But Doc, The Tooth Doesn't Hurt!

May 10 • 6 minute read

“But Doc, The Tooth Doesn’t Hurt!”


You can still chew on that tooth without pain, it doesn’t hurt when you drink or eat cold or hot food, it is not rough to your tongue and it hasn’t caused you any other type of pain. Why should you be concerned about the tooth your dentist pointed out on your x-ray if it doesn’t hurt? 

There are at least four reasons to care about a dark spot commonly known as “tooth decay.” The first is that the dark spot has the ability to cause serious pain.  Anyone who has experienced pain caused by a failing tooth knows they do not want to experience that pain a second time.  The second reason is that it will have long term effects on your ability to chew and enjoy your food. There is nothing like biting into an apple in the fall and feeling the crisp snap of the apple and the flow of sweet juice onto the tongue.  The third reason is that if left untreated decay becomes exponentially more costly to treat as it enlarges and involves greater portions of the tooth.  Who wants to pay more to the dentist?  The fourth reason is that if the cavity is in your smile zone it can have serious negative effects on your appearance and even your employability.  We all want to be liked by others.  A missing tooth, snaggle tooth, or a tooth that just looks rotten in your smile is a real turn off!


Avoiding Tooth Aches

Pain is the gift nobody wants. It tells us that there is a problem, and it often tells us exactly where the problem is.  The only trouble with relying on pain as an indicator of a problem is that it usually tells us about the problem too late!  For example, when you put your hand on a hot stove by the time you know it is hot it is too late.  Other examples would be cancer and tooth decay, both can progress to alarming proportions before the pain alarms are sounded.  

It would be wonderful to be able to set “problem alarms” that would cause pain as soon as a cavity begins to form in a tooth.  These alarms would allow us to get dental problems treated at their earliest stages.  But since most people are not sensitive to the start of dental decay, diagnostic testing is the best way to detect early problems.  The closest thing we have to a “Problem Alarm” when it comes to dental care is Dental radiographs, or x-rays. X-rays are used to help detect density changes in the tooth’s enamel and dentin. These density changes show up as darker areas in the x-ray image.  It is important to realize, for the darker area to show on the x-ray, there must already have been significant decay in the tooth. So by the time a cavity presents on your x-ray, it has already been destructive. 

Other methods of detecting cavities are available to dentists which can be used to support the results of x-rays.  The other methods might include; visual inspection of decayed or decaying surfaces that can be seen, tactile inspection of the decay with an “explorer”, transillumination (a bright light shown through the enamel), and or the use of one of the newer electronic devises that measure the presence and depth of decay but, again these newer electronic devices can only be used on the surfaces of the teeth which can be seen and touched by the device.

X-Rays are the standard of care so if you want to see the decay before it causes you pain, make sure to look closely at those X-Ray images.  Without these images, your dentist is unable to “see” between your teeth where most problems begin.  The X-rays also allow you to see below the gums and tooth root tips.

You may wonder why a tooth ache is worse than so many other aches and pains.  The reason is that often your tissue swells when it becomes diseased.  In most places where inflammation occurs in the body, tissues have room to swell. This is true for most of your body but not for your tooth. If there is inflammation in the tissues inside your tooth, there is nowhere for the swelling to expand. Because there is nowhere to expand the tissues are in essence placed in a vice- the tooth nerve is being pinched.

So, here is the bottom line: when your dentist spots a dark spot on your tooth in the x-ray, the cavity is already present, there is a disease in the tooth, damage is already being done!  Remember even if the decay is only slight, at the most it is only 4 millimeters from the nerve, that’s only 16/100 of an inch! The longer the cavity is left to expand, the closer it gets to the nerve and the greater your chances of experiencing significant pain- pain that can lead to lost hours of sleep at home and lost hours of work on the job.


Enjoying Your Food

Apples or applesauce? Peanuts or peanut butter? The answers depend on how comfortable your teeth are when chewing.

Chewing function is compromised when a tooth is broken, painful or absent.  The smaller a cavity is, the simpler it is to restore and the less chance that you will ever suffer from a broken down, painful or absent tooth.  Broken down or missing teeth also contribute to drifting of the teeth. Teeth need to touch each other to remain stable. When even part of a tooth is missing you can begin to notice that your teeth shift over time.  Broken teeth can sometimes be built up and crowned and missing teeth can sometimes be replaced with implants but when we loose those two options its grandpaw time.  “Honey can you help me find my teeth.”


Saving on Dental Bills

Finally, here is the “pocket book argument” for early treatment.  If your dentist detects a cavity in the biting surface of your tooth, the cost, time and inconvenience of repairing is the least it will ever be. If treatment is delayed and more areas of the tooth become decayed, the cost of treatment can easily double. If treatment is delayed so long that the decay reaches into the nerve of the tooth and root canal treatment and a crown are required, the original cost of treatment can be multiplied by  TWENTY TIMES. When confronted with the cost of root canal therapy and crown replacement many people opt to have the tooth removed.  The cost of removing the tooth at this stage could easily be twice the cost of fixing that decay back when it was only on one surface of the tooth.  The cost of waiting until the tooth causes pain could include:  severe pain, lost work time, lost sleep, emergency room visit, emergency visit with the dentist, also pain medications and antibiotics.  All these things cost time, money, stress and aggravation.  All these things are the result of waiting until it hurts.


Keeping a Beautiful, Confident Smile

A cavity in a front tooth, like all teeth, is not usually visible at first. But as it grows it begins to show black, sometimes orange or brown, and eventually the tooth starts to break. The broken areas are often sharp and painful to the tongue as well as being unsightly. A cavity that is treated early need never adversely affect a confident smile.  The modern materials used in front teeth today blend beautifully with your natural tooth shade and translucency.


The next time your dentist shows you a cavity, you have two options: seek minimally invasive, early treatment, or await the sounding of the pain alarms. If you await the pain alarms, you will pay more in time, money and pain. You also risk the loss of your tooth. If you seek immediate, minimally invasive treatment you will be doing your best to protect yourself from dental pain, keep a smile on your face, enjoy your food, keep money in your pocket and teeth in your mouth.

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Topsham Dental Arts

The team at Topsham Dental Arts is dedicated to excellence in dentistry. They offer a wide range or dental procedures including dental implants, porcelain veneers, dentures and tooth whitening. The office is located in Topsham, Maine and serves the areas of Brunswick, Bath, Yarmouth, Harpswell, Lisbon Falls, Lewiston, Freeport, Bowdoinham, and Portland.

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