Is it possible that a routine dental visit could actually increase the risk of tooth decay by making remineralization of surface decay more difficult?
We love our dentist friends. They provide us so much clinical, ‘from the trenches’ insight to share with you. Among the dentists we are so honored to call our friend is Dr Ellie Phillips. In her excellent book, Kiss Your Dentist Goodbye, Dr Phillips puts forward a premise that the method dentistry uses to probe for potential decay may in fact increase the risk of tooth decay.
Before we explain the details how this risk has great merit, we need to get some foundations in place about tooth anatomy, types of cavities, and the relative success of routine dental probing to detect decay.
Tooth Anatomy 1.0
Our teeth are living crystals. Each tooth has a flow of blood and nerve into, throughout and back out of each one. Despite our cultural understanding that our teeth are ‘just’ bone (which is of course alive too), the fact is teeth are alive.
Furthermore, many of you already know that although our teeth feel smooth, they are in fact more like a honeycomb structure with lots and lots of tiny holes in the surface. Similar to a honeycomb structure, our teeth are actually composed in a crystalline structure.
Minerals and proteins bound together in a crystal matrix structure form our teeth.
And just like a crystal, the strength of the surface relies on the strength and integrity of the whole. If one part of the crystal is compromised, the strength of the whole is compromised.
Anatomy of a cavity…
The development of a cavity generally occurs slowly through the process of demineralization at a certain spot on a tooth. As the demineralization continues, more and more minerals are liberated from within the crystalline structure of the tooth.
However, unlike the analogy of digging a hole, beginning decay occurs by washing away the strength (minerals) of the tooth tissue at the site while the crystal structure ‘scaffolding’ remains intact. As more minerals are liberated from the tooth matrix at the site, the area becomes ‘soft’ and begins to show up on a dental X-ray.
The important takeaway is that demineralization resulting in initial decay is not a hole but tooth tissue that still has its full shape but lacks the mineral density.
As the decay process continues unhindered, the crystal matrix continues to demineralize until ultimately, the scaffolding itself breaks down and a hole in the crystal occurs.
The three types of cavities
Pit and Fissure Cavity – The first insult to the tooth almost without exception Occurs in the chewing surface of the tooth.
Smooth surface cavity – Normally between the teeth (you know, when the dentist says you aren’t flossing enough).
Root cavity – Occurs at or below the gum line on the root of the teeth.
With these three pieces of the puzzle established, let’s go to the dentist’s office to see how a routine discovery strategy designed to help the dentist identify areas of demineralization may compromise this crystalline structure and actually increase the risk of decay…
Tools of the dentist…
We all know these tools. In an attempt to discover areas of decay and relative states of decay on our teeth, the dentist uses the small dental mirror and a tool called the explorer. The dental explorer is a sharp pointed metal probe.
The strategy dentists are taught is to push this explorer into the center of areas that look like they could be heading toward a cavity, areas of surface demineralization. These areas have a sticky, tacky feeling and provide the dentist important ‘real time’ feedback to confirm or negate what the X-rays suggest regarding the existence of a cavity and therefore the need for a filling (from the dentist’s perspective).
Crystals and sharp metal objects…
The problem occurs when the dentist pushes too much into an area that otherwise could be remineralized with proper home care and compromises the crystalline structure of the tooth. A demineralized area is already compromised. When we add pressing the sharp metal tip into the weakened crystal matrix, we add insult to injury and further weaken our ability to heal that decay.
We have heard many stories from customers sharing with us how the dentist pushed too hard and punched through the compromised area into the softened interior of the decayed area.
We find this heavy hand particularly troublesome because research has clearly established that so long as the crystalline ‘scaffolding’ is in place, remineralization can be accomplished. However, once the surface has been punctured, remineralization become more challenging.
The real insult of the dental explorer…
It’s logical to defend the dentist’s need to use the explorer to determine relative states of demineralization.
After all, the dentist needs to do this procedure to be able to test for decay, right?
Well, it turns out that using an explorer in this way to test for the existence of decay isn’t particularly effective.
In a study, researchers tested to determine how effective using an explorer is to identify areas of decay and found that only 24% of the time, using the explorer was successful in accurately identifying areas of demineralized tissue (on pit and fissure decay).
The study concluded its write up with “Probing proved to be unreliable for the diagnosis of fissure caries.”
It’s always so inconvenient when the research doesn’t support the protocol, isn’t it?
So what’s the alternative to the dental explorer?
We always aspire to provide a helpful solution when we identify a problem with a current oral health protocol. Here’s a quick list of resources to help in this endeavor.
1. Prevent decay in the first place.
While this seems obvious, it needs to be stated. There’s nothing quite like going to a hygienist appointment and being told “You’re boring to work on.” because there’s nothing to clean off your teeth or going to the dental appointment and being given the A+.
Here are some articles to help along this path of preventing decay.
If you really want to get your learn on, sign up for our free video tutorial series, the 5 steps to a healthy mouth where we take you through a quick tour of very helpful pieces to the puzzle. Here’s what another dentist friend of ours, Dr Al Danenberg, said about our 5 Steps series…
“Everyone that is interested in oral health should watch your videos, AND every dental professional should be required to watch them.
You did an OUTSTANDING job.”
Sign up to receive the 5 Steps to a Healthy Mouth Free video series.
2. Ask your dentist to use a light hand. Explain to them (gently but in your power) that you have researched and understand that using a heavy hand on the explorer can cause damage to teeth with surface demineralization.
3. Find a dentist who uses new technologies to determine decay.
We have heard that many fringe dental technologies (aka not used by convention yet) exist that provide another means to detect early decay.
Any dentist friends out there want to add their voice to this discussion? Do you know of an alternate solution to probing with an explorer and risking fracturing our living crystals?
Please write a comment below so we can all continue to learn from one another.
Helpful, Related Resources:
What is the primary cause of decay and how to stop it [article]
4 steps to help your kids live a cavity free life [article]
What TO eat to support greater oral health [article]
What foods undermine our oral health and why [article]
5 Steps to a Healthy Mouth [free video series]