Tooth with an old filling

I recently read an article about home renovation written by Mike Holmes of TLC’s “Holmes on Homes” fame, and it reminded me exactly of dentistry!

“It was such a small job…Why did it end up costing so much? Why did it take so long? Why did it become such a nightmare?” is what he hears from people during home renovations.  What I hear often is…”It was such a small filling…why did it cost so much to fix? Why is my tooth sore? Why do I need more treatment like root canal or crown?”

But shouldn’t my dentist be able to anticipate what will need to be done?

Clients of Mike Holmes want a new window.  They think that should be easy, measure for the window, order it, install it…done. But what if the window has been leaking for years?  What if the frame is rotted and needs to be replaced? If you aren’t an expert in windows, you likely won’t know until the window company looks, and maybe even removes the old window to see what lies beneath.

After removing decay – wow, not much left!

This is exactly like what I do every day! A small filling, usually amalgam (silver), was placed 25 years ago when the patient was 10 years old.  In the photo, you can see how the tooth looks dark around the filling…but you can only really see that when we make the photograph of the tooth really large! So we think we are just replacing a filling…but then when I remove the old filling…WOW! Much of the tooth is lost to bacterial leakage and decay, or there’s a huge crack across the whole tooth!  Now, this tooth isn’t structurally sound enough for “just a filling”, and will need a crown to build it up again.  Sometimes if the crack is deep enough, bacteria will have percolated into that crack to infect the nerve of the tooth, and the patient will need a root canal to clean up the infection in the tooth.  Now the “job” is much more difficult than we anticipated, and ends up costing more as well.

Can’t I just leave old fillings in then, if my teeth don’t hurt anyway?

The best thing I can say about decay is that it is usually painless…which is also the worst part about decay, because there often is no signal to the patient of a problem!  The old adage “if it ain’t broke. don’t fix it” is often translated in a patient’s mind as “if it doesn’t hurt, leave it alone.” Important to remember is that often when the tooth is sore, the problem is so great that the solution could be loss of the tooth.  If this is how you are treating your teeth, you are likely to end up losing way more teeth than you need to.

The best way to protect your teeth is to allow your dentist the opportunity to look at them carefully on a routine basis.

This includes necessary xrays when your dentist recommends, usually every one to two years, but remember that an xray doesn’t always show the whole situation clearly.  Why is that?  An xray is only a two-dimensional (or flat) picture of your three-dimensional tooth.  What this means is if there is an old filling in the tooth, it will show up as opaque, or very white, on an xray; this appearance can block our view of any decay in front of, behind, or directly next to any old filling, giving dentists the wrong impression that everything is fine.  This is exactly why in our office, we take digital photographs of our patients’ teeth, just like the ones shown in this blog.  We magnify these images many times and look at them with our patients on large computer screens.  When we do that, it becomes obvious where fillings are no longer fitting the teeth.  The interesting part about this is we often see in this photograph much more clearly than we can even see in the mouth, because the photo is so much larger!  Having said this, the only time we know for sure what is going on under an old filling is when we remove it and take a look. And in all the years I have been practising dentistry, I have NEVER removed a silver (mercury amalgam) filling more than 5-10 years old, and NOT found decay underneath.

Your windows will need to be replaced, your roof will need to be replaced, your carpets will need to be replaced…and so will your old fillings.

Ask your dentist to take digital photographs of your teeth every 2-4 years, especially if you still have the fillings of your childhood, and ask to see those  pictures. If the tooth around the filling looks dark…that’s bacteria and mold underneath, infecting your tooth.  If you see a gap between the filling and the tooth, or if the edges of the filling look rolled up or corroded…that’s how the bacteria is getting in! Time to renovate…even if it doesn’t hurt.