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The Alphabet Blog: C is for Composite

The Alphabet Blog: C is for Composite

Jan 8, 2015 | Auburn WA, Dental blog, Dentistry, Oral Health, Women's Health

Composite is tooth-colored filling material.  Composite filling material, a combination of plastic and glass spheres, has been used for over 60 years.  Dentists in the U.S. place more than 122 million dental composites each year.  Many dentists today have stopped placing amalgam (aka silver or mercury) fillings for various reasons.

At Cook Family Dentistry, I no longer place amalgam restorations because in order to do so, I have to remove much more tooth structure and the tooth is left at a higher risk of breakage.

Benefits of composite filling material:

  • They are bonded to the tooth structure:
    • this blocks out bacteria, acids, sugar, saliva from leaking between the filling
      material and the tooth
    • bonding also helps support the remaining walls of the tooth
  • A composite filling can be more narrow and shallow with amalgam/silver fillings because composite is a more flexible material and is bonded into place instead of being held in by mechanical retention only, which undercuts the remaining walls of the tooth.
  • Composite can be repaired because it will bond to itself.  Amalgam does not bond to itself.
  • Composite is tooth-colored, so dark decay that may start to grow in the tooth later can be differentiated from the filling.  Amalgam/silver fillings camouflage new decay in x-rays and also upon visual examination.
  • Esthetics.  Composite fillings are matched to the shade of the natural tooth.

Here are step-by-step photos of the process of removing an old leaking amalgam filling and replacing it with composite:

Before

Before: Old amalgam filling, leaking around the edges. Decay starting in pits and fissures.

Looking under the old filling. The tooth is partially cleaned out here.

Bevel Example

A cleaning solvent removes surface debris, bacteria, and saliva while creating a rough surface to increase the bond strength of the new filling to the tooth surface.

Bonding agent is brushed into the clean surface.

Bevel Example

Tooth-colored composite filling material that matches the tooth shade is injected into the tooth.

The soft composite filling material is packed into place and sculpted before it is hardened with a blue curing light.

Bevel Example

A thin coat of flowable filling material is applied to the filling to better seal the margins of the filling/tooth.

After the filling is hardened, we mark the bite to identify high spots.

Bevel Example

Polishing the filling and removing high spots.

The finished product. Healthy tooth structure, conservatively cleaned and well-sealed. The tooth surface is now smooth and cleansible to a toothbrush. (no narrow grooves for bacteria to hide in).

In this example of a filling we placed in my office, you can see how a silver filling shows through the tooth and makes it look black/grey.

Before:

After:

Before:

After:

Smiles,

Dr. Cook

OB-GYNs Encourage Pregnant Women to See a Dentist:

Oct 4, 2013 | Dentistry, Oral Health, Women's Health

From the September 16, 2013 edition of ADA News:

“Teeth cleanings and dental X-rays are safe for pregnant women, according to recommendations issued by The American College of Obstetricians and Gynecologists. OB-GYNs are being advised to perform routine oral health assessments at the first prenatal visit and encourage their patients to see a dentist during pregnancy, the College said in a July 26 statement.”

(View the statement: http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Dental_X-Rays_Teeth_Cleanings_Safe_During_Pregnancy)

X-rays? Yes, X-rays. Dental x-rays have produced very small amounts of radiation for a very long time. A full set of x-rays, even with the older film technique, produced as much radiation as standing outside for 10 minutes. Today’s digital radiography produces approximately 1/8 of that already low amount. Dental professionals step out of the room during exposure because radiation is cummulative. None of us should be exposed to it every day all day long. Protective shields covering abdomen and thyroid are used on all patients, and has been standard for decades.

Also from the ADA News article, “…local anesthesia (with or without epinephrine) are safe during pregnancy.”

“…conditions requiring immediate treatment, such as extractions, root canals, and restoration (amalgam or composite) of untreated caries, may be namanged at any time during pregnancy. Delaying treatment may result in more complex problems.”

“For patients with vomiting…the use of antacids or rinsing with a baking soda solution (i.e., 1 teaspoon of baking soda dissolved in 1 cup of water) may help neutralize the associated acid.” Acid is the cause of dental decay.

In Washington State, pregnant women are eligible for free dental care during pregnancy thru Medicaid.

Mothers transmit their oral bacteria to their babies, who are born with no oral bacteria. Good oral health for Mom, especially during pregnancy, reduces her own oral bacteria and thus reduces what she transmits to Baby. Rinsing with a non-alcohol antibacterial mouth rinse such as Chlorhexidine is recommended for pregnant women.

Health care providers weigh risks and benefits of treatment and non-treatment. Lack of oral health care during pregnancy presents unnecessary and avoidable risk to Baby. Care for Mom = Care for Baby.

Smiles,

Dr. Cook

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