Ok, so you’re over 30… What does that mean? Well, lots of things. For most of us we are wondering why this, why that at this stage in our lives. Your 20s are so busy that you can’t keep up & unfortunately once you cross the border into your 30s you can’t get away with mistreating your body anymore.
Your teeth are no different! Look at this ‘before’ photo… look familiar? If you are over 30 than you likely had one of these placed about 20 years ago somewhere in your mouth. It’s called a ‘silver filling’ to most and dentists refer to it as a silver amalgam because it is an alloy of multiple metals. Don’t get me wrong, this article isn’t a post about bashing this very successful dental material… after all – it lasted 20 years!
One of the reasons it can last so long is because silver amalgam restorations corrode over time. Its metal, its wet, so what does it do? It rusts. This ‘rust’ causes an expansion over decades of time that is great if there are gaps when it is poorly placed because it will fill the gaps in so bacteria can not cause dental decay as quickly. This material is known for not being very difficult (technique sensitive) to place in that squirmy young impatient patient you once were as an 8-12 year old. The problem is that most of them are placed very well and as they expand they will cause cracking of the tooth (those of you over 40 who know this very well never got yours replaced and ended up needing a crown).
In this specific case you can see in the photo a silver filling on one side of the tooth known as the central groove, while the other was left untouched (probably because the patient was so young the back half of the tooth was still partially submerged under his gums). There is new decay present on the back of the tooth and what we call recurrent decay (the black stuff) around the left side of the silver filling.
The next photo shows clearly what was hiding under that old silver… eeeeewwwww, gross. The ladies don’t like guys who have this stuff in their mouth because it is contagious! That’s right, the bacteria that cause dental decay and periodontal disease are not genetically passed from your parents, it is a spreading infectious bacteria. When you share a sip of your soda with the kids or kiss them good night you are aiding in spreading of your bacteria. This is why dental diseases are common in families, generation after generation. It’s not (like some people & dentists like to think) hereditary! You won’t have bad teeth just because your parents did! Hooray! You just need some preventative medicine. We’ll talk more about CAVITY FREE KIDS in my next blog.
Back to the timeline… I’ve taken a few photos of my patient Phil who was excited that I was going to share this situation with you all when we took these photos using our intraoral digital camera. This is his upper back 2nd molar we call #15. You will notice in the 3rd photo I have uncovered a surprise amount of caramel colored decay in the bottom part of the photo. Where there is one problem, we often find another nearby. New decay on yellow dentin is often caramel in color, while recurrent decay under a staining silver amalgam filling is black. The amalgam fillings often leave what we know as permanent amalgam tattoos on the teeth and even the gums when placing a silver filling.
This is one of the many reasons why I haven’t placed a new silver filling in someone in over 10 years! We just don’t use this material anymore. In photo 4 you can also see how the recurrent decay spread over what we call the transverse ridge into the distal pit and lingual groove of the tooth. What does all that mean? It’s the anatomy of a tooth that’s in the top right of the photo. In dentistry we do something called “extension for prevention” to SEAL all these grooves up so it’s more difficult to get new decay on this tooth in the future.
Finally, in photo 5 you get to see how this ‘small problem’ really affected a large portion of the tooth surface. Now we get to start the fun stuff. If you look closely in the bottom middle part of the tooth you can actually see the pink part of the nerve of the tooth VERY close to the surface! That means this tooth left untreated would have come close to needing a root canal!!
As a preventative measure we place a material called an indirect pulp cap to sooth the nerve of a tooth with a GLASS IONOMER- see photo 6. This can biochemically bond directly to the dentin (yellow) part of the healthy tooth organically. Like all of our modern dental materials it becomes hardened using the curing light you see in photo 7. This material is great, but not strong enough to survive in the demanding conditions of your mouth for very long so after i smooth out any irregular parts of the tooth we have to put layers of COMPOSITE RESIN over it for strength.
The layering technique I use is called lamination. First we have to clean the tooth (photo 8) with a material that will cleanse all of the remaining invisible bacteria. Next , we rinse the tooth off to show a clean surface and dry it with air (but not too dry or the tooth will be sensitive afterwards).
Then we place a fine layer of bonding that will desensitize the tooth by filling the microscopic pores of dentin with organic resin. At this stage the tooth will no longer be sensitive, but you still have a big hole to fill. That’s why we call it a filling! Varying amounts of flowable and packable COMPOSITE RESIN HYBRID material are used depending on the location of the tooth, functional and esthetic demands. These materials are a combination of glass particles (spheres for flowable and irregular shapes for strength) and more organic resin.
Photo 9 shows that we are almost done! I like to consider these miniature works of art when complete and here you can clearly see why…. it looks like a normal tooth again! We have to smooth it off one last time after checking your bite (occlusion) with blue carbon paper. As I always say, “We have to get it to feel as good as it looks.” Fortunately for Phil, he had ZERO post-operative PAIN sensitivity on this one, but its common for patients to experience slight sensitivity to cold after all of this work has been done close to the nerve of the tooth. Another success!
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Dr. Eric Vanek, d.d.s
Eric has been a practicing dental surgeon for over 20 years and is the owner of Vanek Dentistry, a family dental practice in Costa Mesa, CA.
Published November 17, 2014. Updated August 16, 2021