Tooth Decay: a molar with a cavity on the chewing surface

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


8 thoughts on “Tooth Decay: What does a cavity actually look like?”

  1. That was very informative DR. However what I would like to know the health effects when these cavities are filled by silver fillings( I have 11 in my mouth). What about mercury toxcity from Amalgam fillings? Also if I have had these fillings done since 2006 is it safer to replace them with white fillings in 2013? (only 7 years later?) HOw long does white fillings last? Eventually you have to remove them too which will cause more money and more trips to the dentists?

  2. Very interesting to see that pictures – thanks. After seeing them I looked at my teeth in the mirror and found two similar black spots on my molars. Went to dentist, and yes – they were cavities too even though I didn’t feel any symptoms at all. Had one repaired today and starting to drill he told me that the cavity was large and deep near nerve. But it was only a small black spot and only 4 months since last check up. Is it normal that such small black spots develop so large underneath in just a few months. Normally I don’t have any problems with my teeth when going for check up and only a few fillings form childhood has been done.

    1. Thank you for you comments and for visiting our blog. I’m glad you had your tooth checked out by your dentist. Certain environments in the mouth can cause cavities to progress really quickly – for instance deep grooves or fissures in the chewing surface of the teeth tend to collect plaque and food debris, and if not cleaned properly will lead to perfect conditions for cavities to form. Whether your cavity truly developed only in the last 4 months is hard to say. From your description of the size and depth of the cavity, chances are that it may have been growing over a much longer period of time.

  3. i found what may be two cavities on my molars, I have never been to the dentist in my life (im 15) one of the teeth hurt like crazy to the point I don’t even chew on that side, so would I need a root canal? the other possibly cavity doesn’t hurt at all. One is on right and the other is on the left, they are both on the molars and are on the size f the teeth (not like the one on the pictures)

    1. I would highly recommend a visit to a dentist, especially if you are having pain. Ideally you should be seeing a dentist at least once a year for an examination and a cleaning. More tests would have to be done to determine whether a root canal will be needed for you (ie: an x-ray and a cold test to see if the nerve is still alive).

  4. I have the same thing but with no tooth decay… what should I do. I don’t want to tell anyone or I will get a lecture. What ever I do seems to never prevent cavities.

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