Diagnodent and tiny cavities - get them filled?
February 23, 2012 4:11 PM   Subscribe

I recently moved and went to a new dentist. My old dentist used a probe to find cavities - I haven't had a cavity in a decade. This new dentist used a Diagnodent and told me I had 5-6 areas of decay that he wanted to drill into and fill. He said he didn't know if they went into the dentin or just the enamel, and wouldn't know until he got in there. What's up with this Diagnodent business? Is it legit? YANMD, but is a Diagnodent really better than a probe, and does it sound wise to get them filled? Thanks.
posted by baltimoregirl to Health & Fitness (11 answers total) 4 users marked this as a favorite
You'll find dentists who swear by each. My advice is to find a dentist you trust and feel comfortable with. It doesn't sound like this office is for you.

(I used to manage a dental office. I am not your dentist, I will never be a dentist.)
posted by bilabial at 4:24 PM on February 23, 2012

If it doesn't hurt and can't be seen or felt with the diagnostic scraper thing, then I don't think it is worth it to have them touched. I'd have to see some literature from someone that showed how early treatment is a clear benefit before I let them patch a hole where there isn't a hole.
posted by gjc at 4:48 PM on February 23, 2012 [3 favorites]

Disclaimer: My post is based on information the company I work for was built on. I am not a dentist, never went to med school.

Now that is out of the way :) I work for a rather successful dental company (55 locations in NW US) where we firmly believe on evidenced based dentistry. The big thing: Early treatment is more powerful than ripping teeth out. In fact some tooth decay can be reversed. I thought it was bogus until I worked here since i NEVER heard a dentist tell me that. I did some research, talked to the directors here on my own time/curiosity. I agree with bilabial and gjc.
posted by NotSoSimple at 5:13 PM on February 23, 2012 [1 favorite]

He sounds like my old dentist, which basically tried to get me to do a lot of expensive work like 3 months before he sold the practice and fled the country.

My new dentist, who I love, says that he is very conservative when it comes to removing material--because you can't grow new teeth. He looked at me, had another guy look at me, and they both agreed that I needed no work. I also love my new dentist because I don't have dental insurance and he looks like he hasn't gotten a new piece of equipment since the 70s.

Get another opinion.
posted by danny the boy at 5:19 PM on February 23, 2012 [5 favorites]

I'd have to see some literature from someone that showed how early treatment is a clear benefit

I am not a dentist, but it is absolutely true that minor drilling and filling before you get serious cavities is a real stitch-in-time thing. There are areas of your teeth - eg especially deep crevices in your molars - that are very difficult if not impossible to clean effectively with a brush. Plaque will continue to build in these crevices and it's not a matter of if you get cavities (or caries, the more googleable dentist term), but when.

Drilling off the plaque and performing a minor filling will basically halt this erosion and save you from a root extraction etc down the road. Not only is it cheaper for you in the long run, but far, far healthier.

In short, it's a Real Thing, and I highly recommend listening to your dentist's advice. My dad has had a shitload of root canals and they are no walk in the park.
posted by smoke at 5:22 PM on February 23, 2012

I just had a bunch of fillings done because I went back to my childhood dentist (near my parents' home) and she found a lot of decay using her Diagnodent that my fancy-shmancy New York dentist never would have caught.

My family is big on knowing what we're getting into with dental healthcare, as my mother has had the unfortunate experience of a single broken tooth from a childhood fall cascade into (very, very expensive) replacement of her four front teeth. (It has long been a joke in our family that, alongside me and my sister, my mom's teeth were my parents' third child.)

So, when the Diagnodent found the decay, I did some research into it. I decided that going ahead with the fillings was the right course for me, based on the ideas that smoke outlines above.

One thing I did do, however, was to do the fillings in stages, to mitigate the financial burden. We did them over several sessions, worst decay first.
posted by ocherdraco at 6:02 PM on February 23, 2012

I, too, have found this a bit sketchy given the sheer number of cavities that infernal device found in a single visit. That said, X-rays should give the dentist an indication about whether the cavity has penetrated into the dentite. I think that the reality is that cavities are inevitable over time, no matter how well you adhere to proper dental hygiene, and the Diagnodent simply finds those cavities sooner than they would have otherwise.
posted by deanc at 6:50 PM on February 23, 2012

My dentist does most pin-pointing of initial decay with x-rays. She's quite conservative, and I am as well, so I use prescription fluoride toothpaste to remineralize the enamel. I've stopped or reversed trouble areas and avoided fillings doing this. We monitor those spots for any changes. If this diagnostic tool is very sensitive, it's possible that there are other options besides fillings. Ask your dentist.
posted by quince at 10:49 PM on February 23, 2012

I've also experienced some conflicting reaction plans with a change of dentists. My usual dentist is in my home state on the west coast of the US, and I had visited and he said nothing unusual was happening all fine. Then a few weeks later when I was on the east coast for university, I got into a car accident where I had to go see a local dentist about some issues with my jaw. The dentist noted I had three teeth which were showing indications of decay.

I've also had dentists (I've moved around a lot) where one in the US would say it I had to consider getting 3 wisdom teeth removed ASAP within 6 months or they would just wreck my face and life because it will be impossible to pull out without cutting my face up. So I was freaking out over that, but couldn't fit in an appointment before I left the US so never got it done. Then a year later I go to see a dentist from Singapore who basically says yeah the wisdom teeth are growing the wrong way, but if they haven't bothered me for years now don't worry. And a year after that, same message from an Australian-trained dentist.

Getting another opinion may be expensive, but can avoid unnecessary work.
posted by peachtree at 11:02 PM on February 23, 2012

I am of two minds about this.

First, when I was 15 I had some minor decay only detectable via X-ray on the outer sides of my molars near the gumline drilled and filled with porcelain. They have never needed to be replaced and haven't decayed further.

But biting-surface molar areas with visible decay that were drilled and filled with porcelain have needed to be cleared out and replaced every 5-7 years. It was only the most recent time that my new dentists said "oh yeah, porcelain has to be replaced every 5 years because it has a different expansion rate from your teeth." I said I'd prefer to avoid the constant replacement and so he suggested old fashioned metallic amalgam. It's only been a few years with that amalgam in, but I no longer have hot/cold sensitivity in those teeth and none of the pain that usually follow the previous refills!

So perhaps the difference is high-use versus low-use areas.

Where are the areas that your dentist wants to drill? Just keep in mind that depending on the material used you may need to replace ALL of those fillings every 5 years.
posted by MonsieurBon at 8:17 AM on February 24, 2012

The most telling detail in your post is that you haven't needed any restorative work in a decade. this would indicate to me (and of course askme details are no substitute for a first hand exam) that you have a low caries rate.
If these lesions are 'pit and fissure' lesions, i.e. they are in the grooves of your posterior teeth, waiting 6 months ( a full recall cycle) will not change things much, and they can be checked again.
If the lesions are in between the teeth then radiographs should give a clear picture of whether the dentin has been entered. this is the classic way to identify cavities, and penetration into the dentin would warrant restoration.
I will almost always discuss a situation like yours in the following way: lets choose the lesion that seems most definitely to be a cavity, if you choose to have the restorations done now, and the character of what we find in that one should give us an idea of how urgent the others might be. sometimes we get into what seems like a tiny little sticky spot and find out that a good deal of the tooth is undermined by decay but the density of the enamel hid that from us on the xray; and sometimes we open a groove and find that it's mostly just stain, and stop right there and put a hold on the others until there is a more compelling sign that breakdown is occurring.

the point here is that I always assume that, unless i am rendering emergency services, I am building a long term relationship with my patient, so i seek to explain how cavities occur, what factors influence how aggressive the decay might be , and what the up/down-side would be to treating vs waiting. try to have this type of relationship and you will be more comfortable with your decision either way you go.
posted by OHenryPacey at 10:11 AM on February 24, 2012 [2 favorites]

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