Dental Procedures

White fillings:

White fillings are made from composite resin, and they are a great option for many people. One major advantage is that they can be matched to the color of your tooth. This matters a lot when it comes to your front teeth, since you’ll want to show off your smile. White fillings can also be used in most back teeth, and can often allow the fillings to be smaller. A smaller filling means less drilling and leaving a stronger tooth in place. They also give you a more attractive smile which looks as if you have had no dental work at all.

There are, however, some reasons not to choose a composite resin (white) filling. First, large composite fillings in back teeth are more likely to fracture. They can also shrink during the curing process. This leaves more room to leak and re-decay. Additionally, composites take longer for the dentist to do. This is because you’ll need to keep your mouth open longer, so that the cavity can be kept dry during the filling process–saliva contamination will prevent the bond. Finally, composite fillings are more costly, and some dental insurance companies will not cover composite fillings in the back molars.

The reasons stated by the insurance companies are that

1. They can wear down or break in the high pressure areas of the molar teeth.
2. They are only for aesthetics.

Personally I have seen only a few white fillings break or wear down. Both of these potential problems have been greatly improved; and of course, constant research and development in this very competitive dental materials market, is ongoing.

Silver Colored Fillings:

Silver colored fillings are made from a silver-amalgam and have several advantages. They:

1. Are very durable and typically last longer.
2. Cost less
3. Are self-sealing with no shrinkage.
4. Do not wear down with time.
5. Are also resistant to leakage, making them more resistant to re-decay.
6. Can be placed in a wet environment where saliva contamination cannot be avoided.

There are also some disadvantages of silver-amalgam restorations. This includes the fact that they darken with time and can eventually look black. Silver-amalgam fillings slowly stain teeth, giving them an increasingly gray appearance. Additionally, more extensive drilling is sometimes required prior to placing the filling. This causes the remaining tooth structure to be weaker. Silver-amalgam fillings also tend to expand over time and can be a factor in causing fractured teeth. That said, silver filling can still be a good option in certain situations.

A growing number of people have become concerned about the toxicity of very small amounts of mercury vapor escaping from the fillings. This not considered a health risk by most established scientists, the ADA or the FDA.

Sometimes your tooth can be sensitive after a filling, even if it was not painful before it was filled. This can be upsetting to the patient and to the dentist. Pain can be a complicated topic. I have seen huge cavities, where the nerve is still alive, but they do not hurt. Sometimes even the smallest areas of decay are sensitive. Cavities, however, need to be filled when decay has penetrated the enamel, whether they hurt or not.

Enamel is usually 1 to 1.5mm thick. Under the enamel is the dentin. Dentin is hard and similar to bone, and it is porous. In each pore, there is a very small amount of live tissue which brings pain sensations down to the nerve. If the dentist is removing decay laden with bacteria, the dentin is already infected with bacteria. The tissue in these pores is damaged, both by the bacteria and the drilling. The deeper the decay and the more drilling that is needed, the more damage there is to the dentin. This damage to the dentin can cause pain and inflammation in the nerve, called a pulpitis.

“Desensitizers” and healing coatings are applied under the filling to kill bacteria and to help calm the inflamed nerve. These applications usually work pretty well. However, like anything in health care, you do not know for sure what the outcome will be. Sometimes the new filling will be sensitive for a while, and then the nerve recovers. Sometimes bacteria have traveled far enough down the dentin pores to infect the nerve. This becomes an abscess, and it can occur even months later. The deeper the decay, the more likely the nerve will become abscessed, even after the decay has been removed and the filling placed. Obviously, the sooner decay and bacteria are removed, the better! 

A root canal can save many important teeth that may otherwise need to be pulled. Tooth fracture, deep decay, a deep filling or crown may cause the nerve inside the tooth to deteriorate. This can cause pain or infection. The painful nerve, or in some cases the dead nerve, is carefully cleaned away while the tooth is totally numb. The nerve is in a thin canal from about the height of the gum line to the root tip. The last part of root canal treatment involves filling this canal to seal out any infection. You can save your tooth and avoid the trauma of extraction.

There are several conditions that can affect people’s gums. Gum recession is a common one. This is when the gum pulls back, exposing more and more root as time goes by. These areas can be very sensitive when brushing, when exposed to cold, or to sweets. Some recession is normal as we age, but it can jeopardize the tooth if it is too much. The tough gum around the neck of the tooth is a lighter pink and called attached gingiva. It is in a band along the gum line which is only 1/4-inch-wide (or much less in some areas). Beyond the attached gingiva is the unattached gingiva, which is a darker red in color. This extends toward the root end of the tooth and curves into the lip or cheek tissue. Milder recession, which does not reach the unattached gingiva, is usually not a problem. If the exposed root is sensitive, toothpaste for sensitive teeth can help. If the root is very sensitive, your dentist can treat it. In a more serious case of recession, the gum stripping can reach the unattached gingiva. This situation definitely needs treatment, because the recession will progress quickly and expose much of the root if not stopped. Recession is usually caused by one of three things. Over vigorous brushing, plaque and calculus accumulation, or little muscle attachments (frenum) that are pulling on the gum line. Your dentist can help you with a more preventive brushing technique, as well as help with the other causes.