There’s a white spot on a tooth, but x-rays don’t show decay. What should dentists do?
A study from the National Dental Practice-Based Research Network in the US had dentists keeping an eye on 1,033 questionable spots for 20 months. All of the spots were on chewing surfaces of teeth. The spots were not decay; they were white or stained compared with the rest of the tooth, or they felt rough. Besides monitoring the spots, the dentists gave people instruction on proper brushing and flossing. Sometimes they prescribed fluoride treatment.
After 20 months, 4% of the spots had deteriorated so that dentists decided to place fillings. Another 6% received plastic sealants (coatings that cover the tooth and protect it from further decay). Molars and children’s teeth were the most likely to get a filling or sealant. The dentists intend to monitor the other 90% of teeth.
Nearly all US adults and 75% of children have had tooth decay. A previous study by this group of dentists found that 34% of people have at least one questionable spot on the chewing surface of a tooth.
The group published another study earlier in the year that looked at the treatment of questionable spots. In that study, more than half of the spots chosen for fillings did not actually need to be filled. Some had no decay, some had inactive decay, and some had decay limited to the enamel.
The authors suggest that long-term monitoring is a reasonable option for these spots.
The study appears in the November issue of the Journal of the American Dental Association.