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Composite Fillings

31
Dental Suction Dentists Suctioning
©Racorn/Shutterstock.com

A reader named Jeanny recently emailed me the following questions:

Why is it necessary to suction after local anesthetic?
Why is it necessary to suction when doing a filling?
Can blood be involved in both of the above procedures?

I’ll answer the first two questions later on in this article.  In response to the last question, blood can be involved when giving anesthetic and doing fillings, but many times it is not.

First, let’s talk about the two main types of suctions that dentists routinely use.

The Two Main Types of Dental Suctions

Dental SuctionThere are two main types of dental suctions that dentists use: the saliva ejector and the high volume suction.

The saliva ejector does exactly what its name implies; it sucks saliva out of the mouth.  This is the suction pictured at the upper right of this article.  Many times dentists will have the patient close down on this suction so that it can suction away any remaining saliva in the patient’s mouth.

The other main type of dental suction that we use is the high volume suction.  This suction is so strong that the dental assistant simply holds it close to where the dentist is working and it will suck away any nearby debris, much like a strong vacuum cleaner can suck away crumbs without actually touching them.

You can see the high volume dental suction pictured below – try to pardon the lack of glove use by that dentist!

Dental Suction - High Volume

Why Dentists Use a Dental Suction

Now that the introductions are over, let’s talk about some of the different reasons why dentists will use a suction.

For Patient Comfort

Keeping the patient comfortable is a high priority.  In response to Jeanny’s question, we suction after giving anesthetic because the anesthetic has a bitter taste, and most patients prefer to rinse out with water and use the saliva ejector.  Also, if the anesthetic sits in the back of your mouth for too long, it may start to slightly numb the back of your mouth and could give the patient a gagging sensation.

We will also use the suction to make sure that you don’t get too much water in your mouth while we are working.

To Clean Away Any Excess Dental Materials

When a dental hygienist cleans and polishes your teeth, you can get a lot of cleaning paste in your mouth.  We use the suction to help clean all of that away.  Also, when dentists are do amalgam fillings, pieces of the soft amalgam can sometimes fall away from the tooth surface.  We use the suction to help whisk them away.

To Keep The Tooth Dry

During some procedures, such as white fillings, it is important that the tooth stay clean and dry.  The suction helps keep the tooth dry by sucking away any saliva, blood, and water that may have accumulated around the tooth.  If the cavity went below the gum-line, then it’s pretty likely that the gums will bleed during the filling.

To Help the Dentist See

As I mentioned in a previous article about the dental drill, the drill that dentists use to do fillings sprays out a lot of water to keep the tooth cool and clean.  Unfortunately, that water can quickly build up in the mouth and get on the dental mirror.  In order to ensure that the dentist can see the tooth while working on it, it’s necessary to use the high volume suction to suck away all of that debris.

Those are the four main reasons that I came up with as to why dentists use the dental suction.  In conclusion, let’s take a look at a question that I asked my dental hygienist as a child.

Where Does The Stuff Go After It’s Sucked Away?

I remember sitting in the dental chair in Dr. Arnold’s office as a child wondering what happens to all of the stuff that gets sucked down the suction.  Maybe I was hoping that the tooth fairy would somehow be able to save the bad part of my baby tooth that the dentist removed and put it back together once my tooth fell out.  After gathering up the courage to ask, I think I was slightly disappointed by the answer.

After your saliva, tooth debris, etc. gets sucked away, it travels through the suction line to a vacuum separator that will separate out any solids.  After that, your spit makes a journey down the pipes and into the sewer system.

It is now recommended that dentists install amalgam separators in their suction lines to separate out any dental amalgam and keep it from getting into the public sewer systems.

Questions?

Do you have any questions about why dentists use suction?  Leave a comment below and I’ll try to get back to you.  Thanks for reading!

10
Dental Fillings Fix Chipped Teeth
©Steven Frame/Shutterstock.com

Many people wonder why their dentist tells them that they need a filling.  Although having a cavity is the #1 reason we do fillings, there are also many other reasons that people get fillings.

Why You Need a Filling

1 – Cavities

Cavities remain the number one reason that dentists give patients fillings.  Even so, not all cavities need fillings.  Sometimes very small cavities can be “watched.”  When this happens, the dentist monitors the cavity and if it appears to be repairing itself, you won’t need to get a filling.

I’d like to add a word of caution: Only leave a cavity unfilled if your dentist has recommended that your cavity should be watched.  Putting off necessary dental work can complicate your dental health and increase your costs.

If you do have small cavities that your dentist is keeping an eye on, check out these 12 weapons of plaque destruction to see how you can help your cavity heal.

2 – Tooth Fracture

Many times, fractured teeth can be repaired with white composite filling material.  You can take a look at a tooth that I repaired with a white composite filling before I started working with real patients in dental school.

Prevent your teeth from fracturing by wearing a mouth guard during these 16 activities.

3 – A Slow Loss of Tooth Structure

When you fracture your tooth, you lose a lot of tooth structure quickly.  There are other ways that you can lose tooth structure more slowly, such as abrasion, abfraction, erosion, and attrition.  You can learn about those in the article about the four ways you wear away tooth structure.

The best way to prevent this type of tooth loss is by avoiding acidic drinks and acidic candy, not grinding your teeth, and not using your teeth as tools.

4 – Tooth Discoloration

Do I Need a Filling?Another reason that dentists do fillings is to cover up discolored teeth.  Teeth can be discolored for a variety of reasons, such as staining from antibiotics and dental fluorosis.

5 – Replacing Old Fillings

Old fillings may need to be replaced.  Over time, white fillings can discolor and the bond between the filling and the tooth can break down.  Silver fillings may also fracture after many years of service.  One of the first fillings I did in dental school (unbeknownst to my patient!) was the replacement of a silver amalgam filling that had fractured.

Questions About Fillings?

Do you have any questions about why dentists do fillings or why you need a filling?  Go ahead and leave a comment in the comments section below.  Thanks for reading!

64
Filling Fell Out of Front Tooth
©MicroWorks/Shutterstock.com

I got an email earlier this week from a reader named Trish.  She asked the following:

“What will happen if the filling comes out of your tooth, and you don’t have it replaced, other than pain trying to eat?”

Lost Filling from ToothBefore I answer that question, let’s take a look at why fillings fall out.  A  filling normally doesn’t fall out of your tooth just for fun – it usually has a pretty good reason!  Fillings can come out because of decay around the filling, because the filling cracked, or because it wasn’t put in properly.

Basically, if your filling fell out, chances are that there was something wrong and you should get your tooth looked at by a dentist.

If the filling came out and it was recently put in, your dentist might give you a break and put a new filling in.  If it was an old filling and it just came out, you may have a cavity under the filling.

Regardless of why the filling fell out, it’s important to replace it.  To answer Trish’s question, here’s a list of eight things that could happen to your tooth if your filling fell out and you don’t have it replaced.

Eight Things that Can Happen If You Don’t Replace a Lost Filling

1 – Sensitivity

When you lose a filling, it exposes the sensitive dentin (the inner hard layer of your tooth) to your mouth.  Depending on how close the filling was to the pulp of your tooth, it could hurt all the time or only when you eat, as Trish mentioned above.  Either way, the pain means that there’s something wrong that needs to get taken care of!

Not sure what dentin and pulp are?  Check out my article on the anatomy of a tooth to find out!

2 – Root Canal

The pulp inside of your tooth could get irritated, causing pulpitis.  The textbook Clinical Endodontics by Leif Tronstad states, “Factors leading to an infectious pulpitis are conditions that contribute to the exposure of the dentin and dentinal tubules to the oral environment.”

3 – It’s Harder to Clean

Teeth are hard to clean when they have a big gaping hole in them.  Even if you can get the toothbrush bristles down to the bottom of the hole where the filling was, chances are that you won’t be able to easily clean out the entire hole where the filling was located.

4 – Bad Breath

When you eat food, the natural contours of the teeth allow you to efficiently chew and grind the food into little, easily-digested pieces.  When you have a hole in your tooth and you chew, you push the food down into the hole.  Since teeth with lost fillings are more difficult to clean (see #3), that food could be sitting in there for quite some time and cause your breath to be less than pleasant to those around you!  Even if you do have bad breath, people probably aren’t going to tell you.

5 – Tooth Decay

Because the tooth is harder to clean and you’re buyonlinegenericmeds.com grinding food into it every time you eat, it’s much easier for you to get a cavity in that tooth.  If the reason that you lost the filling was because you had a cavity under it, the cavity will probably get bigger the longer treatment is put off.

6 – The Tooth Could Crack or Break

If the tooth goes for a long time with a lost filling, it may develop a cavity, which can subsequently weaken the tooth structure and cause the tooth to break or crack.  Without the filling, the tooth will also experience different forces that end up causing it to break.

7 – Difficulty Repairing Tooth With a White Filling

When you lose a filling and expose the dentin to your saliva, the dentin reacts by trying to fight off the bacteria.  The little tubules inside the dentin eventually close off to try to protect the nerve of the tooth.  When this happens, it is known as sclerotic dentin.  A problem with sclerotic dentin is that it is much harder to get a white filling to bond to sclerotic dentin than it is to get a white filling to bond to regular dentin.

8 – The Tooth May Need to Be Extracted

If you wait too long, the tooth may break and become so badly decayed that it is what dentists like to call unrestorable.  That means that just like Humpty Dumpty, nobody will be able to put that tooth back together again, and it will have to come out.

What Are Your Options When a Filling Falls Out?

I assume that Trish wants to know what would happen because she either has a fear of the dentist or can’t afford to get a new filling right now.

If fear is keeping you away from the dentist, take a look at this article about reasons people are scared of the dentist, and then figure out your fear and try to overcome it.  There is help available online at sites like Dental Fear Central.

If cost is keeping you away from the dentist, then you can call your dentist and ask how much a temporary filling would cost.  A temporary filling would allow you to get the tooth filled fairly inexpensively until you can save up for a permanent filling.  An even more temporary solution is to try some temporary filling materials until you can see your dentist.  I talk about a few different brands in my article about what you should do when you lose a filling from your tooth.

Conclusion

If you have a filling come out, it’s necessary to get the filling replaced as soon as possible to ensure the long-term health of your tooth.  If you can’t afford it, there are temporary solutions available that you dentist may discuss with you.

Do you have any questions, comments, or concerns about losing a filling from your tooth?  Go ahead and leave a comment in the comments section below and I’ll get back to you.  Thanks for reading!

17
What do White and Silver Fillings Look Like?
©Lighthunter/Shutterstock.com

At my dental school, we recommend silver fillings for the back teeth since silver fillings last longer than white fillings.  However, many people are hesitant to get silver fillings because they stand out, and they don’t want other people to notice them.

If you are also wondering what the difference in appearance between white and silver fillings looks like, then this article is for you!

What a Silver Dental Filling Looks Like

In the picture below, you can see see four silver fillings.  Two are on the left on the top of two teeth.  Two silver fillings are also present on the right: one on the top of the tooth and one in the pit on the side of the tooth.

Silver Dental Fillings

As you can see, silver fillings are noticeable.  However, during your everyday routine, people aren’t likely to see your back teeth.  Because of this, it is usually a good idea to get silver fillings on your back teeth because they are stronger and are more resistant to getting new cavities around them than the newer white fillings.

Another thing you may notice in the above picture is that this person’s lower front teeth are worn down.  You can learn more about the four ways we wear down our teeth here.

What a White Dental Filling Looks Like

White fillings are matched to your tooth’s color by your dentist.  Thus they actually vary from white to gray to even yellowish shades.

As you can see below, the man has numerous white fillings on his back teeth (this is a view of his upper teeth from below). This picture is a good example of how picking the wrong shade of white can make a filling stand out even more.  Some of the fillings are easy to see because they are not matched very well to the shade of the tooth.

White Composite Dental Fillings

I have the arrow pointing at one of the more inconspicuous white fillings where the shade of filling material more closely resembles the tooth’s natural shade.  If you look closely you can see that in the middle of that tooth there is a big white filling.

Conclusion

As you can see, white fillings are definitely less noticeable than silver fillings.  They can be more noticeable if their shade doesn’t exactly match the shade of your tooth.

At my dental school, we generally recommend white fillings in the front teeth and silver fillings in the back teeth.  That way, you can have the strength of the silver fillings in the back of your mouth where there is a lot of force every time you chew, and the white fillings in the front teeth so that you have an aesthetically-pleasing smile.

If you have any questions or comments about white or silver fillings, go ahead and write them below in the comments section.  Thanks for reading!

84
Is Blue Dental Light Harmful?
©Nejron Photo/Shutterstock.com

Recently, Christopher, a thirteen-year-old reader from Michigan wanted to know if the blue light that dentists use to cure fillings and sealants can hurt your teeth when used for a long period of time.

Blue Dental Curing LightHe told me that when he was at the dentist’s office getting sealants placed on his back teeth, they shined a light in his mouth.  After the sealants were put on, the dental assistant hardened (cured) the sealants by shining a blue light on them.  He noticed that after the blue light had shut off automatically, the dental assistant would press the button to get it to turn on again and continue curing the sealants.

Christopher wanted to know if the blue light can burn, irradiate or otherwise hurt someone’s teeth when used longer than it should be.

About the Blue Dental Curing Light

Before I answer Christopher’s question, here’s a little background information for those who aren’t familiar with the blue dental curing light.  When a dentist puts a white filling (or a sealant, or a light-cured filling material) in your mouth, it is in a liquid or semi-solid state so that the dentist can put it exactly where it needs to go and shape it correctly.  In order for the material to harden so that it can withstand the forces of chewing, it needs to be cured.

Curing the material is accomplished by shining a blue light on it.  Not just any blue light will do.  It has to be a certain shade of blue.

The blue dental curing light emits light at a wavelength of around 450 to 490 nm, a blue light.  You can read more about the visible light spectrum here.

The very first light-activated filling materials used ultraviolet light.  Fortunately, today dentists only use materials that are cured by visible light as the use of UV cured materials has pretty much died out due to the dangers posed by ultraviolet light.

Can the Blue Dental Curing Light Hurt Your Teeth?

Blue Dental Curing LightFortunately, the blue dental curing light normally won’t hurt your teeth.  Most of the modern curing lights use a blue LED light for curing.  In some of the old models, the tip could get really hot.  This heat could cause damage to the dental pulp — the innermost tissue composed of nerves and blood vessels inside of your tooth.

A good test to see if the curing light is too hot is to hold your finger 2-3 mm away from the curing light for 20 seconds.  If your finger gets too hot, then the curing light could do damage to the teeth.

The Blue Dental Curing Light Can Hurt Your Eyes!

One of the major dangers of the blue dental curing light is that it can hurt your eyes!  When we were learning how to do white fillings, our professors always advised us to never look at the blue light.

Here’s what the book Craig’s Restorative Dental Materials says about this:

Although there is minimal potential for radiation damage to surrounding soft tissue inadvertently exposed to visible light, caution should be used to prevent retinal damage to the eyes.  Because of the high intensity of the light, the operator should not look directly at the tip or the reflected light from the teeth.

The orange filter that you can see on the curing light above filters out the visible light, allowing the dentist or assistant to see what they are doing without looking directly at the light.

Conclusion

To answer Christopher’s question, there could be some harm in holding the light on your teeth for too long if it heated up your teeth.  Since you probably weren’t numb when the sealants were placed, you would have felt pain if your teeth had gotten too hot.  Other than that, as long as they didn’t shine the light in your eyes, no damage was done, since they used visible light rather than ultraviolet light.

The dental assistant probably just wanted to make sure that the sealant was hardened all the way, and didn’t want to leave any room for doubt.

Do you have any questions or comments about the blue dental curing light used in dentistry?  If so, feel free to leave them in the comments section below.  Thanks for reading!

By the way, I really enjoyed researching for this article.  If you have any dental questions, no matter how odd you think they are, feel free to contact me and I’ll either answer your question via email or in an article here at Oral Answers.

12
Chipped Tooth Fixed Filling
©MicroWorks/Shutterstock.com

Breaking one of your front teeth is something that nobody wants to go through, but unfortunately it is a common occurrence.  Luckily, modern dentistry is able to make these teeth look normal after a tooth fracture has occurred.  Chipped teeth can be repaired with crowns, veneers, and ordinary white composite fillings.

Today in my pre-clinical lab, we fractured a tooth on purpose and then repaired it.  I took some pictures of the finished result so you can see how it looks.  My professor had us mount some natural teeth in a yellow plaster.  When we got to the lab, he had us cut a few millimeters of tooth structure off of an incisor to simulate a front tooth that had been chipped.  Front teeth can be chipped when someone trips and hits their mouth on a hard object, during fights, or for many other reasons.

I worked on the middle tooth in the photos below.

Composite Filling Dry
Above is the finished tooth in the middle. When it’s dry, it’s easy to see the difference between the filling and the natural tooth. In the bottom photo, I drew a red line showing where the natural tooth ends and the filling begins.

In the bottom photo, you can see a red line.  Everything below that red line is the composite filling, and everything above it is natural tooth structure.

In both of these photos, the tooth is dry, so it is easier to differentiate between the white filling and the natural tooth structure.  The composite filling is also easier to differentiate in this example because we only have a couple of shades of composite available to us in the pre-clinic lab.

I took a second photo of the filling after getting the teeth wet.  This better simulates the real world since our teeth live in a very wet environment in the mouth.

Class IV Composite Filling Wet
Here is the finished tooth. I put some water on it to simulate saliva. When the filling is wet (as it is in the mouth), it appears more aesthetically pleasing.

You will notice that it is a lot harder to see the difference between the natural tooth structure and the composite filling when the tooth is wet.

When you compare it to the tooth on the right, you can see that the colors match pretty well; it is more yellow at the top, and gets whiter as you go down the tooth.

If I’d have used the right shade of composite (and if I had a few more years of experience!), it would be nearly impossible for the untrained eye to detect the difference between the composite filling and the natural tooth structure.

Have you ever chipped a tooth?  Did you get it repaired?  If you have any comments or questions, please leave them below in the comments section below.

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