06/03/2026
𝗪𝗵𝗲𝗻 𝗮 𝗰𝗼𝗻𝘀𝗲𝗿𝘃𝗮𝘁𝗶𝘃𝗲 𝗮𝗽𝗽𝗿𝗼𝗮𝗰𝗵 𝗳𝗮𝗶𝗹𝘀.
Helpful information if you or a family member is cavity-prone.
Recently our senior doctor wrote two similar letters to the parents of two different teenagers who are both dealing with loads of more cavities, yet again! It’s a challenging situation to get ahead of, and the following message (edited here into one letter) provides the reader with insight into what we mean by minimally-invasive dentistry.
“Dear Parent,
My associate doctors and I have a practice philosophy that is extremely conservative, which in general means that we are hesitant to drill out minor cavities or address other issues that we may deem to be below a certain threshold. While that sounds great, there is no single threshold that applies to everyone, and our initial assumptions regarding Jane Doe's oral health and habits may have been wrong.
Last year, in addition to the two cavities we fixed on Jane Doe at the time, we also noted seven other teeth with developing cavities as areas to "watch". Restoring them at that time would have meant literally drilling out a bigger hole than they were causing, thus we elected to only monitor them for changes.
𝗜𝘁 𝘂𝘀𝘂𝗮𝗹𝗹𝘆 𝘁𝗮𝗸𝗲𝘀 𝘆𝗲𝗮𝗿𝘀 𝗳𝗼𝗿 𝗮 𝗰𝗮𝘃𝗶𝘁𝘆 𝘁𝗼 𝗱𝗲𝘃𝗲𝗹𝗼𝗽 𝗳𝗿𝗼𝗺 𝗮𝗻 𝗶𝗻𝗶𝘁𝗶𝗮𝗹 𝘀𝗽𝗼𝘁 𝗶𝗻𝘁𝗼 𝗮𝗻 𝗮𝗰𝘁𝘂𝗮𝗹 𝗵𝗼𝗹𝗲 𝗶𝗻 𝘁𝗵𝗲 𝘁𝗼𝗼𝘁𝗵, 𝗮𝗻𝗱 𝗼𝘂𝗿 𝗴𝗼𝗮𝗹 𝗶𝘀 𝘁𝗼 𝗶𝗻𝘁𝗲𝗿𝘃𝗲𝗻𝗲 𝗮𝘁 𝗮𝗻𝘆 𝗽𝗼𝗶𝗻𝘁 𝗮𝗹𝗼𝗻𝗴 𝘁𝗵𝗮𝘁 𝘁𝗶𝗺𝗲𝗹𝗶𝗻𝗲 𝘄𝗶𝘁𝗵 𝗮 𝘃𝗮𝗿𝗶𝗲𝘁𝘆 𝗼𝗳 𝘁𝗲𝗰𝗵𝗻𝗶𝗾𝘂𝗲𝘀 𝘁𝗼 𝘀𝗹𝗼𝘄 𝗱𝗼𝘄𝗻, 𝘀𝘁𝗼𝗽, 𝗼𝗿 𝗲𝘃𝗲𝗻 𝗿𝗲𝘃𝗲𝗿𝘀𝗲 𝘁𝗵𝗲 𝗱𝗮𝗺𝗮𝗴𝗲, 𝗮𝗻𝗱 𝗶𝗳 𝗻𝗲𝗰𝗲𝘀𝘀𝗮𝗿𝘆, 𝗱𝗿𝗶𝗹𝗹 𝗼𝘂𝘁 𝘁𝗵𝗲 𝘀𝗽𝗼𝘁𝘀 𝗮𝗻𝗱 𝗽𝗹𝗮𝗰𝗲 𝗳𝗶𝗹𝗹𝗶𝗻𝗴𝘀. 𝗕𝘂𝘁 𝘀𝘂𝗰𝗵 𝗱𝗶𝗿𝗲𝗰𝘁 𝘀𝘂𝗿𝗴𝗶𝗰𝗮𝗹 𝗶𝗻𝘁𝗲𝗿𝘃𝗲𝗻𝘁𝗶𝗼𝗻 𝗶𝘀 𝗴𝗲𝗻𝗲𝗿𝗮𝗹𝗹𝘆 𝗼𝘂𝗿 𝗹𝗮𝘀𝘁 𝗼𝗽𝘁𝗶𝗼𝗻. 𝗢𝘂𝗿 𝗳𝗶𝗿𝘀𝘁 𝗹𝗶𝗻𝗲 𝗼𝗳 𝗱𝗲𝗳𝗲𝗻𝘀𝗲 𝗶𝘀 𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻.
Those seven teeth marked to "watch" on Jane Doe were already halfway through the theoretical cavity timeline last year. Our hope was that by having a discussion with her about her oral hygiene habits, about her carbohydrate intake (and especially about her sugary drink intake), that we can help her implement meaningful changes that will change the trajectory of her oral health and keep those spots from developing further.
We do not want to berate our patients over their oral condition, and so the challenge is trying to educate in a way that a patient takes seriously, without making them feel bad about their teeth.
In hindsight, Jane Doe's situation is one in which our ultra-conservative philosophy may not have been so helpful, as all those spots we were “watching” have only worsened in time. Other dentists would argue that we should have acted more aggressively to get ahead of her potential cavities from the start. And I worry that our conservative approach minimizes the severity of the issue and only reinforces what an anxious patient already wants to hear.
But alternatively, had we acted more aggressively and proposed the need for nearly ten fillings at that initial exam, that news can be emotionally discouraging and financially overwhelming. For some people, that could be counter-productive towards our goal of better long-term oral health habits. And so there are no easy answers, as each individual is unique.
For Jane Doe, what really matters is that we are changing the trajectory of her oral health going forward. Maybe I need to do a better job of laying this out more bluntly to teenagers, and we will of course review these issues with her on future visits, but I'd appreciate it you would share the following with her as my best advice for her situation:
1. She must consistently clean between her teeth at least once daily with 𝘴𝘰𝘮𝘦𝘵ℎ𝘪𝘯𝘨 (floss, water-pick, dental toothpicks, flossers-on-a-stick, etc.).
2. She must be consistent with brushing gently, but thoroughly, around all of her teeth, especially near the gum line, at least twice daily. Importantly... brushing superficially for only 30 seconds does not count! Take the time and brush thoroughly. Electric toothbrushes are great for that because they have 2-minute timers built in. But think about each tooth as you brush them. Get all the sides of each tooth and clean off the little film that forms on them from food buildup. If the gums are bleeding, it means you need to do it all more frequently. That's the gums' cry for help.
3. Be mindful of sugar intake. Maybe that's not Jane Doe's issue, but 90% of the decay I see in kids is related to sugary drinks. Gatorade, Starbucks drinks, sodas, juices... that sugar cannot be left to sit on and between your teeth.
4. Between brushing, chewing sugar-free gum after snacks or sugary drinks will help to get pieces of food off your teeth and get saliva flowing to help remove sugars. It can't replace brushing, but it's a great habit to use in-between brushing (although it might not be appropriate for school or other social situations).
5. Using supplemental fluoride will slow the progression of any current cavities and extend the life of fillings/crowns. Aside from the fluoride treatments we offer here, using an over-the-counter fluoride mouthwash (e.g. ACT) every morning and night will make a difference over the years.
Our goal is to reduce the likelihood of her ever developing further cavities. 𝗜𝗳 𝘀𝗵𝗲 𝗶𝗺𝗽𝗹𝗲𝗺𝗲𝗻𝘁𝗲𝗱 𝘁𝗵𝗼𝘀𝗲 𝗮𝗯𝗼𝘃𝗲 𝟱 𝘀𝘁𝗲𝗽𝘀 𝘁𝗼𝗱𝗮𝘆, 𝗮𝗻𝗱 𝘀𝘁𝗶𝗰𝗸𝘀 𝘁𝗼 𝘁𝗵𝗮𝘁 𝗿𝗼𝘂𝘁𝗶𝗻𝗲 𝗿𝗶𝗴𝗶𝗱𝗹𝘆, 𝘀𝗵𝗲 𝘄𝗶𝗹𝗹 𝘀𝘁𝗼𝗽 𝗺𝘂𝗰𝗵 𝗼𝗳 𝘁𝗵𝗲𝘀𝗲 𝗶𝘀𝘀𝘂𝗲𝘀 𝗶𝗻 𝘁𝗵𝗲𝗶𝗿 𝘁𝗿𝗮𝗰𝗸𝘀. It will make her gums less sensitive, her teeth stronger, her smile healthier and more esthetic, which can even help with self-confidence, all while also saving her a lot of time and money in the future that she won't have to be spending at the dentist!
Anyway, thank you for your continued trust, and I am looking forward to getting Jane Doe’s smile back!
Dr. A-Rod
