HELP!!!! Important Teeth Issue. Important!!!

[jason1980]

Hi hopefully there are dentists on here....

Im 26 and have been going to the denstist every 6 months for over 10 years now. In 2001 I was told one of my teeth have what is called 'a developmental pick' despite it looking like a cavity it's just the genetic makeup of my tooth and its fine to have one. Now in 2006 I have a new dentist who bought the practice, he said that it is a 1 milimetre depth cavity and if he don't fill it within 6 months it will cause problems with the root and if I keep it I could need root surgery and lose more of the tooth, where as if I get it filled now, its only a tiny filling rather than a big one. He showed me plastic toy like teeth of root rot through cavities and scared me!!!!!

I have agreed with the filling and rebooked next tuesday 9th May. The filling will be 2mm by 2mm and might not even need injections.

Anyone know about teeth and since I've had the 'pick' for 5 years plus, why didn't I need fillings sooner??? Do you think this is right. I love my teeth and I still have all of them with no fillings anywhere - this is my first filling. Im OK about having a filling, just so long as it really is necessary.......

lots of comments please, hopefully you're all dentists.

[alijangra]

Get the filling if your dentist says its a cavity. Or get a second opinion? Sorry Im not a dentist and I only have 1 filling which was caused by my tongue stud so I dont know anything about cavities.

[jason1980]

Hi, its not about the filling. My original retired dentist told me it was a natural 'developmental pick' thing which is similar to the black inclusions you can get in your nails, like tiny thin black lines. My original dentist saw this every 6 months for 5 years. its the new dentist that says I need a filling. If I have had this thing for 6 years on the back of my tooth and it hasn't changed colour or even gotten any bigger then why is it being filled?? I've searched for cavities on the net and if it was a cavity Im pretty sure it would have eaten away at my tooth in 6 years looking at what I've seen.... I have a week to try and get a second opinion off of a different dentist and its pretty difficult because they only seem to be interested in knowing the situation if you switch to them,

[Joflump]

I'm a Dental Nurse and it sounds like your Dentist means a "developmental pit" to me. It's nothing serious it's just an area on the tooth where the natural fissure is unusually deep and therefore more prone to decay. Some Dentists just keep an eye on them and others like to fill them before they cause probs. If the pit is not showing signs of decay you could ask if it could be kept under observation. We sometimes apply a fluoride paste and leave it at that. Once you have had a filling the chances are that it will need redoing in the future, making the cavity a little bigger each time. I'm for the less invasive approach! Hope this helps.

[MrXLA]

Hi Jason

It is not uncommon to have what you refer to as a 'developmental pick'. Your probably referring to an unusual morphological variant of that particular tooth. Whilst this is not a cavity unfortunately just like the 'normal pits and fissures' found in your molar teeth it is a potential site of decay. This is beacuse usually tooth brush bristles are too wide to effectvely clean the area. Dental decay (caries) can take many years to develop and cavitate a tooth. It sounds as though the lesion is confined to the outer enamel (non-living) part of the tooth and therefore shouldn't be sensitive and as you have said probably won't require an anaesthesia.

Hope this helps, if you have any further questions just ask.

[jason1980]

Thank you joflump that is it exactly. It hasn't changed in 6 years, but my new dentist is persistant. Its a tiny black mark, but it has always been black but unchanged in depth and width. I always had the opinion that if it was something that eventually needed filling, I just as well have it done whilst it was small. He said I wouldn't even need an injection the filling is that small. Im battling 2 things, do I have a tiny filling which gets rid of it with possible future work, or do I decide to leave it and have a filling when there is signs of it getting bigger. Its been on watch for 6 years. My old dentist has retired, its only cos I know he would have left it again, but the new dentist that just bought the practise wants it filled and not on watch despite it being unchanged....

I dont know what to do

[MrXLA]

Hi Jason has the new dentist taken an x-ray of the tooth?

[MrXLA]

I ask because you said the dentist had said the tooth needed drilling. This would only be the case if the tooth had active decay. Since otherwise as JoFlump said it would probably just be a case of appying fluoride varnish or if appropriate a fissure sealant.

[jason1980]

Hi,

The 'developmental pit' is really really small but black in colour. He isn't taking an x ray until after the filling. The x ray is because he just wants up to date ones, my last x ray was 10 years ago.

I take it that because the pit is black, it must be decay then? Im kinda over the shock now and think I should have the filling, my teeth must be better without the pit in it logically...id have thought

[jason1980]

Hi this question is for joflump and MrXLA.

I feel that the xray is unnecessary as the dentist knows the 'pit' hasn't gone to the roots. Ive had check ups regular at the practise for 10 years with the old dentist there and have had no dental treatment needed in 10 years. He has bought a new xray machine and has asked all patients to have an xray and pay �25 each. I feel I dont need one and he says its just an update. Do I have a right to refuse the xray, like me do you fell it 'probably' isn't needed.

[MrXLA]

Well taking an x-ray purely for an update in NEVER indicated in medicine or dentistry. Review x-rays can be taken for example to monitor bony healing, cyst growth etc but only where necessary.

However in your case I would not be happy to take a drill to your teeth unless I was positive that there was active decay present. Id probably take a small x-ray of just the tooth in question. Black staining if a result of decay usually indicates that the decay has arrested (stopped). However like I say an x-ray might be required to confirm this.

[jason1980]

Hi MrXLA are you a dentist? Great if you are because just for me to get my head round this as I feel I might not need an xray or even a filling. Can I ask the following...

1: The dentist told me about having an xray before he looked into my mouth. he has bought a new machine and said it was an update. I must pay �25 for the xray. The xray is nothing to do with that particular 'pit' tooth. He stated he wanted an update and Im to have it next Tuesday. I went in with my mother & sister we all go same day, he wants them to have update xrays too. Its not just me. Now I am refusing the Xray for sure.

2: My tiny black developmental pick I can see at the back of my left canine tooth and its near the edge of the tooth rather than right in the middle of it. It is roughly 1 millimeter x 1millimeter and it is dark in colour. The new dentist looked at it and said it needed filling because if it went down to the root Id need worse treatment. He just isnt listening to the fact that it has been a tiny tiny black mark for 6 years and it hasn't changed a bit. But he's pushy and booked me in for next Tuesday. Im okay about having a filling if it is only necessary. He's dont talk good english, so im not even sure if he understands me.

3: Are you saying that if my 'pit' is black, means the decay 'possibly' isnt active. because I always associate black with rotting really or does black mean its stopped rotting?

4: He does want to take a drill to me, and would have done it tomorrow, his xray machine isn't turning up until next monday, but I couldn't do tomorrow and next Tues was the earliest. I know the xray is not part of my tooth situation. He is making a lot of people have them.

5: The only reason I am so questionable is because he wanted to take ALL 4 of my sisters new healthy wisdom teeth out because she had slight discomfort.

[MrXLA]

Hi Jason1980,

All address each of your points as best I can.

1. Im assuming this dentist is private, this is because the charges your describing are not inline with new NHS fee system. Of course I appreciate the difficulty in finding an NHS dentist. It is completely unethical and unjustified to have x-rays merely for an update. The only indication for them is suspected disease or assement of extent of disease as I mentioned earlier. It could be that there is a genuine reason in your case why the dentist wants an x-ray, but from what I can gather your talking about a DPT which is a full mouth x-ray NOT indicated in your case.

2. I appreciate that you are obviously very aware of your teeth. But I would find it impossible to effectively examine my own teeth. This developmental pit could extend all the way down the tooth and root surface (of course I couldn't say without seeing it). If it does then it is particularly at risk of decay.

3.To address blackness of decay is very difficult if the lesion is hard to a dental probe (scartchy doesn't sink in) then this could indicate that the lesion has arrested and the black is merely staining of the slightly altered tissue. On the other hand if its soft then it could be decayed. Unfortunately the progression of dental decay is a chemically complex process and believe it or not it is possible to have 'holes' in your teeth below hard enamel.

4. I find it worrying that you are being pushed into a treatment you are clearly not happy with. Its is any healthcare professional's duty to ensure that you are fully informed of any treatment they intend to carry out, what that treatment entails, associated common risks and of course the intended benefits.

[MrXLA]

5. As you are probably aware they commonly impact (fail to erupt usually due to insufficient space) but it is unusual that this occurs in all 4 at the same time. The practice of removing wisdom teeth 'just in case' is long out dated and not current best practice. Of course it could be that there are genuine problems with all 4 teeth as in they are all impacted and causing problems some of which can become quite severe.

[jason1980]

Hi thanks for replying. I've always paid for my own checkups so Im not bothered about it being private.

He does want a full mouth xray, and it was brought up as soon as I sat in the seat, because he had hoped his new machine would have been there today. He hadn't looked at any teeth then.

I was told I was having a filling, and when. To me if just felt a forgone conclusion what he wanted to do before I even got there. He didn't explain the reasons as to why now, or because of this that and the other. Just said I needed a filling and to come back soon as. I mentioned that its been like that for 6 years and he talked over it, he's dismissive. I didn't like his approach.

I have made the decision now that he's not touching any teeth of mine. Im going to get another check-up with another dentist, see what their approach is to the tooth and if they think it should be filled if theres no other sealant alternative, then they can fill it - and I would be happy knowing I got a 2nd opinion on it too.

My new dentist to me carries an attitude like, "Im a dentist, and you must have....and Im right, end of" I think very old style approach. I dont mind going to the dentist, but he would me off returning - and has! Its why im finding a new private one somewhere else.

Thanks again for your comments, they've helped me to understand it more.

[jason1980]

Hi. Just posting an update for those who are reading this.

Spoken to my new dentist today and he has cancelled the filling. He will now wait until his x-ray machine has arrived and will xray the that tooth only to see if there is active decay and how far deep the cavity 'pit' might have gone. BUT the only treatment he will do is a filling regardless? Just he will now x-ray first and will call me when his x-ray machine is in!!

Yes! anyway...

I am making an appointment with an Oasis dentist for a checkup, x-ray, and to discuss treatment for my 'pit' including sealants to make the tooth last a bit longer before it will "Eventually" get filled, as I know it will at some point only when its needed. BUT if the x-ray shows it is quite deep then I will accept that it will be filled now and my Oasis dentist can fill it, because that would be 2 dentists that suggest it.

I also spoke to the NHS Helpline on 08 45 46 47 who were really really helpful and explained that my tooth could go on longer and longer if I wanted with the help of fluoride treatment and get a filling done only when I experience some pain. They were surprised about filling it when Ive never had any discomfort, never had any pain, never had any treatment on it.