Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

November 18, 2008

A DIAGNOdent question

Filed under: Tooth decay — mesasmiles @ 1:18 pm

Dr. Hall,
I just started at a new dentist. They used a laser to detect tooth decay. While they didn’t find any actual cavities, they found some four areas that could be cavities in the future. I am a little confused. They want to give me fillings where there are no actual cavities. Does this seem normal, and will it seal in decay? I feel a little bit like they were trying to sell me something that I don’t need? Thank you!
– Melanie in Indiana

Dear Melanie,
I don’t think your new dental office is trying to sell you something you don’t need, but I do think they need some help with their communication skills. I think it would be helpful for you to tell them how confusing their explanation was, so that they can explain this better to the next patient.

The new laser that is used to detect tooth decay is called DIAGNOdent. It detects actual decay, not areas that will in the future become decay. There may be someone in your dentist’s office who is confused about that, because the decay detected by DIAGNOdent doesn’t appear to be decay yet, since it is decay under the surface. But DIAGNOdent is very helpful because it enables the dentist to find and fill cavities when they are smaller and thus they can intercept problems before they become bigger and more expensive.

The way decay grows on a tooth makes it hard to detect when it is small. First, acids from decay-producing bacteria start to work on the enamel in a spot and they make it porous. This early change in the enamel often isn’t visible. Then the decay begins to grow just underneath the enamel in the dentin of your tooth. When the decay has grown enough, the enamel begins to cave in, and you have a full-fledged cavity that is visible to the dentist. What the DIAGNOdent does is it detects this decay under the surface before the enamel caves in. With the new bonding technology that is used with white fillings, the filling can be made quite small and unobtrusive.

And, besides being cheaper, smaller fillings tend to last much longer than large fillings, and they don’t weaken the tooth as much.

 I’m assuming, in this answer, that your dentist is interpreting the results of the DIAGNOdent properly. If the results aren’t interpreted properly, you can get a false positive – an impression that there is decay when there is simply debris, say, clogging the pit of the chewing surface of a tooth. But when the clinician is properly trained, the results of this instrument are highly reliable and most helpful.
– Dr. Hall

Related links:
Laser tooth whitening
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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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