"Tiny" Hole in Tooth - Does it Need Filling?

My child recently had his first visit with a new dentist, and they say he has a tiny hole in the tooth -- the size of a pin. The dentist says she can see a shadow behind it, and it could lead to a cavity. She wants to drill and fill. Would it hurt to wait and see if it gets worse?

Question:

It is a good possibility that there is a cavity in this area. Because the bacteria which cause decay are microscopic, it only takes a tiny hole for the bacteria to be able to penetrate the enamel (outer layer of tooth structure) to cause decay in the dentin. Once the bacteria reach the dentin, the decay they cause can mushroom. This occurs because the dentin is "softer" and more susceptible to decay than the enamel. The dark shadow can be a tell-tale sign of decay.

Dentists are generally more satisfied with their diagnosis with confirmation by a radiograph and better clinical confirmation (such as decay detected by "stickiness" with an instrument called an explorer), but we also need to rely on some other data, such as discolorations. There have been a number of occasions in which I was presented with a situation similar to your description. After anesthetizing the tooth, I started drilling and actually discovered a fairly large cavity.

While I can understand your skepticism, it is important that you do not let this go. Decay does grow, causing further loss of tooth structure and, eventually, sensitivity. Not having decay treated can lead to more painful conditions and expensive treatments for your child. If you are still skeptical, you should feel free to seek a second opinion.

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