05 December 2011

Dental caries may be overdiagnosed

From a thought-provoking article in the New York Times:
With increasingly sophisticated detection technology, dentists are finding — and treating — tooth abnormalities that may or may not develop into cavities. While some describe their efforts as a proactive strategy to protect patients from harm, critics say the procedures are unnecessary and painful, and are driving up the costs of care...

An incipient carious lesion is the initial stage of structural damage to the enamel, usually caused by a bacterial infection that produces tooth-dissolving acid. The lesion doesn’t always lead to a full-blown cavity, which entails decay of the layer right beneath the enamel, called dentin. Mineral-containing saliva can repair these lesions, especially when bolstered with fluoride.

Many experts think it doesn’t make sense to operate in the early stages of decay. “If you don’t have any kind of demonstrable collapse of the enamel wall, then you shouldn’t put in a filling,” Dr. Bader said.

Yet a majority of practitioners are inclined to do so. According to a 2010 National Institutes of Health survey, 63 percent of more than 500 practicing dentists said they would operate on a tooth with decay that had not progressed beyond the enamel, even if the patient had a history of good dental hygiene. Such operations typically cost $88 to $350 per filling...

Different dentists hold to different treatment philosophies, and the dental association intentionally offers little guidance...

To find incipient caries that can’t be seen with X-rays or the naked eye, dentists like Dr. Young use a variety of new and sophisticated detection methods that include fiber-optic techniques and infrared laser scanning. The Diagnodent is a popular fluorescent light scanner that picks up on abnormalities in tooth density...

Gabriella Ribeiro Truman.. has never had a cavity. “I’ve never had any extensive dental work, and I go for a cleaning twice a year,” she said. About a month and a half ago, however, she went to a see a new dentist. He took some high-resolution pictures of her teeth and enlarged the images on a screen. He pointed to six microcavities, and a possible seventh.

The dentist handed her a quote for $3,500 worth of work...
The source article at the NYT presents additional arguments on both sides of the question.  Blogged because a member of our family who practices superb oral hygiene went to our family dentist earlier this year and was told her xrays showed seven cavities that needed attention.  So she went to a different dentist, who found none.  I've now switched to the new dentist.

Addendum: note from the first three comments that others are experiencing the same phenomenon, so keep this in mind  on your next visit to your dentist.


  1. I had a similar experience about 10 years ago where a new dentist found a cavity in my first visit after he install the new digital xray machine. I had it filled for what I thought was a lot of money (compared to my old dentist in my old home town). When he found another "cavity" that was just forming the next visit I went for a second opinion. I'm now with the new dentist, and the spot still hasn't been mentioned to me as a problem. Maybe it closed over as the article says can happen and the first dentist wasn't a complete crook as I have been assuming all these years.

  2. This happened to my daughter, too. Moved to a new town. Told she had 18 cavities when she'd had none before and good checkups. Unfortunately, she had all the work done. She's switched dentists and has not been told she's had any cavities since.

    My husband was told much the same thing at his new dentist. He's now in the care of my dentist and his teeth are fine and he did not need bridges and fillings replaced after all.

  3. I have also had a very similar experience. A dentist I trusted left to start his own practice and the replacement immediately "found" more than a half dozen cavities that were not present before.

    This coincided with her giving me the hard sell on expensive, unproven, and not-covered-by-insurance toluidine blue dye oral cancer screening. I never went back.


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