Why I Am Taking a "Watch and Wait" Approach re: Two Small Cavities

In the kisser!

Recently I went to my new dentist in Oakland. While going to the dentist is rarely much fun, everyone at this office is friendly and professional, and you get good dental advice with very little guilt-tripping. They are also amenable to my treatment preferences, such as getting X-rays every two years instead of every year.

My dentist pointed out two small cavities while I was there. She showed me the cavities with a small mirror, and also had me listen to the sound of metal pick touching my teeth. “Clanking” is good, indicating the enamel is hard. When the instruments sticks and doesn’t clank around, that can indicate the enamel is soft.

I made an appointment to get the two cavities filled. The estimate was $240 per cavity, which according to this site is just slightly above average for composite fillings. I’m self-employed and I don’t carry dental insurance, so for me all dental costs are out of pocket. Cost is definitely a consideration in regards to dental care. On the other hand, dental health is a real priority, and I’m not going to wait until I have a toothache to take care of any problems.

A couple days after making the appointment for the fillings, I called the office and cancelled it. I told them I wanted to take a “watch and wait approach,” and check those teeth again in six months.

Here’s my reasoning behind the decision:

1. Neither tooth has ever been drilled before. If at all possible, I’d like to keep it that way.

2. I’m concerned about the overtreatment of microcavities (also known as “incipient carious lesions”), as discussed in this article from the New York Times. It’s not that I think my dentist acted unethically in suggesting I treat the teeth, but the trend in dentistry in general is to drill and fill smaller cavities that, in years past, might have been given a “watch and wait” pass.

One also has to consider the incentive system. What if, instead of getting paid by the filling, dentists were to receive a fixed annual stipend from the government for keeping your teeth healthy, as part of a national healthcare system. Would so many fillings be recommended?

3. Six months ago, I had soft spots in two of my upper right molars. To her credit, my dentist said I could have either them filled, or use a fluoride rinse and see if the enamel hardened up. I chose the watch-and-wait approach. One tooth hardened up entirely, possibly because of my home treatment plan (see below). The other one she didn’t notice until I reminded her of it, at which point she checked it again, noticed it was still a little soft, and recommended a filling.

So, at least one tooth has hardened up on its own. Possibly, my home treatment plan is working. So I’m going to give it another six months, and see what happens. Here’s what I’m doing:

Dental “Enamel Building” Home Treatment Plan

1. Brush twice a day with fluoride toothpaste, at least once with an electric toothbrush (Oral B).

2. Floss at least once a day, before bed.

3. Fluoride rinse after brushing, at least three times a week. Right now I’m using ACT, but I plan on buying a “more natural” brand that is not only alcohol free, but also doesn’t contain propylene glycol and artificial color (but still contains .02% fluoride).

4. Reduce my protein intake. My period of best dental health (no cavities at all) was when I was a lacto-ovo-vegetarian for a number of years (of course this could be entirely coincidental, or related to the fact that I also didn’t drink coffee or consume alcohol at the time). A more-or-less paleo diet works well for me these days, but I think reducing total protein intake (thus making my overall diet less acidic) could potentially assist in the process of tooth remineralization. There are other reasons for me to reduce meat intake in particular; I carry a recessive gene for hemochromatosis (I learned this from my 23andMe profile). I’ve never had a toxic iron levels, but I never have low iron either (even though I give blood regularly, and even when I was a vegetarian). I’m also concerned about recent research linking carnitine consumption to species of gut bacteria that raise TMAO, which in turn may contribute to arteriosclerosis — that probably deserves a post of its own in the future. I’m replacing “lost” meat calories with good fats (olive oil, coconut oil, avocados, etc.) and slightly more beans. Compared to most people I probably still eat a high-protein diet, since I eat fish and poultry or eggs pretty much every day, in addition to nuts, aged cheeses, yogurt, and other high-protein foods.

5. Fat soluble vitamins several times a week (K2, Mk-7 form, 100 mcg / D3 2000-4000IU, cod liver oil for vitamin A 1t). K2 especially may help with bone and tooth remineralization. I also eat dietary sources of vitamin K2 including aged cheeses, and pate made from poultry liver (providing the Mk-4 form). In this post, Stephen Guyenet discusses the relationship between tooth healing and fat soluble vitamins.

6. A magnesium glycinate supplement on most days, as well as adequate calcium intake from yogurt, aged cheeses, whole sardines, almonds, cooked leafy greens.

7. Good diet overall — whole foods, high nutrient, low in sugar and grains. No soda, which is highly acidic and dimineralizing.

8. Rinse mouth after eating to restore neutral pH level, especially after acidic foods and beverages (of which I consume a fair amount, including citrus, berries, coffee, and wine).

9. Chew xylitol gum, which normalizes pH, and has been shown to reduce caries. Xylitol is made from xylose, a wood sugar extracted from the white birch tree.

So, we’ll see how it goes. I’ll report back in six months with the results of this n=1 experiment.

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