Xray questions..
 

The dentist i went to today looked at my panoramic xray and saw what looked (to me) was worn enamel, such as it should show all white around the tooth, she showed me spots where it was grey. Just because it's grey, does it mean a filling is needed? I'm 25, she told me I needed fillings (white) in tooth: 2, 3, 4, 5, 11, 12, 13, 14, 15, 18, 19, 20, 21, 28 with 29, 30, 31 needing crowns and three wisdom teeth removed. I understand I didn't take great care of my teeth but I also don't want someone to ruin my teeth with white fillings since they do only last 5-7 years on average, so I'd be needing crowns probably at that point..

Mike,

Two questions ... do you floss your teeth every day? Do you drink soda, other sugary drinks or gatorade?

Not flossing every day can cause cavities to form in between the teeth. Which means if #2 has a cavity on the (medsial) side of it next to #3 then #3 will have a cavity on it too... and so on.

Drinking soda, any sugary or acidic drinks will cause the enamel to break down and cavities will form.

If you don't have the cavities fixed, the decay will progress into the nerves and infect the teeth. That is not a maybe, that is a definite thing.

White fillings can last 10 yrs or more depending on how large they are. That sure beats ending up with no teeth in 10 yrs!

If you are in doubt of what she told you, get your xrays and seek a second opinion.

Bryanna

yes i used to drink soda, never gatorade, and i do floss at night.

i did take photos of my xrays, but not sure how readable they are, and i can't post them either according to the forum rules, boo.

also, at what point can it be reminerlized, as most of the grey spots she showed me were right on the edge, like if the "enamel" was a crown, it would be on the left and right edges only, not in the middle

Also, she wants to do RCT on the tooth that broke because it's near the root, however there's no pain. Is that normal?

Hi Mike,

Other people have posted their xrays here. So I don't know if that rule has changed or not. You could ask Chemar.

One of the problems with teeth is that sometimes there is no pain. However, that does not mean it's ok to leave a problem alone. I personally would not do a root canal on any tooth because it renders the tooth chronically infected and inflamed so the only sure way to rid yourself of that and the systemic consequence of that would be to have it removed.

Any sugar in the diet causes the enamel of the teeth to break down. It is like putting acid directly on the teeth. The more sugar you consume in your diet and bathe your teeth in (any sugary drink), the higher the acid in the mouth, the more break down of the enamel. Once the breakdown occurs, there is no reversing it back to it's original state. The only thing you can do it repair the damage that has already been done and eliminate the sugar to avoid it from occuring again.

Using Xylitol in place of sugar... chewing xylitol gum after meals can help to remineralize some tiny areas of newly developed enamel breakdown. But it will not restore the damage that has already been done if it is more than minimal.

Hope this is helpful to you..
Bryanna

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Hello Mike
as you are a new member, the forum software will automatically block you from posting links to anything ie your posts get blocked if you try to post any form of link
BUT
as Jo*mar suggested above, you can use our attachments feature to upload images directly from your computer. Just follow the instructions she posted which will show you how to do so

I think I attached them properly now.

Hi Mike,

Wow... see how helpful people can be on here.... amazing!!!

Thanks for posting the x-rays.

Okay yes, you have several cavities. I just compared my findings to your dentists and yes, I see cavities in all of those teeth you mentioned and some possible others starting to form in teeth # 25, 26 and 27. She may see these also but they appear fairly new and tiny. I assume she is referring to #29 for the root canal, but you have others that are just about as deep as that one is. Your wisdom teeth also have cavities and they are not accessible to restore. Not only that, they are just plaque collectors because you are not able to get a tooth brush back that far to clean them properly. So they should be extracted.

Most of your cavities are what is called Interproximal which means in between your teeth. Cavities occur in these areas from not flossing. So in the future if you floss every day, you will minimize or eliminate new cavities in these areas. If you don't floss, then you will get what is called Recurrent decay around the new fillings.

Based on my extensive professional experience as a chair side assistant....... having had countless patients with your exact situation with extensive decay in several teeth ....... it might be wise to discuss extraction of the teeth with the deep cavities that are very close to the nerve because there most likely will be nerve involvement when she tries to remove the decay. Discuss replacement options for these teeth which could mean a removable partial denture which is something that you take in and out. Or dental implants... all depends on how much you can afford to spend.

I know this is all very scary and you are very young to have to deal with this. But if you want to have a healthier future and do not want to spend countless hours with tooth pain and time in the dental chair..... then consider removing the teeth that will have nerve involvement now. Give yourself a clean slate and take good care of the teeth that you will have left. This is probably your healthiest, least painful and least expensive option.

Hope this information is helpful to you.... keep in mind you are not alone. Many people find themselves in this situation and the ones who deal with it rather than prolonging it... always come out okay!

Bryanna

JoMar!!
 

THANK YOU FOR THIS!!! SO GLAD YOU ARE HERE TO HELP :-))

Bryanna

Chemar!!
 

THANK YOU FOR HELPING!! YOU AND JO MAR CAME TO THE RESCUE :-))

Bryanna

im definitely not ready to give up on my teeth and go with a partial, thats what im afraid of when im 40 not 25. i've started taking better care of my teeth recently but i haven't been able to find a dentist able to take me so that's why it's gotten so bad. I assume all of the fillings have "crossed" the dentin thing where it can't be put off? most of the fillings she recommended as MOD (8) and 13 of them on the top (O?) but most were 3-surface, with a couple being 2-surface

edit: yes 29 was the RCT, but it was because the tooth broke
edit2: are most of the fillings deep? i assume if they are, then in 3-7 years when the fillings go bad, i would need to get something worse done like a crown since there wouldn't be enough to re-fill, even if i kept up my oral care?

she also said she'd probably have to crown # 30, 31 but she wasn't sure until she cleaned it out

here's what she has down
4, 5, 12, 13, 19, 20 are all MOD
14 is MOL, 15 is ODL

the rest are 2-surface.. 28 is OD, 11 DL, 18 MO, 21 OD, 2 OL, 3 MO

i assume the two surface ones aren't as bad, and the 3 surface ones are worse? is it recommended to get silver in some, white in others? i know silver lasts longer generally, but silver keeps your tooth together better?

Mike,

Many of your cavities are deep. The more surfaces there are, MOD as compared to DO, does not imply the depth of the decay. It implies how many surfaces of the tooth are decayed. There are 5 surfaces to every tooth.... so you can see how wide spread your decay actually is on all of these teeth. Also when a cavity is deep, the tooth structure that has to be removed in order to remove all of the decay and reach solid tooth often makes a 2 surface or 3 surface into a larger one. So you actually may have more teeth that will end up with nerve exposure which means either a root canal or an extraction.

Tooth decay is actually infection and it spreads very easily. The decay in your teeth has passed the enamel into the dentin. To be truthful, waiting is not really an option unless you want full dentures. Here is a diagram:http://www.nlm.nih.gov/medlineplus/e...pages/1121.htm

Tooth #29 broke because of the extensive decay. That portion of your tooth is literally eaten away.

If your fillings are done well, your oral hygiene is thorough including flossing, and your diet is nutritious, you should not have to replace the fillings in less than 10 yrs. If you don't have recurrent decay at that time, the fillings can be replaced without removing much tooth structure. So crowns would not be necessary under those circumstances. Fillings don't go bad... they wear out from chewing on them. Filings in between the teeth generally last longer than those on the top of the tooth providing there is no recurrent decay.

I cannot stress enough that your situation will be ongoing if you hang on to teeth that have any nerve involvement. I am giving you this information so that you are well informed of what you are getting yourself into. The best option is to be pro active which gives you a fresh start at having a healthy mouth.

What do you mean you cannot find a dentist who will take you?

Bryanna

Mike,

It is never ok to have "silver" amalgam fillings put in your teeth. These fillings are 50%+ mercury combined with other metals. They are highly toxic. It will not be long before it is illegal to place these fillings. Most dental offices stopped using them 10-15 yrs ago. Those that have not are in denial about the toxicity and are causing harm to themselves, their staff and their patients. As far as the metal keeping the tooth together... not at all true. The metal is sensitive to hot and cold temperatures so it constantly contracts which causes it to crack and corrode. Bacteria gets in these cracks and causes decay to form underneath them.

Tooth colored fillings called composites actually bond to the tooth making the tooth stronger.

Bryanna

I couldn't afford it so I was trying to go to a low cost clinic, however none of them were accepting new patients at the time. Which fillings do you consider deep and may need RCT other than #29? They also retook xrays & panoramic due to some of them being blurry, maybe that would change how these xrays look? (they were the blurry ones).

She's taking out my silver fillings and wanting to replace with either a crown or white filling, but I wasn't sure how good they were on molars. I do know they bond the teeth better and require less structure removed, so I figured it might be best to get the 14 filled with the white stuff and hope it lasts 10+ years as I intend to take much better care of my teeth including the removal of sodas.

edit: Also 13 of 14 were "O" so that would be the top of the tooth, so most would wear down easily I think? They also recommend all their clients to do 3 month cleanings.

nevermind i dont think i want to know, the less i know the better, way too stressed/depressed over everything. i'm going wednesday to start the deep cleaning, then they're going to pull the two wisdom teeth because the third has to be surgically removed, and then i believe theyre going to root canal and crown #29. then 14 fillings and possibly 2 more crowns. (30, 31).

Mike,

I have given you a lot of information to help you understand not only the severity of your situation but to help you communicate more effectively with your dentist about your treatment options that could save you pain, money and chronic infection for the long term. Any teeth that have root canal therapy will be infected for the life of that tooth. That is something that you should know and understand before you decide that is a good idea. Most dentists will not provide that information to you. They will instead say... this procedure will cure your problem. What that means is... this procedure will allow you to "retain" an infected tooth for an undisclosed amount of time. The word "cure" pertaining to root canal means nothing other than "retain".

My intentions for telling you this..... simple... so you are better informed. It's my attempt at helping you to prevent any further unnecessary anguish with your teeth. To make a wise choice you need to be properly informed. Then you can decide what is in your own best interest.

The x-rays were clear enough to see that many of your cavities are deep. Your dentist will know just how deep and big they are when she removes the decay. So it would not be a surprise if with certain teeth she says to you.... the decay is near the nerve or it has gotten into the nerve. At that point you will have to decide whether you want to do a root canal or schedule an extraction. So this is another reason why there should be a discussion with her about removing "these" teeth and replacing with a partial or implant so that you have a back up plan with her just in case there are a few teeth in this category. As I said, the extent of the decay will be more apparent once she starts to remove it.

This is a lot to deal with it. I see it every day. I feel terrible for you to be in this situation :/ I also am trying to educate you on ways to deal with this situation so that you never have to deal with it again.

I wish you all the best... I cannot stress enough to communicate with your dentist about your options.

Please check back with us to say how you're doing.

Bryanna

i went to get a second opinion today from the place where the xrays originated from (i took these to the second dentist, who gave me the opinion in the OP)

they suggested:

removal: wisdom teeth (1, 16, 32)
3: L
4: MOD
5: OD
12: OD
13: OD
14: L
15: OL
16: MOL
18: O
19: MODB
20: OD
21: OD
28: OD
29: MOD
30: OB

She did say after cleaning, it would be possible I'd need an additional surface as it's hard to see on xrays sometimes with plaque buildup, but she would try to do a large filling in 29 (the broken tooth) as long as the pulp isn't exposed. If it's exposed, they would give me an option of RCT or removal, however none of the other teeth appear to need RCT/crowns.

Now I have about 20 hours to decide which dentist to go with as I have part 1 of the cleaning scheduled at the inital dentist (in OP) on Wed at 3pm.

The biggest difference is this one actually did a full mouth exam with the icky dental tool, the first one primarily went off xrays with a few pokes. She also recommended to go to an ortho for my bite but I can chew fine and it isn't bothering me (one tooth, i believe 17, appears slightly raised up which causes the bite to be off). She also caught the B in 19 which is already existing (and first one missed somehow) as well as a B in 30.

Mike,

Go with the one who seems the most thorough. The surfaces noted by both dentists are similar and the reason for that is because they don't know what is going to be uncovered until they remove the decay.

I like the fact that this second dentist offered you the option of rct or removal if there is an exposed nerve. However, she is talking about doing some very large fillings which may or may not hold up very well. Whereas a crown on some of these teeth with large cavities may support the tooth better than the large filling. Obviously, this dentist is trying to save you money.... initially. Which can end up costing more in the long run.

There is no right answer here... go with your instincts.

Keep us posted...ok...
Bryanna

I missed 31 as MOD. She thought a crown wasn't needed on any other teeth as I made sure to ask, even mentioning 30, 31 as the first dentist said those would possibly need crowns but something along the lines of most of the tooth structure being there so it wasn't needed.

The second one was a clinic so it would likely just be one appointment per month, I have #29 scheduled for Feb 20th and cleaning for March 3rd as that's the soonest they had, but I can get the work done faster if I went with the initial dentist. I like the second one better, but I'm not sure about waiting so long?

Would you think a sedative filling would work on #29, or is RCT still likely? The biggest difference is #2, which she didn't mention at all, as well as #11. And they both appear to disagree with #3, MO vs L.

Really unsure what to do, I wish I could combine the thoroughness of the one today with the fast appointments of the first one.

edit: Also the first one is a chain dental place, which is what scared me to begin with, as I've heard bad things about chain dentist offices (Bright Now Dental). The second is a clinic, hence the long waits on their appointments.

edit2: Also at the chain dentist, I believe it was the hygienist that went over the fillings, rather than an actual dentist. I'm not sure if he'd be better at it, though? At the clinic, it was the dentist.

Hi Mike,

You are stressing over the number of surfaces and what you need to realize is that the surfaces are somewhat irrelevant in that the true size of the cavity will be known once the dentist removes all of the decay. I can also tell you that teeth that have cavities larger than 3 surfaces will not have much tooth structure left above the gum line once the decay is removed. So depending on the situation, very large fillings are not always the best way to go. Very large fillings tend to fracture because there is so little tooth structure above the gum line to bond the filling to. That's why onlays or crowns which are cemented to the remaining tooth structure are better at protecting teeth in that condition.

Unfortunately, every dentist will come away with their own opinion because of their individual preference and skill level. There is no way for you to know ahead of time who will be the best dentist for you. You have to go with your gut instinct and/or positive referrals to someone in particular.

The cavities that you have cannot be definitively determined by your x-rays or a clinical examination because they may or may not be deeper than anticipated. Meaning when someone has extensive and multiple cavities there may (or may not) be other areas/surfaces of early decay that are not evident until the tooth is cleaned out. I am telling you this not to make you worry more. I'm telling you this so that you stop stressing over the specific surfaces. It could also be that some of the areas are not as deep as they appear on the x-rays. Now wouldn't that be wonderful!!

I personally think you will end up with more problems if you have one visit per month unless multiple teeth were done at each appointment. Can they do quadrant dentistry? Meaning there are 4 quadrants in your mouth... at each appointment have all of the caivites done in one quadrant. At the second appt do all the cavities in that quadrant and so on. Not only will you get the dentistry done quicker, but it will be less anesthetic injections as opposed to doing a tooth here and there and different appointments. The entire quadrant gets numbed up every time you have a filling done. SO why not do as many as possible in that quadrant at the same time? If you had some crowns done, it would take more than 4 appointments but not too many more. Of course you would have to have long appointments and you would have to pay more per visit as well. But you need to know that the longer you wait to have the cavities done, the deeper they will become. So the quadrant option is an important thing for you to consider.

Regarding tooth #29... a sedative filling can be tried only if there is no nerve exposed during the removal of the decay. Though I think you better prepare yourself for the choice of root canal or extraction. This way you won't be making a last minute decision if it comes to that.

Is there any way you could go to a private dental practice rather than a chain or clinic? I'm not a big fan of either of those because it's been my experience (from a dental viewpoint as a chair side assistant) they both tend to be more focused on quantity than quality. But if that is what you need to do, then go with your instinct. You can always change if you are not happy.

Bryanna






\

Unfortunately my insurance is mostly just chain dental places, and the clinic is by income so there's really no other options. The one four-surface is actually not that bad, there's a small circular hole that was already filled in the middle that makes up the fourth surface, with say 85% of that side still there, if not more.

Is it bad if I mention what the clinic said to the chain dental place, since there's a differing opinion regarding cavities in #2, #11? And #3 since MO vs L seems quite different?

I think the clinic place is pretty honest though, and they seem to match almost what the chain dental place said, although less "aggressive" about it. The clinic seemed pretty sure I wouldn't need a crown on #31, #32 but the chain said it wouldn't know until it was cleaned out. I know #32 is a deep filling but not sure about #31 as the clinic said it would just be a two surface, including the side whre I previously had filling placed so most of the tooth itself is still there.

Mike,

Deep cavities often involve more than just one surface. The number of surfaces can only be determined when the tooth is drilled into and the decay is removed. Not just because of the depth of the decay but because any weak areas will also need to be removed. Dental x-rays are only two dimensional and therefore can not show multiple dimensions to determine the exact size of the cavity. Clinical examination can only see what is visible. Does this information help make things clearer for you?

There is no reason to tell one office what the other one has said as neither of them are really going to care. They have their own ways of restoring teeth and that is how they are going to proceed. No one wants to intentionally miss a cavity. So you may want to say something like this .... I am concerned about the number of cavities that I have so please be sure not to over look any. That is the best way to let the dentist know to take a second, third look.

What you need to be prepared for is making the decision of whether or not to go forward with root canal(s) or extraction(s) because it may come down to that at some point or another. Again, this is not to scare you but to inform you that you may be faced with this decision.

It is a shame that you have to be so insurance dependent. But I totally understand how expensive dentistry is and it can be unaffordable for many people. I wish it wasn't that way... but it's not going to change unfortunately.

Bryanna