Dental fillings and things to know

 Suddenly one day you discover that your tooth is painful. You go to the dentist and are prescribed dental restoration treatment with fillings. If you are in this situation then don't worry as this is a completely painless and sensitive treatment. Before treatment, you may be confused and have many questions to be answered about this treatment. However, your dentist will give you time to research carefully before deciding on treatment. The following article will provide you with some information you need to know about fillings.

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• 1. What is a filling?
• 2. Steps to diagnose the condition that requires dental filling treatment
• 3. Types of materials commonly used to fill teeth
• 4. Classification of filling sinuses 
• 5. Steps of filling teeth
• 6. Lifetime of fillings
• 7. Possible problems when filling teeth

1. What is a filling?

Filling is a treatment to restore function and anatomy to teeth that have lost their structure due to tooth decay, fracture due to trauma or tooth wear. Fillings are also used for restoration after other dental treatments such as root canal treatment. The dentist will use different materials to replace and reshape the missing part of the tooth. Restoration of teeth can be performed directly or indirectly depending on the location and size of the loss.

There are many different materials used to restore teeth such as composite resin, amalgam, gold, GIC... The choice of materials depends on the dentist's assessment in each clinical case. There are many factors to evaluate such as: deep sinus width, location, cost...

2. Steps to diagnose the condition that requires dental filling treatment

The most obvious signs of tooth decay are pain and sensitivity in the affected area or food crammed between the teeth. As soon as the above signs appear, you should visit your dentist immediately to avoid prolonged discomfort and stinging.

Most of the time when you feel pain, the tooth decay has already advanced. Therefore, if you do not treat it quickly, there is a risk of infection to the pulp. Do not perform folk remedies for toothache such as using essential oils for deep holes. These methods are only meant to provide temporary pain relief. The most correct treatment is to quickly remove the decayed, infected tooth tissue.

When you visit the dentist, you will be examined and do some simple tests to assess the condition of tooth decay.

Examine, observe

Your dentist will look and examine your entire mouth, especially the area where you feel pain. In this area, the dentist will look for signs of tooth decay such as: cracks, discoloration, white spot lesions or rough areas on the tooth surface. 

Type and probe for luxury

After observing, the dentist will use an instrument (usually a mirror handle or handle) to gently tap the tooth. Different types of cavities also give different tooth sensations. This typing is used to assess the severity of tooth decay.

The dentist will also use a small-headed instrument (dental probe) to probe deep sites. Probe helps to identify access to deep orifices on occlusal or smooth surfaces. It is difficult to insert the probe if the lateral cavity is adjacent to other teeth.

Luxury exploration

Observation and exploration will help the dentist detect other problematic tooth positions. For example, the location of pain in the upper teeth can originate from the lower teeth. This is called “transposition pain,” making it difficult to make an accurate diagnosis.

There are many problems that can cause pain in or around a tooth in addition to tooth decay. A toothache in a displacement can be caused by problems with the heart, lungs, cold, or even nerve pain. For example: The root of the upper molar near the maxillary sinus, when sinusitis can also cause this toothache.

X-ray film

After the physical exam, the dentist may take some dental films. These films help to see more closely the structure as well as the apical area within the bone. From there, the dentist can assess the extent of the lesion. The x-rays also help the dentist make decisions about whether to treat a filling or to have a root canal or to remove it.

Diagnosis and treatment planning

You will be given a list of the problems and treatments, as well as the progress of the treatment. Usually, if the carious lesions are small, on the enamel surface, the dentin has not yet been penetrated, the dentist can perform remineralization of the deep sites. However, this treatment can only be done if the patient adheres to good oral hygiene and has a reasonable diet. In cases where the decay is too large, the location is difficult to control for hygiene, and the oral hygiene is poor, you need to be filled with cavities.

>> What is good oral hygiene? Read the article Do you have proper oral hygiene?

3. Types of materials commonly used to fill teeth

Today, there are many dental materials available that are used for fillings. These include: gold, porcelain, amalgam, modern tooth-colored materials such as composite, plastic, GIC...

The following is some information about the types of materials.

Gold fillings

Advantages

1. High durability: can be used for 10-15 years or more, less wear.
2. Good bearing capacity: withstand chewing force in molar areas.
3. Aesthetic: some patients are more satisfied with the gold color than with silver amalgam fillings.

Gold fillings

Defect

1. Expensive: the cost of gold fillings can be more expensive than other materials, up to 10 times the cost of amalgam fillings.
2. More appointment time: patients have to come to treatment more times, at least 2 times.
3. Galvanic Currents: Gold fillings placed next to amalgam fillings can cause a sharp pain (galvanic current). This current is generated by the interaction between the metal and the saliva. However, this phenomenon rarely occurs.
4. Aesthetic: Some patients do not like the color of metal. They prefer the filling to match the color of the remaining tooth tissue.

Silver Fillings (Amalgam Fillings)

Advantages

1. High durability: can last up to 10-15 years, more durable than composite fillings.
2. High strength.
3. Low cost: can be lower than composite.

High strength silver fillings

Defect

1. Poor aesthetics: the color of the filling does not match the natural tooth color.
2. Destruction of many tooth structures: the process of creating enough sinuses to save amalgam fillings causes more tooth tissue to be lost.
3. Discoloration of surrounding mucosa: Amalgam fillings may discolor the tissue around the tooth.
4. Micro-interstitial cracks: amalgam compared to other materials has a wide elasticity and high ability to cause cracking.
5. Allergies: low rate about 1%. The patient may be allergic to the mercury in the filling.

A low percentage of amalgam vapor released from the filling can be absorbed by the lungs. If released at a high rate, it can cause problems in the heart and brain. However, studies show no link between amalgam fillings and health problems. Therefore, the ADA still recommends it for use in adults and children over 6 years of age.

Composite tooth-colored material

Advantages

1. Aesthetics: the color of the composite can match the existing tooth color. Composite is often used in cosmetic teeth such as incisors.
2. Micromechanical bonding to the tooth structure provides structural support.
3. Versatility: used to restore deep sinuses, chipped, broken, worn teeth.
4. The preparation saves more tooth tissue: creating a composite cavity takes less tooth tissue than amalgam fillings.

Fillings made of composite tooth-colored materials

Defect

1. Lack of durability: composite fillings wear more easily than amalgam (lasts only about 5 years compared to amalgam which is 10-15 years). In addition, for large deep sinuses, composite fillings may not be as resistant as amalgam.
2. Increased operation time: the manipulation process can take 20 minutes longer than amalgam fillings.
3. Increase the number of appointments: if doing composite inlay/onlay, you will need more appointments.
4. Chipping: Depending on the location, the filling can chip or chip.
5. Expensive: composite fillings cost twice as much as amalgam.

In addition to composite, there are some filling materials similar to tooth color such as porcelain, GIC.

Other filling materials

Ceramic

The material has higher wear resistance than composite, can last up to 15 years and is as expensive as gold.

Porcelain fillings are quite durable

Glass ionomer

Mixed materials of acrylic and glass. This material is commonly used in fillings under the gums or for children. GIC releases fluoride to help protect teeth from cavities. However, this material is weaker than composite and susceptible to abrasion, leading to cracking. GIC usually lasts about 5 years and costs less than composite.

Indirect recovery

Indirect restorations are similar to restorations with composite materials or other tooth-colored materials. But the restoration is done in the lab and the dentist will make an appointment for you to come in for the next time. Indirect restoration is performed when the tooth tissue is insufficient to support the filling but the damage is not severe enough to warrant a crown.

During the first appointment, deep tissue or old fillings will be removed. The dentist will take an impression of the tooth to be worked on and surrounding structures. This mark will be sent to the lab for an indirect filling. While waiting for the final restoration, your dentist will temporarily fill you to protect the tooth. At 2nd appointment, the temporary filling will be removed, the dentist will check the fit of the indirect restoration. The indirect implementation makes the restoration more precise and is securely mounted with mounting cement.

There are 2 types of indirect restoration: Inlays and Onlays.

• Inlays are similar to fillings but the entire restoration is on the occlusal surface.
• Onlays are more extensive than inlays, covering one or more zones. Onlays are sometimes seen as partial crowns. 

2 types of indirect recovery

Inlays and Onlays last longer than conventional fillings, up to 30 years. These two restorations can be made of tooth-colored materials such as resin, porcelain or gold. Onlays can help protect a weak tooth by covering the chewing surface and spreading the force around like a crown.

Another type of Inlays and Onlays is Inlays, Direct Onlays. The process is similar to the indirect type. However, the restoration is done in the mouth and is completed in one appointment. The choice of restoration type depends on the remaining tooth structure and aesthetic requirements of the patient.

Temporary fillings

Temporary fillings are used in the following cases:

1. When fillings are made several times. For example, while waiting for the lab to perform a gold filling or an indirect restoration.
2. Between root canal appointments.
3. While waiting for pain relief when the pulp is stimulated.
4. During emergency treatment.

This is a temporary patch

Temporary fillings usually don't last long. It is easy to fall, break, wear out for several months. The temporary filling must be replaced with a final solid filling. Otherwise, the teeth will be susceptible to infection and other complications.

4. Classification of filling sinuses 

Previously, the Greene Vardiman Black classification of fillings was used depending on the location:

• I: caries in the fossa, occlusal surfaces, lingual and medial surfaces of molars, palatal surfaces of maxillary anterior teeth.
• II: caries at the approach of molars.
• III: caries at the apex of the anterior teeth.
• IV: caries related to the anterior biting edge.
• V: deep in the lateral third of the neck and in the teeth.
• VI: deep at the apex of the molars.

Classification of fillings according to Greene Vardiman Black

Currently, the cavity is divided according to Graham J. Mount. Mount's sinus classification is based on location and size, making it easy to identify the lesion and its extent of enlargement.

Position:

• Trench: 1.
• Access side (side view): 2.
• Neck area: 3.

Size:

• Small: 1.
• Medium: 2.
• Limit: 3.
• Expansion: 4.

5. Steps of filling teeth

To perform a filling treatment, your dentist will typically follow these steps.

5.1. Anesthetize

Usually, if there is no pain, there is no need for anesthesia. In case the patient is sensitive or needs to have a dam, the dentist will give you a local anesthetic.

5.2. Remove deep tissue or old fillings if present

When the tissue around the tooth is completely numb, the dentist will use a drill or hand tool (dentin scraper) to clean the tissue deep in the sinuses. This stage is very important because deep tissue must be cleaned to prevent reinfection. 

5.3. Insert the material into the filling cavity and shape

The filling material will be placed into the sinus and shaped according to the zone, angle, and edge to resemble the old shape of the tooth according to anatomy.

When creating a sinus, there is no need to remove too much tissue other than deep tissue. But for amalgam fillings, creating the right sinuses to preserve shape can result in more tissue loss.

When restoring with gold fillings or inlays/onlays, you will need an additional appointment to wait for the restoration casting from the lab. If the cavity is on the side between two teeth, the dentist will place a small mold around the tooth. This helps to create a better point of contact between the two teeth. Two teeth do not stick together, cleaning with thread is easy. After inspecting the finished filling, the mold will be removed.

If you have a composite filling, the filling process consists of 3 steps:

• Erode.
• Apply glue – Shine lights.
• Place composite – Projecting lights.

Performing dental fillings

The filling process needs to be isolated from fluid and saliva because if the cavity is wet, the material will not adhere to the tooth surface.

5.4. Polish and check bite

After filling the cavity with filling material, the dentist will smooth and form the finished filling. Finally, the dentist will perform an occlusal examination using colored records. This will help prevent the filling from clumping. If your joints are tight, you should see your dentist soon to correct them, to avoid problems.

6. Lifetime of fillings

Each type of material has different durability, so the life expectancy of each type of filling is also different.

• Amalgam: average 10 years, can be up to 15-30 years.
• Composite: usually from 3 to 10 years, in some cases up to 20 years but very rarely.
• Porcelain: 10-15 years.
• Onlays/golden Inlays: the longest time, up to 40 - 60 years.

There are many factors that affect the longevity of a filling such as:

Dental care

Cleaning of fillings is similar to normal teeth. You must regularly brush your teeth and clean the interstitial area, avoiding the recurrence of decay around the filling.

Maintain regular hygiene

Pay attention to the problem of teeth grinding

If you have a habit of grinding your teeth , especially at night, you can break or wear down the filling. If you notice you have symptoms similar to those described for your teeth grinding habits, tell your dentist right away.

Remember, fillings are not real tooth tissue

How long the filling lasts is a very difficult question to answer. Since it is not a real tooth, it cannot last forever. It is also not as good as real tooth tissue. When filling a tooth, the tooth tissue and the filling will have different physical and chemical properties. Therefore, problems such as micro-interstitial, cracks, breakage, etc. may arise. You should see your dentist regularly to check on old fillings. This helps you know when it's time to replace it.

7. Possible problems when filling teeth

Pain and sensitivity

Tooth sensitivity after fillings is a common problem. Teeth can be sensitive to pressure, gas, temperature, or sweets. Usually, the sensitivity goes away within a few weeks. During this time, avoid tooth sensitivity triggers . Usually you don't need to take pain medication. If sensitivity does not subside in 2-4 weeks or pain increases, you should contact your dentist. Your dentist will instruct you to use certain products to prevent sensitization. At the same time, the dentist will evaluate whether a follow-up treatment should be performed.

Pain may also occur in the area around the filling. If you feel pain while chewing, the filling may be crooked. You need to go to the dentist to readjust. If pain occurs when two teeth touch, it may be due to an electric current interaction between the fillings. This pain should subside in a short time.

You may feel pain after filling

In the case of a deep sinus near the pulp, your pain may also be due to irritation of the pulp. In this case, the dentist is forced to treat the root canal.

Sometimes, the tooth that hurts is not the tooth that has been filled. This does not mean there is a problem with the filling. It is simply the filling tooth that transmits pain signals to other teeth. Pain usually subsides in 1-2 weeks.

Allergy to filling materials

Allergic reactions to amalgam fillings are rare. There are currently about 100 reported cases as documented by the ADA. In this case, the patient may be allergic to mercury or to the metal components in the filling. Symptoms are similar to skin allergies: rash and hives. Patients allergic to amalgam often have a personal or family history of metal allergy. When an allergy occurs, the filling should be removed and replaced with another material.

Damaged fillings

Normal chewing forces can cause the filling to wear down or break. However, you cannot detect it yourself. Your dentist will notify you at your regular dental check-up.

When the sealant and enamel do not adhere, it creates an opening for food and bacteria to enter. This can cause recurrent decay around the filling, potentially leading to infection of the pulp and apex. You need to replace it with another filling.

In case the filling is too large, the remaining tooth tissue is not enough to hold, the dentist will suggest replacing with a crown. Fillings can also fall out if sinus preparation is poor, contaminated, or due to trauma.

Filling is a simple treatment, helping to restore the lost tooth structure. The choice of material and filling depends on the location, size, cost and ability of the dentist. Patients need to have a good sense of care for the filling to last a long time. If there are problems with the fillings, you need to contact your dentist immediately for the most appropriate treatment.

Doctor Truong My Linh