Can I Have a Dental Cavity That Does Not Cause Pain?

There is a popular misconception that all dental cavities cause pain.  This is not true.  You can have a dental cavity that does not cause pain. Let’s clear up some misunderstandings by starting with a few facts:

Dental cavities, or caries,  is a bacterial infection in a tooth that causes demineralization and destruction of the outside of the tooth (enamel) and then into the tooth (dentin).  Eventually, if left untreated, the caries process will make it’s way to the nerve inside of the tooth.  This entire process can have pain associated with it, or it can be completely painless.  It can vary from tooth to tooth and patient to patient.

Right about where I’m pointing is how far a cavity usually has to get in a tooth for it to start causing pain. That’s pretty deep!

Caries and Pain: An Unusual Relationship

1. A small cavity in a patient may only be visible on an x-ray or under high magnification.  It is typically painless, but occasionally patients will complain of sensitivity to sweets or temperature sensitivity.

2. A medium sized cavity may still only be visible on an x-ray or under high magnification.  It may be visible to a person depending on where it is. It usually, but not always, has some sensitivity associated with it (hold, cold, sweets, air, etc.).  It may be painful, or it might be completely painless.

3. A large cavity is always visible on the x-ray and 9 times out of 10 is visible to the patient.  It may be painful, or it may have no pain or sensitivity at all.

4. Sometimes, a tooth hurts due to a cavity, and then the pain goes away.  This should never be interpreted as the body healing the infection on it’s own.  It is typically a sign that a more serious problem is going on, like necrosis of the nerve tissue inside the tooth.  There are several possibilities, and it is best to have the tooth evaluated by a dentist to determine exactly what is going on.

The point is that caries and pain can be frustratingly unrelated.  When patients use pain as an indicator for whether or not they should seek dental treatment, it’s not the best way to assess whether or not treatment is necessary.  The idea that treatment isn’t necessary on a tooth until it is causing pain is a recipe for disaster.

All cavities/caries require some form of dental treatment or else they are in danger of progressing.  It can sometimes be difficult to predict when pain will work it’s way into the equation, but it usually happens on a Friday or Saturday night or on a vacation when your options are most limited.  It can be difficult to find a dentist at odd hours and ER facilities are typically not equipped to handle emergency dental needs with much more than antibiotics and pain medication.

In summary, waiting until you are suffering from dental pain before you seek care is not a safe or wise decision.  You can have a tooth with a cavity that doesn’t hurt.

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