Currently, our dental office in Kitsilano, Vancouver offer three main types of ‘direct’ fillings: amalgam(metal), composite, and glass ionomer.
Fillings are recommended to be replaced when they break, leak, or esthetic concerns are an issue for the patient. While we try to accommodate a patient’s request, sometimes we are limited by the environment the fillings are placed in and cost to the patient on what they can afford.
Amalgam fillings are the ones that contain mercury, but the type used in it is ‘inorganic’ meaning it is actually much less toxic than ‘organic’ mercury. Organic mercury bio-accumulates in tissues and eating a can of tuna gives you a higher exposure to toxic mercury than a silver filling would. The advantages of Amalgam fillings is that they seal very well when placed, even if there is moisture contamination from fluids in your mouth during the procedure. They are an excellent filling material when there is too much saliva or blood where the filling needs to be placed. They however are not the most cosmetic filling as they are silver/grey and are easily noticed against a white tooth. Also silver fillings are lock and key fit, meaning they fill the tooth by locking into place as it hardens, and is not actually ‘glued’ or stuck to the tooth which is was placed on. Another draw back is that in order to place a silver filling, the hole is recommended to be approximately 1.5mm deep so that the material has the needed bulk to be strong enough to avoid fracturing.
Composite fillings are a white plastic material that can actually bind/adhere to the teeth. This adhesion is compromised when there is any moisture contamination during the placement and they will leak. Well done composite fillings can last many years and also don’t need a required minimum thickness, so that tooth structure can be saved when placing them. Moisture control is paramount to the success of these fillings, which is achieved through the use of various isolation techniques: rubber dam, cotton roles, suction, and various instrument placement to prevent leaking into the cavity being filled. They do cost more than silver fillings, as they are more technique sensitive to place and a more expensive material to use. The advantages of a well placed composite filling is that the remaining tooth structure is held together by the filling as it is bonded to the tooth(instead of a lock/key fit with amalgam), less tooth structure is sacrificed in placing one, there is less temperature sensitivity as it is less likely to conduct hot/cold extremes like a metal filling would, and esthetics as it is white like your natural tooth colour.
Glass Ionomer fillings are the in between filling with respect to amalgam and composite. While they are coloured similar to a tooth, they are not as esthetic as a composite filling material. They do bind to the tooth and are able to be placed in less than ideal situations where moisture control is an issue(though not as good as a silver filling). They wear away more easily when exposed to the oral cavity, so they are not as durable as a composite or amalgam filling. They are recommended when moisture control is an issue, with esthetics and a lack of a lock and key fit that would allow an amalgam filling to be placed. They don’t require a minimum thickness, and thus most often used as a filling material when a cavity on a tooth is close to the gum line. Cost wise, they are the same as a composite filling.
At Accord Dental we do our best to inform our patients on what material would be the best option for you and as our patient you have the final say. And as always, estimates for all dental work is always provided/available free of charge.
Answer: The most common reason for this is because the bacteria that destroyed the tooth went too close or into the nerve of the tooth. Sometimes a special dressing can be placed under a filling to help prevent a root canal but sometimes that is not always the case. The bacteria being so close to the nerve inside the tooth can irritate it and cause it to die – making it very sensitive to hot or cold temperatures. Left untreated a dying nerve will eventually become infected and will result in the dental pain that wakes/keeps you up at night. Do note that if it hurts to chew AND you have hot/cold sensitivity with a newly placed fillings, the most common reason is the filling was placed too high and a simple adjustment will fix that problem without a root canal being needed!
Question: How long does a filling, crown, or bridge last?
Answer: Statistically they are expected to last 6-8 years. Insurance companies cover the cost of white fillings every 2 years, silver fillings every 3 years and crowns/bridges every 5 years. However many factors come into play on why they last longer or shorter. The oral environment of the patient(how good are their oral hygiene habits, do they grind their teeth, what kind of foods do they eat etc), the skill of the dentist, the quality of the materials used, and also the skill of the lab technician who makes the crowns and bridges.
Questions: My dentist placed a filling but said food will be trapped between the teeth and recommends a crown or onlay/inlay. Why won’t a filling work?
Answer: Sometimes too much of a tooth is lost and it is very difficult/impossible to properly place a well sealed filling that won’t fail. Food being trapped irritates the gum/tooth and cause increase the risk for a cavity being formed on the teeth where the gap is. It can also cause bone loss due to the irritation which is called ‘food impaction’. A crown or only/inlay can be made outside of the mouth by a lab from an impression taken. They are then cemented in or glued to the tooth.
Even above asthma and hay fever, the single most common chronic disease in childhood is tooth decay. This problem has swept British Columbian children aged four to six, regardless of neighbourhood or family income. In fact, among children in the most affluential neighbourhoods, as many as one in three has shown evidence of poor dental health.
How do we know this for sure? Since 2006, periodical studies have been conducted by the provincial government on children of kindergarten age. The study spanned close to 500 neighbourhoods and each time, more than 35,000 kids were assessed. The University of B.C. researchers were surprised at the result, and not in a good way. Two sets of data examined found that almost 50% of children from the lowest income neighbourhoods were currently experiencing some form of tooth decay. This decay is characterized by fractures in the teeth or filling, stripped enamel, and other general signs of decay that eventually leads to dental caries (cavities).
What was even more surprising was that the rate of tooth decay was not much better for children in richer B.C. neighbourhoods. The data showed that poor dental health affected close to 30% of children. The Fraser Health region seems to have been the most affected by tooth decay in children, but other regions have only seen minor improvements since the studies were conducted. A subsequent 2009-2010 study in the same time period as the last showed a 2.2% decrease in rates of dental decay across B.C.
The problem persists across B.C., and it is unfortunate that the Kitsilano area ranks among these troubling areas. However, all is not lost. The government and health professionals are being pushed by the study to help promote new and targeted approaches to dental health for children. This includes using the public school system, educating children on the dangers of sugar for teeth, and offering/educating children and parents on healthier food options. Of course, this bows in comparison to the importance of getting a regular checkup by your dentist.
In all of B.C., under the BC Healthy Kids Program, among others, there are subsidy options that exist for low income families. This particular program can cover up to $1,400 of basic dental care every two years for those who are eligible.
Knowing what you’re entitled to as a Kitsilano resident and how you can take advantage for your family is extremely important. If you believe that your child may be suffering from tooth decay, or any other form of dental issue for that matter, make an appointment with Dr. Alex Rosenczweig in the Kitsilano area today. The sooner the better!