One of the hardest things I have had to do is tell a patient transferring in from another office that they have some decay or leaky restorations. If they had a great relationship with their previous dentist but the quality of care was low judging by the amount of decay or poorly contoured fillings, it is a difficult situation. This happens frequently. My mother in law is one example. She was surprised when I told her she needed a dozen new restorations when she had been going to the same dentist for over 40 years. Often patients may think you are just trying to use them for your personal ATM. A few years back Reader’s Digest even did a story titled, “How Honest are Dentists?”
This is why I am a big fan of the diagnoDent and intra-oral photography. These are technologies that allow the dentist to show you what is going on. Everyone knows that pictures are worth a thousand words but the diagnoDent is an instrument that uses laser fluorescence to measure tooth hardness. When that hardness is lacking it is called decay.
Recently I have been involved a few discussions, some heated, about when or when not to restore a tooth. Often Ray Nagel’s book, Cure Tooth Decay Repair and Remineralize Teeth Naturally with Nutrition is invoked. I have read his book and want to show that listening to his advice may not be in your best interest. In fact, my copy says on the back states, “The information your dentist does not want you to know.”
Nothing could be further from the truth. It is not a secret that tooth decay can be reversed – to a point. Dentists know it and we want you to know it! To understand, first you need a small lesson in dental anatomy.

There are three mineralized structures and one soft that make up a tooth. The hard structures are enamel, dentin, and cementum while the vessels and nerves of the pup make up the soft component. Enamel is the hardest substance in the human body it is over 95% mineralized and despite what you may have been told or read in the popular press, once it is formed your body has NO capacity to make new enamel. If it decays or wears thru you never can get more. Cementum is a thin layer, about 70% mineralized and is responsible for holding your tooth in the jaw via the periodontal ligament. Dentin, which is also about 70% mineralized, makes up the bulk of the tooth, protects the nerve and does have the capacity to lay down material. Since the cementum and dentin are less mineralized, once exposed, they are more susceptible to decay.
Dentin forms in three “waves.” Primary dentin is made as the tooth is formed. Secondary dentin is made in all teeth as people age. If you radiograph the teeth of a child and them re-radiograph them again at 20, 40, or 60 years later you will notice that the pulp area has gotten smaller. This is because dentin formation grows INWARD. This is a normal physiologic process and occurs in everyone. Even in impacted teeth that are never subject to biting forces. Tertiary dentin (Nagel mistakenly calls this secondary dentin) is reactionary to decay or trauma. This is a localized, rapid dentin formation in an attempt to protect the nerve.
When your tooth decays it loses mineral content. This is very easily picked up by the diagnoDent and quantified in a number from 0-100. It has been my experience that for most people when that when that number reaches over 30 you have reached a “point of no return” and would be best served by having that tooth restored. At this point while there is decay, there is almost never any pain or symptoms. Most dentists, myself included, hate to watch decay because it tends to get larger. The only way to remineralize is to eat a nutrient rich diet and avoid the non-obligate nutrients such as sugars and starches that feed the bacteria that cause it. Without getting into the controversy of using fluoride, conventional dentists will want to use it here as it does make a stronger, more acid resistant remineralized tooth.
Now we all know everyone knows smoking is bad yet some continue to smoke. If you have been told your entire life that oatmeal, pasta, and bread are healthy do you really thing the average patient is going to change their diet based on a 10 minute conversation with me? It does not happen.
If you are told that you have decay and you are opposed to fluoride or having it restored by all means work with a dentist who can quantify and put a number on how deep the decay may be. Tooth decay is usually a slow process and an instrument like the diagnoDent can tell you if it is remineralizing or not. I have many patients that I do this for and am happy to say it does work.
Now my problem with Nagel’s book is that without this behavioral change decay will progress. I am concerned about people not changing their diets completely or ignoring modern dentistry entirely based on some of his speculative entries. He shows a great picture of tertiary dentin bridging that may also be found on the bottom of page 259 (or page 307 of this pdf copy) of Weston Price’s bookNutrition and Physical Degeneration. What he does not state is that since the tooth has little enamel it is subject to fracture and will not stand up to a lifetime of function in the mouth even if you make the appropriate dietary modifications. If you read to the bottom of his website, you will find this disclaimer:
“This material has been created solely for educational purposes. The author and publisher are not engaged in giving medical / dental advice or services. The author and publisher provide this information, and the reader accepts it, with the understanding that everything done or tried as a result from reading this book, or website is at his or her own risk. The author and publisher shall have neither liability nor responsibility to any person or entity with respect to any loss, damage or injury caused, or alleged to be caused directly or indirectly by the information contained in this book or website.”
In other words, this is not Gospel. For some complicated reasons, which you can read about here,decay effects children worse than adults so there is a tendency as we progress from childhood thru adolescence and to adulthood that the incidence of decay will diminish. This will happen regardless of you taking his advice or not.

This is a picture of a small cavity. Notice the two holes. They were connected under the enamel. These do not hurt but registered over a 50 on the diagnoDent. If untreated it will get larger. Most dentists are hard working and truly want to help you. If there is a disconnect it is with our education. We are taught to restore rather than prevent via evolutionary biology. As I am trying to change this please educate then, not hold it against them. The basis of the doctor patient relationship is trust. Quantifying the degree of decay is one way to build that bond. If you do not trust your health care practitioner you will forever have doubt and would most likely be served best by finding a new one.