Conservative Treatment of Cavity

When we have a cavity, we need a filling.  It appears to be the most conservative treatment.  It will be shocking if you are told that filling is not the only solution.

Mr. Wang has an impacted wisdom tooth (Fig.1: #3, 3rd molar).  It causes a cavity in the neighboring tooth (#2, 2nd molar; <).  All we are going to do is to take out the wisdom tooth and at the same appointment to trim the top portion of the 2nd molar above the cavity (Fig.2: blue xx) and scoop the junk from the cavity.  No filling is necessary, since the back part of the 2nd molar is not so important for chewing.  Filling may pop out several years later.

Fig.3 is taken 1.5 years after treatment.  The patient is fine with daily life, although he has a little sensitivity when we do professional cleaning with a lot of cold water.  The shape of the cavity is still there (<), but the cavity appears not to grow big.  What we want Mr. Wang to do  is to use dental floss every day to clean the back surface of the 2nd molar (Fig.4: two circles and a string in between).  He promises to follow the instruction.

Fig.5 is taken 5 years after treatment.  The cavity appears to remain the same (<).  Mr. Wang does not feel sensitivity when we clean there.

Fig.6 space is originally reserved for Mr. Wang when he returns later on.  But he has moved out of town.  Before his family moves 6 years after treatment mentioned above, his wife reports that Mr. Wang does not even brush his teeth every day.

The story demonstrates that filling is in fact not the highlight (the most critical part) of cavity treatment.  Removing germs out of the cavity is!   If Mr. Wang were the most diligent (brush and floss crazily) and most conservative person in the world,  the only thing we need to do is just take out the wisdom tooth.  This changes the environment of cavity formation and progression.

Most of time, we need filling, because after germ removal, there is a big hole.  We cannot chew normally.  There is a cosmetic issue in the front.  As a matter of fact, the latter is also not so important sometimes.  Christina had two big cavities when she visited us six months ago (Fig.6 E, F).  The cavities may have existed for at least 4 years.  Since the cavities are not so deep and easy to clean because of position, treatment is not so urgent.  Now one of these front teeth is gone (F).  She was too scared of dental work to care about the appearance.  The bottom tooth (<) is in bad shape.  The root is exposed.  Since this does not bother her, we do not force to do treatment.

Xin Wei, DDS, PhD, MS 1st edition 06/22/2011, last revision 09/15/2012