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Stopping Early Tooth Decay – Without a Filling

You know all about tooth decay, don't you? It's very simple — you get a cavity and the dentist fixes it with a filling.

But today that's not the only way to deal with tooth decay. Some dentists are using newer technologies to help detect decay as it begins. The aim is to find out when the tooth begins to lose some of its minerals, before it develops a hole (cavity). At this early stage, decay often can be reversed.

Cavities take longer to develop

The way a cavity forms has not changed. It starts with bacteria called Streptococcus mutans. They eat carbohydrates (found in sweets and many other foods) and produce acid. The acid attacks the hard outer surface of the tooth, the enamel. If the surface breaks, then you have a cavity.

What has changed about the decay process is how long it takes. On average, a cavity does not break through the tooth surface for several years after decay begins, said David A. Albert, D.D.S., M.P.H., of Columbia University College of Dental Medicine. Dr. Albert is an associate professor of dentistry and public health at the Columbia University Medical Center. He is director of community health at the College of Dental Medicine.

Just a few decades ago, Dr. Albert said, a cavity could form in only months.

What has slowed down tooth decay? The short answer is "fluoride." Now almost all toothpastes contain this mineral, which strengthens teeth. It also is added to most U.S. water supplies. Because of fluoride, teeth are stronger than they used to be. They can fight off the loss of minerals in the early decay process.

Early decay often can be stopped

Tooth decay often gives a warning before it causes an actual cavity. You or your dentist may see a white spot on the enamel, or your dentist may see a suspicious spot on your X-ray. New types of imaging and laser technologies also can help dentists to find early tooth decay.

In some cases, a filling is a no-brainer. If you're in pain or have an obvious cavity, you need a filling. But "if there's no cavity and no pain, the tooth can fix itself," Dr. Albert said

This works best if your overall risk of developing cavities is low. So the next step is to assess your risk. Your dentist will ask questions and perhaps test the bacteria in your mouth.

You probably are at low risk of cavities if you:

  • Have low levels of cavity-causing bacteria
  • Don't eat many sweet or starchy snacks
  • Have not had a cavity in the last year

Treatment tailored to your risk level

If your risk is low, the dentist could paint fluoride varnish, silver diamine fluoride or calcium pastes on the problem tooth. These treatments often can stop or slow the decay process. They can help the tooth to repair the area. The dentist also will work with you to improve your home brushing and flossing habits and possibly make changes in your diet. You may come back to the office more often during the next several months. The dentist will see if your tooth is improving and may treat it again. In many cases, the tooth will be repaired without a cavity ever forming. If you are at high risk for cavities, your dentist may add other treatments, such as mouth rinses to kill bacteria. Sometimes, if you are at high risk, the best treatment may also include placing a filling. People at high risk of cavities should visit the dentist more often than average. Your visit may include preventive treatments such as fluoride.

Fillings have risks, too

Why not just remove the decay and fill the tooth for everyone? Dr. Albert noted that teeth without fillings are stronger. For example, there is always a chance that a filling will crack, break or fall out. The space between the filling and the tooth is also a hot spot for further decay.

Although newer technologies can help diagnose early decay, Dr. Albert recommended caution with treatment. "Some things look like cavities, but they're not. For example, a dark discoloration does not mean a cavity."

So if your risk of dental decay is low, he said, it is better to "watch and wait" than "drill and fill."

Last updated Feb. 20, 2016