How much for a filling? Wrong question – Part 1: Why have I the need for a filling?
The why answer helps us to how we can best help you for the future.
The saying “do no harm”, not only applies to the treating dental surgeon but also to the patient. Achieving both makes for a lasting health outcome.
Let’s start with a case that even surprised me with the extent of the problem that needed to be solved.
The patient had a strange sensation on eating in area of his mouth. He could not pin point where it was exactly.He had two teeth with metal fillings that had been there for a while. However, I was suspicious of one of them that was slightly discoloured and had a deep groove leading, between the teeth leading to the filling. I have seen this patient over many years.
The xray take showed no decay between the teeth but a shadow under the shallow filling. The way many were done many years ago was to place a protective layer before placing the filling. We now know that they can be too thick for the thicknees of the final filling. Overtime with the every change bite and usage, the layer is softer than the filling on it, so it wears away. The tooth is always bend and flexing. No filling is a replacment for tooth material, so the hollow out tooth filled by a filling, will tend to flex and bend more than a complete tooth.
Following the principle of “do no harm”. I decided to remove the filling to view directly the shadow in the Xray, as the other had no other supicious finding on the xray or symptoms.
Upon removal of the filling, decay was found in the middle of the tooth, where it was indicated on the Xray. However a crack line was found running under the groove between the teeth and further into the tooth.
The problem with a crack, it allows bacteria to travel further from the mouth. Also there was spot decay under other grooves (fissures) on the biting surface.
Usually the darker the decay, the slower the decay progression.
So, with gentle cleaning of the decay, the surrounding tooth structure was found to be soft with decay. If the decay is quickly progressing, then it does not have time to stain, nor wash out of the tooth. This means the Xray can look normal, but the structure of the tooth is collapsing and soft, hence the sensitivity.
The decay at the end of the crack, was much more extensive and deeper. This was a complete surprise, at of all proportion to the shadow on the Xray.
The filling was then placed at least twice the volume of the previous filling.
Why did this happen?
Yes, more thinking!!
I do that all day.
The time we will assess the following to help us understand the why…
Medical History, Diet, Clenching, Sealing and more.
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Next week
How much for a filling? Wrong question - Part 2: Assessment