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RESTORING DAMAGED TEETH
Silver Fillings (Amalgams)
Silver fillings, otherwise known as Amalgams, are an alloy of several metals (Silver, Zinc, Tin etc.) and Mercury. Once mixed, they make up dental amalgam. This restoration has been used successively for many, many years and has stood the test of time. Periodically, reports are generated about the possibility of mercury toxicity from old existing silver fillings. To date, it is the opinion of the American Dental Association that there is no substantial proof that dental amalgam poses any threat to the safety of the dental public.
Initially, the decayed tooth is excavated and all the decay is removed.
The tooth is then shaped in a specific manner in order to accept a silver filling.
Finally, a band is placed around your tooth and the amalgam is condensed into the prepared tooth. The final filling is then carved and adjusted to your bite.
Once placed, it takes almost two (2) weeks for your new filling to become fully hardened. You may, however, safely chew on it after twenty-four (24) hours. But, please, chew carefully!
New silver fillings can be sensitive to hot and cold liquids and other foods for the first four to six weeks or in some special cases, even longer. If the sensitivity should continue 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 the appropriate therapy.
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 in excess of 40,000 pounds per square inch when chewing on your back teeth. Fillings which have not had the appropriate amount of time to harden, or are " high ", cannot stand this kind of pressure and may break.
White Fillings
In the past, teeth were most commonly repaired with amalgam (silver) fillings or gold restorations. Thanks to advances in modern dental materials and techniques, teeth can be restored with a more aesthetic and natural appearance. There are different types of cosmetic fillings currently available. The type used will depend on the location of the tooth and the amount of tooth structure that needs to be repaired.
Direct Composite
The most simple form of 'white filling' is technically called a Composite.It is made up of a composite quartz resin and usually contains some sort of light sensitive agent. These light cured composites are extremely cosmetic and most often bonded into place in one appointment. For this reason, they are often referred to as "bonding". They can be used in both the front of the mouth as well as in your back teeth. These materials come in a variety of shades so that they will match the color of your own teeth. Some of these composite materials have been specifically designed to actually withstand the incredible forces you can exert when chewing on your back teeth.
In order to bond a filling material to your tooth it is first necessary to remove decay, prepare the tooth and then to condition the enamel and dentin. Once conditioned, a thin resin is applied which bonds to the etched surface. The bond strength of these fillings is incredible. Today we can bond plastics and even amalgam (silver fillings) to your teeth. Bonding increases the strength of these restorations far beyond those of only a short time ago.
After placement, composites are hardened by shining an intense light on them for a specified period of time, usually around 40 seconds. Since we tend to look at this light all the time ( many times a day) it is necessary for us to protect our eyes from it with an orange shield. It is not necessary for us to protect your eyes since you look at this light only once in a while. However, it is probably a good idea for you not to look directly into the light anyway. An ounce of prevention, is indeed, worth a pound of cure!
We are constantly asked the same question," When can I eat?". Well, after placement, as long as you brought your own food and you share, you may chew right away. These fillings are instantly hardened by the light. Your teeth may experience some degree of temperature sensitivity for a few days to a week. If it does not disappear within that period of time, contact your dentist
Indirect Composite/Porcelain Inlay
The other type of 'white filling' is called a Composite or Porcelain Inlay. These fillings are usually placed in back teeth when esthetics is of utmost concern. In order to increase their strength and longevity, they are fabricated in the laboratory and then bonded into position in the office. This is a two visit procedure rather than the one visit required to place a composite filling. However, when it comes to strength and cosmetics, the extra time and expense is well worth it! I hope that you now understand a little bit more about white fillings.
Crowns
At your clinical examination, your dentist suggested that the proper means of restoring your tooth was a crown. The reasons for making that suggestion can vary from case to case. Some of the indications for a crown are:
1. A previously filled tooth where there now exists more filling than tooth. The existing tooth structure becomes weakened and can no longer support the filling.
2. Extensive damage by decay.
3. Discolorations and compromised esthetics.
4. Fractures
5. Root canal - After root canal, teeth tend to become brittle and are more apt to fracture. They, therefore, need to be protected by a crown.
6. Bridges - When missing teeth are replaced with a bridge, the adjacent teeth require crowns in order to support the replacement teeth.
Crowns strengthen and protect the remaining tooth structure and can improve the appearance of your teeth. Crowns can be made from different materials which include the full porcelain crown, the porcelain fused-to-metal crown and the all-metal crown. You and your dentist will decide which type is appropriate, depending upon the strength requirements and esthetic concerns of the tooth involved.
Fitting a crown requires at least two appointments. During your first visit, the tooth is prepared for the crown, an impression or mold is made of the tooth, and a temporary crown is placed over the prepared tooth. At the subsequent visit, the temporary crown is removed and the final crown is fitted and adjusted and cemented into place.
First Visit
The first visit begins by giving you a local anesthetic. Depending upon the type of local anesthetic used, you can expect to be numb for one to four hours. If your anesthesia should last longer, do not be concerned. Not everyone reacts to medication in the same manner. One word of caution : While you are numb, please be careful not to bite your lip or tongue. A soft diet or no meal at all while you are numb is probably a good idea. If your child has been the patient, please watch them carefully to be sure they do not play with their tongue or lip while it is numb.
Once you are numb, your dentist will prepare your tooth in a very specific way in order to maximize the retention and esthetics of your new porcelain to metal crown. After the tooth is fully prepared, we proceeded with the impression stage. We used a thin piece of retraction cord which is placed around your tooth in order to get the impression material under the gum where the crown ends. Please rest assured that this small piece of cord was removed prior to the end of today's visit.
Should you experience any discomfort you can take a mild analgesic (Tylenol™, Advil™, Anacin™, etc.) as long as there is no medical contraindication based upon your medical history. Typically, you can take anything you would normally take for a headache. If the discomfort persists, please call your dentist.
Once the impression stage is completed , your dentist or his assistant will place a temporary (transitional ) crown (or bridge if multiple teeth were involved) on your tooth. These plastic (acrylic) restorations are placed on teeth to protect them and the gum tissues between dental visits. The temporary cementing medium used is designed to allow the easy removal of the temporary at your next scheduled visit.
There are a couple of additional facts you should know about regarding the care of your temporary crown:
* Home care is extremely important while your temporary crown is in place. The health of your gum tissue and the success of your final treatment restoration depends upon it. PLEASE do not be afraid to clean your teeth between visits. With a minimal amount of home care, you should be able to maintain the continued health of your teeth and gum tissue during the time required to fabricate your new crown.
* Sometimes, even with meticulous care, temporary crowns or bridges may become loose between visits. If this should occur, please place the temporary crown or bridge back on your tooth immediately. Putting a drop of Vaseline™ in the temporary crown or bridge will very often increase the retention and hold the temporary in place until you can schedule an appointment. Once again, REPLACING THE TEMPORARY CROWN IMMEDIATELY IS VERY IMPORTANT ! It only takes a short time for teeth to move if the temporary is not put back into its proper position. This could affect the final restoration significantly and may necessitate new impressions and a great deal of time. If you can not replace the temporary crown yourself, put it in a safe place and call the office. We will be happy to recement it for you at the earliest possible moment.
Second visit
At that time, the temporary crown is removed and any temporary cement is cleaned from the prepared tooth. Your dentist will fit the final crown, check for accuracy, adjust for any bite discrepancies and evaluate the esthetics. If all of these factors are acceptable, the crown is cemented to your tooth. It is not unusual for the new crown to be mildly sensitive to cold temperatures for a few weeks. However, if the sensitivity is severe, does not subside, or if the bite feels uncomfortable, contact your dentist. Further adjustments to the crown may be necessary.
We hope that this brief instruction sheet will answer most of your questions regarding crowns. Following these simple guidelines will help provide you with the finest in dental care. If you have any questions regarding this or any other procedure,please contact your dentist.
Bridges
The loss of a single tooth can have a major impact on your dental health and personal appearance. Your teeth support and rely on each other. When one or more teeth are missing, the remaining teeth can shift out of their normal position. Teeth adjacent to the space or from the opposite jaw will often drift or tilt. These teeth are often more susceptable to decay and gum disease because they are more difficult to clean around. All of this shifting and drifting will lead to changes in the bite, which may put stress on the jaws, muscles and teeth. Ultimately, your ability to chew comfortably and your appearance may be affected.
If tooth loss occurs, your dentist may recommend that a bridge be placed. A bridge consists of a replacement tooth/teeth attached to crowns on each side. The bridge is cemented to the teeth adjacent to the space, effectively replacing the missing tooth and preventing any shifting.
The procedures involved in making a bridge are very similar to those for making a crown. Bridges can be made from the same materials as crowns - full porcelain, porcelain fused-to-metal, and all metal. At least two appointments are necessary. At the first visit, your dentist will prepare the teeth next to the missing tooth for crowns. An impression of the prepared teeth will be made and a temporary bridge will be placed. At the subsequent visit, your dentist will fit and adjust the bridge and then cement it in place.
Your new bridge will require some special care when brushing and flossing. Your dental professional will instruct you how to clean around and under the bridge. They may recommend various cleaning aids to help you keep the plaque off and prevent further decay and gum disease.
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