Amalgam/composite fillings

Mrsmoneypenny

My husband had his amalgam fillings removed and replaced with composites, around about 2 or 3 years ago.

While at another dentist today, the dentist said that his composite filling needed to be replaced.

He showed us a blown up view of the tooth and we could see what appeared to be a slight brown line between the filling and the tooth.

He asked which dentist we used and suggest we go back there rather than he suggest one at his practice/hospital.

My husband mentioned that he hadnt had them done very long and how would this happen.

He told us that composite can shrink. We had never heard this before.

Has anyone had the same problem or ever heard of this?

Toothsmith

It's not that it 'can' shrink. It DOES shrink.

When it sets it can shrink by between 1-4%, which is a sod of a lot really.

The effect of this can be offset by building it up slowly and setting it in little bits at a time.

But this requires a lot more time and very good moisture control (as the things don't stick properly if they get wet).

This is why white fillings cost a lot more - they take a lot longer to do (properly). This is why if you have things like this done, it should be at a dental practice where you feel a lot of time is spent and a lot of care taken. Not somewhere where there is a constant queue of people in the waiting room and a dentist working at 100mph.

White fillings done well can last a long time. White fillings done badly fail very quickly, and if not spotted in time take a lot more tooth with them when they go.

If you have any doubts about your dentist's ability to do things well:
1. get a new dentist
2. if you don't get a new dentist, only have amalgam fillings. These can be done adequately, pretty quickly and in a wetter field (But even here, they'd still last much longer if done nicely and in a dry field.)

netty1_2

Hi,

Not posted on this site before so here goes.

Composite fillings do shrink but most of the shrikage occurs whilst the fillings is being placed.

IF the filling is placed well the shrinkage is minimised and composite fillings can last. If not placed well it 'breaks down' where it meets the tooth and can be a site for decay. (The brown line shown to you).

Some say that they may last as long as silver fillings. A point here is that there are 'cheaper' quality composite filling material as well which will not perform as well as some of the newer modern composites.

There are some advantages of composite fillings over amalgam
1- as they bond to the tooth you do not need to remove as much tooth
2 - they look better
3- do not contain any mercury (however there is no strong evidence to show any health issues. The main issue could be an environmental one i.e realease of mercury into the environment).

I do both types of fillings (composite and amalgam) however at least 90% of the fillings I do are composite. I will recommend against composite filling if I cant keep the tooth 100% dry or if the filling is very large and may benefit from a crown (and ideally Gold on back teeth). I recommend against replacing good amalagam fillings for composite.

It may be worth getting the original dentist to have a look and seeing what the options are. Just wandering does your husband grind his teeth??

Hope this helps. First post so be kind!!!

Mrsmoneypenny

Thanks for your replies, I timed that well for two (one new to MSE - Hello) dentists to get back to me.

I think the dentist took her time, the appointment was booked for two hours and my husband did feel very confident in her, he had been seeing the same dentist for around seven years. Although with a 40% price hike on 1 January 2009 we had decided to look around for a new hospital.

Replacing the fillings was done through insurance last time and I would imagine that would be the case this time, if that was the way to go.

The filling was a big one, at the back and my husband doesn't grind his teeth.

I think he will be giving them a call today and going in tonight to see what can be done. I have a feeling this does not look good. When we were in UK in February he went to his usual six monthly check up and the decay was not brought up and neither was it at his monthly brace adjustment, although the orthodontist probably isn't focusing on that, i would imagine. I don't for one minute think that they were not doing their jobs properly, i just wonder how quickly decay does rears its ugly head to be seen by a trained eye?

Could I ask both dentists another question?

This probably sounds like a silly question to ask, however, if this filling has to be replaced would it be worth considering having the other composite fillings removed and replaced with amalgam at the same time? Perhaps there is a question or some advice he should be asking tonight while he is sitting in the hot seat. Any suggestion from you both?

Which is a cheaper and which is a more expensive composite material?

This came to light because my husband has had a brace put on his lower teeth and the orthodontist saw the decay last night.

Thanks again for taking the time to reply, you have both given us something to think about

Toothsmith

If they wee done well, the it was probably just unlucky that this one went.

Providing a close eye is kept on them, there'd be no need to have the others changed just because one has failed.

As to expensive/cheap materials, dentists rarely keep a range of them. They use the one they like best. But here's where the sort of practice you go to is key again.

You want a dentist who likes a 'good' one best rather that a place where material cost is the thing that decides which one is used.

Mrsmoneypenny

Thanks Toothsmith, I think this is the only time I like having a "consultation" with a dentist; on the internet with my mouth firmly closed!

I really do have a phobia (dont think that is too strong a word) of dentists. I have been very lucky and have strong, white, straight teeth but even so the dentist scares me. Very very bad experience when I was sixish but it has stuck with me. Having taken both my children to the dentist twice a year for the past 20+ years I know things are much different now. Bit off the topic there, i think.

Thanks again for the your reply

netty1_2

I wouldn't recommend removing the other composite fillings and placing amalgams in them.

There could be a differenecs in opinion as to whether the brown mark is actually decay? One Dentsit may monitor the tooth over a period of time the other may be proactive and decide to fill sooner.

Othodontist rely on the individuals regular dentist to examine the teeth for decay - but will pick up obvoius decay if they see it.

A good practice will always have the best composites of which there are a few composites. Sometimes however if you are not the practice owner you may not have that choice (the practice owner buys the dentists there materials) again a good practice will buy the best for all there dentists - depends on the practice.

Your insurance should cover the replacement but its always best to check with them.

If it is a large back filling it may be worth discussing with the dentist the options for a crown.

Good luck. If you have any questions I will try and help.

Mrsmoneypenny

Thanks Netty1

Thanks for the help, I think the hubby has spoken to the dentist before about a crown and it wasnt possible for a reason i can not remember now.

He shall go to the dentist next week, suffering a bit with sinus problems he doesnt fancy sitting in the chair at the moment.

Thanks again, hope you become a regular on MSE.