Posts for tag: tooth colored 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 controversial issues that I deal with over the past couple years is the dangers of silver fillings. Do I feel silver fillings pose a threat from medical standpoint...yes I feel they are a risk to some patients as there are many documented side effects associated with a mouthful of silver(amalgam) fillings. If the fillings are small, they should be replaced with a safer material(i.e. composite tooth colored filling). There are inherent risks, however, with larger fillings. Larger fillings, when replaced, often times require a crown as well due to the tooth's susceptibility to fracturing. While the tooth colored fillings have been shown to reduce medical issues when compared to silver fillings, there are risks with removing larger fillings. I have had many patients who have had all of their silver fillings replaced and have reported improvement in their symptoms(i.e. decreased headaches and insomnia, improved taste perception, less depressed, improved memory, etc). Talk to your dentist about whether or not you should replace your fillings!

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!

Question: If I want to whiten my teeth, should I whiten before or after my dental work.

 

Answer: Almost always you would want to whiten prior to commencing with your dental treatment. Modern teeth whitening techniques are designed to remove external stains from natural tooth structure. It is well known that there a variety of successful brands and techniques available that can help whiten stained and darkened teeth. However, in spite of the technological advancements, whitening materials have no effect on existing restorations in the mouth.

 

Restorations such as crowns, bridges, fillings, etc. will not respond to whitening. Because of this, it is encouraged to whiten before any major restorations are placed or there could be some discrepancies in the tooth colors.

Is it necessary to replace silver fillings that are not bothering me?

 

Absolutely not. I kind of like the "If it's not broke, don't fix it" attitude. But I will try and explain further. There are many dentists who are urging patients to replace all the silver fillings in their mouth without a reasonable explanation why. There is a lot of controversy and literature that suggests the harmful effects of silver fillings can cause multiple health problems. More specifically, critics state the small amounts of mercury in the silver restorations can be potentially harmful leading to neuropathies.

 

Neuropathies are nonspecific disorders that can affect the nervous system and brain which alter things such as vision, memory, sense of smell and taste, etc. While mercury has been shown to demonstrate potentially harmful effects if exposed in large amounts, there is not enough conclusive evidence to deter dentists from still routinely placing silver fillings. If in doubt, you can consult the American Dental Association and the FDA as they still support the use of silver fillings as an acceptable restoration in dentistry.

 

So why should silver fillings be replaced?

 

Silver fillings should be replaced if they develop cavities around them. If the silver fillings(amalgams) chip, fracture, break, or develop symptoms such as cold/biting sensitivity, then it is acceptable to replace the fillings. In these cases, a tooth colored filling (aka "composite") would typically be used to restore the tooth back to function.

 

Is there any harm in replacing my silver fillings if they don't bother me?

 

Depending on the size of the filling and location, there is always a chance of sensitivity developing following replacement of the filling as with any other filling. This should be discussed at detail with your dentist prior to replacements. If the filling is more than 50% of the tooth, then a crown may be necessary to restore the tooth back to function as well as recreating an esthetic appearance.

 

If silver fillings are safe then why do you not do them on a regular basis?

 

Two simple reasons:

 

1. There are environmental hazards associated with disposing of silver filling material in the garbage. This is one of the few dental materials that has specific instructions for disposal requiring special filters/traps as well as pickup services that is not only expensive but time consuming.

 

2. Most patients simply do not want them! Less than 5% of the general public prefer silver fillings or the tooth colored kind. It becomes a supply and demand issue where there is no demand.

 

What happens if I whiten my teeth following my white fillings being placed?

 

Tooth colored fillings, much like crowns, dentures, bridges and veneers will not respond to teeth whitening like natural teeth. It is for this reason that tooth colored fillings that will be placed on the front teeth will typically follow teeth whitening so that the fillings will not have to be redone. Back teeth have less issues with esthetics simply because of their position, therefore not as critical.