This question was posted by one of our readers, Jess:

I have a question about dentistry. My son is almost six years old and was recently taken to the dentist. He has ten cavities. 7 of which you can hardly see, like tiny brown ‘pin’ dots. One is a hole and hurts him. The dentist wants to get them all filled even though the ones in front would fall out soon.. I want to tell the dentist to only fill in the bigger cavities and wait a while for the tiny pin hole ones. Is that okay to do? What are the dangers of keeping a tiny cavity like that, especially the ones closer to the front which he will lose soon? Also, can I tell his dentist which ones I want filled? Or will the dentist only fill all or nothing?? Thank you so much for your answer in advance.

Dear Jess,

For the most part, teeth should be fixed as soon as possible. Cavities have a tendency to grow quickly in children, however baby teeth (sometimes called primary teeth) will most likely fall out. Baby teeth are lost over a 5- or so year time frame. The question for the ones with cavities is: will they be lost first or will they abscess? Your dentist should be able to give you an idea as to which ones are at a higher risk for abscess and help you decide a good time frame to follow for treatment.

This situation begs another question as to why your son has so many cavities. This should be addressed so he does not have a repeat experience with the permanent teeth. I encourage you to work with your son in developing good oral hygiene habits as well as good eating habits to help him enjoy a a healthy mouth for the rest of his life.

I hope this answers the questions.

Respectfully,

Dr. Sperbeck, West Los Angeles

Renee, one of our blog readers, posted this question:

I have a bad habit of grinding my front teeth. I think it’s just a nervous habit. I’ve done it for about 5 years. I do it all the time day and night. My bottom front three teeth are now smooth across the top. Do I need a mouth guard or anything else to break this nasty habit?

Thanks!
Renee

Dear Renee,

Uncontrolled grinding of teeth is never good. In healthy mouths, the amount of time teeth are in contact is very little. It is important to find the reason for your grinding. For some people, some medications can be the cause, but in the majority of cases I see, it has to do with a mal-alignment of teeth.

Teeth serve many roles for the body. One of the important roles is to help position the upper and lower jaws in relation to each other. They act as nerve extenders that are highly sensitive (about 20 million nerves per tooth) so if the teeth do not send the correct message to your brain like “Do not grind” then your natural defense mechanisms are not working. In other words, grinding is used by the body to help keep the jaw in alignment by wiping away the interferences to proper closing of the jaw. This is why it is important to find the cause of the interference and address it to protect both the jaw joint and the tooth structures.

Regarding mouth-guard /splints when made well and properly adjusted they can be highly effective in protecting the mouth. The key is properly understanding how the mouth is supposed to function so that the splint works in harmony with the jaw joint. I use splints to help me diagnose the extent of the mal-alignment. This help me decide what are the best choices to present to the patient for solution. Once the plan is devised then the implementation can take place. I feel a significant amount of dental problems are related to uncontrolled grinding.

I hope this helps answer your question.

Dr. Sperbeck, West Los Angeles

After we have completed the full exam, a lot of patients are ready to proceed with restorative work. There are a variety of restorations that we do in our practice. These include different types of tooth-colored fillings, bondings, veneers, crowns, bridges, implants and dentures.

The key to a successful restoration is ensuring that whatever is done fits in and supports the overall oral system. On the larger level, this requires proper understanding of function, speech, bite, hygiene and so on and on the more detailed level, precision and attention to detail is key.

Restorative procedures in my office typically last thirty minutes for a single filling to ninety minutes for a crown to three hours for restoring a larger section. The reason they are so time consuming is because I pay a lot of attention to detail in order to ensure the best chance of long-term use and comfort of the finished product.

For example, when I do a filling or crown preparation, I use multiple caries detection techniques. One is caries detector which is 95% accurate in identifying diseased remnants of the cavity. Another is the Diagnodent, a light sensor that detects the off gas put out by bacteria. The third method is the halogen light which raises the visibility of the caries. Combined use of these three tools allows for exceptional precision and success in removing the disease from the site being worked on. When this is done, I am ready to proceed with the actual restoration.

For fillings,  I use the latest generation of sealers and desensitizers which help to virtually eliminate sensitivity by blocking the tubules where the nerves reside and sealing them closed. Next I place the primer which is essentially a very thin filling below the filling. This is an important step because that is the first line of defense to protect against new cavities. After the primer we put in the solid filling material in stages in layers to ensure proper curing. Finally, we are ready for the tooth-colored top coat, which we customize to the natural teeth colorings surrounding and shape to accurately work with the natural bite process.

When the restoration is too large to be completed with a filling, I typically proceed with some type of crown restoration.  I use a Cerec machine to custom mill the restoration. I have chosen this method because it allows for the most conservative type of restoration and the most accurate fit, not to mention that, in most cases, you have your permanent crown the same day, eliminating the need for a second visit.

Dr. Sperbeck, West Los Angeles