Worn Out Fillings
All fillings will wear out eventually and replacement fillings are needed if they are worn down a lot, or they develop gaps around fillings that are now leaking, decaying at the edges or broken. If fillings have been there many years then wear and tear is normal, we do chew and bite with them every day after all.
There are many new choices apart from metal Amalgams, such as Composite, Ceramics and even Gold, with new advances in bonding and sealing filling to tooth too. Dr.Kilcoyne provides all aspects of Advanced Cosmetic Dentistry including all White fillings, bonding, sealing, Tooth Bleaching, Teeth Whitening, Cosmetic Bonding, Latest Ceramic Restorations, Second Opinions, Smile Profiling, Gum Diseases, Tooth wear and worn, uneven teeth, TMJ's, Difficult Occlusions, Excessive Wear Cases, Root canal treatment, Trauma and Emergencies; Anxious or Nervous Patients welcome too!
My silver/mercury fillings are wearing out and failing. What should I do?
Everything wears out or fails eventually, and silver fillings are no exception. They have to endure an incredible amount of biting force, and as they age, they wear down, disintegrate and sometimes break. More subtly, fillings "leak" which means narrow gaps/spaces develop where the filling meets the tooth, allowing bacteria to get underneath fillings. Sometimes, even the tooth around a filling can break under a heavy bite or night-grinding!
Often the edges of a filling have broken away and space has opened up between the filling and the tooth. When this happens, the filling loses its seal and no longer protects the tooth from decay. Some concern has also been expressed about the leakage of mercury from these kinds of fillings. Science has yet to "prove" any harm, but more and more patients are asking for alternative choices at replacement, including tooth coloured fillings or Crowns to reinforce previously heavily filled and hollowed out teeth.
When fillings "leak", they can let in liquids and bacteria under existing old fillings, yet you cannot get your toothbrush underneath the filling to clean it - eventually the bacteria infect and kill off the nerve in the root, coming out the end of the root as an "Access", often causing pain and tooth loss.
It takes great skill and careful technique to remove such a tooth and it's abscess sack completely and although we can do this, how much better would it be to have replaced the leaking filling BEFORE the bacteria had been given the chance to cause this abscess, pain and tooth loss?
Below one can see old fillings failing = unsightly too - look how our expert whitening and bonding improves things!
Also just leaving decay too long or not detecting it early enough can let it get deeper than one first thought, possibly leading to deeper problems and tooth loss later on - this is why teeth with large fillings sometimes just get an abscess years later, without warning! The deeper decay had done damage to the nerve, which then took years to appear as an abscess from the bacteria in the deep decay years ago! This is why we emphasise "Prevention" and seal teeth against decay or use the latest advanced technology to detect decay early, even before the standard techniques of sharp metal probes and X-rays, which cannot detect early decay in the biting surfaces of teeth until it's well into Dentine. That's why we have used early laser probe detection techniques that can find the earliest signs of decay, so we can treat it early and PREVENT all the future consequences and complications of allowing decay to spread undetected by standard techniques. It is truly possible to have teeth for life, but only if problems are dealt with early enough. Even we could not save the tooth pictured below because we did not get the opportunity to detect to treat it's problems early enough!
The Picture below shows an extracted molar back tooth with a leaking filling and the abscess sack that we carefully removed intact:
Remember a larger filling will have more edges or surface area to "leak" and let in bacteria in the future too, so the smaller a filling is, the longer it lasts, the less it leaks, the easier it is to "seal" and dentine bond it to prevent or dramatically reduce its future leaking etc, so smaller fillings or sealants are always preferable to bigger fillings later on!
When your dentist recommends a restoration to replace a worn-out or "leaking" filling, both the size of the filling and the amount of remaining tooth structure and any fracture lines are considered. Ironically, it would be better to have a "small" filling earlier, than wait too long and get a larger filling later, because larger fillings nearly always wear out quicker and need replacing much more often than smaller ones! When a worn-out filling is fairly small ( eg: <50% of the tooth), you could safely replace it with another metal or tooth-coloured filling. However, it too will eventually wear out and have to be replaced again, inevitably getting bigger each time (never smaller!). When a worn filling is larger (eg: >50% of the tooth), and much less good tooth structure remains, tooth fractures can become a major problem, as the more good tooth is inevitably lost. This problem is worsened by a heavy bite and grinding, which can fracture teeth so badly, that the tooth may not be savable if the fractures go vertically into the root foundations.
By switching to a (gold or bonded porcelain or ceramic) Crown restoration, one can strengthen the tooth and prevent these complications, if done in time.
Unfortunately, deep fractures happen without much warning (like a stick snapping), so the knowledge and experience of your Dentist need to be used to "predict" when restorations should be replaced before there's a problem. This advice varies between different Dentists (understandably) because we are always trying to get the maximum life and wear out of the existing fillings etc, yet step in just before a sudden problem occurs or worsens. There is no right answer that can be easily applied to all patients (who vary), so you have to let your Dentist know how much of a risk you are willing to take by leaving older fillings and Crowns etc for longer. If you would prefer to take the minimum risks with your teeth, in terms or leaving defects as long as possible, then earlier replacement of some defective work may be preferable. This is something you need to discuss with your Dentist or Specialist.
As always, prevention can avoid these complications completely, or at least minimise them if done in time.
Dr.Kilcoyne is a fully registered UK Specialist in Prosthodontics, which includes Implants, Crowns, Veneers, Dentures, Bonding etc, to Restore or Replace teeth functionally and cosmetically so you can have a Smile that you can be proud of, without compromise. Yes, all this expertise, experience and excellent track-record have a price, but we still believe it is Good Value for the level of Specialist Quality one is getting and can be confident in.
Dr.Kilcoyne has won National Prizes for the Quality of Patient Services, so you don't have to compromise!
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As always, Prevention is cheaper and better than Cure - that includes Preventing making bad choices based on costs alone!
Wishing you good Dental Health AND a Smile to be proud of, from all at the Smile Specialist Team.