TOOTH FILLINGS

I. Types of Tooth Fillings:

Tooth fillings are required to treat decay in teeth, a cavity formed in a tooth, or to repair cracked or broken teeth that have been worn down. In such cases, the dentist will remove the decayed portion of the tooth and then “fill” the gap thus created with a dental filling material.

Several types of dental filling materials are available today. They vary from gold filling; porcelain filling; silver amalgam filling (which is a mixture of mercury, silver, tin, zinc, and copper); or tooth-colored plastic material known as composite resin fillings.

In addition, there is also a material known as glass ionomer which has glass particles in it. This material is used in ways like the use of composite resin fillings.
The location and extent of the decay cost of filling material, the insurance coverage, and the dentist’s recommendation assist in determining the type of filling best for a patient.

The different fillings have different properties.

• Cast Gold Fillings last longer (10 -15 years) and don’t corrode. They also have aesthetic appeal being pleasant to the eye.

• Silver Fillings (Amalgams) also last long (say 10-15 years) though there are concerns about its long term side effects.

• Tooth-colored Composite resin fillings have benefits such as aesthetic appeal (they blend with the natural color of the teeth); they bond to the tooth structure; they are versatile and are ideal in cases where less tooth structure needs to be removed.

In addition to the above, two other tooth-colored fillings exist — ceramics and glass ionomer. They are:

• Ceramicfillings are made of porcelain, resist staining relative to the composite resin material. Ceramics last more than 15 years and are on par with gold in terms of costs.

• Glass ionomer is composed of acrylic and a glass material. This material is ideal in cases where the filling is required below the gum line and for tooth fillings for children (although drilling is required). One major benefit of using glass ionomers is that they release fluoride, which protects the teeth from decay.

Some other types of fillings are as follows:

• Indirect fillings are like any other fillings discussed above. The difference is that they are prepared in a dental laboratory. When the tooth structure is worn out to such an extent that the part of the tooth remaining is not sufficient to support a filling and it is not so badly damaged as to require a crown, then, indirect fillings are considered. There are two types of indirect fillings — inlays and onlays.

• Temporary fillings are.as the name suggests, temporary in nature. They are resorted to when (i) a dentist may need more than one appointment (before placing a gold filling); (ii) after a root canal; (iii) when a tooth nerve needs to “settle down” if the pulp is irritated; and (iv) in times of emergency.

Of the type of tooth fillings available, the composite material is the most widely recommended. The composite material can be described as a type of plastic that is soft initially but gradually hardens when cured with a UV light and chemically bonds with the teeth.

II. Procedure for a tooth filling

First, the dentist may use local anesthesia to numb the area around the tooth that requires a filling. Next, the dentist will remove the decayed part of the tooth using a drill. Appropriate instruments may be used by the dentists for this purpose depending on the location of the affected tooth and the amount of decay.

Next, the dentist will examine the area to ascertain if all the decay has been removed.

Subsequent to this, the dentist will create the space for the filling by cleaning the cavity off bacteria and debris. If the decay happens to be at the root, the dentist will place a liner made of composite resin, glass ionomer or other material to safeguard/shield the nerve.

In case of tooth-colored fillings, some more steps are required to be taken. The tooth-colored material is applied in layers. Then, a special light that hardens (referred to as ‘cure”) each layer is applied. When this process is completed, the dentist will shape the composite material to the desired shape taking care to trim any excess material, and then polishes the final restoration.

III. Tests needed before a tooth filling:

Tooth decay or the realization that a tooth requires treatment issignalled by the symptoms like mild sensitivity to hot or cold liquids or foods; sensitivity to sweets; pain on biting or chewing etc.

The dentist can detect a cavity using special instruments to do this. If needed, the dentist may prescribe a x-ray. Depending on the result of the x-ray, further treatment isadvised.

IV. Measures to be taken after Tooth Filling

It is quite common that a tooth remains sensitive to air, hot and cold liquids or foods or sweet foods after a filling. Usually, the sensitivity subsides within a short time. One must avoid all those liquids and foods that create sensitivity in the affected tooth during this period. Dentists generally advise the patient to keep away from food for the first hour after the appointment and permit the patient to eat hard foods after about 24 hours.

On the other hand, if a filling (or composite) becomes hard immediately after the appointment, in that case, the patient can eat any food so long as the numbness is no longer there.

Dentists generally recommend a desensitizing toothpaste if the sensitivity is too acute or may suggest a root canal procedure.

If there is a pain on biting and it subsists for an unduly long time (beyond 48 hours) or the patient notices any color changes in the affected tooth, then the patient may have to consult his dentist who may reshape the filling.

It goes without saying that to retain the fillings for long, one should follow the below simple oral hygiene rules:

 Getting teeth cleaned at regular intervals
 Using a fluoride toothpaste for brushing
 Flossing and introducing into the oral hygiene the use of an antibacterial mouthwash daily
 In the event, the patient feels a sharp edge or the filling has developed a crack or the filling is chipping off then the patient needs to call the dentist who may recommend further treatment.

Having said the above, it is important to note that each filling may have separate precautions to be taken. Therefore, the patient has to carefully follow the instructions of the dentist to avoid any post-filling problems. Often, there will not be the need for any further treatment if good oral hygiene is followed.

However, it is pertinent to note that if the decay lay close to the pulp of the tooth, the patient may experience pain that resembles a “toothache”. In this case, the dentist may recommend a root canal therapy.

V. Advantages and Disadvantages

It is common knowledge that tooth fillings save teeth that are subject to decay. If an affected tooth is not ‘filled’ in time, then, it may lead to further and total decay and the tooth will ultimately have to be removed. In other words, by ‘filling’ a cavity in a tooth, one can save a tooth.

However, there are some disadvantages in tooth fillings:
 Allergies
Some studies have stated that there could be allergic reactions to silver fillings though this has not been established beyond doubt by any research.

 Deteriorating Fillings
Tooth restorative fillings experience wear and tear with time. They may wear away through chipping and cracking under the constant pressure of chewing.
If the sealant between the tooth enamel and the filling gives way, food particles and decay-causing bacteria can start to form and multiply causing an abscessed tooth.

If the recurrent decay is widespread, there may not be enough tooth structure left to support a replacement filling. In these cases, the dentist may need to replace the filling with a crown.

VI. Preferred Age, Gender, etc. for Tooth Filling

People of all ages can require a tooth filling- young and old alike. Tooth decay can occur in children as well as in adults including the old.

While an affected tooth would necessarily be required to be filled, yet, the difference would lie in the type of way the anesthesia is given to children. For example, dentists may apply a numbing gel near the tooth to be filled prior to using a needle for anesthesia.

The dental problems of the elderly arise in relation to their teeth, gums, dentures and their medical histories. For the elderly, while the treatment, by and large, remains the same as with any adult, care may have to be taken in the maintenance of the dentures, if any. The dentist will give detailed guidelines should a denture be required in addition to prescribing some anti-bacterial/anti-fungal creams.

VII. Advancements in Tooth filling technology

Tooth decay has become very common today. Of the various restoration materials available today, a dentist by and large uses a composite filling material made of acrylate compounds, as it resembles the color of the teeth and is reasonably strong.

But it has to be noted that since composite filling materials have some disadvantages, studies are being conducted for an interdisciplinary collaboration to develop a material comprised of glass ionomer cement. Glass ionomer cement has the following advantages over silver amalgams:

• It is free from mercury content;
• It releases fluoride which beats cavities
• It needs no layer of adhesives to bond to the tooth
• It is strong, relatively speaking
• It is ideal for areas where there may be no continuous electricity supply as it does not need to be illuminated with a lamp to harden
• Experiments were performed with the help of neutron scattering technology to arrive at the right way of mixing acidic content to glass ionomerand the best results have been obtained.
To quote DrHeloisaBordallo, Associate professor and materials researcher at the Niels Bohr Institute at the University of Copenhagen. “Experiments showed that the combination where the acid is mixed up in the cement, so you only have to add water to the cement powder is the weakest material. You get the strongest material by having cement powder mixed with water that has had acid added to it. So, it is better to have the acid in the water — it helps to bind the liquid faster and stronger to the cement and there is less water in the pores”
However, research is continuing with new mixtures to perfect the procedure.

Other advancements in materials:

Researchers at the University of Nottingham and Harvard University’s Wyss Institute are looking at ways to trigger natural repair mechanism of teeth. Scientists are working on a biomaterial dental filling which when comes in contact with tooth pulp tissue, can stimulate native stem cells to regenerate the pulp and dentin around it.

Treatment with silver diamine fluoride (SDF), is said to stop cavities in their tracks and research in this direction is in progress.

Research is also under way for the use of peptides that might prevent decay from starting.
The high cost of porcelain/gold crowns and the fact that porcelain does chip away is paving the way for a more cost-effective material, lithium disilicate (LDS) glass-ceramic crown and tooth material for dentures and bridges.

Lastly, there are advances made in production methods too. Renishaw has developed 3-D printers that use the “powder bed fusion technique,” explained as follows: fine layers of a powdered metal are fused by a laser.

With phenomenal growth in research and scope for further research in technology, dentistry can look forward for newer techniques and methods in every area especially in relation to tooth filling.

VII. Why Dental Planet for Tooth Filling

It is not an exaggeration to say, “All roads lead to Dental Planet for any oral health-related problems. “Dental Planet offers a whole range of treatments for any or all oral health problems- small or big, at reasonable charges.

Ideally located in Gachibowli and Indiranagar, Hyderabad the clinics are within easy reach of the public.

Dental Planet has state-of-the-art infrastructure comprising the latest technology and equipment with a highly qualified medical fraternity. Treatment is sound with prompt reminders for follow-ups!

Staffed with active, energetic and ‘ever-willing to help’ employees, be it at the administration or laboratory, Dental Planet clearly has several advantages over other dental clinics.