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Thursday, September 29, 2011

Front baby tooth is now black!

The parents call up and say "my child's front tooth is black. What should I do?"
Well the first thing we tell them is they should come in so we can have a look.
The history of this situation is that the child had received a blow to this front tooth at some point in time and now the tooth had turned dark.  This tooth is no longer vital (alive).  The nerve inside the tooth has died.  The tooth darkens.
If there is no sign of infection, no swelling of the gum, no pain, we leave this tooth alone.  It will most likely fall out by itself when the permanent tooth comes in.  The permanent tooth will come in without any problems.  If there are signs of infection we will extract this tooth so that the infection will not affect the developing permanent tooth.
This is what happenned to my daughter when she was about 3.  She fell, hit her front tooth and it turned dark.  The gums were fine, no sign of infection so we just left it alone and today she has a beautiful smile. (14 years later)

Just another day for a Hamilton Dentist!

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All the best

Dr. Ron

Friday, September 16, 2011

Composite or Amalgam, White Fillings or Silver Fillings

I am still getting those questions regarding fillings.

Which is better, white or silver?  Are silver fillings safe?  Should I remove all my silver fillings and replace them with white? 

First let me say that in my office we do 99% of our fillngs in white.  I believe that most dental offices today do most of their fillings in white.  What has driven this change is the aesthetics of these fillings.  Who would not rather have white fillings in their mouth versus the dark fillings that may become visible as we smile or talk.

Having said that, when I graduated dental school, white fillings in the back teeth were available but they weren't that good.  They leaked alot around their edges which resulted in alot of sensitivity after the filling and alot of recurrent decay.  Due to these facts, many dentists were reluctant to place them but with the years and the advancement in materials and techniques these problems have been resolved.  Today most dentists are very comfortable placing them.

So what about silver fillings? Are they bad fillings?  Are they dangerous to your health?  Should they be replaced?  Are dentists still placing them?

Silver fillings are good fillings that have been around for over 100 years.  Their safety has been proven over the years with numerous studies.  I have many of these in my mouth and if I thought there was a problem with them, I would be the first to change them.
Many patients do ask me if they should replace the old ones or if they can replace them with the white ones?  I tell my patients that just because the filling is old does not mean it has to be replaced.  If there is no breakage of the filling or decay underneath it then there is no reason to replace it.  If it is not broken don't fix it.  If the darkness of the filling bothers the patient from an aesthetic perspective then yes we can go ahead and replace them.  I do warn my patients who want them replaced that they should know that when a filling is replaced we usually must make the hole the filling was in slightly deeper in order to get the old filling out.  In the really deep fillings where the filling is close to the nerve this may necessitate root canal treatment if there is pain after the filling.

Do we still use silver fillings?  Yes we do.  The white fillings are more technique sensitive fillings.  (that is also why they are a little more expensive than silver fillings) When we place the white filling, the area must be perfectly dry.  If it is not dry then we may get leakage of the filling and subsequent sensitivity and recurrent decay.  As you know the mouth is a wet place and for some people in certain areas of the mouth it is almost impossible to keep the area dry.  For these people we still use silver fillings as it is not so technique sensitive and it can successfully be place in areas that still have some wetness.
We still use silver fillings in children as these fillings can be placed faster than white fillings and in a child whose attention span is limited and where you need to get the job done quickly, silver fillings are a valuable tool.
Some insurance providers only pay the cost of silver fillings in the posterior teeth and then it is up to the patient wether they would like silver fillings or pay the difference for white fillings.

White fillings and silver fillings, both are good.  White is more aesthetic but don't rush out to have the silver replaced unless it bothers you aesthetically.

All the best from this dentist in Hamilton Ontario on this beautiful summer day. (yes it is still summer but not for much longer)

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