Tooth Decay

Tooth decay is one of the most common infectious diseases known to man. (Only the common cold is more prevalent.) Decay or caries occurs when the teeth are attacked by acid, which is introduced to the mouth in one of two ways: 1) Through the consumption of foods or acidic drinks like soda pop, fruit juice, etc. or 2) Through the breakdown of the sugars and starches in our diet by the naturally occurring bacteria in our mouths.

For most people, cavities develop due to excessive ingestion of sugary foods and candy, as well as soda pop. This causes the localized acid load in the mouth too increase to such a high level (pH < 5.5) that the acid literally rots a hole in the tooth. Excessive consumption of carbonated beverages like colas can be especially bad for the teeth, because they contain both acid and sugar.

To avoid cavities, and still enjoy a sweet or carbonated beverage, simply brush and floss immediately after eating or drinking these. This removes the sugars and acids and stops the decay process from progressing.

However, for some of us, the decay process has already occurred, necessitating a filling or perhaps a crown.

Fillings

If the cavity is small, fillings are an appropriate restorative option. By small, we mean that the old filling (if present) and decay must take up less than 50% of the tooth (above the gum line). If the cavity takes up more than 50% of the tooth, then a crown or cap is necessary. In other words, there must be enough teeth left to structurally support a filling. If there is not, then the top of the tooth needs to be replaced with a crown.

Fillings are commonly differentiated by their color, either silver (grayish) or white (tooth-colored). Silver fillings or amalgams are made up of an alloy comprised primarily of silver, tin, copper and mercury. Amalgams have been around for over 150 years are extremely durable and work extremely well. However, cosmetic concerns have resulted in these being phased out in favor of the more esthetically pleasing tooth-colored fillings.

Silver fillings also have a major disadvantage: They contain mercury, which is quite hazardous to the environment (because of this, some countries in Europe have banned silver fillings). However, for the vast majority of the population (>99%), silver fillings are considered to be safe in the mouth. The issue is more an environmental one: factories that process mercury generate waste that is extremely toxic to wildlife, especially birds.

Modern dental offices have therefore largely moved to tooth colored fillings and are doing fewer and fewer silver fillings. Tooth colored fillings are comprised of either composite resin or glass/resin ionomers. Composite resin fillings are more common since they can stand up to heavy chewing pressures and not break. Ionomers are better suited for non-load bearing situations—cavities between the teeth, for example.
Tooth colored fillings look great, but do have the disadvantage of costing slightly more. The white filling material usually costs more than amalgam and typically takes longer to place in the tooth (resulting in a higher fee from the dentist).

And be aware that some (not all) dental insurance companies view silver amalgam as “good enough” and only have one payment amount for a particular type of filling—regardless of whether it is silver or white. This results in the patient having to pay a slightly higher “out-of-pocket” for white fillings than for silver. If your dental insurance downgrades the fee for white fillings down to that for silver, be sure to voice your concerns to the person in human resources that buys your insurance.

Crowns and Caps

When the decay and old filling (if present) take up more than 50% of the upper portion of the tooth, a crown or cap is necessary— there is not enough tooth left to structurally support a filling.

A crown necessitates a two-visit procedure for the patient (unlike fillings which are a single visit procedure). Two visits are necessary with crowns, since the new tooth top (or crown) is fabricated by an outside dental laboratory (though a few dentists do have in an in-house lab). The outside dental laboratory takes about 1.5-2.0 weeks to fabricate the crown out of porcelain or gold, after which the patient needs to return to the dentist to have this placed.

In the crown procedure, the dentist removes the decay from the tooth and then places a temporary plastic crown. The patient wears this temporary for about 2 weeks—the time it takes for the lab to fabricate the permanent crown—and then returns to have the temporary popped out and the permanent crown cemented in.

The temporary crown should feel just fine during this two week period. And for the majority, this is the case. However, if the crowned tooth is sensitive, you need to contact your dentist. With deep decay, a bit of sensitivity can occur and the dull pain should be controlled with Ibuprofen (Advil). If the temporary is sensitive only after eating, you may need a quick adjustment of the bite. And if the crowned tooth if sensitive to hot/cold and percussion (or tapping), you may need to be evaluated for a root canal.

Filed under: Uncategorized by admin