The Real Price of Your First Cavity

     Your lower first molars, also called your six year molars, because the usually show up at six years of age, are the first posterior, or back teeth in your mouth. This honor does not come without potential problems, however. Being the first permanent back tooth means that it will have the longest time, of all your back teeth, to be exposed to all those things you eat that cause cavities. All those sugary candies and sodas will have more chances of causing problems. This is why the six year molars tend to be one of the more decayed teeth in people’s mouths, in general.

     So let’s say you go to ol’ Doc Goodfellow’s and he announces to the world that you have your first cavity, and it’s in your six year molar. Ok, mom, being the good mom that she is, brings you back to have a “filling” placed in that tooth, before you get a toothache. Good idea..Let’s say this happens when little Johnny is seven years of age. If the average lifespan of a seven year old boy these days is approximately 78 years, or so, that’s a long time that that filling is going to be in Johnny’s mouth. Don’t worry about the filling as there is no way it is going to last another 71 years. It won’t. All dental restorations leak saliva and bacteria over time, so it is inevitable that Johnny’s six year molar is going to have the need for a new filling, probably around the time he is in his late twenties, or early thirties. While this is not definite, it is fairly predictable. The problem is that the second time around, upon removal of the original filling and the new decay that has developed under the filling, the “hole” in the tooth is now larger, so a bigger filling will need to be placed. The bigger the filling, the less original tooth structure that remains. Keep this thought in mind.

     Okay, fast forward now another ten or twelve years. Johnny, who now answers to “John”, is married now and has 2.3 kids of his own. While his attention is now on the raising of his kids, it wouldn’t hurt to be aware of what is going on in his own mouth. Especially with his six year molar, which has been “filled” twice so far in it’s lifetime. What John does not know is that over time, a back tooth that has a large filling in it, undergoes a lot of stress during the chewing it is called on to do every day. Remember I told you that the bigger the filling, the less tooth there is? Well, the tooth structure that remains around a large filling tends to develop a lot of cracks and fissures as it is ground upon daily. John’s six year molar is becoming increasingly susceptible to fracturing under this constant stress caused by chewing. Finally, a piece of the tooth breaks off leaving a big void. Since ol’ Doc Goodfellow has retired, John calls new Doc Goodfellow, his son who took over the practice and tells him of the problem. When John is seen, he is told that the tooth will definitely need a crown to properly restore the tooth in a way that will make it stronger again. Because the tooth broke in such a deep way John is told, there is a very real probability that the nerve of the tooth is also affected and a root canal procedure might be needed to remove the nerve before it becomes infected.

    In today’s dollars John’s tooth has cost him approximately $80-100 for the first filling at age seven. The second filling 20+ years later is much larger and could cost him $150-225. When the crown and root canal are discussed, he is probably looking at a bill for $1800-2000 to restore the tooth for the third time.

     The moral of the story is to try and not get your first cavity. Use a fluoridated toothpaste, put sealants on your kids teeth, do everything you can to stop or at least delay as long as possible, getting any cavities, since they get more involved ( and costly) to fix as they get larger.

Ed Magida DMD