New dental fillings are falling out?

New dental fillings are falling out?

There is no doubt that each of us has had or has at least heard about an experience where a fresh dental filling falls out or a newly repaired tooth breaks. As a first reaction, a quick-tempered person may ventilate his or her feelings by making an angry phone call to the clinic and telling the receptionist what he or she thinks about the quality of the service. Strong emotions are perfectly understandable as repairing teeth is quite expensive and many people have to collect money for several months before going to the dentist. Somebody has to be guilty after all, because the expensive dental procedure ended with a failure! Medihub asked several specialists, what could be the reasons for unstable dental fillings. What is the most important factor behind the failure – insufficient skills of the doctor or unsuitable filling material?

When the filling falls out, something has been done wrong

Dentist Ave Põld from the Merimetsa Dental Clinic makes it very clear: a properly placed filling for which there was a medical indication should not fall out or break. „In case a filling crumbles or falls out, something has been done wrong either in the planning phase or during the technical execution,“ stresses doctor Põld.

In dentistry, it is very important to treat the mouth as a whole

A very experienced dentist Merike Immato who is also the head of the Lumen Dental Clinic adds that in dentistry, it is very important to treat the mouth as a whole, to see the big picture. „For example, if the person has no back teeth for chewing, then the front teeth must bear a much heavier load,“ explains doctor Immato. Uneven load and other dysfunctions lead to strong tensions in teeth and finally either the filling or the teeth itself may give way and break.

Glass ionomer is weaker and tends to crumble

In modern dentistry, usually either light cured composite fillings or laboratory-made ceramic inlays or crowns are used to permanently restore the teeth. Glass ionomer cements are also widely used, mainly for treating baby teeth in children or as temporary fillings. Glass ionomer protects against caries and is more resistant to humidity, however, unfortunately is it weaker than composite filling and tends to crumble.

Use of amalgam is restricted mainly because of environmental pollution

For decades, amalgam fillings and other mercury-containing fillings have dominated in dentistry. This is about to change. In this July, a regulation limiting the use of mercury-containing dental fillings entered into force in the European Union, the main argument being serious environmental mercury pollution. A large part of this pollution comes from dental fillings. However, experienced dentists have pointed out that in Soviet time, amalgam saved many teeth that would have been destroyed if other materials had been used. Composite fillings, essentially a mixture of plastic and glass, are bonded (“glued“) to the remaining tooth tissue. These fillings have a serious shortcoming, however. Namely, the cavities where the fillings are inserted, have to be absolutely dry, otherwise the fillings may come loose.

Gold fillings are the best

Surprisingly, the best and the most stable material is gold, however, using this metal for dental treatment is too expensive for most customers. At present, there are still some dentists using gold in Italy and France, for example.

Fulfilling client’s wishes may backfire

There can be several reasons why a fresh filling falls out or why a newly repaired tooth breaks. Using a composite filling – instead of a ceramic inlay or crown – for repairing an extensively damaged tooth may cause problems later. Crowns and inlays are certainly more expensive. Thus, when a client chooses a less expensive filling, the dentist has no other option than to comply. However, a filling that is too large acts as a wedge, putting the walls of the remaining tooth under permanent pressure. As a result, cracks may develop in the the tooth, which may cause the filling to fall out or, more often, damage the remaining tooth tissue. If an inlay or a crown had been chosen in the first place, the tooth would not have broken or the filling would not have fallen out.

To place fillings successfully, excessive humidity must be eliminated

Another important reason why fillings may fall out is related to the insertion procedure. Namely, light cured composite fillings are rather sensitive to humidity. These fillings stay properly in place only when installed onto a perfectly dry surface. In order to guarantee a saliva-free environment, the tooth is isolated by means of a rubber band before inserting the composite filling. The band separates the tooth being repaired from the rest of the mouth environment and guarantees stable and dry conditions in the dental cavity. The isolation also prevents the cleaned dental cavity from being infected with various bacteria living in the mouth. If the environment in the dental cavity is not dry enough or if bacteria have not been eliminated from the cavity, the filling may not adhere to the tooth properly and may come loose. Through microcracks, the cavity may stay connected with the mouth environment and the bacteria under the filling may continue demolishing the tooth until the filling falls out or, even worse, the root becomes inflamed.

New cavities appear under the filling

It may seem surprising, but sometimes new cavities appear under the fillings. It is one of the reasons why fillings need to be replaced from time to time. The main bacterium causing caries is Streptococcus mutans. This microbe can survive in an oxygen-free environment, but can also live with oxygen. New research shows that air-tightness is the most important factor that helps to avoid developing new cavities under dental fillings. Even if a small amount of bacteria remains in the cavity, but it is sealed properly, the bacterial colony dies, having no access to nutrients.

The most widely used fillings last 10 years as an average

It is difficult for the dentist to estimate how long different fillings would last. However, the conditions in the mouth – acidity, grinding, dentition, missing teeth, hygiene and nutrition – affect the stability of fillings even more than the material itself. As a rule of thumb, light cured composite fillings last 10 years, ceramic fillings 25 years and amalgam fillings 15 years.

The stability of dental fillings is most affected by the patient’s habits

The composite filling can be prevented from falling out by placing it in dry conditions, by polishing its surface properly and by restoring normal chewing function. Excessive use of front teeth instead of (missing) molars leads to undesirable overload. The experience of the doctor is also important as choosing the material is part of the solution. By repairing an extensively damaged tooth by means of light cured composite filling, a disservice can be done to the patient. However, understandably, there are patients who just can’t afford more expensive procedures. The effectiveness of dental treatment is most affected by the patient’s behavior and everyday hygiene. If habits that lead to tooth decay are not corrected, then there is no reason to suppose that the repaired teeth will stay healthy forever.

We would like to thank our cooperation partners: Merimetsa Dental Clinic in Tallinn and Lumen Dental Clinic in Viimsi.