Fillings

 

Your first visit to Dr. Chapman's office promises to be a pleasant experience.  Many times patients are relieved to find out that their periodontal health is better than they thought it was!  Don't wait until it hurts.  The sooner you begin to get your mouth healthier, the better!  Gum disease frequently has no symtoms unless it is quite severe.

Making sound decisions about your dental care and oral health is an easy thing to do with the right preparation beforehand:

  • Make a list of questions to ask our office, so you don't forget anything on the day of your appointment. This includes any concerns you have, or oral problems you've been experiencing.

  • If you have dental insurance, remember to bring your insurance card with you.  Also, if your dentist has given you X-rays or a referral form, please bring them with you as well.

 

Periodontics is a dental specialty that involves the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Who is a periodontist?

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. A periodontist typically has had two to three years of additional training in diagnosing and treating gum disease and its associated problems. Periodontists are experts in the most successful techniques for diagnosing and treating periodontal disease. Additionally, periodontists can perform cosmetic periodontal procedures to improve your smile. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced.

During your first visit, Dr. Chapman will review your medical and dental history, as well as any medications you may be taking. This will be followed by:

  • A complete oral and periodontal exam of your gums to check for gum bleeding and swelling, and gum recession; your jawbone, to help detect the breakdown of bone surrounding your teeth; and your teeth, to determine their proper alignment and if any are sensitive, loose and how they fit together when you bite.
  • An assessment of the depth of the spaces, known as periodontal pockets, between your teeth.
  • X-rays, to show the bone levels between your teeth to check for possible bone loss.
  • Once the exam is completed, Dr. Chapman will in most cases immediately discuss with you his diagnosis and recommendations for treatment. He will answer your questions and you will have a thorough understanding of what your situation is and what needs to be done for optimal health. 


Treatment choices include:

  • Root Planing and Scaling, which is one of the most effective ways to treat gum disease when it is caught in its early stage, before it has progressed to significant bone loss. This is a thorough cleaning and removal of the disease -causing deposits on your teeth called tartar and is done by a dental hygienist. 
  • Pocket Reduction Treatment  (PRT) is without a doubt the most successful and time tested treatment for moderate and advanced cases of periodontal disease available today!  PRT is so effective because it involves the complete removal of tartar and the recontouring of the bone that supports the teeth to bring it back to the healthy shape that it is supposed to have.   Pocket Reduction Treatment is very beneficial when pockets are 5mm or greater.  With PRT the diseased pockets are very predictably reduced by 50%!  This allows your toothbrush to keep the now healthy pockets clean and leads to long term periodontal health!
  • Bone Grafting/Bone Regeneration is a very valuable procedure done at the same time as Pocket Reduction Treatment where Dr. Chapman places a special material into indentations in the bone caused by periodontal disease that commonly occur next to teeth.  Bone grafting helps to re-build some of the bone that supports the teeth.
  • Soft Tissue Grafts including: Connective Tissue Grafts which help to cover up the exposed root surfaces of teeth and can be a cosmetic problem as well as cause sensitivity;  Free Gingival Grafts, which move healthy gum tissue from one part of the mouth to another, and Pedical Grafts, which shift gums to cover areas where healthy tissue is needed.
  • Implants  are the most natural, most functional, best looking replacements for lost teeth that dentistry has today!  Think of an implant as a man-made tooth root that your dentist places a crown (cap) on.  Alternatives include a bridge where your dentist drills down on the teeth next to a space and the bridge is glued onto those teeth replacing the lost tooth in between.  This can lead to tooth decay (cavities) on those teeth, and can also put too much pressure on those teeth in some cases leading to additional tooth loss.  Another option is a partial denture, an appliance that you take out at night and put back in in the morning.  Many patients find that partials are cumbersome and difficult to chew with, not to mention unsightly.
  • Ridge Preservation  is done to help decrease the natural loss of bone that will occur after a tooth has been extracted.  This is commonly done in an area where an implant is to be placed.
  • Ridge Augmentation may be recommended if the bone where an implant is to be placed is too narrow and needs to be widened.
  • Crown lengthening is the lowering of the gum around a tooth, most often done so that your dentist can gain access to a cavity or fracture below where the gumline was. 
  • Cosmetic surgery is done to help reveal a beautiful smile where patients have too much gum tissue covering their teeth giving the appearance of very small teeth.  This is a  simple procedure that can have a dramatic effect on a persons smile!
  • Frenectomy is another easy procedure where excess gum tissue is removed from between the upper two front teeth that may be causing a spece to exist.  This is usually requested by an orthodontist who is trying to straighten teeth and close gaps between them. 
  • Fiberotomy is the easiest of all procedures again done at the request of an orthodontist to assist in the long term maintenance of straighter teeth. 

  

Frequently asked questions: dental fillings

Are dental amalgams safe? Is it possible to have an allergic reaction to amalgam? Is it true that dental amalgams have been banned in other countries? Is there a filling material that matches tooth color? If my tooth doesn't hurt and my filling is still in place, why would the filling need to be replaced? Read this interesting and informative discussion from the American Dental Association.

FDA consumer update: dental amalgams

The Food and Drug Administration and other organizations of the U.S. Public Health Service (USPHS) continue to investigate the safety of amalgams used in dental restorations (fillings). However, no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergic reactions.

ATSDR - public health statements: mercury

The Centers for Disease Control and Prevention offers some scientific background on mercury (contained within silver-colored fillings), and whether it believes the substance presents any health hazards.

Analysis reveals significant drop in children's tooth decay

Children have significantly less tooth decay in their primary (baby) and permanent teeth today than they did in the early 1970s, according to the Journal of the American Dental Association (JADA). The analysis reveals that among children between the ages of six and 18 years, the percentage of decayed permanent teeth decreased by 57.2 percent over a 20-year period. In addition, children between the ages of two and 10 years experienced a drop of nearly 40 percent in diseased or decayed primary teeth.

Alternative Materials

Advances in modern dental materials and techniques increasingly offer new ways to create more pleasing, natural-looking smiles. Researchers are continuing their often decades-long work developing esthetic materials, such as ceramic and plastic compounds that mimic the appearance of natural teeth. As a result, dentists and patients today have several choices when it comes to selecting materials used to repair missing, worn, damaged or decayed teeth.

The advent of these new materials has not eliminated the usefulness of more traditional dental restoratives, which include gold, base metal alloys and dental amalgam. The strength and durability of traditional dental materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.

Alternatives to amalgam, such as cast gold restorations, porcelain, and composite resins are more expensive. Gold and porcelain restorations take longer to make and can require two appointments. Composite resins, or white fillings, are esthetically appealing, but require a longer time to place.

Here's a look at some of the more common kinds of alternatives to silver amalgam:

  • Composite fillings - Composite fillings are a mixture of acrylic resin and finely ground glasslike particles that produce a tooth-colored restoration. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be "bonded" or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth. In teeth where chewing loads are high, composite fillings are less resistant to wear than silver amalgams. It also takes longer to place a composite filling.
  • Ionomers - Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that help patients who are at high risk for decay. Glass ionomers are primarily used as small fillings in areas that need not withstand heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for non-load bearing fillings (between the teeth) and they have low to moderate resistance to fracture. Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.
  • Porcelain (ceramic) dental materials - All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel. All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. Their strength depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.

Sealants

Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

Sealants were developed in the 1950s and first became available commercially in the early 1970s. The first sealant was accepted by the American Dental Association Council on Dental Therapeutics in 1972. Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity.

Sealants act as a barrier to prevent bacteria and food from collecting and sitting on the grooves and pits of teeth. Sealants are best suited for permanent first molars, which erupt around the age of 6, and second molars, which erupt around the age of 12.

Sealants are most effective when applied as soon as the tooth has fully come in. Because of this, children derive the greatest benefit from sealants because of the newness of their teeth. Research has shown that more than 65% of all cavities occur in the narrow pits and grooves of a child`s newly erupted teeth because of trapped food particles and bacteria.

Application

Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light.

Sealants normally last about five years. Sealants should always be examined at the child`s regular checkup. Sealants are extremely effective in preventing decay in the chewing surfaces of the back teeth.

Insurance coverage for sealant procedures is increasing, but still minimal. Many dentists expect this trend to change as insurers become more convinced that sealants can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.