If it ain’t broke, fix it.
This summer I had to replace some outdoor stairs at my home. When these stairs were built about 12 years ago, we did not use treated lumber, as a result, there were signs of rot. The stairs were still functional, but I had some concern that they could break. Not wanting to have a stair failure as Aunt Tilley was climbing down, I decided to tear out the old stairs and build new ones.
Many readers are now saying: “Brian, did you whack your head while windsurfing on Friday? This is a dental column. While we find your stair story fascinating, what has it got to do with teeth?” Let me explain.
Many times after examining someone’s teeth and going over treatment options, I hear the line “If it ain’t broke, why fix it?” While it may be true that there are no clinical symptoms at the present time, there may be advantages to treating some teeth before they cause problems. Much the way we replaced the stairs before an accident occurred.
We can often predict which teeth will eventually fail. By taking action before failure we are able to prevent dental emergencies and restorative complications and treatment of the affected teeth can be scheduled at a convenient time.
The most obvious indication that a tooth will eventually have a problem is presence of decay. Tooth decay is a slow progressive disease that does not usually present any symptoms until it is quite advanced. Most new cavities occur on the biting surfaces of teeth or between the teeth. Most cavities are easily diagnosed during a dental exam by using the little dental pick or by looking at dental x-rays. More difficult to diagnose but very common are cavities around old dental restorations. Once the seal on a filling or crown is no longer intact, the tooth around the restoration may start to slowly decay. This is more difficult to detect as the restoration often blocks x-rays and it is hard to detect the extent of the new decay. Often, the decay under an old dental restoration may be quite extensive. The treatment for this problem is to replace the dental restoration or crown the tooth if the restoration is quite large.
One of the things we try to prevent is tooth fracture. A common cause of tooth breakage is stress fracture. This is related most often to the presence of large fillings in the teeth. Intact teeth are very strong and very resistant to fracture, however, if we compromise the original integrity of the tooth, they can become prone to breaking. It has been shown in numerous studies that the strength of a tooth is dramatically decreased once a filling has been placed. In most instances, a filled tooth is still strong enough to function normally. We do, however, start to be concerned about the long-term resistance to breakage in teeth that have very large fillings (over ½ the biting surface). With the lack of support of the underlying tooth material, the glass like enamel is prone to crack. Continual flexing of the unsupported tooth creates small cracks that eventually get larger leading to a fracture. This usually takes time and for some reason, the final fracture occurs while eating bread or some other soft food while at the airport or in some third world country.
Placement of a cast metal, cast porcelain or metal fused to porcelain restoration is the treatment of choice for teeth that have excessively large restorations. These restorations are called crowns or onlays. The function of a crown or onlay is to hold the tooth together much like a casing. Placing a crown or onlay on a tooth with a large filling or evidence of a crack, before the tooth fractures will likely prevent the tooth from breaking. Waiting until the tooth actually breaks before restoring the tooth may cause some problems, mainly that there is no control over where the break will occur. Many times the tooth breaks diagonally from the filling to under the gum. This may require that gum surgery and additional restorative procedures be undertaken to fix the tooth, or worse, the tooth may break in a way that does not allow restoration resulting in loss of the tooth.
Tooth wear is slow progressive tooth failure. Most people exhibit some signs of wear of their teeth, whether from tooth grinding (bruxism), poor bite alignment, acid erosion, or some other noxious oral habit. Excessive tooth wear can be a major dental problem. Once tooth wear has progressed through the strong outer enamel to the soft inner dentin of a tooth, the rate of wear greatly accelerates. Back teeth loose their functioning cusps (the pointy part of the back tooth that does the work), and front teeth get short and start to chip. Tooth wear often happens so slowly that even though a person has worn away as much as 1/3 to ½ of their front teeth, they may not even be aware that this has occurred. (It is sort of like gaining weight, it usually happens slowly so you have time to get used to it.) The front tooth wear is often not even and produces a crooked smile line.
Early treatment of wear would include wearing of a night guard to protect the teeth from night-time grinding, control of acids, alignment of the bite through selective bite adjustment or orthodontics and possible minor restoration of worn teeth. If wear is severe, there are restorative options available, which can restore function and beauty.
Early prevention of dental problems is always our first choice. So even if you do not have symptoms sometimes it is desirable to fix it even if it ain’t broke. If you would like to know more about preventative options available to you to help you achieve your long-term dental goals, ask Dr. Saby.
May 11th, 2009 at 2:18 pm
Great article but my eyes aren’t as young as they were
Keep up the great articles though - thanks for posting!