When your dentist recommends treatment, embrace the prevention

It's a universal feeling. You're sitting in that dental chair as the hygienist is polishing your teeth. Your mind is already wandering to your other daily tasks: pick up groceries, finally return those gardening supplies you splurged on during quarantine when you were convinced you could go 100% farm to table. Then you realized washing a tomato was infinitely easier than spending hours debating if you were over-watering or under-watering.

"Okay, just about finished here, let me get Dr. Bhatt to do your exam."

Your heart jumps for a split second. You reassure yourself you have nothing to fear, you haven't had a cavity in 3 years, you've been brushing and flossing twice a day.... you had that Coke at Christmas but it was the holidays, surely your teeth would forgive the trespass.

"Hello valued patient! (in the real life scenario, I would use your name, but this blog is HIPAA compliant). How's that new garden coming along? I see we updated your X-rays over here, let me take a look."

I swivel over to the computer monitor and begin to click. "Good, good.... goooood"

What was that elongated good!?! It sounds like how you described the clipper cut you gave to your kid in the backyard (hey you saved $20 and it's not like it won't grow back).

"Ok, those X-rays look fine, now let me take a look in the mouth"

Phew! First test passed, now just a quick peek inside and you'll be home free

I linger on the upper left molars for a couple seconds, then continue through. I ask if you've been having any sensitivity and you say no. You feel like an inmate getting his cell inspected, the less you volunteer, the better. Now the verdict.

"Overall things are looking very good. However there are a couple cavities on the upper left that should be addressed with fillings."

NOOOOOOOOOO!!! Your mind screams. I thought you said the X-rays looked good, why didn't the hygienist say anything, damn you Coke! Your streak, 3 years gone down the tubes. And what was that, a COUPLE!?

As you rake your brain trying to remember every time in the last 6 months you went to bed without flossing and every dessert you had, I'm here to tell you, Relax.

At the heart of this reaction is fear of dental treatment. Some of it is totally understandable. Even with insurance, dental work costs money, you have to take time away from your other responsibilities to come in, get poked with a needle, keep your mouth open for what feels like 3 solar cycles, and leave with a lip that makes you question if you'll be able to taste your next birthday cake.

Some go into their hygiene visits with all the answers. "Surely something would hurt if it needed to be fixed. My old dentist never mentioned anything so if this dentist sees someone different who does, they must be overly aggressive."

Too often, dentists are labelled as 'seeing dollar signs' or 'aggressive' if they recommend dental work when often, these recommendations are made to save you money and avoid more invasive treatment in the future.

This photo shows how a cavity grows in a tooth. It starts at the outside layer (enamel) and progresses through the bulk of the tooth (dentin). You can see that by the time a cavity causes sensitivity, it has already eroded a lot of tooth structure. On the right is the corresponding cost of repairing the damaged tooth. Fixing a cavity only when it causes pain would be like addressing termite damage in your home only after pieces started breaking off. If the cavity isn't addressed until it reaches the nerve of the tooth in the center, a root canal will be needed often followed by a crown; 2 procedures that take more time in the chair and more resources to complete and therefore cost more than fillings.

Going from a check up where no work was recommended to one 6 months later where work is needed doesn't mean that all the wear and tear was done during that time. Dental breakdown is progressive and at some point in that process, a prudent dentist will make the decision that treatment will benefit your oral health.The dentist who is most conservative is not necessarily the best dentist. We wouldn't say the best oncologist is the one who never detects cancer. Rather an excellent dentist is one who takes into consideration a patient's personal oral condition to recommend treatments that nip problems in the bud and minimizes complications and emergencies down the road.

Take a look at this tooth that was crowned. While the large silver filling wasn't hurting the patient, this tooth was at high risk of fracturing. By transitioning to a crown (right photo) before it became problematic, we were able to give this tooth the best prognosis. Had the patient waited until the tooth broke to get the crown, it may have been too damaged to fix or the prognosis would be worse.

Evolution has not caught up with our longevity. The set of teeth that was suppose to last us when the average lifespan was in the 40s is the same set that now has to last us into our 80s. The work of a good dentist will extend the shelf life of these teeth so you can enjoy many more birthday cakes.