The Tooth about White Fillings

Recently the world of dentistry has converted to predominantly white fillings as opposed to the silver fillings. What people don't really understand is what these fillings are and what their limitations are. Briefly I will say that the silver fillings known as Amalgam are very strong, safe, and reliable fillings. I will go into detail about them in another post. Lets talk about white filling known as Composite.

WHAT IS COMPOSITE? Scientifically they are called resin, but simple put, its plastic, very hard plastic. It is comes in 2 basic forms: Squishy and flowy also known as Packable and Flowable. Both of these, when hit by an intense blue light become "cured" and turn very very hard. Most dentists use both of the squishy and the flowy - the squishy type is stronger and has been engineered to be strong enough to withstand most biting forces. The flowy type has been engineered to be extra smooth and polishes to be real shiny. It can reach little nooks and cranies that the squishy type cannot.

HOW IS A WHITE FILLING DONE? Unlike other fillings or restorations, Composite fillings do not rely on a wedging effect to stay in the mouth. They rely on bonding or chemically attaching to the tooth. The benefit of this is the dentist can cut less or zero tooth away to put a composite filling on. Simple place the chemicals on the tooth to prepare it and then put the filling material and then blue light (aka cure). By the way if you taste something funky during all of this, it is the chemicals used to bond to the tooth. The side effect of this is that whenever these fillings have problems, they don't stay in - they pop out. Other fillings, when there are problems, they stay in even if they are decayed all around. You can view this as a positive or negative thing.

CAN WHITE FILLINGS BE USED ALL THE TIME? The short answer is yes, but the real answer is no. They CAN be used all the time, but they probably shouldn't. One of the major weaknesses is  that it relies on the tooth being completely dry when it is done. Often times your tongue or even the moisture in your breath can disturb this and make the filling not as strong as it was designed to be. When working in the back, this can be especially challenges to get a strong bond.

WHAT ARE THE DRAWBACKS? Many patients get sensitivity to cold and sweets after composite fillings are done especially when the cavity is deeper. There are several reasons this can happen. The first is that the inner layers have the tooth have nerves embedded in them and the filling material, because it is plastic has a very slight flex to it. This flexing will disturb those nerves. Also, because of the strength of the Packable composite, if the filling was made to be too high you will not be able to grind it down and that tooth will take more force than other teeth leading to sensitivity. Dentists will always check the bite first to make sure this is not the problem. Another drawback is that plastic just isn't as strong as metal and in some strong jawed patients, it will be strong enough and will break.

The Tooth about Dental Extractions

The term "harder than pulling teeth" has been toss around for years now. It gives a very scary impression of what its like to have a tooth pulled. Lets see if we can dispel some of the rumors.

Again I will start with the most important: HAVING A TOOTH PULLED DOES NOT HURT. Just like root canals, a dental extraction, when fully numb, is done without pain. The one difference between an extraction and other procedures is the physical pushing you feel in your mouth. While there is no pain, there is the sensation of something wedged between your teeth which takes some time getting used to.

Now lets talk about the actual procedure. Many times patients are amazed how quickly it is done. Most of the time it takes more time to get numb than to actually take out the tooth. Most of the time it is not difficult nor long to encourage a tooth to come out. When pulling an adult tooth people get the wrong idea of how it is done. We do NOT just grab it an yank it out. Taking out a tooth is approched similarly to removing a nail from a very dense piece of wood: pulling it will feel like you're doing nothing. We take an very thin instrument and wedge it next to the tooth until the jaw bone around it eases up. Once the bone expands in all directions we simply can pluck the tooth out like a flower.

Pulling baby teeth conversely seems like we're pulling. This is because baby teeth are gradually eaten away by the body as they get older and when we pull them out theres just only the top portion of the tooth remaining that is stuck to the gums. They don't require any dealings with the jaw bone so they are simply plucked out.

Some Facts you may not know about Dental Extractions:

- If a tooth is highly infected, the bacteria in the gums will prevent the anesthesia from working. So many doctors discourage pulling abscessed teeth and usually prescribe antibiotics first.

- Doctors will often encourage placing bone in the left over hole to allow the entire hole to fill with bone. This will give better looking gums and makes it easy to place an implant(quicker and less pain).

- The price for pulling a tooth depends on the how hard it is to get out. Often times if you demand a price from a dentist he will quote you the one for a hard extraction just in case. If you don't ask, often he'll charge you for the easy extraction if it was easy.

- When a tooth pops out, it can fly in any direction, so don't swallow!

- The older you are, the more difficult it tends to be to pull your teeth because the jaw bone tends to be less elastic as it ages.

The Tooth about Dentures

As a dentist, I always hope I never have to give my patient dentures. However I know it is inevitable that many people will need to have them made. Lets start with the basics......

Dentures are plastic "plates" that people can wear that have plastic teeth embedded in them. They are for patients that have no teeth or will have no teeth after treatment is completed. The positive: They look great. When it comes to getting a beautiful smile, dentures can give a very ideal beautiful look because they are 100% designed and controlled. The negative.... dentures are not real teeth and feel nothing like real teeth. Your ability to chew will be clearly less than before. The analogy I usually use is comparing wearing a boxing glove vs your fingers - its quite clumsy.

Dentures can be made in two ways: Before your teeth come out, or after. To make them before the teeth are pulled are called "immediate dentures"... namely because they are given immediately after the teeth come out. This allows you to never have to walk around with no teeth. There is a drawback however, and that is that the shape of the plate is a laboratory guess. It will fit moderately well the first day and get progressively worse as the jawbone remodels itself  after the teeth have come out. Some of the time after the bone finishes changing, the internal surface of the denture can be relined to fit the new shape of the bone, but this isn't always possible. Thats why I consider the immediate denture to be a temporary denture. The most reliable way to make a denture is to wait 2-3 months after the teeth are removed to shape it to the final shape of the mouth.

Upper dentures are superior to lower dentures. Why? Because there is suction. The upper uses the palate (or roof of your mouth) to create a seal of air and water to behaving like a suction cup. It won't flop around so easily.  This is why sometimes dentists will often be more aggressive when planning for upper dentures because the end result isn't as dramaticly different from a few teeth and a partial denture - it basically will save you money long run. The lower denture however, is terrible. It will move around a lot and the only way to control it is to use yoru tongue properly. It is a skill that requires practice.

Fortunately we now have dental implants to help use these plates. With two implants placed in each jaw, they can hook onto the denture and give a very stable prostheses. They can be so tight that it will take a lot of effort to remove them. In addition if more implants are used, the upper can be made to not cover the palate for increased taste and comfort. I always recommend this option for those who are healthy enough to have dental implants.

The Tooth about Root Canals

Theres nothing like the look in your eyes whenever I say you need a root canal. Its as if rapture has started and the world is collapsing on itself. I'm kidding of course, but it doesn bring a lot of anxiety. Hopefully I can clarify some common misconceptions.

First of all, lets get the big one out of the way: ROOT CANALS ARE NOT PAINFUL. They got the reputation (similarly to pulling a tooth) of being painful back in the days where dental anesthesia products did not work as well as today. Today, we can make teeth 100% numb so the actual procedure itself is just as comfortable as getting a cleaning.

WHAT IS A ROOT CANAL: A root canals is a procedure where the dentist will removed all nerve and vessel tissue from the center and roots of the teeth so it will not be able to feel pain anymore. The dentist will also clean out all the tooth walls on the inside to make sure that theres no bacteria left clinging on the inside. Finally he will put a filling material that will appear white on xrays.

WHY DO I NEED A ROOT CANAL: The most common reason why you need a root canal is your tooth is infected. When a cavity becomes big enough, the bacteria have dug their way to the center of the tooth where the nerve lives which will cause a LOT of pain. However after some time the bacteria will take over the inside of the tooth and it will die, where it becomes a full blown infection. Often times you will notice no pain because the nerve has died. However, after enough bacteria grow, it will create an abscess (or pus pocket) which will cause pain once more and spread to other locations in the body!

There is one case where a tooth infection actually killed a 12 yr old boy so Root Canals can save lives!
http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html

Other FACTS YOU MAY NOT KNOW:

- After getting a root canal, front teeth tend to turn grey because they have lost blood supply

-After getting a root canal, back teeth are typically vulnerable to breaking, so crowns are always placed.

-Mild discomfort between treatment appointments or after treatment is not unusual but you are less likely to have it if you're tooth wasn't completely dead before the dentist started treatment. It is almost always temporary.

-Root canals on teeth further back are significantly more difficult and more expensive.

- Material used to fill the root canal is similar to the material inside of a golf ball!

The Tooth

First of all, I would like to say thank you for visiting and welcome to my Blog! I am dedicating this blog to provide dental information commonly asked and will try to dispel any myths that may scare you. If you have any questions about any information I post here, feel free to contact me at Jchung@myserenitydental.com or you can ask me at http://www.myserenitydental.com/. Thanks again!

Jeffrey Chung DDS