Fillings are done to remove decay and replace the affected tooth structure. It is called a filling because new a material fills hole that decay left. Now days most teeth are treated with bonded tooth colored composite resin fillings. Early detected decay can be treated easily and painlessly. If not treated decay can lead to tooth pain and/or infection, and the tooth would need root canal treatment or extraction.
Sealants are used to fill in narrow grooves and developmental defects in permanent teeth, generally molars, that cannot be adequately cleaned by brushing. These untreated defects can lead to tooth decay. Sealants should be placed soon after the the teeth erupt, around 6 years old for first molars and 12 years old for second molars.
NON-SURGICAL PERIODONTAL THERAPY
The gums, ligaments, and bone, or the periodontium are the support structures for teeth. When the periodontium is not healthy the stability of the teeth is compromised just as a bad foundation would threaten the stability of a house. Signs of unhealthy periodontium (gum disease) include gums that are red and bleed easily, persistent bad breath, gums that are pulled away from the tooth, loose teeth, and changes in the position or bite of the teeth. Any of these signs may mean something is wrong. With the proper care, however, it may be possible to return them to a healthy state. This is where appropriate periodontal therapy comes in. The best strategy is to take a preventative approach with includes daily brushing and flossing as well as periodic dental exams and teeth cleaning by a dental hygienist. More severe cases may require deep cleaning with anesthetic. Some situations may require surgical therapy which involves soft tissue and bone grafting.
Not a week goes by that I don’t have a conversation with my patients regarding the damaging effects of chronic excessive forces on teeth, the periodontium (bone and tissue supporting the teeth), and temporal mandibular joint (TMJ) including the muscles of mastication (chewing).
Dentist commonly refer to these excessive and chronic parafunctional forces as “bruxism” and “clenching”.
Bruxism is the grinding of the upper and lower teeth against other when not in the act of chewing. This can happen at any time but typically happens during sleep. Clenching involves forces being placed on the teeth without movement. Clenching also seems to occur mostly during sleep.
So, as dentists we have three major areas of concern when it comes to occlusal force damage. First the TMJ and its associated structures, the periodontium and teeth.
Temporal Joint Dysfunction (TMD) can result in headaches, muscle pain and noise (popping, clicking and grating) in the joint. There are a range of things that can and should be done. The best approach is to change the behavior that leads to the symptoms. Stress is usually a driving force in parafunctional joint activity. One study showed that discussing the mechanism of TMD with the patient was effective in changing behavior. The next level of intervention would be a simple occlusal guard (OG) or night guard. Sometimes a the problem needs to be managed by a TMJ specialist.
When it comes to the periodontium soft tissue loss, or recession at the gum line is the most common thing we see. We also see damage to the bone in conjunction with the tissue loss. The damage can eventually lead to the loss of teeth. The most conservative treatment, as in TMD, is to diminish the forces with an OG.
Abfractions are the horizontal grooves that occur at the gum line of the teeth. At one time it was thought that the damage was being caused primarily by aggressive brushing. There may be a brushing/abrasion component. However studies have shown that the majority of the damage is caused by mechanical stress to the teeth. Teeth like any other material flexes when force is applied. If that force is directed horizontally microscopic damage occurs at the neck of the tooth where it emerges from the bone. Over time tooth structure is lost and a groove forms which can threaten the strength of the tooth and the health of the nerve.
Mechanical damage to the teeth includes cracks and fractured cusps. Teeth that have fillings are most susceptible to cracks. Treatment of cracked or fractured cusps requires a crown or cap. We often don’t know the extent of the crack. Sometimes the crack extends into the pulp chamber, or nerve, and in the worst case through the tooth. If the crack is only into the pulp chamber a root canal may be necessary in addition to the crown. Teeth with through and through cracks cannot be saved.
In the frequent discussions with patients about the damage caused by bruxism and clenching the question is raised “Will my insurance pay for an occlusal guard?” The answer is usually “No”. Then the patient frequently will decline my recommendation. This is an unfortunate response.
The potential damage minimized or avoided by an occlusal guard far exceeds the cost of the guard. In fact I have come to the conclusion that most of the crowns we place would not have been needed if the occlusal forces had been controlled. That means many of root canals we perform would not have been necessary and many teeth would not have been lost and a lot of dental implants would not have been necessary.