Dental caries, also known as tooth decay, cavities, or caries, is a breakdown of teeth due to activities of bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss, and infection or abscess formation.
Dental Aesthetics clinical services offer restorative care to treat cavities by doing white fillings. The white filling has replaced the old silver filling nowadays having an aesthetic look and better longevity. When teeth have cavities or are broken, in some cases they can be restored with a simple filling. Fillings have limitations and in order to be successful, a certain amount of strong tooth is needed to support the filling. There are two types of filling materials. One type is a tooth-colored resin material that bonds to the tooth. The other type is a mercury filling that is silver in color. Many dentists today will not use or recommend the mercury based fillings. You should discuss this with your dentist before the filling is placed in your tooth.
Tooth Colored Fillings
The concept of “filling” is replacing and restoring tooth structure that is removed due to decay or fracture with a material. With today’s technology, you no longer have to suffer the embarrassment of unsightly silver/mercury fillings or metal margins of the past. Space-age, state-of-the-art, tooth-colored resin or porcelain adhesive materials are used to replace dark, looking amalgam fillings.
Silver V.S White Fillings
White fillings are either composite resin (not to be confused with true porcelain) containing a mixture of acrylic plastics, quartz fillers, and colorants or true porcelain. True porcelain filling is called inlays (if they fit inside the cavity less than one third the width of the tooth) or onlays (if they replace or support the cusps tips). These porcelain restorations were generally made in a lab with two or more office visits, but with CEREC® 3D, we now precision-mill them from factory manufactured uniform blocks in one visit to our office. Both of these true porcelain type fillings are cemented or bonded into place and are much more precise and biocompatible than silver or composite which are pressed into the prepared hole (cavity) in your tooth.
The cheapest and most common choices for filling small cavities are silver amalgams (a mixture of silver-tin alloy, copper, and mercury that sets up hard and silver colored) and composite resin (a mixture of acrylic plastics, quartz fillers, and colorants). There are several differences besides the obviously more esthetic results of composites over amalgams. A big difference, which insurance companies seem to consider the most important, is longevity. Amalgams last up to 20% longer than similar composite restorations.
For large cavities where more than half the width of the tooth is involved, these cheaper filling materials (silver and composite) are prone to break down. Generally, studies and my personal experience find these fillings breakdown (to the point they need to be drilled out and redone) in the range of 3 to 5 to 7 years when filled with composite while large amalgam fillings last a bit longer but may lead to tooth fracture. Due to the need for more stringent moisture control and more technique-sensitive procedures to place composite, in most dental offices white composite fillings cost more than silver amalgam.
These two factors make silver fillings more economical than the more natural looking composites, so that is why insurance companies rarely approve of a composite filling in the back teeth. (They will substitute payment for the cheaper amalgam when they receive a claim for posterior composites – just look at any Explanation of Benefits forms for composite filling you may have received.)
Besides being virtually invisible, composites have a property of bonding to the tooth structure. This bonding can protect and increase the overall strength of the tooth being restored, but if the bonding stays intact on the biting surface but break down as it usually does in between teeth where it is thicker and flexes more when you bite and chew food, new decay may progress deeply before it is detected. Sometimes, the first sign of this hidden leakage under composite fillings is the sudden onset of severe pain of a root canal nerve infection. The choice of which restorative material to use in your mouth depends on balancing the factors of appearance, longevity, the strength of the tooth involved, and cost. You have to decide with your dentist’s guidance as to the size of the filling and your goals/expectations for the filling.
Root Canal Treatment
Root canal treatment (also called ‘endodontics’) is needed when the blood or nerve supply of the tooth (called the ‘pulp’) is infected through decay or injury. You may not feel any pain in the early stages of the infection. In some cases, your tooth could darken in color, which may mean that the nerve of the tooth has died (or is dying). This would need root canal treatment.
Why is root canal treatment needed?
if the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. An abscess is an inflamed area in which pus collects and can cause swelling of the tissues around the tooth. The symptoms of an abscess can range from a dull ache to severe pain, and the tooth may be tender when you bite. If root canal treatment is not done, the infection will spread and the tooth may need to be taken out.
What does it involve?
The aim of the treatment is to remove all the infection from the root canal. The root is then cleaned and filled to prevent any further infection. Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits at our dental clinic. In the start, the infected pulp is removed and any abscesses can be drained. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle. The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled.
Crowns and bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist
Why is a dental Crown needed?
To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
To restore an already broken tooth or a tooth that has been severely worn down.
To cover and support a tooth with a large filling when there isn’t a lot of teeth left.
To hold a dental bridge in place.
To cover severely discolored teeth.
To cover a dental implant.
To make a cosmetic modification.
For children, a crown may be used on primary (baby) teeth in order to.
1) Save a tooth that has been so damaged by decay that it can’t support a filling
2) Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene
3) Decrease the frequency of general anesthesia for children unable because of age, behavior, or medical history to fully cooperate with the requirements of proper dental care
4) In such cases, our pediatric dentist is likely to recommend a stainless steel crown
Types of Crowns Available
Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal, all resin, or all ceramic. Stainless steel crowns are prefabricated crowns that are used on permanent teeth primarily as a temporary measure. The crown protects the tooth or filling while a permanent crown is made from another material. For children, a stainless steel crown is commonly used to fit over a primary tooth that’s been prepared to fix it. The crown covers the entire tooth and protects it from further decay. When the primary tooth comes out to make room for the permanent tooth, the crown comes out naturally with it. In general, stainless steel crowns are used for children’s teeth because they don’t require multiple dental visits to put in place and so are more cost-effective than custom-made crowns and prophylactic dental care needed to protect a tooth without a crown.
Metals used in crowns include gold alloy, other alloys (for example, palladium), or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, metal crowns rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown’s porcelain portion can also chip or break off. Next, to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown’s porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns. All-ceramic or all-porcelain dental crowns provide better natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.
Temporary versus permanent
Temporary crowns can be made in your dentist’s office, whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by a lab.
Zirconia or milled crown which is digitally constructed either in an office that has the software and hardware to produce them or in a dental lab. Dental offices that have the software and hardware have the ability to produce a crown in one visit with no need for a temporary. These crowns require no impression.
How do Crowns Work?
A crown is used to entirely cover or “cap” a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.