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New tooth-colored fillings sensitive? They should not be!

When most people think of “bonding,” they are thinking of tooth-colored dental fillings, or composite fillings.  To be completely technical for a moment (I try to avoid that as much as possible to not bore you 😉 ), “bonding” is actually the series of steps and the products we dentists use to make the tooth-colored fillings actually STICK to the teeth.  OK – technical moment is over.  Whew, aren’t you glad of that?

An issue that many patients have experienced in the past, is that their new tooth-colored fillings seem to be mildly or even extremely sensitive to cold, and sometimes hot, foods and drinks, even just to tapping your teeth together.  Naturally, it’s not a fun experience, and one that all conscientious dentists try to avoid for their patients, but even in 2009, when one would imagine there is a solution, many patients still run into this problem.  Here’s the thing, though……..THERE IS A SOLUTION!

OK, you’re probably asking, if there’s a solution, why is it still a problem?  Well, it’s simply a matter of technique, really, and getting the technique for bonding is actually more difficult than it might seem to be.  In addition, just as in the rest of the world, there are MANY bonding products that dentists can use when doing tooth-colored fillings, but just because the companies that produce them supposedly have research behind these products, they’re not all they’re always promised to be.  Some work better than others in strength, sensitivity, durability…..and it can honestly be rather tough to sort through all the stuff that companies throw at us, just like for physicians with all the stuff pharmaceutical companies throw at them.  So it is CRITICAL that dentists really stay up on the latest research, but here’s the thing…..just because something has the “latest and greatest, newest and most improved,” labels all over it, that doesn’t mean it actually works as well as the old stuff all the time.

There’s one other REALLY CRITICAL FACTOR for long-term success of composite fillings, and that is keeping the teeth DRY while the bonding is placed and activated, then the filling material is layered into the tooth. Saliva contamination is one of the most common reasons for bonded fillings to be sensitive, and it’s also one of the most common reasons bonded composite fillings fail earlier than they should.  There are a couple techniques dentists can and SHOULD use to do this – a Rubber Dam or something like the Isolite2 Dryfield Illuminator system.  Both are pretty inexpensive for the dentist to have (we have both and use them as appropriate), both are pretty easy to use, and to tell the honest truth, they actually make it EASIER for us to complete your dental work faster and with better results.  I really don’t know why not all dentists use 1 or the other; I can’t imagine practicing without them, ’cause it’s a lot harder to get good fillings!

So there you go: 2 of the most common reasons why bonded, tooth-colored, composite fillings are often sensitive to hot and cold foods/liquids or even just tapping your teeth together.

The good news in our office?  I’m fortunate to actually know the man who basically INVENTED bonding, and I not only use the techniques he teaches, but I even use the most current materials that he himself has developed and/or recommends, and I can honestly say that ALMOST NOONE who gets tooth-colored fillings in my office ever has hot/cold sensitivity afterwards.  There are rare exceptions, ’cause I’m not going to claim perfection, but they’re quite rare indeed.

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September 3, 2009 Posted by | Composite/Tooth-Colored Fillings, General dentistry, News You Can Use, Restorative dentistry | , , , , , , , | Leave a comment

Minimally invasive dentistry with a dental microscope

I sure wish I had the HD video hookup for my dental microscope already, but since I don’t yet, I’ll keep showing you stuff with my Canon cameras.  🙂

One of the most incredible benefits of the microscope is the ability to work on levels of detail that aren’t even imaginable without one.  And that means that I can do VERY VERY VERY VERY SMALL, CONSERVATIVE fillings.  I use teensy little burs to remove the absolute minimum amount of tooth structure, not really big ones that dig out way more than necessary.  I just wanted to show you an example of how this looks using a patient from this morning; the benefits of this are pretty obvious:

Teeth after cavities were cleaned out, really small size possible because of the dental microscope.

Teeth with small cavities that only need small fillings

Teeth after small cavities were cleaned out with very small preps, possible because of the dental microscope.

Teeth after small cavities were cleaned out with very small preps, possible because of the dental microscope.

Teeth after very small tooth-colored fillings were done, possible because of the dental microscope.

Teeth after very small tooth-colored fillings were done, possible because of the dental microscope.

July 30, 2009 Posted by | Composite/Tooth-Colored Fillings, Dental Office Technology, Restorative dentistry | , , , , , , , | Leave a comment

Baby Boomers – get your teeth fixed before you retire when you still have dental insurance and flex plans to help pay

With more and more Baby Boomers approaching or entering retirement, an issue often not considered is their dental health.  I think it is actually an important topic to discuss, even more so in today’s economy.
Many Baby Boomers – my parents included – have put retirement on hold, but it’s still not all that far away, and with retirement usually comes the loss of dental insurance and the loss of medical/dental Flex plans that can help a lot with covering the cost of dental care.  After that, it’s all out-of-pocket.  Ouch!  So we always recommend a thorough re-evaluation of existing dental work for things that may be on the verge of going bad.  Such things could be:
  • Old silver fillings with cavities and cracks that could turn into root canals and crowns or extractions

  • The teeth around the old silver fillings may have cracks that could lead to broken teeth

  • Gum (periodontal) disease

  • Ugly old crowns that could be replaced for a nicer smile in the golden years

  • Replacing missing teeth with dental bridges or implants so you can eat the foods you want

  • Etc etc etc……

This gentleman hadn’t been to the dentist in a number of years but knew that he was approaching retirement, so he wanted to come in, get a cleaning, and find out if he needed to take care of anything while he still had dental insurance.  Turns out that many of his 30+ year old silver fillings were in really bad condition, with pieces chipping off, cavities forming around the edges, teeth cracking, and gum disease to boot.

While the total treatment that he needed involved some gum surgery (not needed for everyone, obviously), the primary issue that we addressed was to clean out the old fillings and cavities, then rebuild the teeth with all-porcelain crowns on several teeth, 1 tooth got a tooth-colored filling, and 1 tooth got a gold 3/4 crown (most of the tooth, but not the whole tooth is covered by the crown).

He can now rest assured that all of the problems with these teeth are fixed, and it’s likely he will not need any of them ever worked on again as long as he takes good care of them.

Broken silver fillings with cavities, fixed with porcelain dental crowns, a gold dental crown

Broken silver fillings with cavities, fixed with porcelain dental crowns, a gold dental crown

May 6, 2009 Posted by | Cavities, Dental photography, General dentistry, Porcelain Crowns, Restorative dentistry, Why Dentistry Fails | , , , , , , , , , , , , , , , | Leave a comment

Silver (amalgam) fillings: still a good choice in 2008

For many years, the dental profession has been moving away from gold and silver restorations to composite (plastic) and porcelain/ceramic restorations.  However, they are not always the smartest options for certain circumstances.   While there is a lot of misinformation out there about the alleged dangers of (mercury) silver fillings, here’s the simple truth: Silver fillings are perfectly safe, and there is not ANY reputable research by any reputable organization that has shown that the mercury from the fillings causes ANY harm.  PERIOD.  All that misinformation is simply that – misinformation.  ‘Nuff  said.

When do I recommend silver fillings?  There are just a couple circumstances in which I actually recommend silver fillings instead of a tooth-colored restoration (composite or porcelain):

1) Patients who have high rates of decay; IOW – anyone who seems to get cavities frequently no matter how hard they try to care for their teeth.  These include patients with acid reflux, who drink a lot of sodas, who are on medications that dry up their saliva, who have recently been through radiation treatment of the head/neck, or similar conditions.  In my experience, while there are steps that can be taken to reduce that risk, silver fillings last longer with fewer problems.

2) Patients who grind their teeth and who do not wear a nightguard.  Again, in my experience and in a fair amount of current research, composite fillings do not last as long.  While the ability of composite fillings to withstand significant wearing forces is definitely improving, in the teeth of patients who really grind, they’re just not there yet.

3) Patients who need a lot of work and need to stage it over time: in our practice, silver fillings are still less expensive because the material is less expensive.  We still take just as much time as necessary to restore the tooth as with a composite filling, but we believe it is fair to pass on the savings in cost to our patients, because that helps make dentistry more affordable.

And the thing is, while old silver fillings can look pretty ugly and flat, properly-placed new silver fillings can look extremely natural, just not tooth-colored.

Here’s an example of a silver filling that’s probably been in place 20+ years:

old-failing-amalgam

Here’s what 2 shiny new amalgams can look like:

amalgams-are-good-too

So while  most patients still prefer tooth-colored restorations, there really isn’t anything wrong with silver fillings, and under some circumstances, they can be a better solution for some patients.

December 22, 2008 Posted by | General dentistry | , , , , , , , | 13 Comments