Decision Time

The round bur traces the perimeter of the cavity with a familiar bounce, exposing immaculate yellow dentin. You press inward toward the center. The brown persists after several successively deeper passes. Now it’s dangerously deep. It’s time to make a decision.

Should you leave behind a bit of decay?

While you consider the options, you reflect on the last time you were staring at brown filth framed by white porcelain. Sitting in a bathroom stall after a large bowel movement, you faced a similar decision.

With a mess this extensive, an absolute solution can be tempting. A bidet will clean it all very quickly— the equivalent of using a huge round bur and achieving complete caries removal. But there are downsides. You really didn’t want to take half a shower in a public restroom.

While your butt is cleaner in the sense that there’s no poop, you wonder what bacteria that water jet will spray at you. What microbes are you introducing into your personal pulp chamber?

Selective caries removal is like using toilet paper. You’ll certainly leave a tiny bit behind, but it’s probably the most practical solution.

It’s not without its downsides though. Laymen know just enough about dentistry to be outraged if another dentist tells them caries was left behind. It’s really tough to accurately explain the details of an indirect pulp cap to a patient. Telling a patient that you intentionally left decay is like telling them you intentionally skipped wiping your butt.

It takes practice to know when to stop excavating decay. Like with toilet paper, ideally you stop before you see blood. Unlike with toilet paper, you should irrigate with bleach if you see a lot of blood.