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FAQs - Restorations, crowns and bridges

Tooth sensitivity following placement of a filling is fairly common. A tooth may be sensitive to pressure, air, sweet foods, or temperature. Usually, the sensitivity resolves on its own within a few weeks. During this time, you should avoid those things that are causing the sensitivity. Pain relievers are generally not required.
Contact your dentist if the sensitivity does not subside within 2 to 4 weeks or if your tooth is extremely sensitive. He or she may recommend you use a desensitizing toothpaste. Your dentist may apply a desensitizing agent to the tooth or possibly suggest a root canal procedure.

There are several explanations for this pain, each resulting from a different cause.

  • Pain when you bite—With this type of pain, the pain occurs when you bite down. The pain is noticed soon after the anaesthesia wears off and continues over time. In this case, the filling is interfering with your bite. You will need to return to your dentist and have the filling reshaped.
  • "Toothache-type" pain—If the decay was very deep to the pulp of the tooth, this "toothache" response may indicate this tissue is no longer healthy. If this is the case, root canal treatment will be required.
  • Referred pain—With this type of pain, you experience pain or sensitivity in other teeth besides the one that received the filling. In this situation, there is likely nothing wrong with your teeth. The filled tooth is simply passing along "pain signals" it’s receiving to other teeth. This pain should decrease on its own over 1 to 2 weeks.

 

Constant pressure from chewing, grinding, or clenching can cause dental fillings to wear away, chip, or crack. Although you may not be able to tell that your filling is wearing down, your dentist can identify weaknesses in your restorations during a regular check-up.
If the seal between the tooth enamel and the filling breaks down, food particles and decay-causing bacteria can work their way under the filling. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscess.
If the filling is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown.

New restorations that fall out are probably the result of improper cavity preparation, contamination of the preparation prior to placement of the restoration, or a fracture of the restoration from bite or chewing trauma. Older restorations will generally be lost due to decay or fracturing of the remaining tooth.

Advantages:

  • Aesthetics – the shade/colour of the composites can be closely matched to the colour of existing teeth; is particularly well suited for use in front teeth or visible parts of teeth
  • Bonding to tooth structure – composite fillings actually chemically bond to tooth structure, providing further support to the tooth
  • Versatility in uses – in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken or worn teeth
  • Tooth-sparing preparation – sometimes less tooth structure needs to be removed compared with amalgams when removing decay and preparing for the filling

Disadvantages:

  • Increased chair time – because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgams to place
  • Additional visits – if composites are used for inlays or onlays, more than one office visit may be required
  • Chipping – depending on location, composite materials can chip off the tooth
  • Expense – composite fillings can cost up to twice the cost of amalgams

 

No. Simply follow good oral hygiene practices. Brush your teeth at least twice a day, floss at least once a day and see your dentist for regular professional check-ups and cleanings.
Because bonding material can chip, it is important to avoid such habits as biting fingernails; chewing on pens, ice or other hard food objects; or using your bonded teeth as an opener. If you do notice any sharp edges on a bonded tooth or if your tooth feels odd when you bite down, call your dentist.

First, the dentist will numb the area around the tooth to be worked on with a local anaesthetic. Next, a drill, air abrasion instrument or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.
Next, your dentist will probe or test the area during the decay removal process to determine if all the decay has been removed. Once the decay has been removed, your dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.
Several additional steps are required for tooth-coloured fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-coloured material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multi-layering process is completed, your dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.

Indirect fillings are similar to composite or tooth-coloured fillings except that they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.

During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental laboratory that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while your restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.
There are two types of indirect fillings – inlays and onlays.

  • Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
  • Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.

Inlays and onlays are more durable and last much longer than traditional fillings – up to 30 years. They can be made of tooth-coloured composite resin, porcelain or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.

Another type of inlay and onlay - direct inlays and onlays - follow the same processes and procedures as the indirect, the difference is that direct inlays and onlays are made in the dental office and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.

Temporary fillings are used under the following circumstances:

  • For fillings that require more than one appointment – for example, before placement of crowns or bridges
  • Following a root canal
  • To allow a tooth's nerve to "settle down" if the pulp became irritated
  • If emergency dental treatment is needed (such as to address a toothache)

Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within 1 month. Be sure to contact your dentist to have your temporary filling replaced with a permanent one. If you don't, your tooth could become infected or you could have other complications.

Over the past several years, concerns have been raised about silver-coloured fillings, otherwise called amalgams. Because amalgams contain the toxic substance mercury, some people think that amalgams are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis.

The American Dental Association (ADA), the FDA, and numerous public health agencies say amalgams are safe, and that any link between mercury-based fillings and disease is unfounded. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.
As recently as March 2002, the FDA reconfirmed the safety of amalgams. Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth. The National Institutes of Health has several large-scale studies currently under way to ultimately answer many of the questions raised about silver-coloured amalgams. Results of these studies are expected to be released in 2006.

In addition, there has been concern over the release of a small amount of mercury vapour from these fillings, but according to the ADA, there is no scientific evidence that this small amount results in adverse health effects.