Small cavities can still warrant the need for root canals.

Q: I recently had what the doctor said were “small” cavities on the chewing surface treated with white fillings. A week later I had pain and wound up needing two root canals. Why would small cavities lead to this?

A: We were told in dental school: never tell a patient “it’s just a small cavity” or “it’s just a small filling.” There is now way to tell how these things progress once you open them up; like a cancerous tumor one needs to get in there and examine in vivo.

Chewing surface cavities, also called pit and fissure decay or occlusal decay often have no symptoms, are rarely picked up by x-rays and can be very close to the pulp (nerve canals). They are hidden by the thickest part of the enamel and there for block the x-ray beam shot at a 90 degree angle to the teeth. The same reason why metal fillings and crowns prevent the x-rays from finding decay underneath.

Have your dentist look at the teeth with an intra-oral camera that can at least see the brown or black soft surface decay, indicating something is brewing below. If the sharp probe, the explorer as we call it in the tooth-biz, sinks into the lesion like quicksand and gets “stuck”, you have active clinical decay that is eating away the tooth making a b-line to the nerve canal.

I also recommend not to use composite resin (tooth bonding) to fill deep lesions on back teeth. They often result in severe sensitivity leading to a need for nerve removal; i.e. root canals. Instead, invest in porcelain inlays which are custom made in a lab off of digital impressions of your teeth after the decay is removed. In my 34 year career, it has been extremely rare that a patient with an inlay has needed a root canal.

See your hygienist and dentist at least three to four times per year to avoid missing these fast moving cavities.