Fillings
To treat a
cavity your dentist will remove the decayed portion of
the tooth and then "fill" the area on the tooth where the
decayed material once lived.
Fillings are also used to repair cracked or broken teeth and
teeth that have been worn down from misuse (such as from
nail-biting or
tooth grinding).
What Steps Are Involved in Filling a Tooth?
First, the dentist will numb the area around the tooth to be
worked on with a local anesthetic. Next, a drill,
air abrasion instrument or laser will be used to remove
the decayed area. The choice of instrument depends on the
individual dentist's comfort level, training, and investment
in the particular piece of equipment as well as location and
extent of the decay.
Next, your dentist will probe or test the area during the
decay removal process to determine if all the decay has been
removed. Once the decay has been removed, your dentist will
prepare the space for the filling by cleaning the cavity of
bacteria and debris. If the decay is near the root, your
dentist may first put in a liner made of glass ionomer,
composite resin, or other material to protect the nerve.
Generally, after the filling is in, your dentist will finish
and polish it.
Several additional steps are required for tooth-colored
fillings and are as follows. After your dentist has removed
the decay and cleaned the area, the tooth-colored material
is applied in layers. Next, a special light that "cures" or
hardens each layer is applied. When the multilayering
process is completed, your dentist will shape the composite
material to the desired result, trim off any excess material
and polish the final restoration.
Today, several dental filling materials are available. Teeth
can be filled with gold; porcelain; silver amalgam (which
consists of mercury mixed with silver, tin, zinc, and
copper); or tooth-colored, plastic and glass materials
called composite resin fillings. The location and extent of
the decay, cost of filling material, patients' insurance
coverage and your dentist's recommendation assist in
determining the type of filling that will best address your
needs.
Cast gold
Advantages:
1.
Durability – lasts at
least 10 to 15 years, usually longer; doesn't corrode
2.
Strength – can withstand
chewing forces
3.
Aesthetics – some
patients find gold more pleasing to the eye than silver,
amalgam fillings
Disadvantages:
1.
Expense – more than
other materials; up to 10 times higher than cost of amalgam
filings
2.
Additional office visits
– requires at least two office visits to place
3.
Galvanic shock – a gold
filling placed immediately next to a silver, amalgam filling
can cause a sharp pain (galvanic shock) to occur. The
interaction between the metals and saliva causes an electric
current to occur – it's a rare occurrence, however
4.
Aesthetics – most
patients don't find any "colored" fillings to be an
"eye-pleasing" advantage
Silver-fillings (Amalgams)
Advantages:
1.
Durability – lasts at
least 10 to 15 years and usually outlasts composite fillings
2.
Strength – can withstand
chewing forces
3.
Expense – is less
expensive than composite fillings
Disadvantages:
1.
Poor aesthetics –
fillings don't match the color of your natural teeth
2.
Destruction of more
tooth structure – healthy parts of the tooth must often be
removed to make a space large enough to hold the amalgam
filling
3.
Discoloration – amalgam
fillings can create a grayish hue to the surrounding tooth
structure
4.
Cracks and fractures –
although all teeth expand and contract in the presence of
hot and cold liquids, which ultimately can cause the tooth
to crack or fracture, amalgam material – in comparison with
other filling materials–may experience a wider degree of
expansion and contraction and lead to a higher incidence of
cracks and fractures
5.
Allergic reactions – a
small percentage of people, approximately 1%, are allergic
to the mercury present in amalgam restorations
Tooth-colored composite fillings
Advantages:
1.
Aesthetics – the
shade/color of the composites can be closely matched to the
color of existing teeth; is particularly well suited for use
in front teeth or visible parts of teeth
2.
Bonding to tooth
structure – composite fillings actually chemically bond to
tooth structure, providing further support to the tooth
3.
Versatility in uses – in
addition to use as a filling material for decay, composite
fillings can also be used to repair chipped, broken or worn
teeth
4.
Tooth-sparing
preparation – sometimes less tooth structure needs to be
removed compared with amalgams when removing decay and
preparing for the filling
Disadvantages:
1.
Lack of durability –
composite fillings wear out sooner than amalgams (lasting at
least 5 years compared with at least 10 to 15 for amalgams);
in addition, they may not last as long as amalgams under the
pressure of chewing and particularly if used as the filling
material for large cavities
2.
Increased chair time –
because of the process to apply the composite material,
these fillings can take up to 20 minutes longer than
amalgams to place
3.
Additional visits – if
composites are used for inlays or onlays, more than one
office visit may be required
4.
Chipping – depending on
location, composite materials can chip off the tooth
5.
Expense – composite
fillings can cost up to twice the cost of amalgams
-back to top-
In addition to tooth-colored, composite resin fillings, two
other tooth-colored fillings exist–ceramics and glass
ionomer.
Other
1.
Ceramics,
which are made most often of porcelain, are more resistant
to staining than composite resin material but are also more
abrasive. This material generally lasts more than 15 years
and can cost as much as gold.
2.
Glass ionomer
is made of acrylic and a specific type of glass material.
This material is most commonly used for fillings below the
gum line and for fillings in young children (drilling is
still required). Glass ionomers release fluoride, which can
help protect the tooth from further decay. However, this
material is weaker than composite resin and is more
susceptible to wear and prone to fracture. Glass ionomer
generally lasts 5 years or less with costs comparable to
composite resin.
What Are Indirect Fillings?
Indirect fillings are similar to composite or tooth-colored
fillings except that they are made in a dental laboratory
and require two visits before being placed. Indirect
fillings are considered when not enough tooth structure
remains to support a filling but the tooth is not so
severely damaged that it needs a
crown.
During the first visit, decay or an old filling is removed.
An impression is taken to record the shape of the tooth
being repaired and the teeth around it. The impression is
sent to a dental laboratory that will make the indirect
filling. A temporary filling (described below) is placed to
protect the tooth while your restoration is being made.
During the second visit, the temporary filling is removed,
and the dentist will check the fit of the indirect
restoration. Provided the fit is acceptable, it will be
permanently cemented into place.
There are two types of indirect fillings – inlays and
onlays.
-
Inlays
are similar to fillings but the entire work lies within
the cusps (bumps) on the chewing surface of the tooth.
-
Onlays
are more extensive than inlays, covering one or more
cusps. Onlays are sometimes called partial crowns.
Inlays and onlays are more durable and last much longer than
traditional fillings – up to 30 years. They can be made of
tooth-colored composite resin, porcelain or gold. Inlays and
onlays weaken the tooth structure, but do so to a much lower
extent than traditional fillings.
Another type of inlay and onlay - direct inlays and onlays -
follow the same processes and procedures as the indirect,
the difference is that direct inlays and onlays are made in
the dental office and can be placed in one visit. The type
of inlay or onlay used depends on how much sound tooth
structure remains and consideration of any cosmetic
concerns.
What's a Temporary Filling and Why Would I Need One?
Temporary fillings are used under the following
circumstances:
1.
For fillings that
require more than one appointment – for example, before
placement of gold fillings and for certain filling
procedures (called indirect fillings) that use composite
materials
2.
Following a root canal
3.
To allow a tooth's nerve
to "settle down" if the pulp became irritated
4.
If emergency dental
treatment is needed (such as to address a toothache)
Temporary fillings are just that; they are not meant to
last. They usually fall out, fracture, or wear out within 1
month. Be sure to contact your dentist to have your
temporary filling replaced with a permanent one. If you
don't, your tooth could become infected or you could have
other complications.
Are Amalgam-Type Fillings Safe?
Over the past several years, concerns have been raised about
silver-colored fillings, otherwise called amalgams. Because
amalgams contain the toxic substance mercury, some people
think that amalgams are responsible for causing a number of
diseases, including autism, Alzheimer's disease, and
multiple sclerosis.
The American Dental Association (ADA), the FDA, and numerous
public health agencies say amalgams are safe, and that any
link between mercury-based fillings and disease is
unfounded. The causes of autism, Alzheimer's disease, and
multiple sclerosis remain unknown. Additionally, there is no
solid, scientific evidence to back up the claim that if a
person has amalgam fillings removed, he or she will be cured
of these or any other diseases.
As recently as March of 2002, the FDA reconfirmed the safety
of amalgams. Although amalgams do contain mercury, when they
are mixed with other metals, such as silver, copper, tin,
and zinc, they form a stable alloy that dentists have used
for more than 100 years to fill and preserve hundreds of
millions of decayed teeth. The National Institutes of Health
has several large-scale studies currently under way to
ultimately answer many of the questions raised about
silver-colored amalgams. Results of these studies are
expected to be released.
In addition, there has been concern over the release of a
small amount of mercury vapor from these fillings, but
according to the ADA, there is no scientific evidence that
this small amount results in adverse health effects.
How Should I Care for My Teeth With Fillings?
To maintain your fillings, you should follow good oral
hygiene practices – visiting your dentist regularly for
cleanings, brushing with a fluoride-containing toothpaste,
and flossing at least once daily. If your dentist suspects
that a filling might be cracked or is "leaking" (when the
sides of the filling don't fit tightly against the tooth,
this allows debris and saliva to seep down between the
filling and the tooth, which can lead to decay), he or she
will take
X-rays to assess the situation. If your tooth is
extremely sensitive, if you feel a sharp edge, if you notice
a crack in the filling, or if a piece of the filling is
missing, call your dentist for an appointment.
Problems With Dental Fillings
Pain and Sensitivity
Tooth sensitivity following placement of a filling is fairly
common. A tooth may be sensitive to pressure, air, sweet
foods, or temperature. Usually, the sensitivity resolves on
its own within a few weeks. During this time, avoid those
things that are causing the sensitivity. Pain relievers are
generally not required.
Contact your dentist if the sensitivity does not subside
within 2 to 4 weeks or if your tooth is extremely sensitive.
He or she may recommend you use a desensitizing toothpaste,
may apply a desensitizing agent to the tooth, or possibly
suggest a root canal procedure.
Pain around the fillings can also occur. If you experience
pain when you bite, the filling is interfering with your
bite. You will need to return to your dentist and have the
filling reshaped. If you experience pain when your teeth
touch, the pain The pain is likely caused by the touching of
two different metal surfaces (for example, the silver
amalgam in a newly filled tooth and a gold crown on another
tooth with which it touches). This pain should resolve on
its own within a short period of time.
If the decay was very deep to the pulp of the tooth, you may
experience a "toothache-type" pain. This "toothache"
response may indicate this tissue is no longer healthy. If
this is the case, "root canal" treatment will be required.
Sometimes people experience what is known as referred pain
-- pain or sensitivity in other teeth besides the one that
received the filling. With this particular pain, there is
likely nothing wrong with your teeth. The filled tooth is
simply passing along "pain signals" it's receiving to other
teeth. This pain should decrease on its own over 1 to 2
weeks.
Allergies
Allergic reactions to silver fillings are rare. Fewer than
100 cases have ever been reported, according to the ADA. In
these rare circumstances, mercury or one of the metals used
in an amalgam restoration is thought to trigger the allergic
response. Symptoms of amalgam allergy are similar to those
experienced in a typical skin allergy and include skin
rashes and itching. Patients who suffer amalgam allergies
typically have a medical or family history of allergies to
metals. Once an allergy is confirmed, another restorative
material can be used.
Deteriorating Fillings
Constant pressure from chewing, grinding or clenching can
cause dental fillings to wear away, chip or crack. Although
you may not be able to tell that your filling is wearing
down, your dentist can identify weaknesses in your
restorations during a regular check-up.
If the seal between the tooth enamel and the filling breaks
down, food particles and decay-causing bacteria can work
their way under the filling. You then run the risk of
developing additional decay in that tooth. Decay that is
left untreated can progress to infect the dental pulp and
may cause an
abscessed tooth.
If the filling is large or the recurrent decay is extensive,
there may not be enough tooth structure remaining to support
a replacement filling. In these cases, your dentist may need
to replace the filling with a crown.
New fillings that fall out are probably the result of
improper cavity preparation, contamination of the
preparation prior to placement of the restoration or a
fracture of the restoration from bite or chewing trauma.
Older restorations will generally be lost due to decay or
fracturing of the remaining tooth.
-back to top-
Recontouring Teeth
Recontouring or reshaping the teeth (also called
odontoplasty, enameloplasty, stripping or slenderizing) is a
procedure in which small amounts of tooth enamel are removed
to change a tooth's length, shape or surface. The procedure
is usually done to improve appearance by creating more
harmony or balance in the look of the smile.
Recontouring is the most conservative cosmetic treatment. It
is a quick and painless procedure whose results can be seen
immediately.
Who Should Consider Recontoruing
Recontouring is an effective method to correct minor
imperfections, such as:
1.
Fixing small chips
2.
Smoothing out bulges or
pits in a tooth's enamel
3.
Adjusting slight
irregular tooth shapes caused by too many or uneven teeth
4.
Adjusting the length of
the canines (the pointed teeth on the side of your mouth)
Recontouring can also improve overall dental health by
removing crevices or overlaps between teeth in which plaque
or tartar can accumulate.
Recontouring is not recommended if your teeth have
substantial imperfections, such as a substantial chip or
deep fracture. Recontouring is not a substitute for
veneers or
bonding, however, it is often used in combination with
these procedures.
Talk to your doctor to see if recontouring is right for you.
What Does Recontouring Involve?
Initial exam
To determine if you are an appropriate candidate for
recontouring, your dentist may first take an
X-ray of your teeth to determine the size and location
of the tooth's pulp (the center of the tooth that contains
the nerves and blood vessels). If the tooth's enamel layer
is too thin or if the pulp lies too close to the tooth's
surface, recontouring may not be possible and another
procedure – such as bonding or veneers – might need to be
considered instead.
The procedure
At your appointment, your dentist will use a sanding disc or
a fine diamond bur to remove small amounts of tooth enamel.
To reach imperfections between teeth, your dentist may use a
strip of sandpaper to shape and smooth the sides. Once
shaped, your dentist will finish the process by polishing
your tooth or teeth.
Since recontouring does not affect the pulp of the tooth, an
anesthetic is not usually needed.
Follow up
A recontouring procedure that is not combined with other
cosmetic procedures (such as bonding or veneer placement)
does not require special care or follow up.
What Risks Are Associated With Teeth Recontouring?
Because enamel cannot be replaced, this procedure should be
carefully considered. The only risk involves the thickness
of the enamel. If the enamel of the tooth that has been
recontoured becomes too thin or exposes the dentin layer
(the layer beneath the enamel), tooth sensitivity to heat,
cold, and sweets could result.
Laugh all you want
A woman and her husband interrupted their vacation to go to
the dentist. "I want a tooth pulled, and I don't want
Novacaine because I'm in a big hurry," the woman said. "Just
extract the tooth as quickly as possible, and we'll be on
our way." The dentist was quite impressed. "You're certainly
a courageous woman," he said. "Which tooth is it?" The woman
turned to her husband and said, "Show him your tooth, dear."
A woman goes to the dentist. When he bows to begin to work,
she grabs his balls. The dentist says,
"Madam, I believe you have taken my private zone."
The woman answers, "Yes. We're going to be careful not to
hurt each other, aren't we."
Dentists are incapable of asking questions that require a
simple yes or no answer.
Did you hear about the dentist who planted a garden?...
A month later he was picking his teeth
What does the dentist of the year get?...A little plaque
What game did the dentist play when she was a child?...Caps
and robbers
What does a dentist do on a roller coaster?...He braces
himself
What did the dentist see at the North Pole?...A molar bear
What was the dentist doing in Panama?...Looking for the Root
Canal
Where does the dentist get his gas?...At the filling station
Why didn't the dentist ask his secretary out?...He was
already taking out a tooth
What did the dentist say to the computer?...This won't hurt
a byte
Mother: Has your tooth stopped hurting yet?...Son: I don't
know. The dentist kept it
What did the tooth say to the departing dentist?...Fill me
in when you get back
Anyone know the six most frightening words in the world ???
"The Dentist will see you now."
"Open wider." requested the dentist, as he began his
examination of the patient. "Good God !" he said startled.
"You've got the biggest cavity I've ever seen - the biggest
cavity I've ever seen." "OK Doc !" replied the patient. "I'm
scared enough without you saying something like that twice."
"I didn't !" said the dentist. "That was the echo."
While I was waiting to see the dentist, a woman came out of
his inner office smiling. Nodding to me, she said, "Thank
goodness my work is completed. I'm so glad to have found a
painless dentist and one who's so gentle and understanding
too." When seated in the dentist chair, I related the
incident to the doctor. He laughed and explained, "Oh, that
was just my Mother."
"I came in to make an appointment with the dentist." said
the man to the receptionist." "I'm sorry sir." she replied.
"He's out right now, but..." "Thank you." interrupted the
obviously nervous prospective patient. "When will he be out
again ?"
A patient sits in the dental chair with severely fractured
front teeth. After discussing how they will be restored and
what the fee would be the patient says, " Before we begin,
Doc, I gotta know: Will I be able to play the trumpet when
you are finished? "
The dentist replies " Sure you will! "
The patient replies " Great, I couldn't play a note before!
"
Patient: Doctor, I am very nervous. You know, this is my
first extraction.
Young dentist: Don’t worry, it's my first extraction too.
Dentist: There goes the only woman I ever loved.
Assistant: Why don't you marry her?
Dentist: I can't afford to. She's my best patient.
Dentist: Just let me finish and you will be another man
after these cosmetic procedures.
Patient: Okay doc, but don't forget to send your bill to the
other man.
When a new dentist set up in a small town he quickly
acquired a reputation of being the latest kind of "Painless"
dentist. But a local lad quickly disputed this. "He's a fake
! " he told his mates. "He's not painless at all. When he
stuck his finger in my mouth I bit him - and he yelled like
anyone else."
Dentist to parsimonious patient "No, we give no discount for
empty spaces when cleaning and polishing teeth Mrs. Borde!"
Young Charlie to dentist's sexy chariside assistant "Aha !
Are you the lady orthodontist ?".
The lady replied "No, but I'll straighten anyone's teeth "
A guy and a girl met at a bar. They started getting along
really well and they decide to go to the girl's place for a
drink.
A few drinks later, the guy took off his shirt and washed
his hands.
He then took off his socks and washed his hands.
The girl looked at him and said, "You must be a dentist!"
Flabbergasted, the guy responded, "Why yes. That's amazing.
How did you determine that?"
The woman replied, "Easy... you keep washing your hands."
Well, one thing led to another, and they migrated to the
bed. Things became more and more passionate and... (*snip*)
After their passionate deed was done the woman remarked,
"You must be a GREAT dentist!"
The guy was very surprised, and said 'Yes! Yes! I sure am a
great dentist... You amaze me! And how did you know THAT, my
dear?
' His lover said, "That's easy. I didn't feel a thing."
Stammering Charlie to dentist's sexy secretary: "I have an
appointment to get my morals - er molars checked."
Young lady to father "Daddy, when I grow up shall I become a
heart-doctor or a tooth-doctor "
"Dentist" "Why father ?" "We have only one heart, but 32
teeth!"
Patient to Dentist: "How much to get my teeth straightened?"
"Twenty thousand bucks" Patient heads for the door.
Dentist to patient: "Where are you going?"
"To a plastic surgeon to get my mouth bent."
A particularly voluptuous lady entered the dentists surgery
in an obvious state of agitation. The dentist tried to calm
her down assuring her that he would do nothing to hurt her.
She sat down in the chair and started fidgeting nervously as
the dentist began sterilizing all the required equipment.
When he asked her to open her mouth, she screamed.
So he tried to calm her down again even though he was losing
patience.
Almost immediately the lady threw a hysterical fit, then
realizing that the dentist had begun glaring at her, she
said, "Oh doctor, I'm so nervous. I hate dentists. Why, I
think I'd rather have a baby than have a tooth drilled."
Replied the dentist " Well Miss, better make up your mind
fast so that I can accordingly adjust the chair."
A dinner speaker was in such a hurry to get to the hotel
that when he arrived and sat down at the head table, he
suddenly realized that he had forgotten to get his false
teeth. Turning to the man next to him he said, "I forgot my
teeth." The man said, "No problem." With that he reached
into his pocket and pulled out a pair of false teeth. "Try
these," he said. The speaker tried them. "Too loose," he
said. The man then said, "I have another pair...try these."
The speaker tried them and responded, "Too tight." The man
was not taken back at all. He then said, "I have one more
pair...try them." The speaker said, "They fit perfectly."
With that he ate his meal and gave his address. After the
dinner meeting was over, the speaker went over to thank the
man who had helped him. "I want to thank you for coming to
my aid. Where is your office? I've been looking for a good
dentist." The man replied, "I'm not a dentist. I'm the local
undertaker."
A guy goes to visit his grandmother and he brings his friend
with him. While he's talking to his grandmother, his friend
starts eating the peanuts on the coffee table, and finishes
them off.
As they're leaving, his friend says to his grandmother,
"Thanks for the peanuts." She says, "Yeah, since I lost my
dentures I can only suck the chocolate off 'em."
Patient: How much to have this tooth pulled?
Dentist: With pain $200 and without pain $100.
Patient: Well, without pain it's cheaper. Pull it WITHOUT
pain.
Without anesthesia neither anything, the dentist begins to
extract the tooth, when the patient outcry: Aaaahhhhhhhh
!!!!!
Hey, WITH pain it costs $200 !!!, replies the dentist.
Patient: How much to have this tooth pulled?
Dentist: $200
Patient: $200 for just a few minutes work???
Dentist: I can extract it very slowly, if you like.
What's worse than having your doctor tell you that you have
VD?
Having your dentist tell you.
Dentist says to the patient: Could you help me? Could you
give out a few of your loudest, most painful screams?
Patient: Why? Doc, it isn't all that bad this time.
Dentist: There are so many people in the waiting room right
now and I don't want to miss the 4 o'clock cricket day-night
game.
Patient: Doctor, I have yellow teeth, what do I do?
Dentist: Wear a brown tie...
A patient asked the dentist, if it wasn’t nasty to be all
the day with the hands in someone's mouth.
The dentist answered "I just think of it as having my hands
in their wallet."
|
