Although everyone appreciates a nice, white, even smile, few people enjoy spending time in the dentist’s chair maintaining their oral health. After having a filling placed, the most common emotion is relief that it is over with, and then people move on, thinking the problem has been fixed forever. Unfortunately, dental fillings almost always need to be replaced at some point in time, and if fillings are placed in younger people, they may be need to be replaced several times during a lifetime.
Dental fillings are used to replace tooth material that has been damaged by bacteria. The warm, moist environment of the mouth is very hospitable to certain kinds of bacteria. Although the body has a number of mechanisms to fight off these bacteria in order to protect the teeth, oral bacteria have a tendency to form biofilms on the teeth that foil these mechanisms. Cleaning the teeth at home and undergoing regular professional cleanings can help to remove these biofilms and protect the teeth.
But sometimes mechanical trauma, exposure to acid, or just some very persistent bacteria manage to make inroads through the tough enamel coating of a tooth, creating a damaged spot called a caries, or sometimes referred to as a cavity. If a caries is not cleaned of the invading bacteria and filled with a material intended to replace the function of the enamel, the bacteria may be able to invade the pulp of the tooth, which may require extraction or a root canal to correct. Thus, dental fillings are considered to be an essential maintenance step in the lifelong process of protecting teeth and maintaining oral health.
Dental fillings can be made of any number of different materials. The most common is the amalgam, a composite of silver, copper, tin, and mercury, that forms the silver-colored filling material most people have encountered at various points in their lives. Amalgam is a very stable, durable, easy to use, and cheap material that has been successfully used for many decades to fill caries. Unfortunately, it is silver in color, which can cause cosmetic issues, and some people are troubled by the fact that it contains mercury, although there is no evidence that the use of amalgam fillings has ever caused any kind of mercury-related toxicity.
The tiny amount of mercury used in an amalgam filling is not sufficient to cause toxicity, even if a filling comes loose and is swallowed. Mercury does not accumulate in the body like some metals, and thus a few mercury molecules being released from an amalgam filling per day have no noticeable effect, especially when you consider that mercury is ubiquitous in the environment and everyone is exposed daily to low levels of mercury in the air, water, soil, and food.
Gold dental fillings are popular in some countries due to their extreme durability, but they can be very expensive and the color is usually even more visible than the silver of amalgam, which can cause cosmetic issues.
A popular filling material that matches the color of teeth is the composite, made from an acrylic resin mixed with ceramic powder. These fillings are not, however, as durable as amalgam fillings and are susceptible to damage if subjected to intense chewing pressure; they can also only be used to fill rather small defects. A similar product that gradually releases fluoride into the surrounding area to strengthen the local enamel is also available.
Do They Wear and Tear?
The mouth is a fairly hostile environment for materials. It is warm and wet, and the pH can fluctuate rather dramatically in response to foods and beverages. In addition, the teeth are required to chew food, and some food types can require considerable effort to masticate, which subjects the teeth and any fillings to fairly extreme forces on a regular, daily basis. In addition, although dentists constantly urge their patients to NOT use their teeth as scissors, nut crackers, and auxiliary hands, and to NOT chew on non-food items like pens, pencils, toothpicks, and the like, people tend to ignore this advice and go about subjecting their teeth to hard, non-food items, which can cause excessive wear and damage to tooth enamel and fillings.
In addition, some people engage in tooth grinding in their sleep and tooth clenching during stressful moments, both of which can cause serious damage to teeth and fillings and dramatically reduce the lifespan of fillings. If you engage in tooth-grinding at night, talk to our dentist about getting a tooth-guard to protect your fillings and teeth.
Diagnosis of Damaged or Missing Dental Fillings
Unfortunately, it is often quite difficult for the owner of the fillings to determine if they are damaged or even if part or all of the filling has fallen out. There are rarely any symptoms. Usually the only sign that a filling has gone bad is localized sudden sharp pain when chewing places pressure on a filling, but damaged fillings are also often not painful in any way. Sometimes, damaged fillings start to show discoloration around their edges, or develop a strange texture, but this doesn’t always happen. If the entire filling falls out or a large chunk of it breaks off, this is usually quite noticeable by the owner, but these events only occur in a minority of failing fillings. In most cases, the filling just gradually and slowly breaks down.
Damaged fillings can result in serious tooth damage. Cracks and leaks in the fillings can allow bacteria and food particles to sneak inside the tooth and hide there. Brushing and other tooth cleaning efforts are unable to dislodge bacteria and debris hiding inside or under a damaged filling, and the bacteria can thrive in there, forming thick biofilms as they gradually destroy the local tooth and invade further into the tissue. They may eventually manage to invade the pulp of the tooth. An infection that has reached the pulp may require tooth extraction or a root canal in order to maintain oral health.
Thus, it is important to undergo regular dental check-ups where in addition to looking for new damage to the teeth, the dentist carefully examines pre-existing fillings to detect any early signs of possible failure. A special instrument called an explorer is used to test the seal between the filling and the tooth. In addition, dental X-rays can be used to detect any signs of infection or tooth decay occurring underneath fillings, which would indicate the presence of some type of filling failure that needs to be addressed.
How Long Do Dental Fillings Last?
The lifespan of a filling depends on a number of factors. The first factor is what the filling is made of; gold fillings can often survive for 15 to 30 years. Amalgam has an average lifespan of 10 to 15 years, while composite fillings may only last five to seven years. However, these estimated lifespans are only averages. The lifespan of fillings varies a lot due to environmental factors, habits in regards to diet and non-diet choices about the uses of the teeth, differences between individuals in regards to the bacteria that live in their mouths, and random traumatic incidents that damage the teeth.
In addition, as mentioned above, people who habitually grind or clench their teeth generally have greatly shortened filling lifespans. People with dry mouth and diabetes also tend to have poor general oral health and to have greatly shortened filling lifespans. Saliva contains many anti-bacterial agents that are not present in abundance in individuals with chronic dry mouths. Diabetes, particularly in cases where the patient is unable to maintain good blood glucose levels, dramatically increases the risk of developing gum disease, thrush, and other oral problems, and in a double-whammy, many people with diabetes also develop chronic dry mouths. Thus, if you have diabetes, it is essential to get a dental check-up every six months.
The process of replacing a filling varies a bit depending on how large of an area was originally replaced with the filling, the location of the filling in regards to cosmetic issues, and how extensive the damage to the tooth is after failure of the original filling. In a simple filling replacement, the dentist will remove the old filling, remove all damaged tooth tissues, and simply put in a new filling; it will by necessity be slightly larger than the previous filling.
If the tooth was extensively damaged after failure of the previous filling, a root canal followed by crown placement may be the best approach in order to maintain both the best cosmetic look and the best oral health status. Even if the tooth wasn’t extensively damaged after filling failure, if the original filling was fairly large, it may be necessary to place a crown in order to maintain an acceptable cosmetic appearance.
A crown is a sort of tooth-cap that is placed over a tooth. It looks exactly like a healthy tooth and when sealed to the underlying tooth it protects the underlying tooth from bacterial invasive and damage. The process of placing a crown is usually a two-step procedure; after the old damaged filling is removed and the infected, damaged tooth tissue is removed, a temporary crown is placed to protect the tooth while a permanent crown that exactly matches the other teeth in color and shape is manufactured. Then, in a simple, quick procedure, the temporary crown is replaced with the permanent crown. Crowns can be made of a variety of materials, such as ceramics, resin composites, metal composites, and porcelain. Crowns are attached to the tooth through the use of a special cement.
If you have some fillings that were placed many years ago and haven’t been checked recently for damage, or if you suspect one of your fillings may be failing, consider making a visit to our dentists at Southside Medical Center in Atlanta, GA. Contact us today to schedule your appointment!