How do I know I really need a filling or have a cavity? Is my Dentist telling me the truth? Who should I believe?
This is a very difficult situation to explain. I see it everyday day in my practice. Patients come to our office and tell me their other dentist told them they have a cavity and need some sort of dental treatment. They ask me if “they really have a cavity”. Their obvious implication is that the other dentist is lying to them for some reason. How do patients with no dental knowledge beyond feeling pain or seeing a brown spot or a broken tooth know what is going on in their mouth? You have to get a good dentist with integrity.
It is also a difficult situation when a new patient comes to my office from another dentist that does not fully explain the long-term condition of their teeth to them. I am left to gently explain that, although they have no pain, they have extremely large fillings. And all extremely large fillings will fail under constant load. That failure may be marginal leakage leading to decay, that failure may be a chip or cracked tooth, or nerve pain, or some other consequence of a heavily restored tooth. As their new dentist, I have to tread lightly but be honest and explain the issues they should think about to have the best chance to maintain their teeth for a lifetime. This may be new information to them.
What should a patient do when one dentist says you have a cavity and another says you do not have a cavity? Obviously, this is a confusing situation. Why is there any doubt? A cavity is a cavity and there should be no difference between two dentists, right? The answer is not always.
Unfortunately, a cavity can be deceptive. It can hide and be obscured by old fillings, location, or just not be obvious by eye or X-ray. Many times I see a small cavity in a tooth that I think will be small and find after drilling that it is much, much bigger than originally thought. So, if we would have “watched” that small cavity it could have turned into a large cavity requiring a crown or a root canal. The previous situation is also a challenge for me and other dentists. What if I want to be “conservative” and not do small cavities and that cavity turns into a major expensive restoration? How do I answer the patient when they ask me, “why didn’t you see and fill that cavity before it got big. It’s hard to explain that I wanted to make sure it was not too small but not too big either.
In summary, I believe most dentists are trustworthy and try to do the right thing for their patients. Fortunately, today we have many different technologies to help us diagnose decay. If you get contradictory opinions ask for an explanation why they think it is decay; ask for an x-ray or intraoral photograph for evidence. If you see a brown spot then most likely you have at least a small cavity. And finally, infrequently a patient goes to their old dentist “that they had since they were 4 years old” or another dentist and he or she says that “that you do not have a cavity”. That dentist may be inaccurate. It’s sort of reinforcing to have them say you are “fine” if you “want” to be cavity-free. However, the only true way when you have a true difference of opinion is to go to a State Dental Society or State Dental Board and ask them what “would a reasonable dentist do in this situation”.
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