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If It Doesn’t Hurt, Does It Need A Filling?

Women in dental office smiling photo

In short, yes. If your dentist tells you that you need a filling, then apparently you do. Whether you are in pain or not has no bearing. As humans we use pain as our wake up call, realizing that there is something wrong if it hurts. Yeah, if it hurts, there is probably something wrong. But sometimes the thing that is wrong has been developing and progressing in severity and rears its ugly head only when a certain point is reached. Perhaps this is why society is so slow to implement preventative care and programs to promote mental health. Sufferers of generalized anxiety disorder or bipolar disorder aren’t really in physical pain are they? Ah, let’s ignore it then. Anyways, when you understand the parts of a tooth and how a cavity develops, you will see that a cavity will not necessarily hurt. Many patients comment on how that cavity doesn’t really bother them, or that leaky crown doesn’t hurt. Well, that’s a good thing! No, the dentist is not just trying to rob you of your money. We want to fix the problem before it becomes a bigger and more expensive problem with a poorer prognosis. Remember, small problems are simple, cheap to fix and easy to maintain. Big problems are more complex, more expensive and comes hand in hand with a lifetime of maintenance and retreatments.

A tooth has three layers: the super strong enamel, the softer dentin, and the nerve (I named the layers from outside – in). A cavity is an area of tooth decay which occurs when bacteria in our mouths produce acid which dissolves tooth. If the tooth softening is only in enamel, it won’t hurt. Hey, at this point we can see if we can remineralize the area and reverse the effects of the enamel softening. Cool, no filling required. If the decay is in enamel and has grown to include some of the dentin, it still might not hurt. At this point we can do a simple and small filling. Nice and far away from that sensitive nerve. If the decay continues to grow larger and is getting closer to that nerve, it still probably won’t hurt. At this point you need a medium to large sized filling. We haven’t involved the nerve, which is good but we are close and the nerve doesn’t like that. There is a chance that the tooth may experience some sensitivity to hot or cold. If the decay has grown so large that it is literally just sitting right on top of the nerve, it still might not hurt. Or it may. It is different for everyone. You could experience sharp sensitivity to cold, it could be a little achy, or it could feel perfectly fine. But now you need to remove the decay which is sitting right on top of the nerve. The nerve may become exposed when the decay is removed, allowing bacteria to get into it and this is really irritating to the nerve! If you don’t need a root canal now, you have a good chance of needing one in the future, even if everything feels great right after the filling is placed. It could feel great for years and then suddenly act up. The body is incredibly resilient at times. The tooth could be completely rotten on the inside, the nerve dead, the bone encasing the root “dissolving” due to infection and the person could still not feel pain! This brings me to my point that even if it doesn’t hurt, you still might need a filling, or treatment, whatever that may be. That is up to the assessment of the dentist who has trained for many years, understands decay progression, tooth anatomy and how to maintain optimal oral health. In short, prevention is king. Let’s catch problems when they are really small so they are easy to fix. Better yet, let’s hone in on warning signs and recognize potential problems to prevent them from even happening. This is why regular, frequent dental visits are so important. This is why even if you have never had a complex dental history you could still benefit from regular visits. What we want is for you to succeed in your oral health!