One Dentist Says Cavity; the Other Says None

[AEMontoya]

I recently got bitewing x-rays taken by a new dentist. I did this because I moved to a new town and am in search of a new dentist. To make my search more cost friendly, under the assumption that I might need to see several different dentists, I used a Groupon that gave a good deal on a package: x-rays, full teeth cleaning, oral exam.

My previous dentist, who performed my last check-up about 1 year ago, noticed no cavities, problematic fillings, or any other issues. After the aforementioned check-up, however, the new dentist said she found a "very small cavity" and said I should schedule an appointment to have it filled. She showed me the x-ray film and vaguely and briefly pointed to a large dark spot on one of the teeth from about 6 feet away (I assumed that was the cavity). She said this about the cavity:

-it is very small

-it requires a 2-surface filling

-it is between two teeth

-it is located on the tooth that is behind my upper left canine tooth (my left). I do not know if it is messial or distal.

After this check-up, I just so happened to have a conversation with my mom's dentist, and he had me send over the x-rays from the abovementioned dentist. Prior to sending the x-rays, I looked at them myself, since they were sent to my email address. Interestingly, I did not notice any slides (out of the 7 total) that appeared to match the one I had been shown in the office, with the large dark spot. My mom's dentist looked at the x-rays and said that he does not see any cavities, let alone one that fits the description given by the previous dentist.

I have done some research on my own regarding the interpretation of bitewing x-rays and how to indentify the presence of cavities, including "incipient cavities." Although I am far from being an expert, I do not personally see evidence of a cavity. I do brush my teeth thoroughly after every meal, I floss every night, and I have a very healthy diet, for what it's worth. I haven't had a cavity in over 25 years (I am 45 now).

With all the above said, I would love to hear an expert opinion about whether the x-rays indicate the presence of a cavity fitting the description from the 1st dentist (note: a hygienist--not the dentist--cleaned my teeth and said they looked great; there was no mention of a potential cavity by her, but perhaps it was not her place to mention such information).


ATTACHED ARE X-RAY IMAGES OF ONLY THE MOLARS/PREMOLARS. Thank you so much in advance!!!

 

[Dr M]

I don't see any cavity on the x-rays that you provided. I would not recommend that you do any filling.

 

[AEMontoya]

Thank you, Dr. M. I appreciate your professional opinion very much.

 

[AEMontoya]

Anyone else?

 

[markhamgatewaydentistry]

Anyone else?

It’s actually not uncommon for dentists to disagree on small or early cavities, especially ones that show up faintly on bitewing x-rays. Very small “incipient” cavities may not need treatment right away and can often be monitored instead of filled, depending on your risk factors and oral habits. Since you’ve had great dental history and take good care of your teeth, it may be worth getting a third opinion from another dentist (ideally one you plan to stay with long-term) and asking them to show you clearly on the x-ray what they see. In the meantime, keeping up your brushing, flossing, and diet is the best prevention.

 

[AEMontoya]

It’s actually not uncommon for dentists to disagree on small or early cavities, especially ones that show up faintly on bitewing x-rays. Very small “incipient” cavities may not need treatment right away and can often be monitored instead of filled, depending on your risk factors and oral habits. Since you’ve had great dental history and take good care of your teeth, it may be worth getting a third opinion from another dentist (ideally one you plan to stay with long-term) and asking them to show you clearly on the x-ray what they see. In the meantime, keeping up your brushing, flossing, and diet is the best prevention.

Thank you for your input. I appreciate that!

I do wonder, how often does a "very small"/"incipient" cavity between teeth that seems very difficult to identify via bitewing x-rays end up calling for a 2-surface filling? I guess my impression of what a 2-surface filling is includes a cavity that is large enough to present itself on two different surfaces, which seems out of line with a "very small"/"incipient" cavity, unless 2-surface refers to the necessity to drill into 2 separate surfaces merely to reach the cavity.

 

[markhamgatewaydentistry]

Great question! A “2-surface filling” doesn’t always mean the cavity is big—it usually just describes the location. Cavities that form between two teeth (interproximal cavities) almost always involve both the side of one tooth and the side of the neighboring tooth, so the filling has to cover two surfaces, even if the decay itself is still very small.

That’s why you might hear “incipient” or “very small” cavity and “2-surface filling” in the same sentence—it can sound contradictory, but really it’s about where the dentist needs to drill and place the filling, not necessarily the size of the cavity.

In many cases, if it’s truly early, dentists will just monitor it with regular checkups and x-rays before jumping to a filling. That’s why a second (or even third) opinion is so valuable in borderline situations.

 

[AEMontoya]

Great question! A “2-surface filling” doesn’t always mean the cavity is big—it usually just describes the location. Cavities that form between two teeth (interproximal cavities) almost always involve both the side of one tooth and the side of the neighboring tooth, so the filling has to cover two surfaces, even if the decay itself is still very small.

That’s why you might hear “incipient” or “very small” cavity and “2-surface filling” in the same sentence—it can sound contradictory, but really it’s about where the dentist needs to drill and place the filling, not necessarily the size of the cavity.

In many cases, if it’s truly early, dentists will just monitor it with regular checkups and x-rays before jumping to a filling. That’s why a second (or even third) opinion is so valuable in borderline situations.

Interesting. Thanks for that explanation. Yes, when examining bitewing x-rays online, I did notice that very often a v-shaped cavity on one tooth would have a "twin" facing it on the adjacent tooth. It sounds from the above that this might also qualify as a "2-surface" filling, it would simply be 2 surfaces of two different teeth, but the treatment would involve what is colloquailly referred to as a "filling" as opposed to "two separate fillings." I'd imagine that if two separate teeth have two separate cavities facing each other that there would technically need to be two separate fillings, since one continuous filling between the teeth would form a physical barrier that would prevent the insertion of floss. Thus, it's just a matter of terminology.

I'll have to obtain my actual treatment plan from the dentist to see what it specifies. It has not been easy for me to get: two requests by telephone and one in writing over the past 3 weeks, but still nothing sent to me, which is another reason I am asking about all of this online, as there do appear to be a few red flags being raised.

 

[AEMontoya]

Any other expert opinions regarding interpretation of the x-rays?