Composite fillings over amalgam.

[kiefm]

I have been told that the dentist drills a much smaller hole in your tooth when preparing a composite filling. With this in mind, wouldn't a composite filling be a better choice then an amalgam for preserving teeth, especially if the cavity is only small and not on one of the larger teeth.

What do you think?

 

[smithers]

from what i have read composite fillings require less healthy tooth to be removed, and of course they look a lot nicer, but amalgam fillings are sturdier, and less likely to leak...but i'm no dentist.

 

[kiefm]

I've read the same and from a dental patient perspective, I would think dentists should offer the chance to keep more of the healthy tooth rather then always opt for amalgam, as they did at my previous dentist.

 

[Gordon]

There's very little difference in the cavity design between composite and amalgam, it's certainly not the most important factor in the choice of material.

 

[decan]

Like Gordon said, the prep is not much different between amalgam and resin composite. Amalgam is a time tested material and while composites are getting better, I've seen amalgams that are 40-50 yrs old and are just now beginning to fail.

 

[Poppy1234]

I know they can't.....but if a 35 year old filling is ok, just wearing thin....why can't they just shove some more filling on top, instead of drilling out the old one??

I have a hole in my bath, and when the sealant wears thin, I never pull the old filler out, I just bung some more on top! Works a treat and lasts for ages!!
Though I guess teeth aren't quite the same as my leaky old bath.....

 

[decan]

It depends on the situation and the material being used but basically it has to do with material properties...when amalgam is mixed it's rather soft and the dentist condenses it into the prep. The prep is designed to retain the amalgam (or any other filling material) using mechanical retention. Most of the time you just can't add to the top because the material will likely not stay.

 

[Poppy1234]

My new dentist is now talking about using just a fissure sealant thingy instead of a filling. What do you think to that??

He said he can drill the tiny bit of surface decay and place a fissure sealant.
I wouldn't have thought they were strong enough to act as a long lasting filling on a lower wisdom tooth?

If a filling comes out you have the hassle of more drilling and filling.
What if this comes out, as I'd expect it to much earlier than a filling?
Can they just stick another one on? Or is it more drilling?
Don't really want the prospect of drilling it every few years if the sealants don't last long.
I like the idea though.
Fed up with all this "shove a filling in whatever" way of thinking.....

 

[Gordon]

It's called a preventive resin restoration. Google time!

I've had a fissure sealant (placed by my dental nurse <don't tell the authorities>!) for almost 25 yrs now. They can last indefinitely. If they wear down then they can be added to rather than replaced.

Fissure sealants are not normally used on adults who have had the teeth in situ without a problem for a number of years, it would be considered to be verging on over treatment to do them without any further indication.

 

[Poppy1234]

It's called a preventive resin restoration. Google time!

I've had a fissure sealant (placed by my dental nurse <don't tell the authorities>!) for almost 25 yrs now. They can last indefinitely. If they wear down then they can be added to rather than replaced.

Fissure sealants are not normally used on adults who have had the teeth in situ without a problem for a number of years, it would be considered to be verging on over treatment to do them without any further indication.

Thanks a lot Gordon.
Should I go for the drill out surface decay and fissure sealant option, or try for remineralisation?
I keep changing my mind which to go for!

Dentist said decay was minimal, and no-where near the dentine, but was "sticky" when he probed, which wasn't a good sign remineralisation would work.

If I did achieve remineralisation, would the tooth always be weakened and prone to decay in the future?
(I would always keep excellent oral standards)
I think this would be the decider as to whether I was going to bother trying to arrest the caries over the next 6 months....whether the tooth would always be prone to decaying again in the future.
If so, I'd go for drilling it now and sealant.

I'd really appreciate your advice on which option to go for Gordon.

 

[Gordon]

Replied by PM. Summary for those following later on... I would try remineralisation first.

 

[Poppy1234]

Replied by PM. Summary for those following later on... I would try remineralisation first.

You're a star Gordon.

Quote from another NHS dentist today, on looking at the x-ray and seeing NO decay at all (though tiny cavity can actually be seen).....

"No matter how much Duraphat 5000, NovaMin or Recaldent you put on that tooth it will never remineralise, and putting a fissure seal over a drilled out cavity will NEVER work"...... (The other dentist wanted to do this)

So..........I've just found a private dentist for the first time in my life.

I emailed the surgery to check the very reasonable prices, and the owner emailed straight back....at 1am!
He was very helpful and friendly.
So popped down to check the place out today.
Met him by chance and he was very nice indeed, and quite foxy too, which is always an added bonus!!!!!!
So I'll go with whatever he says.

 

[brit]

He was very helpful and friendly.
So popped down to check the place out today.
Met him by chance and he was very nice indeed, and quite foxy too, which is always an added bonus!!!!!!
So I'll go with whatever he says.

LOL - better check he's painless though as well...'foxy' is not enough!
Glad you're happy so far.

 

[Poppy1234]

LOL - better check he's painless though as well...'foxy' is not enough!
Glad you're happy so far.

Foxy will do for now!! You can't have everything!
The cool thing is, I can go to this private one for a check-up, and STILL get free treatment on the NHS.
I checked, and that's ok.
So I can get a filling and cleaning for free on the NHS (if I can EVER find one that's any good) and go to this private one once a year just to check if NHS has missed anything.

It's only £38 for a check-up and 2 x-rays private with this new guy!

 

[brit]

It's only £38 for a check-up and 2 x-rays private with this new guy!

Yeah that's cheap for UK private - I paid way more than that in UK for check-ups.

 

[Poppy1234]

I'm getting fissure sealants too! He mis-quoted me £15 per tooth, when it was more, but is honouring the price he quoted! So I'm getting 8 done.
Never spent anything like that on my teeth before!

I may as well use the NHS for something as simple as a filling and good clean though, as it's free for me at the moment, as I got made redundant, so I'm on Income Support.

 

[decan]

"No matter how much Duraphat 5000, NovaMin or Recaldent you put on that tooth it will never remineralise, and putting a fissure seal over a drilled out cavity will NEVER work"...... (The other dentist wanted to do this)

"The main product deposited on the enamel surface and on subsurface carious lesions after the application of topical vehicles with high fluoride content is calcium fluoride...Numerous studies, both in vitro and in vivo, have concluded that fluoride varnishes are capable of depositing large amounts of fluoride on human enamel...Additional in vitro studies of Duraphat have shown that it deposits amounts of CaF2 equal to those of a 2 percent NaF solution (0.9 percent; 9.05 milligrams per milliliter; or 9,050 parts per million, or ppm, F–), but over a longer period47; superior fluoride deposit occurs if teeth are dried before it is applied48; and there is no need to polish the enamel surface before applying the fluoride varnish.49 In a recent study, Joziak and colleagues50 claimed higher fluoride uptake in enamel treated with Duraphat than in enamel treated with Duraflor."

Source: [broken link removed]

And as far as placing a sealant over a caviated lesion, it depends on how deep the cavity is. If it is into dentin I would agree that its better to place a composite or amalgam...but if its just starting to infect the pits and fissures and is a bit deeper, a round bur sealant can work well. Just my two cents.

 

[Poppy1234]

Thanks Decan.

I have asked about a fluoride treatment, but was told there was no point...
They said it only lasted a few hours...
I said I'm sure there are treatments that last for a few months, but they said there was no such thing...

But now I'm hearing fluoride puts a film on the teeth which makes the remineralising products ineffective, as it can't do its job because the film stops it....

Cavity def isn't anywhere near dentine. Not even showing up on x-ray! But he said there was no way you can ever put a fissure seal over a drilled out cavity hole.....Though I had an appointment for this on Thurs with someone else...which I've cancelled now as it didn't sound a good idea.
I'd want any filling to last, and not convinced a fissure seal would be strong enough now.

It does baffle me how dentists often say completely different things though!

 

[decan]

From what we've been taught there are clinically detectable levels of fluoride in the mouth 2 weeks after the placement of varnish. Fluoride treatment works if given the time and opportunity. Its not a quick fix and you have to let it do its job.

 

[brit]

Poppy
I think the trouble is that NHS dental care tries to base itself increasingly on only using 'evidence based dentistry' using some kind of cost-benefit analysis - the cynical would say as a means of cutting costs, others would say as a means of using public money wisely. I'm sitting on the fence on this one. I think this is why as an adult you've been told remineralisation will likely not work and is a waste of time.

All these methods (sealants, varnish - hey no-one's mentioned healozone lol) probably work in some cases in ideal mouth conditions. Most private dentists will do what you want after discussion based on what they personally have found has worked for them....I guess NHS dentists are more inclined to stick to whatever the latest memo has advised is appropriate or what they have been told in dental school (if newly released on the unsuspecting public) as they won't have the clinical experience to have come to any different conclusions from their own practice.

And as we all know, if you have 5 dentists in a room, and show them the same patient, they will likely come up with 5 different treatment plans or sth like that the saying goes. Even if they agree on the treatment they will likely disagree on the timing....there's more than one way to skin a cat. Hence why finding a dentist with a similar philosophy to your own is important.