been talking about. Here's an example I've seen with my own eyes:

A teenager comes into my office for a first visit. He has poor hygiene and a poor diet. He is a medicaid patient. We take a full set of xrays and I see 12 superficial cavities in his mouth between his back teeth. I'm a kids dentist. Do I want to treat all of these spots? No. That eats up 3-4 appointments of doing the most obnoxious work known to man: class II composites. Each filling pays $90-110/tooth so I can produce $400-500 for one hour of treatment. Doesn't matter. I don't want to do it. I'm already busy enough with lots of patients. So I show him the x-rays, I talk about his diet and his hygiene. I explain that in a year or so, if he doesn't change his behavior, he's going to have at least 12 cavities, maybe 16. I prescribe him a stronger toothpaste. We set him an appointment for 6 months. I don't think about him again.

He returns 2 years later. Why didn't he come in? Could be a few reasons I've seen: parents don't care enough or they simply can't bring him every 6 months, he didn't want to come, he didn't qualify for medicaid for 2 years or they just forgot about the appointment the day of and didn't reschedule.

Now he's having some sensitivity. We take new xrays. He has 12-16 small to medium cavities. He still doesn't brush well, still drinks lots of soda, barely used the toothpaste I prescribed. One of his is cavities larger and is now bothering him. Over the course of the next six months, I treat all these cavities, even the small ones that are iffy as to whether or not they need tx because now I know what kind of patient I'm dealing with. 3 months later he's back because his large cavity is bothering him. It needs a root canal. I prescribe him an antibiotic and refer him to a general dentist for a root canal. The pain goes away from the meds. He doesn't go. 6 months later his tooth breaks and needs to be pulled.

Should I have treated all those small cavities when I saw him the first time? An aggressive dentist would say yes and they have a very good argument for why. like I said in other posts, there are several factors that go into it and there's not one right answer.