The Digital Dental Surgeon

Decay occurs more often than not in teeth. Teeth exposed to bacterial attacks would weaken in its tooth structure and as time progresses, the cavity would expand as well.

What is the solution to cavities in our teeth?

Unfortunately, there are still quite a number of people especially within the rural communities that would ignore the initial decay. The decay would be left unattended until it gives off pain. This is not a bright move as cavities that has extended to the nerves would decrease the chance of saving the tooth.

Teeth with decay, should be filled and not left gaping to the mercy of bacteria in the oral cavity.

Basically there are several types of fillings that you would usually find at a dental clinic. The most common would be the metal alloy amalgam filling and the tooth coloured composite resin filling (another form of filling, the glass ionomer cement could also be used but I would prefer the earlier two for permanent fillings).

There are concerns over the amalgam fillings throughout the years. The fillings would not be aesthetically pleasing as it gives off a bland grey and metal-like hue. Another worry is the content of mercury in the filling. There are no concrete proof that the mercury contents in amalgam fillings give any side effects, as free mercury only present in very minute amounts during placing of the filling which only takes a few seconds. Amalgam fillings are structurally strong and can withstand high loads during chewing therefore it is one of the main choice for a filling in the back teeth.

Placing of the amalgam filling is also not sensitive to technique. Moisture control, the presence or absence of saliva and water, is not vital to having the filling placed. Application is simple, by cleaning the cavity and creating undercuts or ledges to help in the retention of the filling within the cavity as amalgam fillings do not stick to the tooth structure.

I used to treat patients with amalgam fillings quite often for cavities in their back teeth. Now, I try not to have amalgam fillings if possible as composite resin based filling materials is available in higher structural strengths to accept the high loads placed on the back teeth.

As the amalgam fillings do not stick to teeth, dentists use a technique where pins are placed on to the tooth structure to assist in holding the amalgam filling in place. This helps alot in the retention of the filling but I found quite a number of them to fail with fractures to the tooth structure.

Amalgam fillings are very strong, even stronger than the tooth structure itself, therefore it may withstand high loads. As the load increases, it is then transfered to the tooth structure and the tooth will fracture upon exceeding of tooth’s load limit.

Now, different dentists may have his or her own preferences, but I prefer to have composite resin based fillings. The colour is aesthetically pleasing (although colour and shade matching should be done properly prior to placement of the filling). Composite resin based fillings also bonds to the tooth structure this require less shaping of the cavity thus allow the dentist to conservatively prepare the cavity for the subsequent filling.

One problem that may arise is the sensitivity of the filling to moisture. Presence of water or saliva would prevent the bonding to take places thus failure of the filling is iminent. Moisture control is very important and I would suggest the usage of a dental dam (although I rarely see this in both the government and the private setting).

Discuss with your dentist for the best type of filling to be done. Having a good filling done would give your tooth the chance to serve you longer.

Cheers

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