Fillings: The Basics

Determining If You Need a Filling

Your dentist may use several methods to determine if you have tooth decay, including:

• Observation — Some discolored spots on your teeth may indicate decay, but not all of them. Your dentist may use an explorer, a metal instrument with a sharp tip, to probe for possible decay. Healthy tooth enamel is hard and will resist pressure by the explorer. Decayed enamel is softer. The instrument will stick in it slightly. Explorers must be used with caution. Pressing too hard with an explorer can damage a healthy tooth.
• Cavity-detecting dye — This can be rinsed over your tooth. It will stick to decayed areas and rinse cleanly from healthy ones.
• X-rays — X-rays can help your dentist see decay that doesn't show on the surface. However, X-rays are often not accurate in detecting smaller cavities on occlusal (top) surfaces. Current fillings or other restorations also may block the view of decay.
• Laser fluorescence cavity detection aids — These small wands measure changes caused by caries (tooth decay). They are especially useful for pit and fissure areas.

Decay is not the only reason you may need a filling. Other reasons include:

• Cracked or broken teeth
• Teeth that are worn from unusual use, such as:
  
  • Nail-biting
  • Tooth grinding (bruxism)
  • Using your teeth to open things 

Steps to a Filling

When you visit your dentist to get a filling, you may be given local anesthesia to numb the area if necessary. Next, your dentist will remove decay from the tooth, using hand instruments or a drill. Air abrasion and lasers also can be used to remove decay.

A drill, which dentists call a handpiece, uses metal cones called burs to cut through the enamel and remove the decay. Burs come in many shapes and sizes. Your dentist will choose the ones that are right for the size and location of your decay.

At first, your dentist will use a high speed drill (the one with the familiar whining sound) to remove the decay and unsupported enamel of the tooth. Once the drill reaches the dentin, or second layer of the tooth, the dentist may use a lower speed drill. That's because dentin is softer than enamel.

Once all the decay is removed, your dentist will shape the space to prepare it for the filling. Different types of fillings require different shaping procedures to make sure they will stay in place. Your dentist may put in a base or a liner to protect the tooth's pulp (where the nerves are). The base or liner can be made of composite resin, glass ionomer, zinc oxide and eugenol, or another material.

Some of these materials release fluoride to protect the tooth from further decay.
If your dentist is placing a bonded filling, he or she will etch (prepare) the tooth with an acid gel before placing the filling. Etching makes tiny holes in the tooth's enamel surface. This allows the filling to bond tightly to the tooth. Bonded fillings can reduce the risk of leakage or decay under the filling. That's because the etched surface of the tooth and the filling material form a mechanical bond. Bonding is generally done with composite fillings.

Certain types of fillings get hardened by a special light. With these fillings, your dentist will stop several times to shine a bright light on the resin. This cures (hardens) the material and makes it strong.

Finally, after the filling is placed, your dentist will use burs to finish and polish the tooth.

After a Filling

Some people feel sensitivity after they receive a filling. The tooth may be sensitive to pressure, air, sweet foods or cold. Composite fillings often cause sensitivity, but other types of filling materials can, too.

In most cases, the sensitivity will subside over one to two weeks. Until then, try to avoid anything that causes it. If your tooth is extremely sensitive or your sensitivity does not decrease after two weeks, contact your dentist's office.

It's important to let your dentist know about any sensitivity you are feeling. The next time you need a filling, he or she may be able to use a different material and make changes to reduce sensitivity. People vary in their response to different materials. Your dentist has no way of predicting if your tooth will react to a particular material.

When you talk to your dentist about the sensitivity, try to describe it as precisely as possible. This information will help decide what should be done next. Your dentist may take out the filling and put in a new one. He or she may add a base, liner or desensitizing agent on the tooth as well. If the filling was very deep, you could need a root canal treatment to solve the problem.

Besides sensitivity, some people feel discomfort when they bite down. There are two types of pain, each with a different cause.

• The first type occurs when you bite, and worsens over time. This is caused by a filling that is too high and interferes with your bite. Once your anesthetic wears off, you would notice this right away. Contact your dentist. You will need to return to the office to have the filling reshaped.
  
• The second type of discomfort is a very sharp shock that appears only when your teeth touch. This is called galvanic shock. It is caused by two metals (one in the newly filled tooth and one in the tooth it's touching) producing an electric current in your mouth. This would happen, for example, if you had a new amalgam filling in a bottom tooth and had a gold crown in the tooth above it.
  

Your dentist polishes the filling after it is placed, but occasionally sharp edges may remain. You can't detect this at first because of the anesthesia. If you find one, contact your dentist and arrange to have it smoothed as soon as possible to avoid injury to your tongue or mouth.

Temporary Fillings

You may receive a temporary filling (usually white, off-white or gray) if:

• Your treatment requires more than one appointment.
• Your dentist wants to wait a short period of time for the tooth to heal.
• You have a deep cavity and the pulp (containing the nerve and blood vessels) becomes exposed during treatment.
• You need emergency dental treatment.

A temporary filling may make your tooth feel better. This is because the filling seals the tooth, protecting the pulp from bacteria and reducing sensitivity.
Temporary fillings often contain eugenol, an ingredient in over-the-counter toothache remedies. Eugenol is also a component of oil of cloves, which people use for toothache pain.

Temporary fillings are not meant to last. Usually, they fall out, fracture or wear out within a month or two. If you get a temporary filling, make sure you visit your dentist to get a permanent one. If you don't, your tooth could become infected or you could have other problems.

Why Replace a Filling?

Fillings don't last forever. They can become discolored. Composite, tooth-colored fillings pick up stains, and yellow or darken over time. When you chew, your teeth and any fillings in them are subjected to tremendous pressures. Even if no other problems develop, some fillings will wear out over time and will need to be replaced. A filling will need to be replaced earlier if it falls out, leaks or cracks.

Food debris and bacteria can seep down under a filling that is cracked or leaking. Since you can't clean there, the bacteria feed on the food debris and form the acid that causes tooth decay. Decay under a filling can become extensive before you notice it or it causes you pain. This is why you should have your fillings checked regularly and get them replaced when problems are found.

Fillings That Fall Out

Fillings can fall out for several reasons:

• You bite down too hard on a tooth that has a large filling, and break the filling or the tooth.
• The filling material that was used cannot withstand the forces placed upon it. For example, if you have broken a large piece of your front tooth, a porcelain (tooth-colored) crown is probably a good treatment choice. In some cases, a dentist may place a composite filling instead. This may look good or acceptable. However, if the composite is too large, a strong biting motion may break the plastic material.
• The cavity is contaminated with saliva when the filling is placed. For composite resins, this will disrupt the bonding of the material. As a result, the bond will not stick well to the tooth and it may fall out.

Cracked Fillings

Both amalgam and composite fillings can crack, either soon after they are placed or after the fillings have been in place for some time.

Cracks can occur soon after a filling is placed if the filling is higher than the rest of the tooth surface, and must bear most of the force of biting. Cracks also can occur over time, as the forces from chewing and biting affect the filling.

Small cracks also can occur at the edges of a filling. These usually are caused by wear over time. These cracks often can be repaired.

Leaking Fillings
A filling is said to be leaking when the side of the filling doesn't fit tightly against the tooth. Debris and saliva can seep down between the filling and the tooth. This can lead to decay, discoloration or sensitivity.

Both amalgam and composite fillings can leak. An amalgam filling sometimes leaks slightly after it is placed. You would notice this as sensitivity to cold. This sensitivity decreases for the next two to three weeks. Then it disappears altogether. Over that period, the amalgam filling naturally corrodes. The corrosion seals the edges of the filling and stops any leaks.
A composite filling could be contaminated with saliva. This would weaken the bond between the filling and the tooth and allow for leaks. Other times, there may be small gaps where the tooth and filling meet. These gaps are caused by shrinkage when your dentist places the filling. Sensitivity after receiving a composite filling may disappear over time. If it doesn't, the filling may need to be replaced.

Fillings also can leak as a result of wear over time. These fillings should be replaced.

Worn-Out Fillings

Some fillings can last for 15 years or longer. Others, however, will have to be replaced in as little as five years. Your dentist can determine if your fillings are worn enough that they need to be replaced.

Clenching and Grinding

If you clench or grind your teeth, you may have more problems with your fillings. The forces placed on your teeth can lead to tooth sensitivity and extra wear on your fillings. Clenching or grinding also can cause your teeth and fillings to crack or develop small craze lines. These are fine cracks you can see if you shine a light on your tooth.

Keeping Your Fillings

Although some fillings can last for many years, the average life of an amalgam filling is about 12 years. Composite fillings may not last this long.

Your dentist will examine your fillings at your checkup visits. You may need X-rays if your dentist thinks a filling might be cracked or leaking, or to see whether decay is occurring under the filling. Make an appointment with your dentist:

• If a tooth is sensitive
• If you see a crack
• If part of a filling appears to be missing

You should visit your dentist regularly for cleanings, brush with a fluoride toothpaste, and floss once a day. If you have many fillings or very large fillings, your dentist may prescribe a fluoride gel you can use at home. The fluoride will help strengthen the enamel of your teeth and help to prevent future cavities. Your dentist or hygienist also can apply a fluoride varnish around the edges of these teeth at your checkup visits.

Replacing a Filling

Before removing your old filling, your dentist will discuss treatment options with you. It is often possible to repair an old filling instead of removing it and replacing it completely. However, if the entire filling has to be replaced, the dentist may reevaluate what filling material to use. Talk with your dentist about how you would like the filling to look. Then he or she can select the material that is best for you.

Article Source via Colgate

If you live in Orange County and are looking for a dentist, feel free to contact Hagen Dental. We offer the latest dental technology and procedures in a caring, comfortable atmosphere.

Hagen Dental
18426 Brookhurst St., #101
Fountain Valley, CA 92708
Tel. 714.965.5255

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Understanding Tooth Sensitivity

Source: http://www.colgateprofessional.com/LeadershipUS/PatientEducation/Videos/Resources/UnderstandingToothSensitivity_High.mov

If you live in Orange County and are looking for a dentist, feel free to contact Hagen Dental. We offer the latest dental technology and procedures in a caring, comfortable atmosphere.

Hagen Dental
18426 Brookhurst St., #101
Fountain Valley, CA 92708
Tel. 714.965.5255
http://www.peterhagendds.com

Your Child's Oral Health

The Primary Teeth

When infants are born, almost all of their primary (baby) teeth already have formed. These teeth are still hidden in the gums. They usually begin to erupt or cut through the gums at about 6 months of age. Some babies get teeth earlier, and some get them later. That's OK. Your 1-year-old may have a different number of teeth than your neighbor's 1-year-old.

Usually, the two front bottom teeth come in first. Next are the four front top teeth and two more bottom teeth. From here, teeth slowly begin to fill the mouth. Teeth usually come in two at a time, one on either side of the jaw. Your child should have all 20 primary teeth by the time he or she turns 3 years old.

Baby teeth usually have spaces between them. These spaces help make sure there is enough room for the permanent teeth.

Caring for Primary Teeth

Take good care of your child's baby teeth. They do eventually fall out. But until they do, your child's baby teeth play an important role by helping your child bite and chew food, and speak clearly. Baby teeth also save space for the permanent teeth, and help guide them into place.

Even before your child gets his or her first tooth, you should wipe your child's gums with a clean damp gauze or washcloth. Once your child's teeth come in, brush them twice a day. Use a soft toothbrush with polished nylon bristles. You can make the bristles even softer by soaking them in warm water for a few minutes.

Use plain water, or a pea-sized dab of children's fluoride toothpaste. When using toothpaste, be careful to use only a small amount. Young children tend to swallow toothpaste when brushing rather than spitting it out. This can lead to cosmetic problems (fluorosis) in the permanent teeth.

As soon as two teeth touch each other, floss between them once a day. You can use regular floss or special plastic floss holders.

Talk to your doctor or dentist about fluoride. If your child drinks water that isn't fluoridated, he or she may need fluoride treatments or supplements.

At some point, your child will want to use the toothbrush. It's OK to give him or her a turn. But afterward you should always brush your child's teeth a second time. Most children won't be able to brush their teeth well on their own until they are about 8 years old.

Children who are at high risk for cavities can get sealants placed on their teeth. Dental sealants are plastic coverings that are placed over the grooves of teeth to protect them from decay.

Early Childhood Caries

Early childhood caries, or ECC, is a serious form of cavities. It can quickly destroy your child's teeth. In the past it has been called baby bottle tooth decay, nursing caries or nursing bottle syndrome. ECC often occurs when your baby's teeth are exposed to sugars for long periods throughout the day. Baby bottles or sippy cups with fruit juice or milk both contain sugars. When these liquids are in the mouth, bacteria start eating the sugars and then produce acids. These acids cause decay if they remain on teeth long enough.

Early childhood caries can occur if your child:

• is put to bed with a bottle filled with any liquid other than plain water
• drinks from a bottle filled with sugary liquids or milk during the day
• receives a pacifier dipped in sugar, honey or a sweet liquid
• Normal breastfeeding has not been shown to cause dental cavities. However, breastfeeding for long periods of time can still put your child at higher risk for dental decay.

Remember, it's not just what your baby is drinking, but how often. The more time that liquids (other than water) are in a baby's mouth, the higher the risk. This is why it is dangerous to let your baby go to sleep with a bottle or use a bottle as a pacifier during the day. The teeth most often affected by ECC are the upper front teeth. But others can decay, too.

Tooth decay can occur much more easily if there are large numbers of cavity-causing bacteria living in your child's mouth. One of the most dangerous types of cavity-causing bacteria is Streptococcus mutans. In the mouths of children with no or little tooth decay, S. mutans makes up less than 1% of the mouth's bacteria. But in children with ECC, it makes up more than half the bacteria.

S. mutans is common. It is passed from parent to child, usually when a child is between 6 and 31 months old. Keeping your own mouth healthy and free of cavities can help your child's mouth stay healthier, too.

The top front teeth usually are the first ones affected by ECC. Often, the cavities start on the backs of the teeth. The top teeth farther back in the mouth are affected next. Finally, the bottom back teeth get cavities. The lower front teeth usually do not get cavities. These teeth are covered by the tongue, which keeps liquids away. These teeth also are close to large salivary glands, so they are bathed in saliva. Saliva helps wash away sugars and bacteria.

Decayed teeth that are not fixed can cause pain and infection. Teeth that are very badly decayed may need to be removed. Tooth decay is a bacterial infection, and it can spread if it is not treated. Also, the permanent teeth under the gum can be affected if the decay is not treated.

Here are some tips on preventing early childhood caries:

Don't put your baby to bed with a bottle unless it is filled with plain water. Even watered-down fruit juice or milk can increase the risk of decay.
Talk with your doctor about weaning your infant from the bottle when he or she is 12 to 14 months old.
During the day, don't use a bottle to comfort your baby unless it's filled with plain water.
Don't dip your baby's pacifier in sugar or sugary liquids
Don't add sugar to your child's food.
Clean your baby's teeth and gums with a damp cloth or a soft toothbrush after each feeding.
Clean your baby's teeth and gums with a damp cloth or a soft toothbrush after each feeding
Take your baby to the dentist as soon as the first tooth comes in.
Teach your baby to drink from a cup by his or her first birthday.
Make sure your baby is getting the right amount of fluoride. If your drinking water does not contain fluoride, ask your doctor or dentist about fluoride supplements.

The Permanent Teeth

Children typically start to lose their baby teeth and replace them with adult teeth when they are 6 or 7 years old. Some children start losing teeth earlier; Others start later. The order that your child's teeth come in is more important than when they start to come in.

Most often, the first permanent teeth to come in are the lower front four teeth. However, some children get their first permanent molars (sometimes called the 6-year molars) first.

The 6-year molars come in behind the primary teeth. They do not replace primary teeth. Around age 11 or 12, the second permanent molars (also called 12-year molars) come in behind the 6-year molars.

By the time your child is 13 years old, most of his permanent teeth will be in place. Wisdom teeth, or third molars, come in between ages 17 and 21. However, some people don't get any wisdom teeth, or don't get all four. More often, wisdom teeth develop, but there may not be room in the mouth for them.

Caring for Permanent Teeth

You should continue to help your children brush their teeth twice a day until they are 8 years old or can show that they can do a good job on their own. Brush after breakfast and before bed. Keep your children's teeth free of food particles, especially the molars. Molars have lots of little grooves and crevices. Food particles can hide there and act as food for bacteria.

Your dentist also can place sealants on your children's molars to protect them from decay. But it's still important to brush and floss.

When your child is still very young, you can cradle his head in one of your arms and use your other hand to brush. Once children have the coordination and dexterity, they can brush on their own. However, be sure to inspect after each brushing and go over spots your child may have missed.

A few other tips:

Use a soft nylon toothbrush with a pea-sized dab of fluoride toothpaste.
Teach your child to spit out the foamy saliva.
As soon as any two of your child's teeth touch each other, floss between them. After age 9, children can floss their own teeth. Flossing removes food from between the teeth where a toothbrush can't reach.
Talk to your child's dentist or doctor to be sure he or she is getting the right amount of fluoride.
Diet and Your Child's Teeth

While what your child eats is important for healthy teeth, how often a child eats is just as important. Frequent snacking can increase a child's risk for decay.

Cavities can develop when sugar-containing foods are allowed to stay in the mouth for a long time. Bacteria that live in the mouth feast on these bits of food. They create acid, which eats away at tooth enamel. Between meals or snacks, saliva washes away the acid. If your child is always eating, there may not be time for this acid to get washed away.

When most people think of sugar, they think of the white sugar that is found in candy and baked goods. But all foods that contain carbohydrates will ultimately break down into sugars. Bacteria don't care whether you eat a lollipop or a pretzel. It tastes the same to them!

Here are a few tips for snacking and mealtime:

Give your child healthy snack foods, such as fresh fruits, vegetables and cheeses.
Buy foods that are sugar-free or unsweetened. Serve sugary or starchy foods as part of a meal rather than as a snack. Most children drink fluids during a meal. This will wash many food particles off the teeth. Saliva also does a good job of clearing the teeth. Avoid certain foods unless your child plans to brush right after he or she eats them. These foods get between teeth and are hard to remove from the grooves in the tooth surface. Some of these foods include:

• cookies
• dried figs
• granola bars
• jelly beans
• doughnuts
• potato chips
• pretzels
• puffed oat cereal
• raisins
• Offer fewer snacks.

After your child snacks, make sure his or her teeth are brushed. If this isn't possible, have your child rinse with water several times.
Encourage your child to choose xylitol-sweetened or sugar-free gum.
Never put your child to bed with a bottle, unless it is filled with plain water.

Article Source: http://www.colgate.com/app/CP/US/EN/OC/Information/Popular-Topics/Oral-Care-for-Children/article/Your-Childs-Mouth.cvsp


If you live in Orange County and are looking for a dentist, feel free to contact Hagen Dental. We offer the latest dental technology and procedures in a caring, comfortable atmosphere.

Hagen Dental
18426 Brookhurst St., #101
Fountain Valley, CA 92708
Tel. 714.965.5255
http://www.peterhagendds.com

All About Cavities

What's In Your Mouth?


To understand what happens when your teeth decay, it's helpful to know what's in your mouth naturally. Here are a few of the elements:


Saliva: Your mouth and teeth are constantly bathed in saliva. Although we never give much thought to our spit, this simple fluid is remarkable for what it does to help protect our oral health. Saliva keeps teeth and other oral tissues moist and lubricated, washes away some of the food particles left behind after we eat, keeps acid levels in the mouth low, and protects against some viruses and bacteria.


Plaque: Plaque appears as a soft, gooey substance that sticks to the teeth a bit like jam sticks to a spoon. It is, in fact, colonies of bacteria, protozoa, mycoplasmas, yeasts and viruses clumping together in a gel-like organic material. Also in the mix are bacteria byproducts, white blood cells, food debris and body tissue. Plaque grows when bacteria attach to the tooth and begin multiplying. Plaque starts forming immediately after a tooth is cleaned; it takes about an hour for plaque to build up to measurable levels. As time goes on, different types of microorganisms appear, and the plaque thickens.


Calculus: If left alone long enough, plaque begins to mineralize and harden into calculus or tartar because the plaque absorbs calcium, phosphorus and other minerals from saliva. These minerals form crystals and harden the plaque structure. New plaque forms on top of existing calculus, and this new layer can also become calcified.


Bacteria: We have many different strains of bacteria in our mouths. Some bacteria are good; they help control destructive bacteria. When it comes to decay, Streptococcus mutans is the bacterial strain that does the most damage. It attaches easily to teeth and produces acid.
How Your Teeth Decay


You need food, particularly sweet and sticky food, for the bacteria in your mouth to produce acids that will attack the tooth enamel (outer surface of the tooth). Sugars, especially sucrose, react with bacteria to produce acid. The acid from the bacteria can decay your teeth.
It's not just candy and ice cream we're talking about. All carbohydrate foods, as they are digested, eventually break down into simple sugars, such as glucose and fructose. Some of this digestion begins in the mouth. Foods that break down into simple sugars in the mouth are called fermentable carbohydrates. These include the obvious sugary foods, such as cookies, cakes, soft drinks and candy, but also pretzels, crackers, bananas, potato chips and breakfast cereals. The sugars in these foods combine with the bacteria normally in the mouth to form acids. These acids cause the mineral crystals inside the teeth to begin to dissolve.


The dental caries lesion forms when these acids start to dissolve a tooth's outer protective layer, the enamel. A cavity forms when the tooth decay breaks through the enamel to the underlying layers of the tooth. You can reverse a caries lesion (before it becomes a cavity) by using a variety of fluoride products. These include fluoridated water, fluoride rinses for use at home, and, of course, any commonly used fluoridated toothpaste.


Every time you eat, the bacteria in your mouth produce acid. Therefore, the more times you eat the more times your teeth are exposed to an acid attack.


Types and Stages of Decay


Dental decay, also known as dental caries, begins first inside the tooth. A white spot appears on the enamel where the tooth has started to weaken inside. At this stage, the tooth can repair the weakened area with the help of fluoride and minerals in saliva. But if the decay continues and breaks through the surface of the enamel, the damage is permanent. The decay must be cleaned out and the cavity filled by a dentist. Left untreated, the decay will worsen and destroy a tooth all the way through the outer enamel layer, through the inside dentin layer and down to the pulp or nerve of the tooth.


In young children, teeth that have recently emerged have weak enamel and are highly susceptible to acid decay. A type of decay called baby bottle tooth decay or early childhood caries destroys enamel quickly and is common in children. This type of decay can eat through enamel and leave a large cavity in a matter of months.


Older adults sometimes have chronic caries: cavities that don't seem to get any worse or do so at a very slow rate. Teeth with chronic caries will tend to be darker in color because the edges of the cavities become stained from normal eating and drinking.


Root caries (decay in the roots of the teeth) is more common in older adults. Older adults are more likely to have gums that have receded from years of hard brushing or periodontal disease. They also are more likely to have dry mouth (xerostomia), which increases the risk of decay. Dry mouth is caused by many common medicines. Be sure to ask the doctor or pharmacist if any of your medicines cause dry mouth.


Decay can form beneath fillings or other restorations, such as crowns. Sometimes, bacteria and food particles can slip into a tooth if a filling hasn't been placed properly or if the filling cracks or pulls away from the tooth, leaving a gap.
Preventing Cavities


Do you or your family members get cavities frequently? Dental research has identified factors that increase your risk of getting decay. Next time you visit the dental office, ask about your risk factors and discuss the best ways to reduce your risks and limit dental decay.


To prevent your teeth from decaying, you can do two things — strengthen your teeth's defenses with fluoride and sealants, and reduce the number of bacteria in your mouth.


Fluoride strengthens teeth by penetrating the tooth structure and replacing lost minerals to repair acid damage. Everyone should brush with a fluoride toothpaste every day. Dental offices sometimes recommend additional toothpastes, gels and mouthrinses for both children and adults.
Sealants are protective coatings placed over the tops of chewing teeth — molars and premolars. They block bacteria and acids from sticking in the tiny grooves on the chewing surfaces of these teeth. Children should get sealants soon after their teeth erupt into the mouth.


Although you can never get rid of all the bacteria in your mouth, you can control bacteria by brushing regularly and flossing daily, seeing your dentist and dental hygienist regularly for a thorough cleaning and check-up, and reducing the number of times each day that you consume fermentable carbohydrates.


Some prescription mouthwashes (those that contain chlorhexidine) can help prevent decay by reducing the number of bacteria in the mouth. Chewing sugarless gums, especially those with xylitol, can help reduce decay and increase the flow of saliva.


Article Source: http://www.colgateprofessional.com/patienteducation/All-About-Cavities/article


If you live in Orange County and are looking for a dentist, feel free to contact Hagen Dental. We offer the latest dental technology and procedures in a caring, comfortable atmosphere.  


Hagen Dental
18426 Brookhurst St., #101
Fountain Valley, CA 92708
Tel. 714.965.5255
http://www.peterhagendds.com