Cavities – Sweat The Small Stuff (Part 4 of 6)

Molar teeth
This is Part 4 of a 6 Part series. The info will be best understood if read in order. Click here for Part 1

Today is about the shape (anatomy) of teeth and how it applies to either encouraging cavities (bad) or preventing cavities (good). I’m not here to give a lecture on tooth anatomy, but rather to point out the hot spots where cavities occur and what you can do to prevent them.

We previously mentioned pits and grooves of the teeth as the parts where toothbrushing and flossing have absolutely NO EFFECT in removing plaque. Therefore, you have to

  1. Starve the plaque by being wise with diet and the FREQUENCY of putting simple carbs in your child’s mouth (best)
  2. Eliminate the groove or pit with a super small filling (next best)
  3. Seal the groove with sealant material (worst because sealants have such a short life)

Let’s talk about where the pits and grooves happen most frequently. It’s easier to see than explain.

Baby teeth showing natural pits and grooves

Baby teeth are really prone to cavities on the biting surfaces of the back teeth.

Permanent teeth showing natural pits and grooves.

The permanent teeth are prone to cavities in a lot more places than just the biting surfaces.

Dentists do more fillings, crowns, root canals, and extractions (pulling teeth) on the permanent first molars than on any other tooth in the mouth (the back teeth with the arrows pointing to them in the image above). It’s because they have more pits than any other tooth AND moms often don’t even know they came into the mouth.

cavity bigAs an example of how big of deal this can be, look at the image I used in Part 1 of this series. That GIANT cavity started in the pit on the side of the lower first molar. If it had been caught early it would have taken a small filling to repair it. Instead, this tooth will require a root canal and crown to save it, and might even need to be pulled in the long run. Knowing what to look for, and then acting on that knowledge, is critically important.

First permanent molars come into the mouth BEHIND the baby teeth. That means no baby teeth get loose so your kid might not even notify you something is going on back there. It usually happens around age 6, but that’s plus or minus 1 year. Start looking for them in your 5-year-old, but don’t be disappointed if they don’t show up until your kid is 7ish.

Permanent first molars come in behind the baby teeth

This can be a big problem. Large cavities, and I mean LARGE cavities can form in these permanent teeth before anyone realizes there’s a problem (cavities generally cause no pain until they’re really huge – like root canal huge). These first permanent molars are supposed to be with your kid from age 6 until they die so it’s really important to watch what’s going on back there. Nip problems in the bud early and the teeth will last a lifetime.

These first permanent molars are supposed to be with your kid from age 6 until they die so it’s really important to watch what’s going on back there. Nip problems in the bud early and the teeth will last a lifetime. That means if you or your child’s dentist detects a small cavity, do a small filling and you eliminate the groove (no more “hotel for bacteria”).

One more hot spot to check for pits is the upper permanent lateral incisors (see vertical arrows pointing to front teeth in 2nd image above). Don’t wait for your dentist to find this. REAL MOMS check to be sure. Admittedly, you can only see cavities with your eyes IF they turn dark (not all cavities are dark). However, you can sometimes see stains building up in the pits before that “random” hole starts to form.

Admittedly, you can only see cavities with your eyes IF they turn dark (and, unfortunately, not all cavities are dark). However, you can sometimes see stains building up in the pits before that “random” hole starts to form.

And after seeing these hot spots, you probably realize that cavities are not that random. They happen wherever plaque sits undisturbed for at least 7 days and are fed simple carbs too frequently.

Remember, though, pits can develop ANYWHERE in a tooth as a defect. Be on the lookout for weird stains or holes besides the common ones I’ve pointed out. All the rules above apply the same.


Slight change of topic from pits and grooves to CONTACT POINTS.

Most of the teeth in your child’s head will contact the tooth next to them. Toothbrushes also can’t reach into those spaces. That means plaque easily sits below those contact points for weeks and months at a time. By now you clearly know what risk that poses for cavities.

The only way to bust up these bacterial colonies well is with floss. Water picks might be great for the very young who are too young to floss, but remember that plaque is sticky and not soluble in water so it isn’t easily “washed” away. But because plaque has the consistency of mayonnaise, it is very easily “wiped” away. Floss seems to do that best at contact points.

Cavities that develop at contact points also can’t be seen by your dentist’s eyes until they become quite large. The best technology is still x-rays to catch these contact cavities while they’re very small. Small cavity means small filling means healthier tooth means less dental care required throughout your child’s life.

If you’re worried about x-rays to find these types of cavities, please don’t. X-rays do cause damage to our cells, but let’s keep it in perspective. Even with the old types of dental films, a few dental x-rays provides no more radiation to your child than a few hours out in the sun.

The good news is that with modern digital x-rays, the radiation is reduced up to 90% from what was needed for dental films. Knowing the cavity is there before it gets big is usually more important than any minor risk from the radiation of a quick x-ray.

Fun fact: we all experience radiation EVERY DAY from outer space and the earth on which we live. Our bodies are made to deal with and repair damage from this normal daily radiation. Dental x-rays with digital systems don’t add significantly to this at all. Remember perspective, please. Save your child from big cavities.

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