Tooth Decay: What does a cavity actually look like?

The only time I open the hood of my car is to refill my windshield wiper fluid. If something else requires work in there, I take it to the dealership. On occasion, during a routine oil change, the mechanic will come out to inform me of some other work that needs to be done, such as a wheel alignment or brake pad replacement. Of course, when this happens, I’m probably not the only one to start wondering if the mechanic is working in my best interests or those of his wallet. After he answers a few of my questions, I usually consent to the work and continue to wait. And as I’m waiting, I can’t help but think how similar my customer experience at the dealership is to how some patients might feel when visiting a dental office to have a cavity filled.

Just like at the mechanic’s shop, patients confer an implicit trust to their dentist when having a dental procedure performed. Unless you are able to watch everything that the dentist is doing, you have absolutely no idea what is being done in your mouth – especially if you are frozen and have no sensation in the area being worked on.

When I do fillings, or any procedure for that matter, I make it a habit of telling my patients everything that I do, before I do it. This approach tends to calm even the most anxious patients, because they know exactly what to expect and leaves little to the imagination. For those patients who grew up with The Learning Channel, I am always happy to provide them with a hand-mirror to observe everything that I’m doing (with the disclaimer that they should not try these things at home).

When time permits, I like to take pictures at different stages during certain procedures to help educate patients and to provide further evidence as to why the dental work needed to be done in the first place. It’s only natural for patients to question if they really need a filling especially if they are not having any problems with the tooth in question – just like when the mechanic tells me I need my brakes replaced. Pictures truly are better than a thousand words, and they never lie.

Tooth Decay: a molar with a cavity on the chewing surface
Molar showing a dark spot on the chewing surface. No symptoms were reported.

The picture above shows a tooth with what looks like a mere dark spot on the chewing surface. The patient reported no symptoms with this tooth. However, upon clinical examination with my instrument called an “explorer”, that dark spot was actually a tiny hole which felt “sticky” to the touch. Soft spots like these indicate tooth decay (AKA: a cavity).

I administered local anesthetic and after confirming the patient was sufficiently numb, we started to clean out the cavity as seen below.

Initial cavity preparation
Initial preparation of the cavity
Further cleaning of the cavity
The cavity is opened more to show the true extent and reach of the decay
Indirect view of the cavity in dental mirror
The true extent of the cavity can be seen in the dental mirror

The cavity is cleaned out with the dental drill until there are no more soft areas (decay) in the preparation. The tooth looks deceptively normal from the initial picture, which can dangerously mask the true depth of the cavity below the surface. Indeed, it’s quite possible for some to not feel symptoms from a cavity of this size. However, if the tooth decay is not treated and is allowed to enlarge, over time it will extend deeper and closer to the nerve of the tooth – at which point symptoms of pain with chewing, sensitivity to temperature and sweets may ensue. If the pain worsens to a throb or ache, that’s when a root canal may be needed whereby the nerve of the tooth is removed. It’s usually best to be proactive and deal with these small problems when they are easier to fix, as opposed to waiting until it becomes a true dental emergency.

Final shot of tooth after a white filling has been placed
The cavity is restored with a white filling

It’s always nice to see pictures (Before, during, and after photos) of any work that you have done by a contractor on your home or mechanic on your car so that you fully understand what is happening and what you are paying for. Ask your dentist for the same!

– Dr. Michael Banh