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Medical Forum / General / Dentistry / June 2005

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caries question

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viktor011@gmail.com - 28 Jun 2005 02:03 GMT
I've got a question regarding caries that is being formed on few of my
teeth.

In fact they are very very small dots.

Is there any other solution than filing (if i spelled right)?

Are there any tooth pastes, any medicaments, drugs, scrubs?

Please answer on my email: viktor011@gmail.com

Thanks.
Winston - 28 Jun 2005 04:35 GMT
> I've got a question regarding caries that is being formed on few of my
> teeth.

Welcome back!

Supplies:

 Sonicare toothbrush.  You can use any toothbrush, of course.
  The Sonicare just 'feels' more effective to me.
  If it feels too 'violent', try the Braun.
  Electric brushes are more fun than the manual type.

 Toothpaste (Plain white stuff is just fine).  Read the ingredient
  list when shopping.  Check for Fluoride.  Fluoride is good.

 Floss
  (Johnson & Johnson waxed. Flat, measures about 0.005" thick)
  (Not the store brand, because that cheap stuff shreds and sticks
  between your teeth, driving you crazy.)
  After you have perfected your flossing technique, you can shop
  for less expensive floss.  Most of the cheap stuff is junk.

 Hydrogen Peroxide Solution, 3% concentration.
  Found hidden on bottom shelf, near the first aid supplies.
  Often in a dark brown plastic bottle.
  The label will say "For treatment of minor cuts and abrasions."
  And "For use as an antiseptic gargle or rinse."
  Get a couple of the smaller 16 oz bottles.  It becomes ineffective
  over time and / or if it is heated much beyond 86 F.
  Try not to jar or shake the bottle.  Leave tightly capped.

  The bottle may say "dilute with an equal amount of water."
  I rinse with the stuff full strength. No problems.

 Forget mouthwash. Stuff is completely ineffective for longer than a few minutes.
 Forget breath mints.  Most contain sugar, which grows oral bugs like crazy.
 Forget chewing gum like 'Dentyne'. Lots of sugar.
 Read the label first.  You will be surprised.

First thing in the morning and after every meal and snack,
 rinse out with an ounce of Hydrogen Peroxide.  The stuff is very safe to rinse in
 your mouth and will not cause discomfort.  Swish a few times and spit.
 The oral bugs will konk out and be rinsed down the drain. Peroxide foams a little
 when in contact with bacteria. The stuff has a very delicate flavor.
 It is 97 percent water.

After rinsing, floss.  Yank about 24" out of the container and wrap the end
 around either index finger.  Saw the floss between each tooth to get the bad
 stuff out.  There will be blood.  There may be pus. This is normal, until your
 gums are back in shape.  After each tooth, wrap the used floss on your finger and
 use clean floss for the next tooth. When you are done with both upper and lower
 jaws, rinse out with another ounce of peroxide solution.
 The stuff is very inexpensive. You are giving the antiseptic better access to
 the bacteria in the gaps between your teeth. Swish and spit.

*"Brushing teeth" is just a figure of speech.*
 Brush only those surfaces that you want to be clean. So in addition to all
 surfaces of every tooth, you will want to also brush the bacteria off of all
 other mouth surfaces, to slow the bugs as much as possible.
 Feel free to rinse the bristles under hot water and reload the brush with
 a little paste to clean another area.  Toothpaste is cheap.

 Brush all surfaces, including but not limited to:
 * Gums, (tongue - side and outside surfaces.) ("Lingual and facial")
 * Tongue. Top and bottom.  (Use a side-to-side motion.)
 * Roof of your mouth.
 * Inside surface of your lips.

 Take your time. This is a lot more pleasant than a root canal.
 Ask me how I know that. Go ahead. Ask.

 The first few dozen times that you attempt to clean the rear part of your tongue
 and perhaps the rear part of the roof of your mouth, you will gag.
 Don't worry, everyone reacts the same way to pressure in these areas.

 You aren't gonna lose your lunch. But stay near the sink anyway.
 After a while, you will react with much less enthusiasm.

 Soon, you may not gag at all.

 With brushing, flossing and the peroxide solution rinse, just about anyone can
 get excellent checkup results.

Want to know what your breath smells like to others?
 1) Sniff one wrist to get a baseline.
 2) Lick that wrist and allow it to dry.
 3) Sniff that wrist again.  This is pretty much what you are radiating.

That is about it.
When you have kids, please show them the dental litany every day, follow up
with them as they grow up because they are not going to think to do this
themselves.

They will grow up to be much happier people.

Best to you.

--Winston
Dr Steve - 28 Jun 2005 12:36 GMT
If the hole is through the enamel, the only option is getting it excavated
and filled.

Signature

~+--~+--~+--~+--~+--
Stephen [What's a Temporary?], D.D.S.
Michigan, USA
....................................................

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here.  Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
......................

> I've got a question regarding caries that is being formed on few of my
> teeth.
[quoted text clipped - 8 lines]
>
> Thanks.
Error - 28 Jun 2005 14:01 GMT
> If the hole is through the enamel, the only option is getting it excavated
> and filled.

And if it is not?
Dr Steve - 28 Jun 2005 14:15 GMT
>> If the hole is through the enamel, the only option is getting it
>> excavated
>> and filled.
>
> And if it is not?

Totally dependent on the patient history.
Steven Fawks - 28 Jun 2005 14:26 GMT
Make note of it in the chart, inform the patient of its
presence, and recommend dietary/home care changes that
could prevent its enlargement.  More effective brushing,
fewer soft drinks, fewer snacks (especially 'sticky sweets'),
and floss would be the main points.

Sealants would also be a good option.  However if this is
the very first exam by a new dentist, it is not always an
easy call (no personal observation of decay activity over
time for this patient).

Fawks

>>If the hole is through the enamel, the only option is getting it excavated
>>and filled.
>
> And if it is not?
Steven Fawks - 28 Jun 2005 14:05 GMT
> If the hole is through the enamel, the only option is getting it excavated
> and filled.

Agreed.

Very small cavities are sometimes 'watched'.  IOW's the dentist is just
waiting for them to get large enough to feel good about getting out
the high speed handpiece and gutting the tooth.

I would rather use a very conservative means of cavity preparation
(laser, air abrasion, or small bur) to remove the carious portion
of the tooth at an early stage and seal any other pits and fissures
at the same time that I am restoring the actual decay.

JMO,
Fawks
Dr Steve - 28 Jun 2005 14:14 GMT
If I see a spot interproximal which is only half-way or less through the
enamel, I will just take a new set of BWx every 12 months.  Any changes in
density or size get treated.  Many small ones like that remain unchanged for
years (if not forever).  A lot of them continue to grow and need treatment
before long.  If you make the image large enough, drop the brightness while
increasing density and then sharpen the edges on the image, you can see when
the caries just breaks through the enamel and starts to attack the DEJ.  You
open the lesion at this point and see the thin brown line in the DEJ about
0.5 mm thick.

You would be amazed how many tiny spots in the interproximal regions you can
see once you digitize the image, enlarge it, and enhance the brightness and
contrast.  I really like being able to show the patient areas which will be
a concern a few years if they don't change their diet and hygiene habits.

I can enhance the image, crop it to just visualize the problem and add
arrows, circles, notes, etc. then save the modified image as a copied image
in the patient record.  Every recall appointment, we can open these images
first as we begin checking the mouth.  Same thing for I/O camera images.

Signature

~+--~+--~+--~+--~+--
Stephen [What's a Temporary?], D.D.S.
Michigan, USA
....................................................

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here.  Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
......................

>
>> If the hole is through the enamel, the only option is getting it
[quoted text clipped - 13 lines]
> JMO,
> Fawks
Jacob - 29 Jun 2005 05:33 GMT
One important thing is your age  -- in other words, how long these caries
have been present.  If you are middle aged or older, and these have been
this way for years, then the best thing to do is keep an eye on them; they
are not very likely to get worse.

Caries risk analysis is important.  I have seen radiographs of caries that
did not progress over a 15 year period.  Just because there is a "hole" in
the tooth, it is NOT necessarily appropriate to restore the tooth.  There is
a constant remineralization process from the minerals in your saliva, and
caries can acutally "heal" under the right circumstances.

The most important thing to keep in mind is when to place [or I should say
"if to place"] the first filling.  We don't have any filling material that
duplicates natural tooth structure, and once the initial filling is placed,
the usual scenario is that the filling breaks down and needs to be replaced
in 5 or 10 years.  Each time the filling is replaced, the "hole" gets a bit
larger, and the tooth gets more irritated by the drilling/filling.
Eventually, a crown is needed, and sometimes root canal treatment as well.

In my opinion, there are many, many cases where the best thing to do is
watch and see what happens.  As long as you go to the dentist regularly,
there is virtually no risk for problems by just watching.  You may find that
by watching, the caries stays the same over time, and you will not need any
filling.

> I've got a question regarding caries that is being formed on few of my
> teeth.
[quoted text clipped - 8 lines]
>
> Thanks.
Steven Fawks - 29 Jun 2005 14:52 GMT
> The most important thing to keep in mind is when to place [or I should say
> "if to place"] the first filling.  We don't have any filling material that
[quoted text clipped - 3 lines]
> larger, and the tooth gets more irritated by the drilling/filling.
> Eventually, a crown is needed, and sometimes root canal treatment as well.

I have been using sealants and PRR's to some degree for many years.  I
don't have 20 year studies, but I do have 26 years of anecdotal
observation.  I think the early intervention with very small
restorations to eradicate the caries will save a lot of tooth structure
over time.

I believe this idea was more true of the days with GV Black preps and
amalgam use than with todays techniques.  Even with the medium sized
Class I amalgams, the 5 year replacement theory does not often turn into
reality.  I do see a lot of 40-60 yr.-olds who need a few crowns.  Most
of these were not due to an intitial occlusal amalgam.  They may have
had occlusal decay treated with an amalgam in 1964, but new areas of
decay led to an MO, then an MOD, and then cusps began to fracture.  It
is rarely continued replacement of one filling that leads to a crown.

Fawks
 
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