06/03/2026
๐ช๐ต๐ฒ๐ป ๐ฎ ๐ฐ๐ผ๐ป๐๐ฒ๐ฟ๐๐ฎ๐๐ถ๐๐ฒ ๐ฎ๐ฝ๐ฝ๐ฟ๐ผ๐ฎ๐ฐ๐ต ๐ณ๐ฎ๐ถ๐น๐.
Helpful information if you or a family member is cavity-prone.
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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! Itโs 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.
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โDear 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.
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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.
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๐๐ ๐๐๐๐ฎ๐น๐น๐ ๐๐ฎ๐ธ๐ฒ๐ ๐๐ฒ๐ฎ๐ฟ๐ ๐ณ๐ผ๐ฟ ๐ฎ ๐ฐ๐ฎ๐๐ถ๐๐ ๐๐ผ ๐ฑ๐ฒ๐๐ฒ๐น๐ผ๐ฝ ๐ณ๐ฟ๐ผ๐บ ๐ฎ๐ป ๐ถ๐ป๐ถ๐๐ถ๐ฎ๐น ๐๐ฝ๐ผ๐ ๐ถ๐ป๐๐ผ ๐ฎ๐ป ๐ฎ๐ฐ๐๐๐ฎ๐น ๐ต๐ผ๐น๐ฒ ๐ถ๐ป ๐๐ต๐ฒ ๐๐ผ๐ผ๐๐ต, ๐ฎ๐ป๐ฑ ๐ผ๐๐ฟ ๐ด๐ผ๐ฎ๐น ๐ถ๐ ๐๐ผ ๐ถ๐ป๐๐ฒ๐ฟ๐๐ฒ๐ป๐ฒ ๐ฎ๐ ๐ฎ๐ป๐ ๐ฝ๐ผ๐ถ๐ป๐ ๐ฎ๐น๐ผ๐ป๐ด ๐๐ต๐ฎ๐ ๐๐ถ๐บ๐ฒ๐น๐ถ๐ป๐ฒ ๐๐ถ๐๐ต ๐ฎ ๐๐ฎ๐ฟ๐ถ๐ฒ๐๐ ๐ผ๐ณ ๐๐ฒ๐ฐ๐ต๐ป๐ถ๐พ๐๐ฒ๐ ๐๐ผ ๐๐น๐ผ๐ ๐ฑ๐ผ๐๐ป, ๐๐๐ผ๐ฝ, ๐ผ๐ฟ ๐ฒ๐๐ฒ๐ป ๐ฟ๐ฒ๐๐ฒ๐ฟ๐๐ฒ ๐๐ต๐ฒ ๐ฑ๐ฎ๐บ๐ฎ๐ด๐ฒ, ๐ฎ๐ป๐ฑ ๐ถ๐ณ ๐ป๐ฒ๐ฐ๐ฒ๐๐๐ฎ๐ฟ๐, ๐ฑ๐ฟ๐ถ๐น๐น ๐ผ๐๐ ๐๐ต๐ฒ ๐๐ฝ๐ผ๐๐ ๐ฎ๐ป๐ฑ ๐ฝ๐น๐ฎ๐ฐ๐ฒ ๐ณ๐ถ๐น๐น๐ถ๐ป๐ด๐. ๐๐๐ ๐๐๐ฐ๐ต ๐ฑ๐ถ๐ฟ๐ฒ๐ฐ๐ ๐๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น ๐ถ๐ป๐๐ฒ๐ฟ๐๐ฒ๐ป๐๐ถ๐ผ๐ป ๐ถ๐ ๐ด๐ฒ๐ป๐ฒ๐ฟ๐ฎ๐น๐น๐ ๐ผ๐๐ฟ ๐น๐ฎ๐๐ ๐ผ๐ฝ๐๐ถ๐ผ๐ป. ๐ข๐๐ฟ ๐ณ๐ถ๐ฟ๐๐ ๐น๐ถ๐ป๐ฒ ๐ผ๐ณ ๐ฑ๐ฒ๐ณ๐ฒ๐ป๐๐ฒ ๐ถ๐ ๐ฒ๐ฑ๐๐ฐ๐ฎ๐๐ถ๐ผ๐ป.
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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.
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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 โwatchingโ 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.
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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.
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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:
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1. She must consistently clean between her teeth at least once daily with ๐ด๐ฐ๐ฎ๐ฆ๐ตโ๐ช๐ฏ๐จ (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.
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Our goal is to reduce the likelihood of her ever developing further cavities. ๐๐ณ ๐๐ต๐ฒ ๐ถ๐บ๐ฝ๐น๐ฒ๐บ๐ฒ๐ป๐๐ฒ๐ฑ ๐๐ต๐ผ๐๐ฒ ๐ฎ๐ฏ๐ผ๐๐ฒ ๐ฑ ๐๐๐ฒ๐ฝ๐ ๐๐ผ๐ฑ๐ฎ๐, ๐ฎ๐ป๐ฑ ๐๐๐ถ๐ฐ๐ธ๐ ๐๐ผ ๐๐ต๐ฎ๐ ๐ฟ๐ผ๐๐๐ถ๐ป๐ฒ ๐ฟ๐ถ๐ด๐ถ๐ฑ๐น๐, ๐๐ต๐ฒ ๐๐ถ๐น๐น ๐๐๐ผ๐ฝ ๐บ๐๐ฐ๐ต ๐ผ๐ณ ๐๐ต๐ฒ๐๐ฒ ๐ถ๐๐๐๐ฒ๐ ๐ถ๐ป ๐๐ต๐ฒ๐ถ๐ฟ ๐๐ฟ๐ฎ๐ฐ๐ธ๐. 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!
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Anyway, thank you for your continued trust, and I am looking forward to getting Jane Doeโs smile back!
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Dr. A-Rod
