Did the dentist get all the decay out of my tooth?

 

On occasion a new patient will arrive to my office with decay around or under a filling that was done years earlier.  They will need a new filling or a crown.  The usual question is: ‘Did the last dentist leave some decay in the tooth?’

 

It can be tricky for the dentist to get all of the decay out of a tooth.  One concern is that we don’t want to expose the nerve if we don’t have to. An exposed nerve invariably means that the tooth will need root canal therapy. If we leave decay behind, that will usually lead to a need for root canal therapy.

One trick that I use routinely when removing decay is a vegetable die that comes out on a brush and will stain the decay. The vegetable dye comes in different colors (green, purple, red) and I then brush it on the tooth. It stays on the tooth for 10 seconds and then is rinsed off. If the tooth holds the stain, then decay remains and I must continue to remove the decay. I find that this is a most useful step for decay removal.

Another product which I like is a glass ionomer cement which is placed under deep fillings. The material contains a small amount of fluoride which helps to thwart more decay.  Additionally, it helps with sensitivity. Also, it is one of the few dental materials that is hydrophilic (it likes water) . Since there is saliva in the mouth it is essentially a moist environment.  This is a good property for dental materials. Why don’t we use that all of the time for the filling material itself? It’s just not strong enough to hold up to the normal chewing forces that teeth frequently are up against with normal chewing. Plus any grinding or clenching put an even stronger force on the teeth.