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Restorative Dentistry

Fillings - Silver & White

What are fillings?

A filling is the dental treatment in which a defect or hole in a tooth is filled with dental material. In filling teeth, the decayed material is removed by drilling and replaced with a restorative material such as silver alloy or composite.

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How are fillings done?

Step 1: Examination and Diagnosis

As in any dental procedure, the first step is a thorough examination. Most dental caries can be discovered in the early stages during routine checkups. The tooth may appear either chalky white or slightly grayish.

Dental X-rays may show some cavities before they are visible to the eye, especially between the teeth and under the gums.

A newer method of caries detection is with the use of a red caries detecting solution. This stains the decayed areas thus detecting caries under old fillings and deep within teeth.

As the caries advances, visible pits and holes are now clearly seen. In the more advanced stages large parts of the tooth are often destroyed possibly even damaging the pulp.

Step 2: Preparing the tooth - Drilling

Initially, the decayed tooth is excavated and all the decay removed from the teeth by drilling. In cases where decay is still in the early stages, the procedure is usually painless. However in cases where the cavity is fairly large, a local anaesthetic may be administered to numb the area making the procedure painless.

Step 3: Filling the cavity.

The prepared cavity is then filled with a filling material. In front teeth, where aesthetics is the prime consideration, a composite bonding material is used, while in back teeth, where strength is more important, silver amalgam is still the material of choice.

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Why do I need fillings?

Once a cavity starts, it continues to spread into the deeper parts of the tooth affecting the pulp leading to nerve damage and even an abscess. In the process it destroys the tooth structure making the tooth weaker and possibly resulting in a fracture. Early treatment is less painful, less expensive and often preserves the tooth.

Visit the root canal section for further details on this.

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What are the different types of fillings?

Fillings are basically of two types: silver or amalgam fillings and white or cosmetic fillings.

Silver or Amalgam filling

Used successfully as a filling material for over a hundred and fifty years, amalgam is ideal for back teeth, as it is one of the most durable materials, capable of withstanding biting pressures. The main disadvantage, besides the colour, is its tendency to expand over time, which may result in stress cracks that could lead to fractures of the teeth. This is usually seen in very large fillings. In such a situation, it is advisable to place a crown on the tooth to avoid it from fracturing.

White or Cosmetic fillings

There are different types of cosmetic fillings currently available, depending on the location and the amount of tooth structure that needs to be repaired.

Direct Composite fillings

Well suited for fillings in the front teeth, these materials come in various shades so you can match them perfectly with the teeth. However they are ill advised for back teeth, as they are not very strong. They are stuck to the tooth with a thin resin layer, which acts as glue. This bond breaks down under heavy pressure like that of biting and chewing, leading to hypersensitivity and eventually to damage of the tooth pulp.

Indirect Composite or Porcelain Inlays

The other type of 'white filling' is called an Inlay. These are used for back teeth, only in cases where looks are a primary concern. These inlays are stronger than direct composite fillings as they are fabricated in the laboratory and then bonded to the teeth. Inlays can be made of composite or porcelain but porcelain inlays are preferable due to their excellent aesthetics and durability. Indirect inlays require two visits rather than the one visit required for a direct composite filling.

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When can I eat after a filling?

Refrain from eating for at least 1 to 2 hours after a filling. If anesthesia is given, eat 30 minutes after anesthesia wears off.

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Why are my teeth sensitive after the fillings?

New fillings can be sensitive to hot and cold liquids and other foods for the first four to six weeks after, which the sensitivity usually decreases. Extensive decay and preparation may result in sensitivity for longer. During the initial healing stages, you may take a painkiller. If the sensitivity continues for an extended period of time or if the discomfort is extreme, call your dentist so that he/she can evaluate the situation and prescribe appropriate therapy.

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Why does my bite feel a little odd after the anesthesia effect has worn off?

Sometimes, due to the effects of the local anesthesia, it is quite difficult to make sure that your bite is exactly right. If you feel any discomfort in chewing, call your dentist. A minor adjustment is usually all it takes to make you comfortable. Don't wait too long, teeth can become quite sensitive if the bite is "high". You can generate 40,000 pounds of pressure per square inch when chewing on your back teeth and fillings which have not had the right amount of time to harden, or are "high", may break under this pressure.

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Are silver fillings dangerous?

In recent years there has been a lot of controversy regarding the safety of amalgam fillings. The American Dental Association (ADA) carried out exhaustive research and found no scientific evidence to substantiate the claims of mercury toxicity from amalgam fillings. According to them there is no substantial proof that dental amalgam poses any threat to the safety of the dental public.

The U.S. Public Health Service finds "no persuasive reason to believe that avoiding amalgams or having them removed will have a beneficial effect on health." In fact, it is inadvisable to remove amalgams unnecessarily because it can cause structural damage to healthy teeth. Current alternatives, such as composite resins, have not been as effective as dental amalgam in providing a durable and long- lasting restoration, especially in the case of large fillings.

The ADA concurs with the findings of the U.S. Public Health Service that amalgam has "continuing value in maintaining oral health."

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