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Cavity Fillings |
The dentist may use several methods to determine if the patient has tooth decay,
including: ( Observation ) some discolored spots on the patient’s teeth may
indicate decay, but not all of them. The patient’s dentist will use an explorer,
a metal instrument with a sharp tip, for a more thorough examination of possible
decay. Healthy tooth enamel is hard and will resist pressure by the explorer.
Decayed enamel is softer and the instrument will stick in it slightly. Explorers
should be used with caution. A healthy tooth can be damaged if an explorer is
used with too much pressure.( Cavity-detecting dye ) this can be rinsed over the
patient’s tooth. It will stick to decayed areas and rinse cleanly from healthy
ones. ( X-rays ) the X-rays can help the patient’s dentist see decay that
doesn't show on the surface. However, X-rays are often not accurate in detecting
smaller cavities, and existing fillings or other restorations can block the view
of decay. Decay is not the only reason the patient may need a filling. Cracked
or broken teeth, or teeth that are worn from unusual use — such as nail-biting,
tooth grinding (bruxism), or using the patient’s teeth to open things — may also
need fillings. And here are the steps to a filling: When the patient visits
his/her dentist to get a filling, the patient will be given local anesthesia to
numb the area if necessary. Next, the patient’s dentist will remove decay from
the tooth, using hand instruments or a drill. Air abrasion and lasers can also
be used to remove decay. A drill, which dentists call a handpiece, uses metal
cones called burs to cut through the enamel and remove the decay. Burs come in
many shapes and sizes, and the patient’s dentist will choose the ones that are
right for the size and location of the patient’s decay. At first, the patient’s
dentist will use a high speed drill (the one with the familiar whining sound) to
cut through the hard enamel. He or she will precisely outline the cavity with
the drill, removing only enough tooth material so the filling material can be
placed properly. Once the drill reaches the dentin, or second layer of the
tooth, the dentist may use a lower speed drill because dentin is softer than
enamel. To clean out the decay, the patient’s dentist may use a round bur.
Throughout the removal process; the patient’s dentist will test the area with
the explorer to see if all the decay has been removed. A cavity-detecting dye
may also be used. Dentists do not use color to judge whether all the decay has
been removed. Not all cavities are discolored, and discolored enamel can be
healthy. Once all the decay is removed, the patient’s dentist will shape the
space to prepare it for the filling. Different types of fillings require
different shaping procedures to make sure they will stay in place. The patient’s
dentist may put in a base or a liner to protect the tooth's pulp (where the
nerves are). The base or liner can be made of composite resin, glass ionomer,
zinc oxide and eugenol or another material. Some of these materials release
fluoride to protect the tooth from further decay. If the patient’s dentist is
placing a bonded filling, he or she will etch (prepare) the tooth with an acid
gel before placing the filling. Etching makes tiny holes in the tooth's enamel
surface, which allows the filling material to bond tightly to the tooth. Bonded
fillings can reduce sensitivity and reduce the risk of leakage or decay under
the filling because the etched surface of the tooth and the filling material
form a mechanical bond. Bonding is generally done with composite fillings. It
can also be done with amalgam materials. If the patient are getting a light-set,
composite-resin filling or a resin-bonded glass ionomer filling, the patient’s
dentist will stop several times to shine a bright blue light on the resin. This
cures (hardens) the material and makes it strong. Finally, after the filling is
placed, the patient’s dentist will use burs to finish and polish the tooth. But
after a filling many people experience some sensitivity after they receive a
filling. The tooth may be sensitive to pressure, air, sweet foods or
temperature. Composite fillings often cause sensitivity, but other types of
filling material can, too. In most cases, the sensitivity will subside over one
to two weeks. Until then, try to avoid anything that causes it. If the patient’s
tooth is extremely sensitive or the patient’s sensitivity does not decrease over
about a two-week period, the patient should contact the patient’s dentist's
office. It's important to let the patient’s dentist know about any sensitivity
the patient is experiencing. The next time the patient need a filling, he or she
may be able to use a different material and make modifications to minimize
sensitivity. People vary in their response to different materials, and the
patient’s dentist has no way of predicting if the patient’s tooth will react to
a particular material. When the patient talk to the patient’s dentist about the
sensitivity, try to describe it as precisely as possible.
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The information the patient give will help decide what should be done next. The
patient’s dentist may take out the filling and put in a new one, possibly adding
a base, liner or desensitizing agent on the tooth as well. If the filling was
very deep, the patient could need a root canal treatment to solve the problem.
The patient’s dentist polishes the filling after it is placed, but occasionally
sharp edges may remain. If the patient finds one, contact the patient’s dentist
and arrange to have it smoothed as soon as possible to avoid injury to the
patient’s tongue or mouth. There is also the Temporary Filling that is when the
patient may receive a temporary filling (usually white, off-white or gray) if:
The patient’s treatment requires more than one appointment, the patient’s
dentist wants to wait for a short period of time for the tooth to heal, the
patient have a deep cavity and the pulp (nerve and blood vessels) becomes
exposed during treatment, the patient need emergency dental treatment. Temporary
fillings may have a sedative effect on the tooth. The tooth may feel better
after a temporary filling is placed. This is because the filling seals the
tooth, protecting the pulp from bacteria and reducing sensitivity. Temporary
fillings often contain eugenol, an ingredient in over-the-counter toothache
remedies that is known to have light anesthetic properties. Eugenol is also a
component of oil of cloves, which people use for toothache pain. Temporary
fillings are just that. They are not meant to last. Usually, they fall out,
fracture or wear out within a month or two. If the patient get a temporary
filling, make sure the patient visit the patient’s dentist to get a permanent
one. If the patient doesn’t, the patient’s tooth could become infected or the
patient could have other complications. Fillings don't last forever. They can
become discolored. For example, amalgam or silver fillings corrode and tarnish,
while composite, tooth-colored fillings pick up stains and yellow or darken over
time. When the patient chews, the patient’s teeth and any fillings in them are
subjected to tremendous pressures. Even if no other problems develop, some
fillings will wear out over time and will need to be replaced. A filling will
need to be replaced earlier if it falls out, leaks or cracks. A filling that is
cracked or leaking can allow food debris and bacteria in the patient’s mouth to
seep down under the filling. Since the patient can't clean there, the bacteria
feed on the food debris and form the acid that causes tooth decay. Decay under a
filling can become extensive before the patient notice it or it causes the
patient pain. This can be prevented by having the patient’s fillings checked
regularly and getting them replaced when problems are found. Fillings can fall
out for several reasons: The patient chews too hard on a large filling, and
fractures the filling or the tooth that is holding the filling, a filling
material was used that cannot restore the tooth to its proper form and function.
For example, if the patient has fractured a large piece of the patient’s front
tooth, a porcelain (tooth-colored) crown is probably the best treatment choice.
In some cases, a dentist may place a composite filling instead. The appearance
may be good or acceptable. However, if the composite iss too large, a strong
biting motion may fracture the plastic material, the cavity is contaminated with
saliva when the filling is placed, For composite resins, this will disrupt the
bonding of the material. If the bond is not strong enough, the filling can fall
out. As a result, the bond will not adhere well to the tooth and it may fall
out. Both amalgam and composite fillings can crack, either soon after they are
placed or after the filling have been in place for some time. Cracks can occur
soon after a filling is placed if the filling is higher than the rest of the
tooth surface, and most of the force of biting is concentrated on the filling.
Cracks can also occur over time, as the forces from chewing and biting affect
the filling. Small cracks also can occur at the edges of a filling. These
usually are caused by wear over time. These cracks can often be repaired. A
filling is said to be leaking when the side of the filling doesn't fit tightly
against the tooth. This can allow debris and saliva to seep down between the
filling and the tooth, which can lead to decay, discoloration or sensitivity.
Both amalgam and composite fillings can leak. An amalgam filling sometimes leaks
slightly after it is placed. The patient would notice this as sensitivity to
cold. This sensitivity decreases over a period of two or three weeks before
disappearing altogether. Over that period, the amalgam filling naturally
corrodes, sealing the edges of the filling and stopping any leaks. A composite
filling could be contaminated with saliva, which would weaken the bond between
the filling and the tooth and allow for leaks. Other times, there may be small
gaps where the tooth and filling meet. These gaps are caused by shrinkage when
the patient’s dentist places the filling. Sensitivity after receiving a
composite filling may disappear over time. If it doesn't, the filling may need
to be replaced. Fillings also can leak as a result of wear over time. These
fillings should be replaced. Some fillings can last for 15 years or longer.
Others, however, will have to be replaced as soon as five years after they are
placed. The patient’s dentist can determine if the patient’s fillings are worn
enough that they need to be replaced. If the patient clench or grind his/her
teeth, the patient may have more problems with the patient’s fillings. The
forces placed on the patient’s teeth can lead to tooth sensitivity, and can
cause fillings to wear faster than they normally would. Clenching or grinding
also can cause the patient’s teeth and fillings to crack or develop small craze
lines, which are fine cracks the patient can see if the doctor shines a light on
the patient’s tooth. Although some fillings can last for many years, the average
life of an amalgam filling is five to seven years. Some can last 15 years.
Composite fillings may not last this long. The patient’s dentist will examine
the patient’s fillings at the patient’s checkup visits. The patient may need
X-rays if the patient’s dentist thinks a filling might be cracked or leaking, or
if decay is occurring under the filling. If a tooth is sensitive, if the patient
sees a crack or if a piece of a filling appears to be missing, make an
appointment with the patient’s dentist for an evaluation. To help the patient’s
fillings last, the patient should visit the patient’s dentist regularly for
cleanings, brush with a fluoride toothpaste, and floss at least once a day. For
people with many fillings or very large fillings, the patient’s dentist may
prescribe a fluoride gel the patient can use at home. The fluoride will help
strengthen the patient’s teeth and prevent future cavities. The patient’s
dentist or hygienist can also place a fluoride varnish around the edges of these
teeth at the patient’s checkup visits. Before removing the patient’s old
filling, the patient’s dentist will discuss treatment options with the patient.
It is often possible to repair an old filling instead of removing ir and
replacing it completely. However, if the entire filling has to be replaced, the
dentist may have to reevaluate the tooth to determine the best filling material
to use. The patient should talk with the patient’s dentist about the patient’s
preferences for appearance, form and function so he or she can select the
material that is best for the patient. | |
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