Sillim-dong Dentist - Cavities Not Visible Even on X-rays?

Hello. I am Kang Dong-ho, the director of 연세유라인치과의원 신림점, located in Sillim-dong, Gwanak-gu, near Sillim Station.

Today, I would like to talk about cavities that cannot be seen even on X-rays—in other words, cavities between adjacent teeth.

Cavities that develop between adjacent teeth are more difficult to detect than you might think.

Most cavities should be visible to some extent on a panoramic X-ray, which is the basic full-mouth X-ray taken at a dental clinic.

However, cavities between adjacent teeth are hidden between the teeth, so they often do not show up clearly in this full-mouth image.

Some people ask, “Can’t you see them just by looking?” In fact, in most cases, even we dentists cannot see them.

Since these cavities develop not on the outer surface of a tooth but on its side, between two teeth, they are nearly impossible to identify visually unless they have progressed enough to cause a visible change in color.

That is why taking X-rays is essential.

However, the results can also vary depending on the angle and image quality of the X-ray.

Something that is clearly visible at one clinic may not be visible at another.

If the cavity is obscured by a dental prosthesis or overlaps with another tooth, it may not be visible at all in the image.

That is why, when we have a suspicion, we recommend taking additional X-rays. When explaining this to patients, we often hear the question, “Why do I need to take another one?”

However, to determine whether a cavity is actually present, it may be necessary to examine it from multiple angles.

In particular, when cavities between the teeth appear likely—for example, when the spaces between adjacent teeth are very tight—we may recommend taking another image, saying, “Just to be sure, shall we take one here?”

On the other hand, if the overall condition of the mouth is very clean, we may think, “This area is probably fine too,” and move on without further examination.

In that case, an early cavity may be missed.

Early cavities between adjacent teeth can easily be overlooked if they are not large.

Even when they are detected, that is when the decision-making begins: Should they be treated right away, or can they be monitored? The approach varies depending on age.

For people in their teens or twenties, when cavities may progress quickly, we generally recommend treatment. For people in their thirties or forties, we may monitor the progression depending on the circumstances.

Many people also come in for a checkup before traveling abroad.

In such cases, we take detailed X-rays of the spaces between the teeth, and if even a small cavity is found, they ask, “Should I have this treated before I leave?”

Then I always ask them:

“When are you planning to return?”

If they plan to return within a year, we may monitor the condition a little longer.

However, if they will not be able to return for several years, I recommend treatment.

After all, it is a matter of time.

For early cavities, one option is to monitor them by taking images every six months to a year.

In my practice, I tell younger patients to have another X-ray taken in six months. If there has been no change, we check again a year later.

However, most cavities do progress.

Therefore, when a cavity between adjacent teeth has progressed beyond a certain point, I recommend treatment.

In the end, what matters is detecting it early and making the appropriate decision.

Taking too many X-rays can also be a problem, but please remember that additional imaging is necessary when needed. Also, the more difficult and uncertain the diagnosis, the more important the timing of treatment becomes.