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Treatment for a small cavity

User Level:
Patient
Posted by: designertattoo  (10 years ago)
Hi there!

I had a small cavity in between my first and second molar on the bottom right side of my mouth. It did not bother me at all but I still went to the dentist to have it treated. The dentist put a composite filling on it. It was a small cavity and the required filling was very small as well. The first day I had it done, I was in a lot of pain. A small piece broke off while I was eating and I had to go back to the dentist to have it patched up. After a month, it is still sensitive when I chew and to anything hot and cold. Five days ago, I noticed a sharp throbbing pain from the filling. I went back to the dentist and he found that the filling had broken again. The dentist said the filling keeps on breaking because it is very small and it does not bond with the tooth very well. He again fixed it. Two days ago, the sharp pain came back with a prolonged throbbing. I called the dentist and he said, he will have to remove the filling, drill deeper and replace the composite with amalgam. As much as possible I want to avoid the amalgam filling. Is there other options for me? My appointment is in two weeks. If I have any other alternatives to fix this, please let me know. Thanks a lot!
User Level:
Student
Posted by: mdhola  (10 years ago)
Dear,
If your dentist said it was very small filling then probably you don't need amalgam filling. Although, composite fillings wear of quickly as compare to amalgam, it is still quite strong. In fact, there are many dental clinics in US where dentists only do composite fillings. It seems like you have been to your dentist for 3-4 times for the same tooth! I would advise you to get the second opinion from other dentist for more accurate diagnosis.
User Level:
Dentist
Hi there!

I had a small cavity in between my first and second molar on the bottom right side of my mouth. It did not bother me at all but I still went to the dentist to have it treated. The dentist put a composite filling on it. It was a small cavity and the required filling was very small as well. The first day I had it done, I was in a lot of pain. A
small piece broke off while I was eating and I had to go back to the dentist to have it patched up. After a month, it is still sensitive when I chew and to anything hot and cold. Five days ago, I noticed a sharp throbbing pain from the filling. I went back to the dentist and he found that the filling had broken again. The dentist said,
the filling keeps on breaking because it is very small and it does not bond with the tooth very well. He again fixed it. Two days ago, the sharp pain came back with a prolonged throbbing. I called the dentist and he said, he will have to remove the filling, drill deeper and replace the composite with amalgam. As much as possible I
want to avoid the amalgam filling. Is there other options for me? My appointment is in two weeks. If I have any other alternatives to fix this, please let me know. Thanks a lot!


THANKS TO YOUR READING A LOT OF FOOLISH STUFF ON THE INTERNET, YOU HAVE COST YOURSELF TIME AND MONEY. SENSITIVITY IS A COMMON PRACTICE AFTER COMPOSITE RESIN FILLINGS BECAUSE THEY LEAK SO BADLY! THERE IS NOTHING WRONG WITH AMALGAM. IF AMALGAM WERE REALLY DANGEROUS, I WOULD BE THE ONE WHO WAS REALLY SICK! DESPITE WHAT THE DENTAL STUDENT SAYS IN HIS POST, AMALGAMS CAN LAST 40 YEARS OR MORE. THERE IS NO WAY COMPOSITE RESINS CAN EVER LAST AS LONG.

Posted 10 years ago
User Level:
Dentist
Dear,
If your dentist said it was very small filling then probably you don't need amalgam filling. Although, composite fillings wear of quickly as compare to amalgam, it is still quite strong. In fact, there are many dental clinics in US where dentists only do composite fillings. It seems like you have been to your dentist for 3-4 times for the same tooth! I would advise you to get the second opinion from other dentist for more accurate diagnosis.


DENTAL STUDENT, BEFORE YOU POST FOOLISH AND MISLEADING ANSWERS LIKE THIS. PRACTICE A FEW YEARS LIKE I HAVE (31!) AND YOU WILL SEE THAT AMALGAM FILLINGS LAST AT LEAST TWICE AS LONG AS COMPOSITES ON BACK TEETH. I HAVE MADE A LOT OF MONEY DOING ROOT CANALS ON PATIENTS WHO FOOLISHLY DECIDED TO HAVE PERFECTLY GOOD AMALGAMS REPLACED WITH COMPOSITES.
Posted 10 years ago
User Level:
Student
Posted by: mdhola  (10 years ago)
Dear Dr.Henry,
I apologies to patient and you if i have posted any misleading information here. I am not strictly recommending composite over amalgam for all clinical situation. My recommendation is based on what pt has posted. If patient has very small proximal caries which i assume from what pt posted here, and if he don't want amalgam filling, there is nothing wrong with giving composite for smaller occlusal and proximal posterior lesions. Clinical evidence suggest with "conventional GV Black Class-II (DO) prep (not the slot prep)" there is:
- 86% survival rate after 7 years and
- 95% survival rate with amalgam after 7 years

This can be different situation if marginal ridge is intact and tunnel prep is needed.

However, i will strongly agree with you that i wouldn't give composite with big carious lesion occluding in load bearing area requiring complex filling.

I don't want to post my resume here and i also believe i am nothing in front of your 31 years experience neither i have made lot of money in US! But, I did went to foreign dental school for 5 years and finish my B.D.S. I did finished my 3 year post-graduation in conservative dentistry and practice for few years before I came to US. Also, I had been to various dental practices here in US before i join advance standing program here. But, yes I am still student in dental school!

Although, You might be right that i should practice more before posting anything, i wouldn't agree with your comment that my post is "FOOLISH" without having more information about:
- Type of occlusion,
- Extent of caries,
- Anticipated occlusal load,
- Caries risk,
- Tooth alignment with adjacent and opposite teeth
- Marginal ridge integrity
- Esthetic demand of pt etc.

If you have read my post carefully, my recommendation is "to get the second opinion for more clinical evaluation" for the restoration that is causing sharp, throbbing pain and breaking off for 3-4 times within very short duration of time!!

I apologies again if i have posted any wrong information.
Please let me know sir if you need any reference to what i have posted here, i would be glad to forward it to you.
Thank you sir!
User Level:
Dentist
Apologies for sounding too rough with you. I imagined a pre-doc student thinking he knew it all.

There is a dark side to esthetic dentistry, and I see it every day. It is comprised of sensitivity, pulp death, tooth breakage, early restoration failure.

When I read a patient that wanted to "rule out amalgam fillings" for whimsical "health" reasons, and suffers the consequence, I just want to puke. However, in the end it is the patient's choice.

At one point I was functioning as an endodontist, sometimes doing as many as 10 root canals in a day. So many times, it was on patients who foolishly decided to have all their perfectly good amalgam out for "health" reasons. They averaged 2 root canals in their mouths for taking this option.

The survival differences start to show up in amalgam versus composite much later than 7 years. But then again, I have seen so many gold restorations in the mouth after 50 years! In many ways, the profession seems to have gone backwards!
Posted 10 years ago
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