When Fillings Fail

Dental fillings don’t last forever. Know your options when it comes time to have one of them replaced.
By: Dr. Kenneth Gonzales

“When should I replace one of my dental fillings?”

We dentists receive this question with common regularity. Dental restorations are intended to replace tooth structure lost to decay. These restorations may last many years; however, they eventually may need to be replaced. Constant chewing forces applied to teeth from normal eating, clenching and/or teeth grinding will eventually cause a dental filling to fail.

Bacteria are the main culprits for tooth decay. Any tooth that has been weakened from the normal wear and tear may develop chipped teeth, cracked teeth or a filling that eventually falls out. Some of this wear on teeth may leave gaps between the tooth and the filling that can provide an entry point for bacteria.

Bacteria can be found in saliva and in dental plaque (a thin film that forms on teeth and gums). What can happen is that the seal between the tooth and the filling deteriorates, and food particles and decay-causing bacteria work their way between the worn filling and the tooth. These areas are hidden from access via your toothbrush or any other means, and decay may develop along the edge of the filling or underneath it.

Most of the time, this process does not take long. It can happen between your regularly scheduled visits to your dentist. Decay that is undiagnosed and untreated can progress to infect the nerve of the tooth, which could mean more invasive treatment such as a root canal or possibly loss of the affected tooth.

Seeing your dentist on an ongoing basis, with regularly scheduled dental exams and X-rays, is important for detecting these problems at an early stage. Although you might not be able to tell if your filling is worn, he or she can identify any weakness in it during your regular dental exam using X-rays and a clinical intra-oral examination.

Tools such as X-rays, photos, dental explorers and electronic caries indicators are helpful in determining if the filling is sufficiently sealed to the tooth or if it needs replacement. The dental radiographs (X-rays) help dentists detect decay under existing dental fillings or between teeth, neither of which can be seen by simply looking at the tooth.

If your dentist finds evidence that a filling has failed or detects decay on the radiograph, your dentist will inform you that it should be replaced promptly so you can make an informed decision on the recommended treatment options. Don’t wait until the tooth hurts or a crack appears because that usually leads to the need for more extensive and costly procedures.

“What are my choices for new fillings?”

Advances in dental materials and techniques offer new ways to create very pleasing, natural-looking smiles. Now available are ceramic, resin and plastic compounds that mimic the appearance of natural teeth.

Several factors influence the performance, durability, longevity and expense of dental fillings. These include the components in the filling material; where and how the filling is placed; the chewing load the tooth must bear; and the length and number of visits needed to prepare and adjust the restored tooth.

Amalgam is composed of a mixture of silver, copper, tin and mercury, all of which combine to form a strong and stable filling material. It is durable, easy to use, highly resistant to wear and relatively inexpensive, compared to other materials. But this material does have its controversy and negatives.

Mainly, thanks to the Internet, many patients are aware and afraid of the potentially negative effects of mercury content in these fillings. The negative effect of mercury content cannot be completely substantiated or measured. The other negative is that it is not a cosmetically appealing restoration. I rarely use this material in my practice mainly for these reasons.

Composite fillings are a mixture of acrylic resin and finely ground, glasslike particles that produce a tooth color restoration. These fillings provide a durability and resistance to fracture in small to mid-sized fillings that need to withstand moderate chewing pressure. They also more closely mimic the expansive and contractive properties of the tooth, compared to amalgam fillings. They can be polished to a high shine that closely resembles tooth enamel.

We have multiple shades and grades of tooth colors to choose from so we can match as closely to the natural color of the tooth to be repaired as possible. Composite restorations can be used on the back chewing tooth, as well as any of the front teeth that are in your smile.

And unlike amalgam fillings, there is a part of the filling called the hybrid layer where the tooth and the filling become one. The modern advances in what we call adhesion dentistry achieve this hybrid layer. This is the material I favor in my practice.

Glass ionomers are tooth-colored materials made of a mixture of fine fluoride containing glass powder and organic acid that forms a solid restoration able to release fluoride. Some of these types of restorations can even be recharged with the fluoride-containing toothpastes that most people use. This can be helpful in patients with caries-prone teeth or areas of the tooth that have had enamel loss or tooth root exposure.

Final word: Talk to your dentist. The ultimate decision about the best material to use is determined by the patient in consultation with the dentist. Before your treatment begins, discuss your options. Most dentists are passionate about their profession and service to their patients. We are honored to be part of helping patients with their total oral health care.

Kenneth Gonzales, DDS, PLLC, practices at 7426 S. Staples St., Ste. 101, in Corpus Christi, Texas. For more information, call 361-992-2421, email info@gonzalessmiles.com or visit www.gonzalessmiles.com




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