What Would Happen If You Never Got A Cavity Filled?
THE HOLE STORY
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​​​This is What Would Happen If, a close examination of mundane hypothetical situations. Each week, we look at something that you could do but probably never would, and take it to its logical endpoint. This week: What would happen if you just didn't get a cavity filled?​

In some ways, the cavity is like a more serious pimple. They almost always arise out of neglect, poor diet or genetics. They're a literal pain to deal with. They can be costly to treat. And they almost always come when you least expect them.

This is, partly, probably why you're avoiding to go to the dentist. Your teeth feel perfectly fine! But you also have a sneaking suspicion it's just chock full of nascent cavities. So what would happen if you just never went back to the dentist and you did indeed actually have a cavity? Would you be damning your future self to a liquid-only diet? Would you die?

To sate these biting concerns we spoke with Dr. Maria Howell, a practicing dentist in Texas and a consumer advisor for the American Dental Association. The short answer? It would not be good.

The short answer? It would not be good.

But before we get to the painful part of this, it's probably worth going over just how your teeth develop cavities. Contrary to popular belief, Howell points out, sugar is not the leading cause of cavities, it's acid. "Every time you eat or drink anything that's not water, the bacteria in your mouth produce an acid," she says. "But your saliva has a healing capacity to take that acidic state and neutralize it back to a non-cavity forming environment." 

In other words, it's not so much how often you brush or the specific things you eat, but how long you keep your mouth in an acidic state. "I mean, you have to eat," says Howell. "But usually it takes your mouth just under an hour to bring things back to neutral."

Think of your teeth like rocks sitting in a puddle. Every time you eat or drink something, you're turning that puddle into an acid bath. And if you're regularly eating or drinking something that's not water, then your mouth will persist in that acidic state. This, obviously, will begin to wear away at the enamel. 

The example Howell brings up is drinking a soda. If you down the soda in 15 minutes or so and then eat or drink nothing for the next hour or so, you're largely OK since you've given your mouth time to "rest" from this "acid shock" explains Howell. 

However, if you're just slowly sipping the soda over the course of an afternoon, then you're keeping your mouth in an acidic state for hours on end. What's more, once your mouth turns acidic, the bacteria in your mouth begin to produce these acids much more efficiently — creating an acid feedback loop that primes your teeth for a cavity.

So let's assume you've just done all of these things. Over the course of a few years — "Cavities don't happen overnight," says Howell — either your diet or hygiene or both has resulted in prolonged acid shocks to your teeth. Eventually the enamel of your teeth starts to decay to the point where you've exposed the dentin, the hard organic layer just beneath the enamel, to the outside world. Now we're off to the races.

You see, because there's — surprise! — bacteria in your mouth, and the dentin is organic material, the bacteria is going to start to hang out there, and that's when the infection starts. "The paitent will start to feel sensitivity, sensitivity to cold, sensitivity to sweet," says Howell. "And the sensitivity will progress the deeper it gets." Normally, this is when most people will start to realize they have a cavity, a dentist will drill out the infected tissue and put in a filling. But, of course, you're not going to do that.

The next stop on the cavity pain train is the nerve. Once the infection eats through the layer of dentin it'll make its way into the nerve. This, you can imagine, gets extremely painful. It also presents the first real risk of doing significant damage to the tooth, and would require a root canal1 to keep the tooth from decaying out of your mouth. At this point there's a chance that the decay has maybe to an adjacent tooth, doubling or even tripling your pain. But let's press on.

Once the nerve of the tooth becomes rotted out, the infection will spread into the space between the tooth and the bone and form an abscess.2 This is, essentially an infection of the bone. "Bone doesn't have much room to swell, so it can really cause some pain," says Howell. "And once you have an abscess, that can be really dangerous." If the tooth is on the roof of your mouth that could spread to your sinuses — which is really not a good place for an infection — or if it travels to your throat you run the risk of your airway swelling shut. If it's in your jaw, you run the risk of developing a bone infection, which, because it's an infection will likely lead to further infections in your body and, well, ultimately death.

If you have a sudden urge to brush your teeth right now, you're not alone. So how do you come good? How do you prevent this nightmare scenario from unfolding? Like any good dentist, Howell recommends that you brush and floss — twice daily for two minutes with fluoride toothpaste, thank you — but also that you watch your diet. "If you brush you teeth and watch your diet, letting it 'rest' from 'acid attacks' so to speak, you can actually heal the enamel before it becomes a cavity."

So brush your teeth, floss your teeth, and don't sip that coffee. Chug it. Your teeth won't thank you, because they're teeth and have no thoughts. But you'll thank you, which is the best kind of thank you.

Further Reading

The Sweethome's Guide To The Best Electric Toothbrush

The American Association of Endodontists's Step-By-Step Guide To A Root Canal Procedure

OralB's Guide To Flossing

Next Week

What would happen if you just stopped speaking?

Got a burning (hopefully not in an infected way) hypothetical question? Submit it to [email protected]. And for more, check out our What Would Happen If archive.

1

Please do not Google this procedure.

2

Also, please do not Google "dental abscess" either.

<p>Steve Rousseau is the Features Editor at Digg.&nbsp;</p>

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