Archive for the ‘White Fillings’ Category
Saturday, July 31st, 2010
I have a four year old son who has some fairly significant dental problems. Before I take the next step, I am trying to research as much as I can. At least four of his upper molars have cavities. The ones in the first molars are small, but quite deep, and the second molars on both sides have started to chip away because of the decay.
What I want to know is do I have to have those second molars pulled, or can we put some kind of a crown on them until his permanent teeth are ready to come in? I’ve also seen where other dental websites talk about white fillings, porcelain onlays or dental bonding to fix teeth that have been chipped or damaged. Which would you suggest for a child his age?
I’m also wondering if I have to send him to a pediatric dentist. We’ve had two different dentists, and my son refuses to open his mouth for them. Do you think I will have to have him sedated for treatment? That seems so extreme, but my son now says that one of his molars hurts when he chews, so I think I have to take action.
I appreciate any insight you can give me.
Thanks,
Ellen
Dear Ellen,
Yes, I do believe that you need to visit a pediatric dentist, and yes, it is likely that they will need to sedate your son to get this dental work done. So you’ll need to locate a good pediatric dentist that practices sedation dentistry. Even though he only has baby teeth right now, those teeth are still important. He needs them, not only to eat, but to maintain the proper spacing for his adult teeth. If he does have to have those molars pulled, your pediatric dentist should suggest the use of space maintainers. Without them, his permanent molars will drift forward, and you’ll almost certainly be looking at fairly pricey orthodontic work when his permanent teeth are in.
In young children, the goal of most dental work is usually short-term maintenance, so the pediatric dentist may place a stainless steel crown. This will cost considerably less than a porcelain crown.
Of concern here is also the behaviors that led to this problem in the first place. Decay to the degree you describe has to have been fed all day, every day. I would lay good odds that your son is a “grazer,” in other words, that he eats pretty much continuously all day. If this is the case, you’ll need to find a way to change that eating pattern, or your son will continue to have serious dental decay problems all his life. At this point, he really needs to be eating only every three or four hours, and because of his problems, you should have him brush his teeth every single time he eats. If he cannot brush, have him rinse his mouth out with water.
Posted in Sedation Dentistry, Tooth Decay, Uncategorized, White Fillings | Comments Off
Wednesday, June 30th, 2010
Years ago, I let a dentist who obviously did not know what he was doing put white fillings in my teeth. Almost immediately I had to have several of them replaced, because my teeth became really sensitive and it was extremely uncomfortable to eat. At that same time, I let the same dentist put white fillings in my lower wisdom teeth, to “protect them against future cavities”. I had never heard of this practice, but did not know enough to argue.
The fillings have since worn completely away, and the teeth underneath where they used to be are not a pretty sight. I need to have fillings done again, but my regular dentist won’t do silver fillings. She said that many dentists won’t do silver fillings anymore, because of the mercury. Problem is that I don’t trust those white fillings to last, or to not cause me pain. What should I do?
Ron from Atlanta
Dear Ron,
The white fillings were not the problem–it was the technique used to place them. Placement of white fillings is still not taught in most schools of dentistry today, and it was certainly not part of the regular coursework “many years ago”. Placing white fillings, particularly in back teeth, is more challenging than placing amalgam fillings, because the area must be kept absolutely isolated from saliva or other fluids.
If your current dentist does not place amalgam fillings, then logic dictates that she is probably well trained and expert at placing white fillings. She would have a difficult time staying in business if she wasn’t! So I have to think you can trust her to do a good job with the white fillings to replace the ones that were in your wisdom teeth. Also, dentists as a group tend to be very ethical, so if she is recommending white fillings for your wisdom teeth, then she knows she can do a good job placing them for you.
The subject of the mercury in amalgam fillings in an ongoing controversy in the field of dentistry. The most current research cannot conclusively prove one way or the other whether or not the small amounts of mercury vapor released when you chew are harmful to the body. Many dentists (and patients) are choosing to err on the side of caution, and are just avoiding the amalgam fillings altogether.
Beyond the mercury issue, white fillings are much more cosmetically attractive than amalgam fillings. This may not be a top priority to you in the very back of your mouth, but an added selling point is that white fillings create a stronger structure after placement. The composite material actually bonds to your tooth, creating a stronger, more stable structure overall.
I hope you can trust your dentist to place those white fillings for you. The technology to place them has evolved a great deal, and hopefully you can trust your dentist’s skill and training.
Good luck.
Posted in Stained Teeth, White Fillings | Comments Off
Tuesday, February 16th, 2010
One of my molars has recently become really sensitive to everything - heat, cold, even air. The tooth has a large filling, so I started to worry that maybe the filling was thinning or something, or had a hole in it. I went to my dentist, and she blew air on it a couple of times, then put some kind of gel on that was to desensitize my tooth, and that did take care of the pain right away. She said if the pain had stayed, she would have to remove the nerve of my tooth, but I want to know how she could know that with a couple puffs of air? My dentist is always in a really big hurry, so I was too nervous to ask her to explain how she knew what was wrong, or if it could be anything else. I guess I am kind of nervous that she did not really figure out what is wrong.
Oliver in Bostwick
Dear Oliver,
Diagnosing the causes of dental pain issues can be a clear cut process sometimes, and it sounds as if this was the case with you. Different sensitivities tell your dentist fairly specific things about what is wrong with your tooth. Sensitivity to air is an indication of an unprotected spot on the tooth, which can be treated with a desensitizing bonding agent. In your case, the pain was transient, meaning that it went away after the desensitizing agent was applied. That further indicated that the pulp or nerve of your tooth was irritated, but had the potential to heal without interference. If the pain had lingered, your dentist would probably have recommended a root canal treatment, because that lingering pain would have been an indication of irreversible irritation.
You say your tooth has a large filling, and that causes some concern over whether or not that filling could be leaking, or have decay under it. Certainly most competent dentists would check the integrity of the filling first, to make sure that was not the cause of the pain. If the tooth continues to trouble you, it may be time to consider a root canal treatment and porcelain crown.
The greater issue here is your lack of trust in your dentist. Trust is the key to good health care, and dental care is no exception. If you are not comfortable asking your dentist questions, she may not be the right dentist for you.
Posted in Porcelain Crowns, Tooth Decay, White Fillings | No Comments »
Thursday, November 19th, 2009
Hi, Recently I had to make a decision between amalgam and composite. My dentist, who is up in the years, stated that in his opinion, amalgam is the better filling and does last longer than composite. I asked, in general, how long does an amalgam filling last vs. composite. He said there is a wide range of time difference which depends on each person’s dental habits but he has had amalgam fillings he has done last 30-40years and he felt that a good composite would last about 15 years. Is this reasonable to you? My wife, who uses a younger woman dentist, told her that nobody uses amalgam fillings anymore. The composite is much better and will last longer than amalgam - a complete opposite opinion. Thank you for taking the time.
- Shawn from Maryland
Shawn,
Your dentist is reflecting the old-fashioned view. When they were first used on back teeth, composite filling materials did not hold up as well as they do now. There is also a great variation in how good dentists are at placing them.
Another factor that may be at play in your dentist’s answer is his comfort level with the newer techniques. He prefers amalgam. He is comfortable with it. Very possibly in his hands the composite simply doesn’t work well. Don’t press him to use a filling material with which he isn’t comfortable.
As far as the lifespan, there are many factors and it’s difficult to put a number of years of lifespan on a filling. Composite wears as well as amalgam. It is bonded to the tooth, and so it is better at sealing out recurrent decay. It strengthens the tooth, where with amalgam the frequency of breaking of the tooth is greater. Composite is more technique sensitive, meaning it is easier to place a good amalgam than a good composite, so there is going to be a wider variation in quality of the filling from one dentist to another.
Related links:
Dr. McKay is a mercury-free Seattle dentist
Read about dental bonding.
Dr. David Kagan has an interesting page about gold fillings.
Posted in White Fillings | No Comments »
Saturday, July 19th, 2008
Dr. McKay,
My wife’s dentist put in some white fillings, and she really liked them, so when I needed two fillings I asked my dentist to give me white ones. She was reluctant, said the silver fillings were better, and warned me about possible infection from saliva contamination. Well, I had them anyway. That was about a week ago. And not only was the procedure quite painful, but now I have a constant aching on that side. I’m taking Advil for the pain.
What should I do? Is this likely to clear up on its own? I’m reluctant to call my dentist back.
- Mark in Seattle
Mark,
It’s generally not a good idea to try to push your dentist out of his or her comfort zone. Now you know why your dentist was reluctant to do these — she’s unfamiliar with the proper technique for doing them, but was naturally reluctant to frankly admit that.
When a dentist knows the proper technique for placing white fillings, I think you will find that he or she will far prefer doing white fillings to doing the old silver/mercury amalgam. We all take pride in our work, and the white fillings are not only beautiful, but they are sealed to the teeth, they contain no toxic mercury, and there is usually zero post-operative sensitivity, besides which the patients love them. Naturally, we love doing work like that. So if your dentist doesn’t offer you the option for doing white fillings, I wouldn’t bring it up.
What should you do now? I’d go to a dentist who knows how to do these white fillings properly and have them replaced. We’d be happy to see you here, of course, if that is your choice. You may not get insurance coverage for their replacement because of the restrictions of some dental insurance plans, but I still wouldn’t risk the continuing damage to your teeth. Not only have bacteria been allowed to contaminated the dentinal tubules inside your teeth, but the fillings aren’t sealed and will be constantly leaking, continuing to irritate the teeth.
Related links:
Read about mercury-free fillings.
Seattle cosmetic dentist
Click here to make an appointment.
Posted in White Fillings | No Comments »
