Whether it’s discovered by a dentist or stumbled upon while brushing or flossing, many people notice a small notch, or dent, in their tooth near the gum line. This notch wears a number of different masks depending on the situation. For some people, the notch is large and causes sensitivity and pain. Some people find that the notch causes consistent pain or seems to have a cavity. For others, the notch goes easily unnoticed and is small enough not to pose cosmetic concerns. However, the severity of these notches might be understated, and leaving them untreated could pose the risk of further damage in the future.
This “notch” is just as complex for dentists to understand, and can manifest in a number of ways. Understanding what these notches are, what may cause them, and the risk they could pose, will help you decide how to treat the notch in your tooth at the gum line.
What is this Notch?
These “notches” on the surface of the teeth are generally called “lesions” and can be grouped into two categories: carious cervical lesions and non-carious cervical lesions. The first type, a carious cervical lesion, is diagnosed by signs of tooth decay. In other words, carious cervical lesions are notches in the tooth that contain a cavity. The cause of most carious cervical lesions is the same as the cause of most dental cavities. It differs for each person, but can generally be linked to poor nutrition, high-sugar diets, improper oral hygiene, genetically weak teeth, and certain bacteria that cause tooth decay and lives in the mouth.
Non-carious cervical lesions are exactly the opposite. These are generally smooth notches found in a clean tooth’s surface, and there are no signs of bacterial decay. These lesions can still cause sensitivity depending on the placement and severity of the notch, which might be deep enough to affect the tooth’s nerves. Sometimes, though, non-carious cervical lesions are painless, which makes them easy to ignore. However, research identifying the many possible causes of non-carious cervical lesions (which could be a combination of biological and lifestyle factors) suggests that ignoring them could lead to continuous damage.
That means that a small, painless notch could eventually become a larger notch that exposes the tooth’s root and leaves the nerves vulnerable to different foods and temperatures. If the notch continues to degrade, it also could be at higher risk for trapping bacteria that causes cavities, turning it into a carious cervical lesion.
What Causes Non-Carious Cervical Lesions?
There are several theories as to why these non-carious cervical lesions form on the surface of the teeth, and it is likely that a combination of factors is responsible for the different severity of these notches for different people. Researchers have listed a number of possible causes of this notch. First, notches may form where the gum has receded away from the tooth. This is because the root is up to seven times softer than the tooth itself, and the exposed soft flesh of the tooth forms an “undercut.”
Other researchers identified aggressive tooth brushing or using an abrasive toothpaste as a possible cause of non-carious cervical lesions. In fact, many researchers support the idea that certain abrasive toothpaste and brushing techniques can erode enamel and even the tooth’s surface over time, causing abrasions and lesions.
Because the roots surface (near the gum line) is vulnerable, any number of causes typically linked to damage to your teeth could also be factored in. This means that poor dental hygiene, eating disorders or otherwise poor diet, and poor general health could also be a potential cause of non-carious cervical lesions.
Other causes could be linked to mechanical stress on the teeth, link clenching, grinding, or poor bite alignment. People with weak teeth or a history of dental diseases might also be at higher risk of these non-carious cervical lesions. The wide array of possible causes and the many different levels of severity of these notches makes it difficult to predict or understand how a non-carious cervical lesion will manifest for each patient.
Is a Notch in Tooth Near Gum Line Serious?
Again, these lesions vary in appearance, position, and severity for every person. Carious legions are often approached with more urgency than non-carious legions since they are treated the same as a cavity. Cavity-causing bacteria grows and results in further decay over time, which means carious cervical lesions will get worse if left untreated.
Non-carious cervical lesions are more frequently overlooked. For some people, the notch may be painless, smooth, and pose no cosmetic concerns. This makes it easy to assume that no treatment is necessary. However, this may not always be the case. Because there are many factors that may cause these non-carious cervical lesions, chances are they will continue to worsen over time. As with most dental issues, if left untreated, a non-carious cervical legion will almost definitely get worse. A shallow groove can slowly deepen over time, eventually affecting the nerves and possibly killing the tooth altogether. As the notch deepens over time, it is also more susceptible to trapping bacteria that causes cavities. In most cases, a non-carious cervical legion should be treated as seriously as any other dental abrasion in order to avoid further damage. However, many dentists and patients don’t see it this way. There may be a number of reasons many decide to forgo treatment for non-carious cervical lesions, but no reason reduces the risk it may pose.
Non-Carious Cervical Lesions are Underdiagnosed and Undertreated
Many patients assume that because the lesion does not carry a cavity, it isn’t of serious concern. In many cases, people only feel that a dental issue requires treatment if it causes pain. Some adults assume that if their insurance doesn’t cover it, it’s just not as necessary as other dental procedures. Many of these patients are unaware of the cause of their “notch” and aren’t considering that the notch will worsen over time.
Further, a dentist may be less inclined to treat a lesion that’s causing no pain. Dental professionals may be hesitant to push treatment for a non-carious lesion because there is always a small chance that they treat it incorrectly, causing pain or the need for more dental work down the line. When a patient walks in with a small groove on one tooth that isn’t bothersome and walks out with a bothersome filling that causes sensitivity or falls out, no dentist is happy with that. This is the reason that non-carious legions often get overlooked or ignored until they begin to cause discomfort or the patient brings it up.
Treatment Options for Notch in Tooth Near Gum Line
Choosing a dental treatment option always includes factoring in a number of health and lifestyle factors. A great dentist takes all things into consideration before recommending treatment. Is the patient healthy enough for a dental procedure? How severe is the lesion and what treatment may be best? How healthy is the affected tooth? What about the surrounding teeth and gums? Most importantly, what are the patient’s expectations and desires when it comes to dental care?
All of these things and more will need to be considered when deciding on a treatment for a carious or non-carious cervical lesion. When looking for dental treatment options for a notch in a tooth that’s in poor health, there are two options that dentists may turn to.
The first option may be to extract the tooth. If the tooth is in poor health and no dental treatment is viable or will improve the health of the tooth and patient, the dentist may decide to remove the tooth altogether. If the affected tooth is in relatively poor condition and is causing pain, extraction may be the best method. Typically, this is done as a last resort on a tooth has too much decay to be saved. Extraction is typically chosen for carious cervical lesions that have been left untreated, but there may be other circumstances where extraction is the best route. Non-cervical lesions that are too large or too deep may cut off or compromise the root of the tooth, which can deaden the tooth and make it a candidate for extraction.
Sometimes the best option is to ignore it. in severe cases (where the tooth cannot be saved but the patient or gums are in extremely poor health) the best option may be to ignore it. For a tooth that is decayed past the point of saving or is already dead (especially if it is causing no pain) the dentist and patient may make the decision to leave the tooth until it falls out naturally or begins to cause pain.
After deciding to leave the tooth alone or to plan an extraction, there is another treatment that may help relieve discomfort in the meantime. The dentist may suggest several methods to help desensitize the tooth until the tooth can be extracted or otherwise removed, like getting a fluoride varnish. Fluoride, a mineral that strengthens tooth enamel, can be applied to the area to help prevent further decay. Combined with proper oral hygiene, like regular brushing, flossing, and rinsing, a fluoride varnish may keep carious cervical lesions from getting worse. The dentist may also recommend a desensitizing toothpaste and suggest that you avoid any foods that trigger pain or discomfort, like cold foods or sweets.
If you are vigilant about your oral health or have an attentive dentist, cervical lesions can be recognized early enough that there are several other treatment options. In the case that the patient is in otherwise good health and the “notch” is on the smaller side and decidedly repairable, the dentist may consider restorative options, like filling or grafting the hole.
Filling the cervical lesion is the most frequently chosen treatment option. The patient or dentists notices the hole, and they decide to fill it with a direct composite (white) filling to prevent further decay and smooth out any cosmetic imperfections. This option is by far the most frequently chosen but isn’t always the best option. Fillings so close to the root area of the teeth have several possible implications. First, reactions between the tooth’s root and the chemical agent used for filling teeth is likely to lead to the development of sensitivity to certain foods or temperatures over time. Second, the chemical bonding agent used for these fillings is less effective on the soft tissue near the tooth’s root. Fillings placed near the gums are more likely to fall out over time. Another reason is that most restorative procedures result in a weaker surface than the original tooth. If the patient isn’t sure what caused the cervical lesion to begin with, this can be problematic. The resin used to fill the notch may wear away as easily (or easier) than the tooth if the original cause (like tooth grinding or poor bite alignment) is not recognized and fixed. For these reasons, filling a cervical lesion may not be the best long term fix on its own.
Grafting the tooth is another option that may provide a long term (or permanent) fix to the problem. There are several different types of grafts used in dental care, but the principle is the same. The dentist removed a piece of healthy tissue from another location in the patient’s mouth and uses it to cover the area of the tooth that is exposed. Depending on the individual case, a combination of filling and grafting may be most effective. Grafting the tooth may be better for several reasons. Alone, a graft will not increase sensitivity in the affected tooth. In fact, after grafting, many patients experience a decrease in sensitivity over time. Also, unlike a filling, the grafted tissue actually grows to be stronger than the original tissue that was there. The new tissue protects the tooth from further damage and is much less likely to recede or expose the cervical legion again. Grafting is generally a stronger option for treating cervical lesions and may be the best option in many cases. Unfortunately, many dentists recommend that patients have the lesion filled before considering a graft. Many patients don’t always know that grafting is an option that may provide a long term fix to the notch in their tooth.
What Should I Do About The Notch in My Tooth at Gum Line?
If you notice a notch, whether it seems to have a cavity or not, you should always take it seriously. Taking immediate action with any dental issue can help increase the chance of saving the tooth and prevent further damage. Most dental problems continue to worsen over time, and a notch in the tooth at the gum line is no different. Left untreated, even painless notches can worsen and become sensitive or painful. Eventually, what was only a small notch can become a dead tooth that can’t be saved. Always contact your dentist about a notch in tooth at gum line or other dental concerns to take action quickly.