by Capn at 1:39 PM on June 24, 2005

Oh...and one thing no one has mentioned yet...the stuff they use to freeze your mouth tastes really terrible. I think the taste is the worst part.
posted by duck at 1:43 PM on June 24, 2005

I am extremely phobic of dentists and can understand your anxiety. Here's a few things I can recommend -
Bring a portable CD player, or borrow one, and bring the best headphones you can scrounge up. For me one of the biggest things is the sounds of drills, asking the aide for a needle, etc. I've never had a dentist complain when I just sort of tuned everything out. Some dentists will have thier own headphone system set up for patients.
Ask a lot of questions about the procedure before they start, it may help clear a bit of anxiety.
In combination with the headphones, I usually just close my eyes and try as best as possible to relax. If I don't see the needles it's not quite as bad.
If you can afford it, you can ask for something like Ativan or other relaxer to take before the procedure, or nitrous oxide right before they start.

On the other hand, it is just a cavity. In my far too extensive experience, I've never had more than a brief second of pain, from not enough novocaine being injected. Don't be afraid to tell the dentist if something feels wierd or painful.

Best of luck on Tuesday
posted by efalk at 1:49 PM on June 24, 2005

The wellbutrin could definately have caused the start in grinding. It's a known side effect and a quick google on "ssri teeth grinding" turns up this for example. It's in the Wellbutrin data sheet as well.

"Digestive: Infrequent were abnormal liver function, bruxism, "

Bruxism being tooth grinding, as the other link showed.

If your experience with depression is anything like mine you'll find the SSRI way worth it. Mouth guards are available in most drugstores now, which raises the interesting question of whether that's because it's an increasingly identified problem or a problem on the rise...
posted by phearlez at 1:50 PM on June 24, 2005

that first line from unixrat should be deleted. Geesh.

fuzzbean, do you ever use guided relaxation techniques, or meditation? these two techniques are VERY helpful when in the dentist's chair. Much like a few people who wrote in before me, I really don't like needles, and I've had most of my dental work done without freezing (even one root canal).

I don't feel the pain, really - rather, I compartmentalize it and send it back to a place in my consciousness where it is not so much in focus (hard to describe, this).

There are a few moments where sensations are perhaps a little strange - a dentist's drill has water coming out of the element to wash the area away while the drilling is done. Sometimes that water is a bit cold. It is a surprising feeling.

If the cavity is a deeper one, you may feel the drill as a sharp pinch for a moment or two- much like the pinching of a zit being squeezed, or of a cuticle being torn away from a finger. So as you see, it's not so bad.

There's a mystique built around dentist visits - with those ugly chairs, the strange smell of the antiseptic, people with masks and labcoats running around. Thing is, they are all professional people, they don't like to inflict pain (they HATE to be bitten) they are caring people who worked through years of hard university training. It's a tough job.

I used to be VERY phobic about dentists when I was a little girl because I had two or three bad dentists. And my teeth are weak, perhaps only two or three teeth have not had work done. I changed my fears because they were no longer working for me. And I started using the same kind of disassociation as I get when I run long distances over the course of a few hours. I also got excellent dental care when I moved to Vancouver. I have low blood pressure and poor circulation - the freezing would stay with me FAR longer than the actual operation. I decided to no longer accept freezing and realized that the actual discomfort in a dentist's chair is only a few seconds long at most.

So my biggest piece of advice to you, fuzzbean, is don't let your mind get away from you. The physical discomfort is short-lived. Take the freezing, get the work done, and relax. Bring an mp3 player loaded with your favourite music, and mentally transport yourself to a pleasant place while the dentist does his work. All the best to you.
posted by seawallrunner at 2:00 PM on June 24, 2005

I haven't had a cavity filled for a while. but I had a bunch in my teens, and I can say I've never had to hold my own mouth open. They always gave me a plastic mouth-holder-opener.

I can't imagine trying to hold my mouth open that wide for that long.

Ayway, this might put it in perspective:

Tooth cleaning/examination: Annoying
Cavity drilling/filling: Uncomfortable
Root canal: Bad stuff, yo
posted by o2b at 2:03 PM on June 24, 2005

I just had what the dentist told me was a huge cavity filled last week. It was completely painless. My experience is a bit different than some others, in that my dentist uses some wacky novacaine contraption that slowly oozes the stuff into your gums, so there is no needle pinch, or any of that uncomfortableness. The worst part was holding my mouth open for so long, and that, really, isn't so bad at all.

As for root canals...i've only had two. One was as painless as my filling, and the other was pretty bad. The key...pay for an endodontist, and hope your tooth isn't very infected.
posted by Doug at 2:18 PM on June 24, 2005

How Fillings Are Done
posted by ericb at 2:23 PM on June 24, 2005

"Isolate the tooth" probably means that they will be using a dental dam that will cover all of your teeth except the one they are working on. This is a new-ish thing, and not all dentists do it. The dam is supposed to protect the rest of your mouth from bacteria and flying tooth chips while they work. The dental dam does not hurt, but it adds to the unpleasantness of holding your mouth open for so long: now you're holding it open with this piece of rubber stuffed in it also.

But, all in all, you shouldn't worry about the pain/discomfort. It is pretty minor (I've had about 8 done) and for one cavity should be over very fast -- like 30 minutes.
posted by Mid at 2:26 PM on June 24, 2005

Sometimes "isolating the tooth" can mean that they put a dental dam in your mouth... basically they put a bracket around your tooth [not the spreader] and then they put this piece of rubber with a hole in it around the bracket, then they spread out the piece of rubber using a spreader thing outside your mouth. I can't explain this too well but it means that when the dentist is drilling your tooth, anything that is drilled out stays in the dental dam, an does not fall into your mouth. It feels annoying but works well and does not hurt. If you don't have a dental dam, the dentist may use suction to get out extra spit and possibly little pieces of tooth and/or filling material from your mouth. This sounds terrible when it's happening, but it's not too bad to deal with.

I'd also recommend sunglasses if your dentist is okay with them [mine used to give them to me]. It keeps the bright lights out of your eyes and makes you a little more able to space out in the chair.

Generally, fillings don't hurt. Sometimes the novocain needle hurts some in a pinch-y way. Sometimes the drilling can be painful but usually not. If it is painful, let your dentist know because that is something they can almost always fix.

Once you get the filling done, your face will be numb for a bit and you probably can't bite on anything hard for 24 hours so plan your eating accordingly. I've found that drinking coffee or other caffeinated beverages seems to speed the novocain wearing off.
posted by jessamyn at 2:27 PM on June 24, 2005

Also, you might want to make sure they use white filling material, if possible. Some dentists are using only white stuff now, while some are still using the silver/metal stuff. The white stuff looks a ton better, but might cost you more. You'll want to hash this out before they are drilling.

Also: eating food makes the Novocain wear off. Dentist told me that -- something about blood sugar and metabolism. But be careful when eating because you can bite your tongue or cheek and not notice if you are too numb.
posted by Mid at 2:30 PM on June 24, 2005

I've had lots of work done on my teeth. Bite block (the wedgy thing) or no seems to be a personal dentist practice. I've observed about 50% of my dentists use them.

Everyone else has summed the procedure up except for what I think is the freakest part when drilling: the sometimes fine spray of decayed tooth that looks like smoke coming out of your mouth when drilling. I just close my eyes and try not to think about it.
posted by Mitheral at 2:36 PM on June 24, 2005

I'm not squeamish about any of it except for the needle, but I still tend to belong to the "don't ask don't tell" school rather than the "explain every step of the procedure" school. Headphones and engaging music (e.g., Mozart opera) seem to help. I hadn't thought of sunglasses before, but that's a great idea.

Oh, and BTW, your mouth will be numb for a few hours afterwards, you will talk funny and maybe drool a little bit on one side. Don't be too embarassed about it; everyone will understand because everyone's had it too.
posted by matildaben at 3:10 PM on June 24, 2005

I used to be terribly dentist-phobic, but I now know that came from a dentist drilling a cavity without anaesthetic when I was younger. *DON'T* go for that option, ever. It hurts, regardless, and you'll never want to go back, which is bad because good dentistry is important.

The turnabout came after I had two teeth fracture in my mouth. One led to a plain filling, the other to a root canal.

The only time I've ever had a tooth "isolated" was during the root canal procedure. That's also the only time I've ever brought headphones to the dentist, and the only time I've ever insisted on Nitrous, but *damn* that was a pleasant way to have something nasty done.

One thing that I found really helped was to tell the dentist in advance that you're phobic about the procedure. He/she can then either take steps to reassure you, offer additional calming methods (gas, music, etc.) or just take it really easy. My current dentist explains what he's about to do before he does it, if it's something new.
posted by 5MeoCMP at 3:38 PM on June 24, 2005

About a year ago I had my first filling (and I'm in my late 30s) - I was pretty nervous about it, having gone that far without the experience. I was dreading the needle the most...about 12 years ago I had my one wisdom tooth out and the needle before they numbed me for the extraction was one of the worst pains I had ever felt.

I imagine that numbing for drilling a cavity and number for extracting a tooth are very different, but I was expecting the same thing.

It was a joke; it was nothing. I asked about it, and without being able to compare the injection I got for the wisdom tooth, one thing I found out was they had a new numbing technology - rather than forcing all the novocaine into you at injection speed, they pump it in slowly - this was some electronic gizmo that delivered it in a needle-like fashion. I guess it numbs as it goes, so the numbing spreads and the ongoing delivery of stuff is slow and is mostly on numbed tissue so it's less painful.

I am not a dentist, and I only managed to get that vaguely confusing description; sorry...but it's an indication that perhaps the technology has improved and can be less painful.

Note that this is a small-town dentist and they have some technology but they are not particularly super-cutting edge. I will say (unrelated to our topic) that they have a digital X-ray device - instead of the cardboard films that are kinda chewy that they jam in your mouth, they have a hard plastic (with square edges) receiver on a cable that is put in a loose plastic "condom" and then jammed into your mouth into a space that is too small for it in the corner, and then you hold it while they take the picture. It hurts! It has sharp edges and doesn't fit in my mouth. Yuck. I guess it's tradeoffs - Xrays hurt now but injections don't?
posted by stevil at 3:56 PM on June 24, 2005

Be sure to tell the dentist what drugs - Rx or otherwise - that you have taken recently enough that they might still be in your system. You do not want drug wars conducted in your body along with your nervousness.
Bringing tunes is a good idea since that will help cover the noises that you do not really want to hear.
If you are able to concentrate, use that skill to imagine yourself out of that chair and onto the deck of a cruise ship, or into a green field.
posted by Cranberry at 4:52 PM on June 24, 2005

I'm surprised that no one else has mentioned this, but the worst thing for me is having my mouth fill up with spit because I can't swallow. It makes me gag so much that my dentist lets me hold the suction tube myself on occasion. If this happens to you, just let them know and the hygienist will make more of an effort to suction out the spit.
posted by gokart4xmas at 5:44 PM on June 24, 2005

As a lifelong dental-phobe, I get jittery about just sitting in the damn chair. Fortunately, I stumbled across the best dentist EVER about two years ago. She was totally cool with my anxiety, and prescribed two Halcion tablets, which I dissolved under my tongue about 30-40 minutes before the procedure. NOTE: do NOT do this unless you have a spouse/trusted friend who can escort you to and from the dentist! The Halcion tablets don't exactly make you sleep, but the effect is much the same: I remained concious for the procedure, but very pliable and open to suggestion. She told me to open my mouth and not to worry about the tiny needle, and sure enough, I opened my mouth and didn't care at all about the needle.

Here's the kicker: I remember sitting in the chair, and then...nothing. Absolutely nothing. The next thing I recall is waking up in my bed about six hours later. The Halcion has a "forgetting" effect, known as anterograde amnesia; it basically means that you will have little or no memory of what occurs once the drug hits your system, and lasts for several hours. I was conscious through the whole procedure, and being driven home by my co-worker; and my daughter greeted me at home and said that I posted to my website, drank a cup of coffee, and was moving pretty slow and talking slow, and then I shuffled off to bed and dozed for about four hours. But I have absolutely no memory of anything after sitting in the dentist chair.

No pain, no memory. Fascinating. Of course, your mileage may vary, but if you opt for this solution and it works, your dental-phobia will vanish. Good luck.
posted by davidmsc at 7:32 PM on June 24, 2005

It took a long time before I needed to get my first filling (mid-20's), and when I finally did...well, "terrified" was an understatement. It didn't help that just going in for regular checkups kind of freaks me out. And of course I'd built the horror of fillings up so much in my mind that actually having it done was incredibly anticlimactic.

My advice is twofold: Ask for the gas, and bring a portable CD player (trippy/relaxing music optional, but highly recommended. Maybe some ambient Eno). It'll make all the difference. Ativan is not a bad idea either, if you can swing it...but absolutely have the nitrous.
posted by Vervain at 7:55 PM on June 24, 2005

davidmsc - what did you post to your website?
posted by stevil at 8:07 PM on June 24, 2005

Doesn't look as trippy as you might imagine -- but as mentioned above, the REALLY trippy part is that I truly have no memory of typing it or anything else from about 2:00 pm until 10:00 pm. Very weird, but it got the job done!
posted by davidmsc at 9:32 PM on June 24, 2005

If you've never had cavities before, and you have a good dentist, then chances are they're small. If they were only spotted via x-rays, then they were very small, (unless your dentist is a bit lazy/rushed and did most of the inspection via xrays rather than checking the teeth manually and then using x-rays to see if he missed anything small).

If they're small, unless you have sensitive teeth, you can have them drilled without anaethestic . That's unpleasant, and there would be brief flashes of pain while s/he works, but I'm putting this in perspective - you don't even need anaesthetic for this kind of proceedure, yet you're going to have a local anaesthic anyway, just because it's more comfortable that way.

What that means is that the cavity itself is most likely going to be complete a non-issue - the only things left remaining that are likely to be unpleasant is the few seconds with the needle, and the hour or three part of your mouth numb afterwards.

Actually, I take that back, the time spent in the waiting room, and the time spent watching the dentist get the needle ready, will be worse than any of the actual proceedure :-)
posted by -harlequin- at 12:25 AM on June 25, 2005


Just make sure with the memory-erasing drugs that you DO always write down your experience as soon as you get home - I know someone who only discovered that he had a bad dentist because he wrote it down before he lost the memory. He got the impression that once he was under the drug, the dentist felt more able to do things hurridly (and painfully), because he knew it was unlikely to hurt the client relationship - the client would forget everything. So no need for best behaviour any more.
posted by -harlequin- at 12:30 AM on June 25, 2005

Heh...thanks, -harlequin-, but in my case, I'm safe -- the dentist is a friend of mine, and we both serve in the military together. But I can easily see your point -- Halcion can leave a person VERY vulnerable if not in the company of trusted friends.
posted by davidmsc at 8:30 AM on June 25, 2005

Thanks to everyone for their comments and suggestions. I do feel a little better now knowing what is going to happen. I will probably avoid the nitrous oxide/halcion/other sedatives as I am going to need to drive myself home. On the other hand, I'm taking the day off work on the grounds that I deserve it.

I will give an update on Tuesday. Now I'm going to go not think about it really hard.
posted by fuzzbean at 1:24 PM on June 25, 2005

Everything went far better than anticipated; I was out of there in 20 minutes. He is a very good dentist--I felt almost nothing, not even the needle. Should anyone be in the Newton/Wellesley area and need one, email me and I will give you his name. The freaking out was well out of proportion to the actual event (which I knew, but that's just how things go).

Thank you to everyone. I appreciate all the advice and information very very much. Danke.
posted by fuzzbean at 2:38 PM on June 28, 2005

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