Composite Fillings - Anxious Patients

[JamieAnn]

Hello,

I have a long post in Support with my history and current situation, but this is very much a specific dental question. I am changing my dentist after a long time and need a number of fillings. My new dentist has put together a treatment plan for composite fillings as apparently this is now their standard practice. However, I have only previously had amalgam fillings and my former dentist has advised that composite is a very bad choice for anxious patients. Is this true and could someone explain why it is specifically not recommended for anxious patients - he mentioned something about needing a dry environment for them to bond? Ought I be trying to request amalgam fillings?

Thank you for the clarification.

 

[Gordon]

You're basically on the right track, composite doesn't work properly if the cavity gets contaminated by saliva. Amalgam is a lot more forgiving and is quicker to place.

I wouldn't say composite is a bad choice per se, just that the patient needs to be able to co-operate well during the filling, I don't think phobic patients are any less likely to co-operate in general than anyone else in my experience.

 

[JamieAnn]

@Gordon - thank you.

It was just that my former dentist had said that composite 'would not be good for people like me who have anxiety about dental treatment because the conditions need to be dry'. I have looked at the pros and cons of both amalgam and composite but could not find anything anywhere about composite being specifically difficult for anxious patients and was struggling to understand why bonding due to saliva might be more of an issue for an anxious patient. That said ... he is my 'former dentist' for a reason and the relationship has completely broken down.

I have a call with my new dentist this week ahead of treatment under nitrous oxide later in the month (first time for nitrous sedation but I really want to try it) so will check with her that composite is definitely appropriate for all of the required fillings (I think that there are aesthetic benefits for at least one of the fillings). Providing that she confirms this, I will simply proceed under her professional opinion. Presumably, if it is the standard for that particular dental practice, she must be very used to its application for 'people like me' as she specialises in the treatment of both children and anxious patients.

Different dentist, different type of sedation, different filling process ... what could possibly go wrong?!

 

[Gordon]

Keep me posted how you get on.

 

[JamieAnn]

@Gordon

So I had my first appointment this morning. The good news is that I now have two composite fillings ... the bad news is that one of them was apparently deeper than anticipated and the dentist told me that she has put a liner in (no idea what this means?) but there is a chance that it might not settle in which case I am looking at either an extraction or possibly RCT. I really don't want to lose the tooth but don't know how I'd cope with a root canal! I'm hoping that it will settle.

More good news in that the nitrous was not a bad option at all. I had originally been told by another dentist that my only option going forward would be a GA following a very bad midazolam experience with him. I've gone elsewhere to find inhalation sedation (why is it so difficult to find?) and really wanted to give it a go. There were admittedly odd moments where I started to feel a bit anxious but I just took long slow deep breaths and inhaled more gas - frankly, this idea of focusing on breathing seems like a fantastic solution whether or not you are breathing nitrous oxide. I cannot understand why it is not more readily available and would definitely opt for it again and the dentist also confirmed that she would be happy to continue the next session of treatment with it.

I feel as though I've made a bit of progress anyway - even though I am a bit worried about my deep filling

 

[Gordon]

Well done you and thank you for the update. A lining is just putting in some other material to cover the floor of the cavity before putting the composite in. Usually calcium hydroxide or glass ionomer. It makes for a smoother cavity floor and the CaOH2 can stimulate some secondary dentine to help seal up the pulp, as well as being quite toxic to decay bacteria.

Nitrous is great stuff, I really wish it was more available. The barriers to use are well documented.
1) The capital costs of the equipment is fairly expensive £5k or so
2) There is an ongoing maintenance and materials cost which is quite significant
3) The NHS fee for nitrous sedation was a complete joke, I'm not sure what difference the "new contract" for dentists in England made to it but I doubt it made it more attractive
4) There are fairly stringent ongoing training costs for the dentist and nurses
5) There is a feeling amongst a lot of dentists that it's a very slow, time consuming process, they don't want to "waste" that much surgery time for the fees on offer from the NHS.

I've had the nitrous run out halfway through a procedure before and the patient didn't notice at all. (Basically they were just breathing pure oxygen). The power of the placebo effect in operation.