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You have a cavity....Now what?

Fillings can come in all shapes and sizes and are commonly used as the first line of defense when a cavity is present. I'll explain the good, the bad and the ugly. What to look out for and what you can do if things don't turn out right.

Why Do I need a filling and what are my options?

Did it hurt when you bit into something sweet last week? Were you drinking something hot and have an intense pain in your tooth that ached or throbbed even after the heat went away? You may have been in for your regular cleaning and your dentist noticed decay on your x-rays, but you don't have any symptoms yet. Usually when your dentist first notices a cavity in your mouth their first line of defense will be a filling, unless the size of decay is too large that by removing it will put the tooth at jeopardy of breaking (a crown would be the next choice) or the decay is too close to the nerve (requiring a root canal).

(The picture above has arrows that show what decay can look like on x-rays at different stages, the black shadows circled is decay, as the decay gets larges and closer to the nerve, pain can become more severe). This type of decay is known as interproximal decay and is most times caused by lack of flossing and diet. A high sugar and acid diet changes the Ph of the mouth, this environment allows for breakdown to occur over time. It all boils down to "time to tooth ratio" meaning the amount of time you expose your teeth to that environment. It is better for your teeth to drink an entire 6 pack of soda in one sitting and be done with it, then sip on 1 soda all day long. Rinse your mouth with water after soda, coffee/tea or juice to help bring the Ph back to normal faster.

Fillings can also be used to cover areas of abrasion or recession. These areas can be more sensitive and are more prone to decay as the area exposed when the gum recedes is called Dentin and it is much softer and more porous than enamel.

(Picture on the Left is of what abrasion and recession looks like on the tooth) There are many things that can cause this, and a few ways to treat this. A filling on the root surface can protect the root from further abrasion and help with any sensitivity. Another option would be connective tissue grafting done by a specialist, I will talk about that more later.

Amalgams Versus Composite

Amalgam fillings better known as metal fillings, are made of mercury and were typically used many years ago. There have been many studies done on the effect of leaking mercury into the body, and most people no longer want metal in their mouth. Metal also contracts and expands every time you have something hot or cold in your mouth, which over time traps bacteria between the tooth and the filing which can lead to recurrent decay and breakdown of that filling.

Composite resin fillings AKA "tooth-colored fillings" are the most commonly used nowadays. These fillings also pose their own flaws as they can break and crack under grinding/clenching force, get staining around the edges and leak over time requiring replacement.

Both of these fillings can be sensitive after they are placed, but this should clear up in a few weeks after the fillings is placed. If it, doesn't you may have a larger issue on your hands. Make sure you contact your dentist if pain still exists after a few weeks, and don't just wait it out.

What type of issues can happen with POORLY done restorations?

- Overhangs on Fillings: when there is an overhang on a filling, it can lead to future decay much sooner than later. This is due to the inability to clean between the tooth and bacteria getting caught up underneath the overhang making decay easier. Overhang fillings can also lead to bone loss in between the teeth as food is more prone to get trapped under it. Poorly contoured dental restorations do not always reflect a low skill level or lack of attention to details. In some situations, establishing ideal tooth contours is complicated by poor visibility, decay that extends well below the gum level, restricted ability of a patient to open their mouth adequately, and other factors.

- Open Contacts: Don't you hate when you are eating meat and it gets wedged between your teeth? Do you have that one spot that food always gets caught in your mouth? If you have an open contact between 2 teeth because your dentist did not check to see that the filling had a tight contact with the tooth it touched you could be dealing with this issue for a lifetime!! You may want to invest in a lifetime supply of floss because you are going to need it!! Open contacts also put you at risk for future bone loss in those areas when food gets stuck there and not removed. As that food sits there it can cause a cavity to start around your current filling. The 2 black arrows in the picture below are pointing to what an open contact looks like on a radiograph. The white arrow is pointing to what bone loss can look like due to that open contact and food and debris constantly getting stuck in the area.

- Poorly done restorations: This is actually provider error and can be due to many reasons. Some of which are due to patient positioning, size of tongue and/or access to area being filled. Most of the time poorly done restorations are just due to sloppy dentistry. The lack of providers who check their work after or the time constraints on which they are mandated to complete the work in. Bad restorations often time leave decay in the area that YOU PAID to be fixed. The only problem is you don't know it. The largest downside to this is that the decay will continue to grow most likely requiring more extensive dental work in the future and even sometimes leading to a non-restorable tooth.

- Improper Occlusion: Occlusion is the way your teeth come together when you bite down all the way. If a filling is too high (meaning too much filling material built up) you will feel like you hit that side first. You will most likely have pain or soreness on that side of the mouth from bruising the ligaments around the tooth while biting. You may even get headaches. If you are a heavy grinder or clencher you could even crack the newly placed filling or even chip the tooth occluding with it. The bottom line is if you are still feeling discomfort upon chewing (cold sensitivity is normal for a while after filling placed pending on size of filling), you feel like one side of your mouth hits before the other or something just feels off call your dental provider. Improper occlusion is easily fixed and often time missed because your mouth is numb and it's hard for you to tell what feels right or not. Don't let this go for months, it's unnecessary and a very simple fix often times requiring no anesthetic.

I tell you all of this to give you a voice. The more educated you are about your own health and the procedures being done on you, the more likely you are to speak up if you feel something is wrong. It is ok to ask for a dental x-ray after your filling is done, even if it is something not common practice for that office. Those x-rays are yours, some offices may require you pay for a copy, that is up to the dental practice.

Even the best dentists can do improper restorations, we are all human. The main difference is a good ethical dentist will own up to their mistake and fix the issue. Bottom line we want to make sure you have your teeth for your whole life.

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