Archive for the ‘White Fillings’ Category

Will white composite fillings break down under saliva?

Tuesday, January 31st, 2012

Would exposure to human saliva collecting in the bottom of your mouth break down a white filling? I have decay under the gum line of a front tooth and my dentist wants to put in a silver filling but I also have receding gums and I am afraid it will eventually show. Also I am worried about sensitivity since it goes down into the root area. I have two other white fillings in my front teeth. One I have had for over a decade with no problems and the other (really deep) for just about a year … no problem.
- Katrina from Ohio

Katrina,
Exposure to saliva doesn’t break down a white filling. White fillings, or any type of dental restoration, are designed to function in the presence of saliva.

However, the filling site, when the white composite is used, must be totally isolated from saliva at the time it is placed or it will not bond to the tooth and will fail. In this respect it is different from the silver amalgam filling, which can be successfully placed in the presence of saliva or other contaminates.

And you are also correct that the silver amalgam filling, besides looking unsightly, will make the tooth hypersensitive to cold for a few weeks, especially if the filling is deep or is down on the root.

If you have decay under the gums, your dentist may be concerned about being able to properly place a white filling, and I suspect that this is what your dentist is concerned about. His or her concerns are justified. But there are a couple of things more to be said about this.

First, there is always a way to place the filling in almost any situation, even if it is under the gumline, and keep it isolated while it is being placed.

Second, I would never push a dentist to place a filling that he or she is uncomfortable placing. Your dentist probably doesn’t know how to isolate the filling, or doesn’t know the variety of white materials that are available that could be placed in a situation like this, and the restoration will therefore will fail. If having a white filling here is important to you, you need to find a dentist who is more familiar with these techniques and who has the confidence to be able to do this correctly.

This blog is sponsored by Colorado Springs dentist Dr. Joseph Rota.

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A response by Monica on her tooth erosion question

Wednesday, August 18th, 2010

We received a response from Monica and follow-up questions about how to approach her dentist and about her insurance coverage, which we won’t post here. But it is significant that she did confirm that yes, she has a night grinding problem (bruxism).

Read the original posting with Monica’s question about erosion areas in her teeth and what to do about them.

Dentists for years have been telling patients that these dished-out lesions on the teeth near the gumlines are from brushing too hard. But they are from the teeth flexing, and the way to get fillings to stay in is to use a flexible microfill like Silux Plus, Renamel, or Heliomolar, not a stiff hybrid material or microhybrid.

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I have tooth erosion. Does it need to be fixed?

Monday, August 16th, 2010

Is it necessary to have abrasion fillings done to prevent any further erosion of teeth at the gum line? One dentist told me it was very necessary, so that the situation doesn’t worsen and necessitate a root canal on those teeth. But another dentist told me it wasn’t necessary to have these eroded areas at the gum line filled, and even stated that it may make the situation worse. How can a lay person know what to do, when one dentist says one thing, and another dentist says the complete opposite?
- Monica

Dear Monica,
Thanks for an excellent question.

Actually, it may be that both dentists are right – which may seem a little strange, but let me explain.

The correct term for these dished out areas of your teeth near the gumline is abfraction lesions. I think the problem may be that the second dentist doesn’t know the right way to fill these, and may have outdated information about what causes them. These types of fillings are notorious for popping out, but when the dentist really understands them, the fillings have a high rate of retention.

It used to be thought that these lesions were caused from too vigorous brushing. But recent research shows that they are actually caused by flexing of the teeth, and they usually occur in patients who grind or clench their teeth a lot. Some dentists, frustrated by the tendency these fillings have to pop out of the teeth, try stronger and stronger filling materials. But the answer to the problem is to use very flexible filling materials – microfilled composites such as Silux Plus, Renamel, or Heliomolar.

If these areas aren’t protected, more and more tooth structure will wear away, and yes, in some cases they can cause a tooth to need a root canal treatment, or to become so weakened that it breaks off.
Before the dentist fills these lesions, I would quiz him or her by asking if they’re familiar with the theory that the tooth needs to be filled with a flexible microfill material. If the tooth isn’t filled correctly, the filling will probably pop out within a few months. And in that case, the second dentist will be right, because continually refilling the tooth will cause more harm than good.

If you’re interested to read the experience of another patient with a problem similar to yours, where the dentist simply couldn’t get the fillings to stay in, read the posting on the mynewsmile.com blog about afraction lesions.

Links: read more about tooth bonding and white fillings.
Read about Monica’s follow-up comment where she confirms that she grinds her teeth at night, thus validating the idea that these lesions are caused by flexing of the teeth from grinding or clenching forces.

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