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Fillings

Colored Dental Tooth Fillings
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“Your child has a cavity.”

Not many parents want to hear those words, especially if their child has dental anxiety.

Last summer, I saw a three year old child who needed to have a filling on one of his upper molars.

Green Colored FillingThe only reason he sat still in the chair long enough for us to remove the decay and get a filling put in was because we told him we were going to give him a yellow colored filling.

He loved tractors, and wanted it to be yellow like his toy tractor. When he was all done, we took a picture of it and gave it to him so he could show his friends and family.

I’ve found that giving children a colored filling (along with some other things we do to make the comfortable), helps them to sit in the dental chair and get their needed dental work completed.

Find out why baby teeth need to have fillings if they just fall out.

Colored Fillings

Pink Colored FillingColored fillings are made of the same composite materials as tooth-colored fillings, they simply have more exciting coloring added to them.

At our office, we have five colors to choose from: blue, green, yellow, orange, and pink.

To the right, you can see how the pink filling looks on a tooth – it’s what most of the girls end up choosing.  That filling, as well as the green one above, was placed to fill in a cavity that formed between the teeth, which is one of the more common places you can get a cavity.

While we can do a colored filling to repair most cavities in baby teeth, nobody has had us do one on a front tooth yet!

8
Dental Fillings Fix Chipped Teeth
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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!

1
No Dental Work is as Good as Your Natural Teeth
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Pretend that you’re in your car driving on a freshly-paved road.  Doesn’t it feel nice as your tires effortlessly glide on the smooth, even surface?

A Repaired Pothole Isn't as Good as the Original RoadFlash forward a few years and imagine driving down the same road.  Due to the recent bad winters, the road is now lined with potholes that have been repaired.

When you drive over that filled in pothole, does it feel as good as the road did when it was new?  Probably not.

Dental Work Isn’t As Good As Your Natural Teeth

When you get a cavity, a dentist is able to remove the decayed portion of your tooth and then replace it with a filling.  However, even the best dentist in the world (is there one?!) can’t make a filling that is the same quality as your natural tooth used to be.  This is the reason that many people can keep their teeth for their whole lifetime, yet many fillings last less than ten years.

Teeth last longer than fillings.  One of the best things you can do for your teeth is to avoid needing dental work by keeping your teeth healthy.

To learn more about keeping your teeth healthy, read about the Top 12 Weapons of Plaque Destruction and What Every Human Needs to Know About Plaque.

Do you have any questions or comments about how you can keep your teeth healthy to avoid losing your natural tooth structure? I’d love to hear them in the comments section below. Thanks for reading!

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High Dental Filling Problems
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Many people wonder what they should do when they come home from the dentist after getting a filling and notice that their bite isn’t quite right. If you end up having problems with a filling, it’s always best to check back with your dentist to see if you have a high filling.

If your filling is high, the dentist can simply smooth it down. High Filling ProblemsSmoothing down a filling is usually a quick procedure and doesn’t require any injections.

Here are seven problems that a high filling can cause.

Problems That a High Filling Can Cause

Keep in mind that some people with a high filling may experience many of these problems while others might not go through any of these difficulties.

1 – Biting Pain

The ligament may become inflamed around the tooth, causing the tooth to hurt when you bite down on it.  This may affect the tooth with the high filling, but it can also affect other teeth if the high filling has thrown off your bite.

2 – Aching and Sensitivity

The tooth may develop pulpitis.  It could become sensitive to hot and cold or it may simply ache.

Find out more about pulpitis here.

3 – Excessive Tooth Wear

The tooth can wear down rapidly.  Also, other teeth may wear down if the high filling causes you to shift your bite slightly.

Learn about the four ways that your teeth get worn down.

4 – Loose Teeth

The tooth can become loose.  If the high filling causes your jaw to shift, other teeth can become loose if they are subjected to high forces that didn’t exist before the high filling.

5 – Muscle Pain

The muscles in your jaw can ache because your bite has changed and the muscles are forced to adapt after so many years of moving your jaw in it’s natural bite.  This can make it difficult to open your mouth and/or chew your food.

6 – TMJ Problems

Problems with your temporomandibular joint (TMJ) can occur due to the abnormal movement that now takes place due to the high filling.

7 – Headaches and Stress

The muscle pain coupled with the TMJ pain can bring on headaches and increased stress in your life.

Don’t Ignore a High Filling

If you think that you have a high filling and you are in pain, it’s a good idea to get it checked out before a small problem turns into a bigger one.

If you have any questions, comments, or personal experiences, please share them below!

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Contents of Silver Amalgam Fillings
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Have you ever wondered what an amalgam filling looks like inside?

Dental Amalgam CapsuleMany people question how a metal can be soft enough to be shaped into a tooth yet hard enough to endure the force of chewing and other abuse that occurs during its ten or more years in your mouth.

Other people are curious about the amount of mercury contained in an amalgam filling…so let’s get some answers!

I opened up an amalgam capsule (pictured to the left) and took a picture of what I found inside:

Amalgam Filling Contents

Aside from the capsule body, I found three main components:

1 – Mercury Disc – Amalgam fillings are made up of about 50% mercury, and 50% metal powder.  The mercury is sealed away in a plastic disc so that it doesn’t evaporate and contaminate the environment.  The mercury disc breaks open when the amalgam capsule gets mixed.

2 – Metal Powder – The metal powder is made up of varying metals.  In the Dispersalloy brand of dental amalgam (a widely used brand), the metal powder contains about:

  • 69% Silver
  • 18% Tin
  • 12% Copper and
  • 1% Zinc

3 – Pestle – The pestle is simply a plastic rod.  When the amalgam is mixed and vibrated quickly back and forth, the pestle breaks open the sealed mercury disc and helps to thoroughly mix the mercury with the metal powder to form a soft metallic mixture.  While the amalgam is still soft, the dentist uses it to fill your cavities.  The amalgam begins to harden after a few minutes and eventually hardens into a filling that can withstand lots of force.

Conclusion

As you can see, the formulation of amalgam is pretty simple: mercury and metal powder.  Fortunately, modern amalgam capsules come pre-measured so that dentists don’t have to worry about mixing up mercury with other metals by hand.

Do you have any questions about the contents of amalgam fillings?  I’d love to hear your thoughts int he comments section below.  Thanks for reading!

43
Cavities In Baby Teeth: Do They Need Fillings?
©Ilya Andriyanov/Shutterstock.com

A lot of parents wonder if it’s really necessary to have their children get fillings in their baby teeth.  Since baby teeth just end up falling out, why not let the cavity fall out with the baby tooth rather than paying to have a dentist remove the cavity?

Many people assume that baby teeth aren’t that important since they quickly get replaced by permanent adult teeth as a child grows.

Fillings Baby TeethEven though they do end up falling out, baby teeth are important!  When they’re healthy, they can help children eat healthy foods.  When baby teeth get infected, they can damage the permanent teeth developing under them and in severe cases they can cause brain infections.  If you missed my earlier article, you can read it to learn five reasons why baby teeth are important.

Now that you understand why baby teeth are important, let’s talk about whether or not baby teeth need fillings.

Should You Get Cavities in Baby Teeth Filled?

When thinking about getting cavities in baby teeth filled, there are a couple of main things to think about: How much use your child will get out of the filling and how big the cavity is.

First, let’s talk about how much use your child will get out of the filling.  The book Pediatric Dentistry by Pinkham says, “A carious primary molar in a 6-year-old is a problem; a loose carious mandibular incisor may not be if it is about to exfoliate.”

If a tooth is about to fall out (or exfoliate if you want to speak in fancy dental terms), then your child probably wouldn’t get much use out of a filling in that tooth.

The other main factor to look at is how big the cavity is.  Although dentists recommend treating cavities when they are small, sometimes a cavity can be so small that it can repair itself under the right circumstances!

In the book Paediatric Dentistry, the authors discuss the question of whether or not to treat baby teeth.  One of their points supporting not getting fillings in baby teeth says, “Remineralization can arrest and repair enamel caries. It has long been known that early, smooth surface lesions are reversible. In addition, it is now accepted that the chief mechanism whereby fluoride reduces caries is by encouraging remineralization, and that the remineralized early lesion is more resistant to caries than intact enamel.”

If the cavity is small and has just started, there is a chance that it can repair itself through the process of remineralization.

Keep in mind that this repair will probably NOT occur unless your child’s diet and oral hygiene dramatically improve!  There’s a reason that your child started to get a cavity and if nothing is done to change the habits that started the cavity, then the cavity will probably get worse.

If you don’t think you will alter your child’s diet or oral hygiene, then it’s probably a good idea to have the dentist put a filling in the baby tooth while the cavity is small so that the cavity doesn’t get bigger.

On the other hand, if the cavity is small and you are willing to work really hard at improving your child’s diet and oral hygiene, then the cavity can remineralize.  In this case, there there’s no need to get a filling in your child’s baby tooth.

Conclusion

When considering a filling in your child’s baby tooth, it is important to think about how much longer the tooth will be in the mouth and the size of the cavity.  If the tooth will be falling out soon, it may not be necessary to get a filling.  If the tooth won’t fall out for a couple of years, then it’s probably a good idea to get a filling in your child’s baby tooth.

Most dentists will be able to give you a good idea as to whether or not your child would benefit from a filling in a baby tooth or if it’s really not necessary.

Do you have any questions or comments about fillings in baby teeth?  I’d love to hear them in the comments section below. Thanks for reading!

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What do White and Silver Fillings Look Like?
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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!

1
Most Likely Places to Get a Cavity
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Imagine you are in the dental office and the dentist is showing you on a screen where in your mouth you are most likely to get cavities, much like in the picture below.

Where Cavities Occur on TeethWouldn’t that advice be invaluable?  It would probably help you know where to concentrate when you brush.

Although you’re not sitting in my dental chair, I can still tell you in general the six most common places where you’re most likely to get a cavity.

Six Common Places Where You Can Get Cavities/Dental Decay

1 – In the grooves on the chewing surface of your back teeth. There are many grooves that run in the teeth.  These are called fissures.  There are also pits.  Some molar teeth have pits on the side of them that commonly get cavities.  You can find these pits on the tongue side of your upper molars and on the cheek side of your lower molars.

2 – In between your teeth. In a normal mouth, all the teeth touch each other on each side except for the ones all the way in the back.  In the area between the teeth, it is hard to fit a toothbrush and easy for plaque to grow and create a cavity, especially if you’re not flossing daily!

3 – At the margins of fillings, crowns, bridges, and other dental work.  Sometimes the tooth/restoration interface isn’t as smooth as we’d like it to be.  This area between the restoration and the tooth is an easy place for plaque to grow.  White fillings don’t last as long as silver fillings, so if you want a long-lasting filling, ask your dentist if you can have a silver amalgam filling.

4 – On the tooth just above the gumline. This is a common place for cavities.  I have seen it a lot in people who drink lots of energy drinks and soda pop.  It is believed that acids can pool around the gumline and attack the teeth, creating a cavity.

Here’s a list of nine drinks that can dissolve your teeth if you drink them frequently!

5 – On the roots of teeth. When you have periodontal disease (commonly known as gum disease — a leading cause of tooth loss), the bone and gums that surround the teeth gradually fall down.  This exposes the root surface of the teeth.  The root surface is much softer than the hard enamel shell that encases the tops of our teeth.  It is much easier for cavities to occur on the root surface, which is why it’s important to catch periodontal disease in its initial phases and treat it.

6 – Teeth that are right next to a partial denture. It is easy for food to get trapped between a partial denture and the natural teeth.  Plus, there’s usually a metal appliance that fits around the tooth making it easy for plaque to grow.  If you have a partial denture, ask your dentist or denal hygienist for methods to help you keep your remaining teeth healthy.  They can come up with an oral hygiene program tailor-made for you.

Conclusion

Hopefully that gives you some new ideas on how you can better take care of your teeth.  Make sure you’re brushing the grooves and pits of your teeth and flossing to get between them.  If you find that when you floss around a filling, you can’t get the floss to go down or come back up from between the tooth, you should go visit your dentist so that he or she can fix the filling so you don’t get a new cavity around it.

Do you have any questions or comments about how and where cavities occur?  Type them below in the comments section.  Even if you have a story to share about your cavity, go ahead and leave it below in the comments.  Thanks for reading!

47
Rubber Dental Dam Advantages
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Have you ever gone to the dentist and had them put a big rubber blanket over your mouth?

In 1864 (nearly 150 years ago), a New York City dentist by the name of S.C. Barnum invented the rubber dam for use in dentistry.  He was looking for an easy way to isolate the particular teeth that he wanted to work on during procedures.

The rubber dam is simply a thin sheet of rubber that is clamped around the tooth or teeth that will be worked on.  There are many advantages to using a rubber dam, some of which are listed below.

9 Advantages of Dental Rubber Dams

Pink Rubber Dental Dam1 – The dentist is better able to visualize the tooth or teeth that he is repairing.  By providing a contrasting background, the rubber dam makes the tooth easier to visualize.  If the dentist can see better, chances are you’ll get a better filling.

2 – It helps keep the tooth dry.  Amalgam fillings aren’t as good if they are used in a wet tooth.  Bonding composite fillings to the tooth also doesn’t work very well if it is wet.  So rubber dams lend to the success of such procedures by keeping teeth dry.

3 – It protects the patient in several ways:

  • It prevents the patient from breathing in the debris associated with drilling teeth.
  • It protects the patient from irritating chemicals used in dentistry such as those used to disinfect a root canal or the acids used to etch teeth to prepare them to be filled with a composite resin filling
  • It protects the patient’s tongue and cheek from the dental drill

4 – It helps isolate the tooth from the bacteria in the mouth – this is especially important in a root canal treatment and when restoring very large cavities that are close to the pulp.  It is important to keep the pulp shielded away from the many bacteria that live in your mouth.

Green Rubber Dental Dam - Photo Courtesy of Produnis

5 – It can shorten the duration of a procedure. When using a rubber dam, there isn’t a tongue constantly in the way and it is easier for the dentist to drill with no other distractions in the mouth visible.  This increases the dentist’s efficiency, which means you can leave the dental office sooner!

An interesting side effect of rubber dam is that they discourage the patient from talking.  If the dentist wants to get a rubber dam on you as soon as you walk into the office, it could be a sign that you’re pretty talkative!

6 – It can calm down a patient. With the rubber dam on, it may not feel like the dentist is really inside your mouth.  It kind of adds a layer of separation between your body and the dentist.  This is helpful for patients who become anxious during procedures.

7  – It can help in the administration of nitrous oxide (this is especially true with children ) since it forces the patient to primarily breathe through their nose.

8 – It protects the dentist and dental assistants from any diseases that the patient may have. Did you know that if a dentist drills on one of your teeth for 30 seconds, the dentist is exposed to as much bacteria as he or she would be if you sneezed right in their face?  Here’s the source for that fact. For more on how dental dams prevent the spread of infection from the dental patient to others, here’s a study, another one, and yet another one.

Rubber Dental Dam Isolating Six Front Teeth

9 – Rubber dams give you a higher quality tooth restorationA study by Dr. Gordon Christsenen concluded that rubber dams allow the dentist to perform better, thus creating a higher-quality restored tooth in the end.

Why Some Dentists Don’t Use Rubber Dams

Rubber Dental Dam Clamps
Rubber dam clamps that can be used to anchor the dam around various teeth.

Some dentists think that rubber dams take too much time to place or that the patients dislike them.  To be honest, it does take some time to put a rubber dam on a patient.  You have to punch a few holes in the rubber dam for each tooth and put a clamp around the tooth to stabilize the dam.  To make sure that the clamp doesn’t fall down the patient’s throat when you put it in, you have to wrap floss around it.  Finally, you have to stretch the rubber dam around the clamp and floss it between all of the teeth that you want to be visible through the rubber dam.

At my dental school, they usually require us to put a rubber dam on our patients when we are doing fillings.  After doing this so often, it has become easy to put a rubber dam on a patient.  Plus, there is usually a period of a few minutes that the dentist has to wait for the anesthesia to begin working.  Those few minutes are the perfect opportunity to put a rubber dam on, and as I mentioned above, using a rubber dam can shorten the duration of a procedure overall.

Do You Like Rubber Dams?

Have you ever had a rubber dam?  Was it a good experience?  Some patients I’ve talked to say they like it, and others find it uncomfortable.

If you have any questions or comments about rubber dams, please leave them below in the comments section.

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Chipped Tooth Fixed Filling
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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.

Lost Filling from Tooth
©Sebastian Kaulitzki/Shutterstock.com

Earlier this week, I wrote about what you should do when a crown falls off.  Today, I will discuss what you should do when you lose a filling.

An Amalgam aka Silver FillingLosing a filling from your tooth can be quite a traumatic event, especially if it comes out while you’re eating and you accidentally bite down on it.

However, there’s really no need to worry when a filling comes out of your tooth because your dentist will be able to fix it.

Also, there’s no need to save the filling if it was a composite, amalgam, or glass ionomer filling (the majority of fillings.)

If it was a gold or ceramic inlay filling (rather uncommon) then you may want to save it if you can find it since your dentist may be able to cement it back into place.

What to Do When a Filling Comes Out of Your Tooth

The first thing that you should do is remove it from your mouth so that you don’t accidentally swallow it or breathe it in.  A majority of the time when you swallow a filling, it simply passes without a problem.  On the contrary, if you accidentally breathe a filling into your lungs, it could cause an infection.