Dental frustration - any dentists here?

[GetawaysRus]

I have a bit of dental frustration. I'm hoping there is someone knowledgeable who can explain this a bit and answer a few questions.

Although it is not painful, I just don't care much for dental work. I try hard to be good and take care of my teeth with brushing and flossing.

I was very surprised earlier this week when I went in for a routine 6 month dental cleaning and had X-rays done (X-rays are once a year). Lo and behold, there was decay in a molar (#15), and my dentist said it was so deep in the tooth that it would require a root canal. A root canal would be a new treat - I've never needed this in the past.

I saw the endodontist yesterday (who agreed) and underwent the procedure. When the endodontist started working, she found the decay under a previous composite filling in this tooth. If I understand, because molars do some serious grinding, the fillings in molars can be prone to loosen over time. This allowed the evil bacteria to get in under the old filling. And because the tooth had been previously drilled (possibly twice? I am not sure if the composite filling was a replacement for an old metal filling placed when I was very young or if it was the initial filling), the bacteria had a big head start - they were already deep enough in the tooth that the decay could rapidly progress deep enough to require a root canal.

I am to go back to my general dentist for a crown in a few weeks.

This is frustrating. I think I still have some old metal fillings in my mouth that are 30-40 years old. I understand that over time, old fillings may need replacement. Here are my questions:

1. Are the newer composite fillings more prone to loosen (age) more quickly than the old metal filling material?
2. Is this situation common? That is, if a tooth has already been drilled once or twice in the past for a filling (or a replacement filling), and if the filling is not tightly adherent, does this allow bacteria entrance deep into the tooth, sometimes requiring a root canal procedure?
3. With my old metal fillings, these are of course easily visible, and my dentist checks these to see if they need replacement. Can the dentist also see and check the newer composite fillings? How do we know when a composite filling is "leaking" and in need of replacement?
4. How long does one expect an older style metal filling to last? How long do the more modern composite materials last?
5. If one already has fillings, and wishes to avoid the need for such major dental procedures, should X-rays be done more than once a year? If the risk to me from the X-rays (radiation) is minimal, I would gladly pay a fee for more frequent X-rays if it picked up decay earlier and helped me to avoid a root canal procedure.

 

[chellej]

I am not a dentist but find your questions very interesting.

My DS who was 16 at the time had a toothache last year. When I took him in I was told that the decay was so bad that he needed a root canal and crown. I was very suprised. While waiting, I heard a young girl on the phone with her Dad with about the same story.

I have to wonder if this is a trend that rather than just fill it - root canal and crown.

I just had a crown replaced & had 2 dentists tell me I needed a root canal and my current dentist said not - just replaced the crown.

Hopefully there is a dentist out there that can enlighten us.

I had 3 fillings replaced last year on teeth that were not bothering me but that is what the dentist recommended.

 

[AwayWeGo]

Old Age & Dental Work.

The older I get the more readily my dentist tells me some newly installed feature -- filling, crown, implant, etc. -- will last me a lifetime.

-- Alan Cole, McLean (Fairfax County), Virginia, USA.​

 

[Don]

you might find some info in this thread Root Canal Nightmare

 

[planada]

It is the age and size of the filling that is the biggest determination as to when a filling needs to be replaced. AND it is your age (and the age of your tooth) that is a huge determining factor. The larger the amalgam(silver filling) or composite restoration.... means it needs to be replaced sooner. As you age, your tooth becomes more dry and brittle because the nerve in the tooth shrinks. If that tooth has a large restoration in it, that "filling" has plugged up the hole but has not given the tooth any strength. Older teeth are subject to stress fractures, sometimes the crack is in the tooth below the filling. The filling (or) restoration doesn't necessarily need to leak, the tooth has just weakened to a point where the crack has turned to the pulpal wall. The fact that the endodontist found decay under the composite filling COULD be related to the filling being old and the margins did not fit properly anymore. Cracks do not show up on xrays, sometimes they reach a point where the patient has pain, other times it is just clinically visable. The solution is a crown to hold the crack together. Putting a new filling in where there was a big filling previously, will just weaken the tooth more. Small fillings that were placed 50 yrs ago may last you a lifetime because they are small. Large ones won't. To your question comparing composites to old amalgams........the materials in composites are very good the past 15 years. There is more glass used, they hold up well in strength, and patients love that they don't show. They are here to stay. If you had lots of large fillings as a kid, you will probably have lots of crowns as an adult over 40.

 

[pjrose]

I have never had tooth problems; my former dentists have laughed and asked what I was doing there, b/c my teeth are so good and I just don't get plaque build-up. I only go once a year.

I do have the usual assortment of old fillings from childhood.
Around 20+ years ago I went to a new dentist who immediately said I had to have 6 fillings, the old ones had to be replaced, some had mercury, etc etc. I never went back.

I found another dentist who said everything was good but maybe one needed replacing b/c of a small crack - did that, and it was fine.

Years later I cracked one and needed a root canal and crown - took care of that, no problem.

Years later I had a vague achiness but couldn't really tell which tooth - dentist said he was sure it was the back molar and needed a crown. His partner did that, but the new crown didn't fit right. After lots of grinding and adjustments to the crown as well as my nearby teeth the fit was better, but the achiness was still there - not significant, but there, so I thought it might be the next tooth over.

Dentist's partner left, and dentist insists it's the same tooth, but the crown wasn't seated right, so now it needs a root canal as well as a new crown. Insurance will only cover a crown once every 7? years (even though it's not the same insurance company or policy that paid for the original one!) Plus it was (presumably) his partner's fault for doing it wrong, and he doesn't seem to want to take responsibility for his partner's work.

It's stopped bothering me over the last year or so, so maybe it it is ok after all - or my pain meds for arthritis are masking it. If it acts up again I guess I'll go for the root canal and crown and if I can't convince insurance to cover it I'll just have to myself.