Direct Filling of Lower Right Second Molar: Is It Safe?

Direct filling of the second lower molar cavity?

Hello, last week I suddenly noticed a small hole on the buccal side of my lower right second molar, which also had a black spot inside.
At first, I thought it was a cavity; the hole is a nice round shape, about the size of a pinhead, but I haven't felt any pain or sensitivity to hot or cold.
Today, I went to a clinic for treatment.
The dentist just poked at it a little and filled it in without first drilling to remove any decay.
Later, I asked the dentist why there was no drilling to remove the cavity, and if filling it directly wouldn't allow decay to continue inside.
The dentist replied that the hole didn't look like a cavity but rather like a previous filling that had fallen out (because he said the shape of the hole resembled a tire mark), and that the inside was hard, indicating it had likely self-repaired, so there was no need for removal before filling.
Could you please advise if this treatment approach is correct? (Because I have never had a filling in that tooth, I am worried that decay might continue inside after just filling it.)

Taichung Ren, 20~29 year old female. Ask Date: 2016/05/20

Dr. Zeng Guanghui reply Dentistry

There is a small black cavity on the buccal side of the upper right second molar, without any pain or sensitivity to hot or cold.
During the filling procedure, there was no drilling to remove decay.
There is concern that if the cavity is not filled, it may continue to decay.
If the remaining tooth structure inside the cavity is hard and not softened, it may be reparative dentin, and it may not be necessary to completely remove it.
It is recommended to fill the cavity and schedule regular follow-up observations.

Reply Date: 2016/05/20

More Info

When it comes to dental procedures, particularly regarding the treatment of cavities or defects in teeth, the approach taken by your dentist can vary based on the specific circumstances of each case. In your situation, the right lower second molar exhibited a small hole with a black dot, which you initially suspected to be a cavity. However, the dentist assessed it and determined that it did not resemble a typical cavity but rather a defect that may have resulted from a previous filling that had fallen out or a natural wear of the tooth structure.

The decision to directly fill the tooth without drilling or cleaning out the area first is not uncommon in certain scenarios. If the dentist believes that the structure of the tooth is sound and that the area is not actively decaying, they may opt for a direct filling. This approach can be justified if the following conditions are met:
1. Assessment of Decay: If the dentist evaluated the area and determined that there was no active decay present, filling the tooth directly can be a safe and effective option. The presence of hardness in the cavity suggests that the tooth may have undergone a natural remineralization process, which can occur under certain conditions.

2. Previous Treatment: If the area has been previously treated and the dentist believes that the filling material is still intact and functional, they may choose to fill it without further intervention. This can be particularly true if the shape of the cavity indicates that it is not a new decay but rather a result of wear or a previous filling.

3. Patient Comfort: The absence of pain or sensitivity to temperature changes is a positive sign, indicating that the nerve of the tooth is likely healthy. This can also influence the decision to proceed with a direct filling.

However, it is essential to monitor the tooth after such treatment. Here are some considerations and recommendations:
- Follow-Up Care: Keep an eye on the filled tooth for any changes, such as increased sensitivity, pain, or visible changes in the filling. If you notice any of these symptoms, it is crucial to return to the dentist for further evaluation.

- Oral Hygiene: Maintain excellent oral hygiene practices, including regular brushing and flossing, to prevent any potential decay from developing around the filling.

- Regular Dental Check-Ups: Schedule regular dental check-ups to ensure that any issues can be detected early. Your dentist can monitor the filled area and assess the overall health of your teeth.

- Dietary Considerations: Be mindful of your diet, particularly sugary foods and beverages, which can contribute to tooth decay. A balanced diet can help maintain dental health.

In conclusion, while the approach taken by your dentist may seem unconventional, it can be appropriate under certain conditions. The key is to remain vigilant about your dental health and communicate any concerns with your dentist. If you have lingering doubts about the treatment, consider seeking a second opinion from another dental professional for peace of mind. Remember, proactive dental care is essential for maintaining healthy teeth and preventing future issues.

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