Our teeth are made up of three parts:
- A) Enamel: this is outside layer of the teeth we brush and keep sparkling clean. This enamel contains no nerve endings. Brush it, scrape it, chew on it…it won’t hurt you. This also means you won’t feel a cavity on the enamel.
- B) Dentin: directly under enamel (about 1mm away to be precise) lays a yellowish layer called dentin. Now this part of the tooth does have nerve endings which will start explaining why some deeper cavities can cause discomfort. Ever drink something cold and you feel some sensitivity? That likely is some exposed dentin on the tooth.
- C) The pulp: here lies the blood vessels, the nerve, the lifeline of the tooth. This layer is directly below that dentin and is responsible for the dreaded toothache. A major toothache is likely resulting from the bacteria in the pulp which can cause excruciating pain!
Let’s talk briefly about cavities and their progression. A cavity starts on the enamel (because that’s where the acidity, food, and bacteria are). If the cavity has only minimally penetrated the enamel, we place a “watch” on that tooth. That watch goes on your chart and every time you come in for a cleaning we monitor whether or not the cavity has stayed the same size or grown. That’s one reason why fluoride treatment is so imperative as it halts the progression of small cavities and in some cases even reverses them! Now if a cavity has penetrated further through the enamel and is encroaching the dentin, that cavity is unfortunately past the point of no return. Those cavities we do need to treat to prevent them from getting to the nerve. Now let’s say the cavity gets to the nerve. What now? You probably guessed root canal and you would be correct. Once a cavity is at the heart of the tooth we need to clean out that bacteria to prevent or treat an infection from getting to the bone.
I believe, just as I do myself, many well qualified dentists try to avoid doing cavities until they are an absolute must. Until then, we watch and monitor. Unfortunately, there may be a time when they do have to be tackled and we at McLean Family Dentistry determine this by taking low-radiation digital X-rays with extremely clear resolution. We will review these X-rays with you and show you where the cavities are as it’s important to us that you understand completely what is going on in your mouth.
This concludes your Intro to Cavities 101. Dr.Chand is always available for extra tutoring sessions!