Patients are generally unaware of the differences in materials and why some are better than others. Although a resin/composite filling and a porcelain filling look similar, how long they last in the mouth are not the same. Porcelain lasts longer because it’s more stable in an oral environment. In general, a filling is needed to restore a tooth when less than half the tooth has been damaged. If the material used is asked to restore more than half the tooth, the material’s lifetime in the tooth is greatly shortened. That’s because the shape of the filling’s hole can undercut the good part of the tooth, which gives a filling retention to stay inside the tooth.
Once a filling is larger than 50% of the tooth, the filling becomes the major part of the tooth. The little part of the tooth remaining is left to try and support the filling. Physically, this is a weak arrangement. The small part of the natural tooth has insufficient mass to support its work load and hold on to the filling. Eventually the tooth breaks, opening an avenue for decay down the side and underneath the filling.
Subsequently, fillings should generally be done in conservative sizes and situations. Small, conservative fillings can last decades. Massive fillings often fail before they fall out. When they do fall out, there is generally a pool of decay around them and fracture lines on the outside and deep into the tooth. These cracks are avenues for bacteria to attack the nerve of the tooth.
Stretching these materials to ”save money” usually has the opposite effect. One pays for a filling, and later a crown. If the filling is deep, it traumatizes the nerve in the tooth twice, pushing the nerve closer to irritation and even death to the tooth, requiring root canal treatment.
Crowning helps a tooth because it acts as a slipcover that goes over and all the way around the tooth. It holds the tooth together. as opposed to a filling that slices through it and separates it into halves or quarters. With our latest technology, we can give patients a crown that looks like the day it was born. Our E-max crowns are guaranteed not to chip or break as long as the patient comes in for their bi-annual check-up. If one does break or chip, we will replace it, free of charge, no questions asked.
Sometimes stresses get down to the nerve in the center of the tooth. The nerve, or pulp, is the remnant of the organ that forms the second layer of the tooth. It is trapped inside and with every decade of life, the nerve gets less and less blood supply. Although comedians love to use “I’d rather have a root canal” as a punch line, there is nothing funny about the pain associated with a tooth before root canal therapy is performed.
When a nerve dies, the life-giving and healing blood source stops and that organ inside the tooth breaks down and rots. This rot leaks out the end of the tooth into live bone which gives pain. This overwhelming pain can be relieved by root canal therapy. Basically, once the space is cleaned, disinfected and sealed up, the problem stops. This treatment works well if enough of the structure of the tooth remains. If not, the tooth will need to be removed by an extraction. Extraction should be your last resort.
The most commonly extracted teeth are the third molars or wisdom teeth. They are called wisdom teeth because they generally appear at age 18, the coming age of wisdom. They are usually extracted because, as the last teeth to emerge, there is not enough room in the jaw to fully erupt. They grind against the adjacent teeth as they hopelessly try to erupt. Even if there is no pain, the wisdom teeth can do damage to the healthy, neighboring teeth and bone.
If there is room in the mouth, and the wisdom teeth can fully erupt, they can remain as happy members of the group. However, wisdom teeth are also the most difficult teeth to keep free of plaque and decay.
Sometimes a tooth is so badly broken and decayed, there is no other alternative than to have it removed. This is the last resort, and many people feel that it is better and cheaper than trying to save a tooth. Indeed, it may appear so.
Dr. Lemke often reminds people how expensive it is to build a house and how little it takes for a match to burn it down. Once a tooth is lost, changes occur subtly. The face appears sunken in, the tooth behind the space falls forward into the gap created, and the forward tooth moves back into the gap. If left for even a year, the tooth on the opposite arch will erupt out of its place raising up or hanging down into the gap, complicating any remedy. If left without treatment long enough, options decrease and the solutions increase in cost. It’s less trouble and less costly to restore early, rather than later. We would love for you to come in and discuss your situation for free before the problem gets any bigger.
When a tooth is lost, a cascade of changes begin to happen in the oral cavity. To restore the balance, there are restorations that make it possible to achieve normal dental health.
In the 1960s, it was discovered, in Sweden, that pure titanium gently laying next to bone attracted the bone cells to its surface and appeared to bond to it. With more research, a system of dental implants was developed to build entire dentitions using titanium implants.
Dr. Lemke started placing and restoring dentitions in the late 1980s. He has been very successful in treating areas where teeth have been lost. Although there are unusual cases where implants can be built on immediately after placement, implants generally are given time before the final restoration is placed.
Implants are a rapidly developing field of dentistry and each year, Dr. Lemke takes classes to keep current. The advantage of an implant as a replacement for a tooth is that the adjacent teeth are not affected by the implant. They are easier to clean because they feel and function as an individual tooth. The disadvantage is the higher cost and waiting period for the bone to integrate into the titanium.
Another way to solve the missing tooth problem is with a bridge that is fixed, or cemented, in place and does not get removed. This is a traditional method where the teeth on either side of the gap are prepared for crowns and a false tooth is created in the gap. The crowns and false tooth are created as one solid piece of metal and porcelain is formed around it to make it look like teeth. This custom-made appliance is durable, natural looking and feels normal. Its advantage is that it is less costly and can be done in less than 10 days. The disadvantage is that it requires extra time to clean beneath the false tooth.
A removable bridge is also a remedy, although it has become less appealing of late. It has the same false tooth as a bridge does, however is has clasps that hug to the adjacent teeth. The clasps are metal, and some people do not like the look or feel. A removable bridge is the least expensive remedy, does the job, and doesn’t prohibit the placement of a bridge or implant in the future. The disadvantage is that they are bulky, have a bit of metal that is visible, they do wear out and must be periodically replaced because the clasps get brittle and break. If you haven’t decided on your best options yet, you can learn more here.