U.S. CitiesCity-Data Forum Index
Go Back   City-Data Forum > General Forums > Health and Wellness > Dental Health
 [Register]
Please register to participate in our discussions with 1.5 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Jump to a detailed profile or search
site with Google Custom Search

Search Forums  (Advanced)
Business Search - 14 Million verified businesses
Search for:  near: 
Reply Start New Thread
 
Old 07-22-2010, 08:32 AM
 
432 posts, read 2,306,579 times
Reputation: 369
Default Composite or amalgam fillings in back molars

I recently went to the dentist and was told I have a shallow cavity on a back molar that is next to a degrading amalgam filling in the same tooth. Dentist wants to remove old amalgam filling, check for any decay underneath, and replace with a composite filling, and fill in the shallow cavity. Went for a second opinion and was told the same thing.

So....the thing is that I've read a lot about how composite shouldn't be used for back molars b/c they don't last long and crack easier, and how amalgam should only be used for back molars. No dentist that I've been to in the last few years even offers amalgam any more. They only do composite. That was also my hometown dentist's policy (to only use amalgam in back molars), who I saw for 25 years without any problems with my fillings, and which is why I have very old amalgam fillings in most of my molars. However, they've lasted a long time and I've never had any problems with them, except for one amalgam filling that cracked, but it was probably 25 years old.

The only problem I have ever had with a tooth was two years ago when I had an old amalgam filling that was cracked replaced with a porcelain onlay--have had problems with that tooth ever since, so I am very wary of messing with an asymptomatic amalgam filling that is not causing any problems.

I am wondering what is the best restoration for this tooth. Maybe a crown instead of a composite filling? I just want to minimize pain and problems. I probably made 12 trips to the dentist just to deal with the pain and problems stemming from the old amalgam I had replaced with the onlay, and don't want to repeat that experience again!
Reply With Quote Quick reply to this message

 
Old 07-22-2010, 10:54 AM
 
Location: Pacific Northwest
1,053 posts, read 2,629,578 times
Reputation: 759
Bass, the dentists are switching to composites because of the health-related issues with mercury leaching from the amalgums.

You're correct in assuming composites don't have the strength and endurance of amalgums, although I still have a small composite (not on a molar though) and told it may only last about five years .. that was 35 years ago.

Crowns are certainly stronger and longer lasting, although they aren't always fool-proof either.

Years ago, if the tooth and root were considered healthy, the dentist would crown the tooth without doing a root canal. Down the road though, for some reason or another, the root may become inflamed and infected.
In this case, the dentist would either have to remove the crown or may be able to get away with just drilling through, in able to perform a root canal. Once the root is extracted, then either an amalgum or composite filling applied to the drilled crown, or a new crown is required, new impressions, etc.

More recently, dentists sometimes do an automatic root canal before administering a crown to prevent any problems in the future with that tooth, depending on the dentist's philosophy.
Reply With Quote Quick reply to this message
 
Old 07-24-2010, 01:25 PM
 
8,681 posts, read 7,426,107 times
Reputation: 14926
Six of one, half dozen of the other. Composite fillings are really not meant for bite surfaces. They are not as stable and there's a higher rate of bonding problems.

I can vouch for that. I had a dentist that did the replacement on three fillings on three teeth on my left side, and I had bonding problems with one such that it had to be replaced twice more. It just wasn't sticking, and it hurt.

After a while I suspected that he was just playing the insurance game, and sure enough, when I went to another dentist, he said the same thing.

Yes, many dentists won't offer amalgam any more. Part of it is paranoia about mercury and part of it is that, yes, composite doesn't last as long as amalgam: More money for them when they have to replace it 10 years later.

FWIW: I have amalgam fillings on the right side of my mouth from when I was a child. I'm 43. They do last longer.
Reply With Quote Quick reply to this message
 
Old 07-24-2010, 10:36 PM
 
432 posts, read 2,306,579 times
Reputation: 369
Yes, I am well informed about the health risks of amalgam, and it does concern me. At the same time composite fillings have estrogenic properties, which also concerns me. It seems that every dental restoration material has issues! What is one to do?

Unfortunately, it looks like the old amalgam (which could have been from 25 years ago) needs to be replaced. If I go with composite, I could be looking at having to replace again in a few years. If I go with amalgam, I will be worried about mercury toxicity. Plus I haven't been able to find a dentist who even still uses amalgams.

Why aren't there more options for dental restoration materials?

So what does one do in this situation? Just get a crown, even though it's a relatively small filling that needs to be replaced? All the dentists I've been to say replace with composite, but I don't feel 100% good about this, because I don't want to be back there in a few years complaining of a problem with that tooth when the composite fails. I don't want to get a porcelain inlay, because I already did that once and it was nothing but problems.
Reply With Quote Quick reply to this message
 
Old 07-25-2010, 12:13 AM
 
5,367 posts, read 6,232,257 times
Reputation: 6350
Here's my story with amalgam fillings, draw your own conclusions.

When I was a teenager, seems I was constantly getting fillings, the silver kind. Then, the "kind dentist" decided I needed all my silver fillings replaced before I turned 22 and went off my father's insurance. So, I had all the back molars re filled with silver amalgam.

In about 6 months, I developed joint problems, prolgressed into rheumatoid arthritis. By the time I was 26, I needed both knees and both hips replaced. Nothing really seemed to help the progress of the disease. I tried everything, including methotrexate and enbrel.

Then, when I was about 45, I had a dentist remove all the silver fillings and replace with composite. Within about a month, my RA was in remission.Although I continue to take meds, the meds now work. The horrible pain, especially in the morning, had subsidided. The disease is now in remission and controlled with drugs.

I wanted the silver fillings removed for years, but couldn't afford it. Finally I found a dentist who knew how to "play" the system. He was able to document the silver fillings were cracked and needed replacement, wich he did. Insurance paid what they would approve to replace with silver, I paid the difference to get composite.

Draw your own conclusions!
Reply With Quote Quick reply to this message
 
Old 07-25-2010, 01:25 PM
 
432 posts, read 2,306,579 times
Reputation: 369
Quote:
Originally Posted by MaryleeII View Post
Here's my story with amalgam fillings, draw your own conclusions.

When I was a teenager, seems I was constantly getting fillings, the silver kind. Then, the "kind dentist" decided I needed all my silver fillings replaced before I turned 22 and went off my father's insurance. So, I had all the back molars re filled with silver amalgam.

In about 6 months, I developed joint problems, prolgressed into rheumatoid arthritis. By the time I was 26, I needed both knees and both hips replaced. Nothing really seemed to help the progress of the disease. I tried everything, including methotrexate and enbrel.

Then, when I was about 45, I had a dentist remove all the silver fillings and replace with composite. Within about a month, my RA was in remission.Although I continue to take meds, the meds now work. The horrible pain, especially in the morning, had subsidided. The disease is now in remission and controlled with drugs.

I wanted the silver fillings removed for years, but couldn't afford it. Finally I found a dentist who knew how to "play" the system. He was able to document the silver fillings were cracked and needed replacement, wich he did. Insurance paid what they would approve to replace with silver, I paid the difference to get composite.
I'm sorry to hear about your issues. That's terrible. It seems as if there really is no best dental filling. Amalgam clearly has issues, which I have read a lot about, and composite also has issues with being estrogenic. Maybe a porcelain crown is my best option.

Personally, I have about 12 silver amalgam fillings from childhood/teen years and I've had no problems with them. I had one of these cracked amalgams removed and replaced with a porcelain restoration a few years ago and had no problems with the removal. I would never remove and replace my amalgams just because they're amalgams. If it's not broken, I sure am not going to "fix" it given that most are in molars and haven't given me any trouble.

I think I'd rather do amalgam on my back molars which is known to be durable than do composite, have it crack due to chewing forces, and then have to have a crown or root canal in a few years. There really is no good option for the back teeth it seems. Will have to get a few opinions before I decide.
Reply With Quote Quick reply to this message
 
Old 05-04-2012, 12:45 PM
 
2 posts, read 33,802 times
Reputation: 13
I recently had 4 small amalgam fillings, but after knowing the fact about mercury usage I'm tensed. I have small superficial cavities on side of last molars of my lower jaw and 2 premolars cavities. Should I go for Amalgam removal with Composites restoration or any other, do suggest?
Reply With Quote Quick reply to this message
 
Old 05-09-2012, 08:45 AM
 
71 posts, read 111,150 times
Reputation: 162
Quote:
Originally Posted by Bass101 View Post
So what does one do in this situation? Just get a crown, even though it's a relatively small filling that needs to be replaced? All the dentists I've been to say replace with composite, but I don't feel 100% good about this, because I don't want to be back there in a few years complaining of a problem with that tooth when the composite fails. I don't want to get a porcelain inlay, because I already did that once and it was nothing but problems.

Do you grind your teeth in your sleep/clench your jaw? A bite guard might prevent the filling from wearing down so fast.

When you chew feed throughout the day, your teeth don't actually make a whole lot of contact. Most of the wear and tear comes from grinding your teeth. A dentist should be able to look at your teeth and see if you grind. And if you do, you could be fitted with a bite guard. I wear one over my lower teeth, which prevents me from grinding them down (which I would otherwise) and it should help the filling to last longer.




Honestly, I really wish dentists still did gold fillings. They used to, but many don't learn how to do gold fillings. I've heard about gold fillings lasting for 40 and 50 years. My dentist showed me xrays of a 90yr old patient who has a lot of gold in her mouth from 40-50 years ago, and it's all in place and healthy! Since gold naturally repels bacteria in your mouth, you cannot get a cavity underneath one. Bacteria can leak under composite fillings because they expand and contract (gold or silver fillings fit more tightly, so this isn't a problem), and they can develop cavities. Eeek!

Last edited by abrokegal; 05-09-2012 at 08:54 AM..
Reply With Quote Quick reply to this message
 
Old 05-10-2012, 08:09 PM
 
420 posts, read 1,339,510 times
Reputation: 453
Composite fillings are really not meant for bite surfaces. They are not as stable and there's a higher rate of bonding problems. Say what? Okay, I'm a dentist so let me put my thoughts into this thread. I have no problems with amalgam restorations, in fact I have a few in my mouth. With that said, I'm mostly doing composite restorations these days becaue that's what I'm use to doing. But to say that composite fillings are really not meant for bite surfaces and aren't as stable, you actually got that backwards. It's the amalgam fillings that aren't as stable. And if there bonding problems well then the dentist didn't do it right, has nothing to do with the bond itself because the literature has shown to be very effective under stress and biting forces. More and more dental schools are allowing their students to do composite fillings because that's what they want to learn and get good at.

Problem is, the board examinations still require students to do amalgams, so the schools legally have to keep teaching about amalgam fillings. If a school stops teaching a dental student how to place an amalgam restoration and it's still on their board exam and they fail, the student could always turn around and cause problems for the school and I'm not kidding either. If all the board exams across this country were to get rid of placing amalgam restorations tomorrow, you'd better believe half the dental schools would scrap amalgams.

Also, understand the properties of both restorations. With an amalgam you can't carve any anatomy into it with a bur or handpiece because it's too soft, all the carving of the anatomy is done by hand, not that it's a big deal to do, but most dentist prefer to use a nice football shaped bur and carve the anatomy, which is what you can do immediately after curing a composite. Let's say you're doing a post-and-core, well you can't really buildup the amalgam and prep that tooth on the same day, it's too soft and needs time to set up. Not with a composite! Once it's cured, it's as hard as it will ever be and you can carve it immediately and shape it any way you like.

If there's a contamination problem, meaning you can't get the tooth nice and dry and it's a back molar, then yea, go ahead and place an amalgam because you can't have moisture inside the preparation, the bonding won't work. As for gold restorations, believe it or not I still believe gold is the best. It's amazing to me why some insurance companies won't pay for a gold crown on a back molar. I would totally offer that to my patients for a number of reasons. One big one is that you don't have to reduce the tooth as much as you do with a porcelain crown. Remember you have to reduce the tooth more for a porcelain crown to make room for the porcelain, but not with gold. 0.75mm all the way around the tooth, that's all you have to reduce to really make a gold crown fit. And I too have seen elderly patients come in with gold crowns and inlays that were placed well over 30 years ago and they look like they're brand new. Why? Because gold doesn't tarnish like other metals. Hope this helps!
Reply With Quote Quick reply to this message
 
Old 05-11-2012, 08:15 AM
 
10,150 posts, read 16,325,935 times
Reputation: 7908
Quote:
Originally Posted by drsmiley06 View Post

If there's a contamination problem, meaning you can't get the tooth nice and dry and it's a back molar, then yea, go ahead and place an amalgam because you can't have moisture inside the preparation, the bonding won't work. As for gold restorations, believe it or not I still believe gold is the best. It's amazing to me why some insurance companies won't pay for a gold crown on a back molar. I would totally offer that to my patients for a number of reasons. One big one is that you don't have to reduce the tooth as much as you do with a porcelain crown. Remember you have to reduce the tooth more for a porcelain crown to make room for the porcelain, but not with gold. 0.75mm all the way around the tooth, that's all you have to reduce to really make a gold crown fit. And I too have seen elderly patients come in with gold crowns and inlays that were placed well over 30 years ago and they look like they're brand new. Why? Because gold doesn't tarnish like other metals. Hope this helps!
I have a gold bridge in my mouth that was placed over 40 years ago. Elsewhere in my mouth I have porcelain bridges/crowns that have had to be replaced three times within that time span. I do believe gold is the best.
Reply With Quote Quick reply to this message
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.

Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.


Reply
Please update this thread with any new information or opinions. This open thread is still read by thousands of people, so we encourage all additional points of view.

Quick Reply
Message:


Over $84,000 in prizes was already given out to active posters on our forum and additional giveaways are planned!

Go Back   City-Data Forum > General Forums > Health and Wellness > Dental Health
Similar Threads

All times are GMT -6.

2005-2014, Advameg, Inc.

City-Data.com - Archive 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 - Top