By: Dr. Elizabeth Eggert
How did this start?
We met John back in 2013 when he was only 3 years old and needed some fillings on his primary (baby) teeth. After completing this treatment, unfortunately, his family moved out of state and we lost touch with him. Fast forward to this summer when his dad reached out for a second opinion because John was having a severe toothache. They sought out a dentist in Texas, where they live, but the recommendations were extreme, especially for a 15-year-old young man.

Here are the x-rays taken in Texas and sent to Dr. Elizabeth Eggert for a second opinion. It is easy to see the extreme decay in these images on multiple teeth. While Dr. Elizabeth was very concerned that the decay was so deep, it might be infecting the nerves of these teeth, she was also discouraged to hear that the other dental professionals had recommended extraction, or root canals and crowns for someone so young, without truly exploring what was happening in these teeth.
Luckily the family was headed to Minnesota for the summer and after a limited exam with Dr. Elizabeth, along with additional x-rays, it was determined that it was at least worth seeing how deep the decay was in these teeth to see if the teeth were working to protect their nerves by laying down protective layers of tooth structure.


Dr. Elizabeth had a serious conversation with John and his family about why John got infected with these cavities. To only attempt a repair without determining how to prevent serious issues like this in the future, would not help break the cycle. Tooth decay in teenagers is primarily caused by a combination of poor oral hygiene, frequent consumption of sugary foods and drinks, and the presence of bacteria in the mouth that produce acids that erode tooth enamel. In John’s case, the most likely culprit was the sugary candy he often consumed (and hid from his parents) as well as inconsistent dental care over the years.
What did he want?
John and his parents were hoping to avoid the extreme options presented by the dentists in Texas. Not only are the treatments recommended irreversible, but they would have been a huge investment and financial strain for the family. Therefore, they liked Dr. Elizabeth’s conservative option of decay excavation, which is almost like an exploratory surgery. If the decay hadn’t yet reached the nerve, or even if it still was just over the nerve canal system, with John’s young age, there would be a chance that his teeth could heal and protect the nerve if the decay is removed.
In Dr. Elizabeth’s mind, it is very important to attempt to preserve the natural tooth and root for as long as possible. Dr. Elizabeth recommended that they start with decay excavation on the three teeth with the deepest decay, do indirect pulp caps if needed, and finish the treatment with a composite buildup, which will help build back the tooth until the nerve has some time to heal and before a crown is done. This option gives John time to heal and see how well his teeth respond to the treatment.
What was involved?
Dr. Elizabeth saw John for multiple appointments to address as much decay as possible when he was in town. She started on John’s lower right side, where John had the most discomfort. The most interesting thing about John’s case was how deep the decay got internally without giving many outward signs until his toothaches started. These photos show the three teeth with the deepest decay. While there is evidence of “holes” or cavities forming, they do not appear to be as extreme as what the x-rays were showing. This likely kept John’s family from realizing the severity of John’s situation and why regular dental care is so important because it is likely that these areas of decay would have been caught much earlier.

Dr. Elizabeth removed the decay, but had to leave a small amount in order to avoid the nerve. This is called an indirect pulp cap and can help the tooth promote healing. A protective layer is placed over the decay with the hopes that the natural tooth structure will continue to lay down more natural protection. The amount of tooth lost to decay was extreme, but with ideal bonding ability, Dr. Elizabeth replaced the missing tooth structure with resin (composite) filling material for a buildup, knowing that if John is able to keep the infection away and keep his teeth, crowns will be in order in the future.

What does he think?
John and his family were so appreciative for the alternative and conservative treatment option. This definitely is a favorable result, although not necessarily conventional. Unfortunately, since John’s treatment was a unique approach, John’s family is still fighting for insurance coverage and they may never see the benefits they deserve. We are finding that more and more insurance policies place strict limits on what they will and will not cover. Still, John’s family believes this treatment was the right choice for them.
John and his family have gone back to Texas so we won’t be able to follow his treatment long-term. We hope he is able to keep his teeth for many more years to come and that his teeth cooperate and heal fully. John’s story is an important example of why it is very important to implement dental recare appointments at a very young age. These appointments are crucial for maintaining optimal oral health by catching problems early to help prevent serious long-term problems. We’re happy to have your trust John and we wish you the best!












