Prevention: Big Cavities and Bad Reviews


Chandler Cosmetic Dentist, Kelly Jorn Cook, DDS

I recently received a bad review on Yelp.  Two stars.  Yikes.  Essentially my patient felt I was recommending unnecessary preventative treatment.  The assertion bothered me, but forced me to think about how I could have better explained the clinical narrative.  Saying the phrase “early caries detection” to most people translates as babble.  In my discussion of treatment, the patient left thinking “preventative” meant “unnecessary”.  What I said to my mind was, “your enamel is soft on the biting surfaces of these teeth indicating the early stages of decay.”  The patient heard “you do not have a full blown cavity yet, but we recommend a filling anyway.”  Clearly I did not effectively explain my clinical recommendation, because the patient left with the impression that unnecessary treatment was being recommended.

In this day and age, dental diagnostic technology has progressed.  We have tools that allow us to detect the early stages of decay beyond what an x-ray will show or an explorer can find.  We use DIAGNOdent™ laser technology engineered to detect early invasion of decay into tooth enamel. Sub-surface caries lesions can be extremely difficult to detect using an explorer, thus the DIAGNOdent™ is a useful diagnostic dental tool. It is especially useful for pit and fissure areas (the grooves on the biting surfaces of your teeth).  The laser reads the density of the tooth enamel to detect softening. Depending on the number value that the laser reads, we will recommend “watching” a tooth for any progression of the decay or removing the decay to prevent the need for a larger restoration in the future.

The grooves of natural teeth often form small cavities over time, which can be treated conservatively without anesthetic and with very little natural tooth structure removed. The preventative nature of the smaller restoration placed at the early detection of decay diminishes the likelihood of a more invasive treatment in the future.

I appreciated the feedback, even though it was through a negative and public review. I regret that my patient was not provided with thorough explanation regarding early caries detection, but this is how we learn and grow.

We try to provide our patients with a conservative approach and the best service for optimal dental health.  If you happen to be interested, additional information regarding DIAGNOdent™ technology can be found