Posts for tag: fillings

What are bitewing xrays?

Bitewings are also known as “cavity detection” xrays and are often times conducted once a year. The xrays specifically focus on looking at the chewing (“occlusal”) surfaces as well as the area in between teeth surfaces(“interproximal”). They are done at least once a year as cavities can develop very rapidly on baby teeth. The cavities detected on xrays are often times not able to be seen during a physical exam by a dentist therefore are very important!

One of the most common questions I get from parents is “If a baby tooth has a cavity, why should I fix it if my child will eventually use it”. The most obvious answer is to help protect the permanent teeth. Infected baby teeth, if left untreated can cause damage to the underlying developing permanent adult teeth. Removing the baby teeth before they are due to erupt can also lead to space maintenance issues. As a result, there is greater likelihood your child will develop crowding of the adult teeth leading to the need for braces. We highly encourage saving the baby teeth if all possible! An ounce of prevention prevents a pound of problems. Talk to Dr.Glasmeier about the options to fix a broken or decayed baby tooth!

Question: How are cavities detected by a dentist?

Answer: There are multiple ways a dentist can screen for and detect cavities or tooth decay:


1. Visual- The dentist looks for unusual discolorations, stains and dark spots found along different surfaces of the tooth. The most obvious occur along the biting surfaces of the teeth and are found more commonly on the molars.


2. Feel- The dentist uses an instrument called an "explorer" trying to feel for "stickiness" or catches along the surface of the tooth. The stickiness is often found along the grooves and fissures of the tooth and represents an area where the enamel coating of the tooth has been compromised.


3. Xrays- Digital xrays allow a dentist to see cavities not only along the biting surfaces but the flossing surfaces between the teeth. Not only do xrays provide insight to the presence or absence of a cavity, but it can convey the extent or depth of the cavity. A dentist can use xrays to determine how deep the cavity is and if there is nerve involvement.


4. Laser- Using a device called a "Diagnodent", a dentist can use a special laser that measure the damage that is left behind as a result of cavity or tooth decay. While this is not a primary means of detection, it will typically reinforce the presence of absence of a cavity if there is suspicion.


So the next question is, if there are multiple ways a cavity can be detected, what is the best way?


While there are many ways to detect tooth decay, one way is not more advantageous than the other. Simply put, the dentist should use as many ways as possible to help assess. All four ways can give the dentist tremendous insight into cavity assessment and provide the patient confidence that nothing was missed during an exam!

Do we always need an injection?(i.e. being numb, being frozen, putting the tooth asleep)


Sometimes patients do not require injections for fillings. It depends on how large and how deep the cavity(decay) is and where is sits in relation to the nerve. I like to think of a tooth like an M&M peanut. The outer candy shell is the enamel, which has no nerve endings. The inner chocolate layer is the dentin, which does have nerve endings and then there is the peanut, aka the "pulp" or nerve of the tooth.


Cavities that form only in the enamel tend to not cause sensitivity therefore do not need to be numb to be fixed. However when the cavity penetrates into the second layer, the dentin, hot/cold/sensitivity begins. Decay into dentin will require local anesthesia(injections) to put the tooth into a comfortable state so the cavity can be removed. When cavities get into the nerve, thats when we speak of root canals. Once decay(bacteria) have penetrated into the nerve, an onslaught of symptoms begins. Ranging from cold sensitivity to throbbing, sharp pain to biting pain to gum tenderness, the nerve will require removal to eliminate the infection and sensitivity.


So to summarize, the need for being "numb" relies on how far the cavity got into the M&M peanut :)

What is a filling?


A filling is a material that your dentist uses to fill a cavity after the tooth decay has been removed.


To fill a tooth, I will:


* Numb your teeth, gums, tongue, and surrounding skin. I will first put a jelly substance directly on the area to start the numbing process and then inject an anesthetic to complete it. Sometimes we will give you nitrous oxide gas (laughing gas) to reduce your pain and help you relax.

* Sometimes we use a small sheet of rubber on a metal frame (rubber dam) to target the decayed tooth and to stop liquid and tooth chips from entering your mouth and throat.

* Drill out all the decay and replace it with a filling.

Fillings can be made from many types of material. Talk to your dentist about which type would be best for you.


* Amalgam is the easiest material for a dentist to use. It is the fastest and least costly choice. Amalgam is a mixture of mercury, silver, tin, or other metals. I do not use this material anymore due to patient preference and because it is expensive and difficult to expose of.

* Composite resins are tooth-colored fillings. This process is sometimes referred to as "bonding" if it is on a front tooth. This is standard nowadays for the cosmetic dentist. It is the most esthetic(cosmetic) material and the newer materials have longevity comparable to the amalgam silver fillings. Composite resin is easier than gold for a dentist to work with and generally is less expensive than gold.

* Ceramics are costly tooth-colored fillings. They require special equipment and may require dental lab support. You may need several appointments. These are used in much larger fillings where the tooth is in between needing a filling or a crown.


What To Expect After Treatment

After I filled the cavity, your lips and gums may remain numb for a few hours until the numbing medicine wears off. Avoid chewing on your numb lip or cheek to avoid injuring your mouth.


Why It Is Done

You need a filling when tooth decay has caused a hole (cavity) to form on a tooth surface. If you don't get a filling, the cavity will get worse and lead to more severe problems, such as bone loss.


How Well It Works

A filling repairs the tooth and stops tooth decay. Over a long period of time, you may need to replace a worn-out filling.

Your filled tooth may be sensitive to heat and cold for days to weeks after you get the filling. Talk to your dentist about toothpastes that may help you with this discomfort. Tell your dentist if your teeth are too sensitive after you get a filling, because you can usually treat this problem.



There is almost no risk involved in having a cavity filled.

Some dental work can cause bacteria in the mouth to enter the bloodstream. These bacteria can cause infections in other parts of the body. People who have difficulty fighting infections may need to take antibiotics before and after dental surgery. Such people include those who:


* Have heart valve problems, such as endocarditis.
* Were born with heart defects.
* Have an impaired immune system.
* Have liver disease (cirrhosis.
* Have artificial joints, such as a hip that has been replaced.


What To Think About

It is important to start treatment before tooth decay becomes worse. More severe decay may cause pain and tooth loss and may require a costly crown, a root canal, or tooth removal (extraction).

Some dentists now use a laser system to remove tooth decay and prepare the tooth for filling. The laser is quiet, does not vibrate like a drill, and is usually painless, so medicines to deaden pain often are not needed. Laser treatment is a relatively new choice for dental treatment. Two dental laser systems have been cleared by the U.S. Food and Drug Administration (FDA). These systems are under review by the American Dental Association. I do not use this type of system at this time due to it being a relatively new technology but the current research shows much promise in this innovation. Depending on the size, I can use air abrasion, which is a drill-less instrument to remove the cavity before filling. This is preferred as it is less noisy and more comfortable but only used when the filling is relatively small.