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Video: Amalgam Removal and Replacement
Question:
Silver Fillings Replacement: About a year ago on my dentist's recommendion I let him replace all 4 of my 25-yr-old silver fillings with new composite ones even though I had never had any problems with them - I've regretted it ever since.
There is one back lower molar which gives me very sharp nerve pain when I eat - it only seems to be senstive to pressure. I gave it ten months and it got a little better but still hurt alot so I went to another dentist who said the filling was probably bonded wrong so he replaced it and now it hurts more.
What should I try next, replace it again but with a silver filling or a root canal or what? ...Visitor from CA
Answer:
I am sorry for your problems. As far as the American Dental Association is concerned, amalgam is a safe material to restore a tooth.
I personally have placed thousands of these restorations and don't regret them. That being said, I do use white fillings now for 99% of fillings and have an extremely low rate of sensitivity.
If people had problems, I wouldn't do them! The dentist that replaced your amalgams probably saw signs
of cracks, chipping, ditching of the margins and was concerned that problems may have existed below the filling.
So when they replaced the old filling the new one hurt-why? Well first of all the tooth may have had a fracture under the silver. It was asleep and now it hurts- remember that if left alone, it may never have hurt or it could have led to a non-restoreable fracture.
If a large crack extends from one edge to another, the tooth may need to be extracted. The problem is that you have pain now.
Well, if a fracture was found, photographed, documented and explained to you, a root canal would be needed, and a crown placed to both remove the nerve and cover and protect the remaining tooth structure.
If a crack exists that is self-limiting, this will solve your problem. If the crack is through and
through, then the tooth will be lost and an implant, bridge or partial are indicated.
Sensitivity to pressure can be a sign that the filling is too high; so adjustment is the first thing that should be done! Then it should be tested for sensitivity to temperatures. If sensitivity to cold or hot creates lingering pain, the nerve has been affected and needs removal.
Remember that nothing lasts forever. The average filling needs to be redone every 7-10 years. Even if we push that to 15 years, the wear and tear of chewing have changed the topography of the tooth, it is now hitting differently, wearing as a result of chewing and grinding and would need to be replaced to maintain optimal biting if nothing else.
So I would be concerned about what you have been through, would have the bite checked, get a second opinion if need be about the quality of the new fillings and have protective crowns or partial crowns done when all "nerve pain" is gone.
If your dentist can't resolve your sharp pain, go to an endodontist to have a thorough evaluation and treatment.
As far as the second dentist is concerned, it is impossible to say whether or not bonding was done
incorrectly, based solely on pain. Drilling on a tooth will damage your tooth to some degree, create micro cracks and irritate the nerve so you may simply have an inflamed nerve that would have responded this way to any additional treatment on this tooth.
Nerve damage is cumulative from the first day you had this tooth worked on til today. I tell my patients, sometimes the last treatment is the "straw that broke the camels back".
Good luck, get an adjustment, seek another opinion and protect what you have. Trust your dentist that these teeth needed work and you will understand that they arent' the bad guy. Fixing a tooth while it is still fixable while not risk or "pain" free all the time, is still much better to waiting for it to break and having a $4,000 implant procedure.
Wisconsin Reconstructive Implant Dentistry
Richard Winter, DDS MAGD
Winter Dental Associates
5323 W. Hampton Avenue
Milwaukee Wisconsin WI 53218
(414) 464-9021
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