Tooth Decay in Upper Second Molars: Causes and Treatment

Cavity in the second molar?

Hello Doctor, my upper left second molar hurts when I bite down on hard objects.
After visiting the clinic, the doctor suspected there might be a cavity inside and that the silver filling needs to be removed to confirm, but mentioned that this tooth is difficult to treat.
I was advised to have the adjacent wisdom tooth extracted or to wait until I experience severe pain before proceeding with treatment.
After a while, the entire left side of my mouth started hurting so much that I couldn't sleep.
However, during the examination, the doctor tapped on the tooth with instruments and I didn't feel any pain, and the X-ray appeared normal.
Later, when the molar was opened, it was discovered that the nerve inside was already decayed, and I need a root canal treatment.
I would like to ask: 1.
Will not extracting the adjacent wisdom tooth affect the treatment? 2.
What makes this tooth difficult to treat? Is it related to the position of the tooth? 3.
Is this type of cavity not detectable by X-rays? If so, how can it be detected early for treatment? Thank you for your answers!

Ally, 30~39 year old female. Ask Date: 2020/03/14

Dr. Zeng Guanghui reply Dentistry

1.
If the adjacent wisdom tooth is growing at an angle, it may have an impact.

2.
If the wisdom tooth is excessively tilted and presses against the second molar in front, root canal treatment may involve complete cleaning of the nerve canal, but it might not be able to thoroughly clean the nerve.

3.
Sometimes, even if a cavity has been filled and the extent of decay is not close to the tooth nerve, it can still cause inflammation of the tooth nerve due to prolonged thermal stimuli.
Dr.
Tseng Kwang-Hui, Nantou Hospital.

Reply Date: 2020/03/14

More Info

Tooth decay, particularly in upper second molars, is a common dental issue that can lead to significant discomfort and complications if not addressed promptly. Understanding the causes and treatment options is essential for maintaining oral health.

Causes of Tooth Decay
1. Bacterial Infection: The primary cause of tooth decay is the presence of bacteria in the mouth that produce acids after consuming sugars and carbohydrates. These acids can erode tooth enamel, leading to cavities.

2. Poor Oral Hygiene: Inadequate brushing and flossing allow plaque to accumulate on teeth, which can harden into tartar and lead to decay.

3. Diet: A diet high in sugary and acidic foods can increase the risk of cavities. Frequent snacking without proper oral care can exacerbate this issue.

4. Tooth Position: The position of teeth can also play a role in decay. Teeth that are misaligned or crowded can be more challenging to clean, making them more susceptible to decay.

5. Age: As people age, the risk of decay increases due to factors like receding gums, which expose more of the tooth surface to decay.

Treatment Options
1. Dental Examination: If you suspect decay, a thorough dental examination is crucial. This may include X-rays to identify cavities that are not visible to the naked eye.

2. Root Canal Treatment: If the decay has reached the pulp of the tooth, a root canal may be necessary. This involves removing the infected pulp, cleaning the inside of the tooth, and sealing it to prevent further infection.

3. Fillings: For less severe decay, your dentist may recommend removing the decayed portion of the tooth and filling it with a material such as composite resin or amalgam.

4. Extraction: In cases where the tooth is severely damaged and cannot be saved, extraction may be necessary. This is often the case with molars that have extensive decay or structural damage.

5. Preventive Care: Regular dental check-ups, professional cleanings, and fluoride treatments can help prevent decay. Additionally, maintaining good oral hygiene practices at home is essential.

Addressing Your Concerns
1. Impact of Wisdom Teeth: The presence of adjacent wisdom teeth can complicate treatment. If the wisdom tooth is impacted or misaligned, it may exert pressure on the second molar, potentially leading to pain or further decay. Removing the wisdom tooth may alleviate some of this pressure and allow for better access during treatment.

2. Difficulty in Treatment: The difficulty in treating your upper second molar may stem from its location and the potential for complex root structures. Molars often have multiple roots and canals, making root canal treatment more challenging. Additionally, if the tooth is positioned in a way that makes it difficult to access, this can complicate treatment.

3. Detection of Cavities: Not all cavities are easily detectable through X-rays, especially if they are located between teeth or in areas that are not easily visible. Regular dental visits are crucial for early detection. Dentists may use additional diagnostic tools, such as digital imaging or laser cavity detection, to identify decay that X-rays might miss.

Conclusion
Tooth decay in upper second molars can lead to significant pain and complications if not treated promptly. It is essential to maintain good oral hygiene, have regular dental check-ups, and address any signs of decay as soon as they appear. If you have concerns about your wisdom teeth or the treatment of your molar, discussing these with your dentist can help you make informed decisions about your oral health.

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