Patients entering a dental office fall within four general categories. They may be a patient coming for yearly checkups or cleanings, a Patient of Record returning for a treatment session, or someone seeking a second opinion or a friend referral. They may be a new patient who often fill in the ‘last dental appointment when’ question with 5 years, 10 years, or simply a question mark or unanswered.
We see children who have had little or no home dental care, and adolescents with adult teeth decayed because someone assumed they were ‘just baby teeth’. Some older new patients arrive ‘defeated’ saying they are about to have all their teeth extracted and fitted with dentures, just like their parents or grandparents. A few are shocked to hear that their teeth are in generally pretty good condition and that a return to good oral health is straightforward. In our clinics, we use a Panoramic X-Ray, chairside X Rays, or a CT Scan which allows us a complete picture of general oral health, oral history, and a general idea of treatment options and necessities.
Once the deteriorated tooth structure is removed, the decision on ‘type’ of filling can be made. The black/silver amalgam fillings have been around since 1816 and created by Auguste Taveau of France. A pair of Englishmen named Edward and Moses Crawcour introduced them to the USA in 1833. They are composed of a combination of silver, copper, tin, mercury, and when mixed together become a metal alloy. Their advantage is superior strength and long durability. One disadvantage of amalgam fillings is the colour. Another disadvantage is expansion as it turns to an alloy in the first 3 years. This can cause cracking which can lead to the ultimate destruction of the tooth. Zinc was later added to reduce expansion.
Amalgams may discolour teeth with a grayish hue as well. There is a controversy over low levels of mercury vapour which may be released into the organs of the body including the brain. They are permanently banned in Norway, Denmark, and Sweden, and in the process of the same ban in Ireland, Finland, and Slovakia.
Gold fillings or crowns may be used, and have the advantage of good durability and strength, and aesthetically some choose it over the black/grey amalgams. We see less of that nowadays and many dentists are not trained directly to work with gold fillings, known as gold foil. They are costly compared to composite, porcelain, or porcelain/metal combinations.
White composite resin fillings are the most common today. They are composed of a mixture of a resin base and powdered quartz, silica, and other ceramic particles. They bond well to tooth structure, and have great versatility. They have the flexibility of being used in smaller spaces (like cracks) and are more technique sensitive. They may require more chair time, and a greater chance of chipping and damage. Some patients show up at the door with a mouth full of amalgam fillings, and simply instruct the dentist to remove and replace them with white fillings. This is a personal choice and the subject of ongoing great controversy.
Another less common restoration are Indirect Fillings called inlays and onlays. They bridge the gap between normal fillings, and perhaps a full dental crown. They are tooth coloured, and are made by a lab requiring two visits, or in one visit with a new technique known as digital dentistry. Similar to a dental crown, they are made from dental impressions or the single visit with a dental scanning camera and no impressions.
What is the ‘latest’ answer? The Cerec machine fabricates a tooth shell or covering from ceramic, from a digital impression delivered to our milling machine. It is a combination of a chairside computer and a video camera, a remote milling machine, lab grade furnace, with ceramic finishing and other additions to make the restoration.
A ceramic restoration with a thin film of resin bonding reduces any chance of sensitivity. We can fabricate a crown, inlay or onlay, and a three-quarter crown on the Cerec matched to your existing tooth colour.
If anyone is time sensitive (who isn’t?), this unit allows them to depart the office with a new restoration the same day they enter it. Many patients familiar with it insist on it. Currently in the USA 8 per cent of dental offices use Cerec. In Canada, it is estimated this number will be similar. It has become for many patients - their treatment of choice!
Dr. Michael Dolynchuk is a General Dentist practicing in Caroline and Red Deer. Forward inquiries to: DentalQuestions@shaw.ca