Quality & Affordable Dentistry in Malaysia

Restorative or Operative Dentistry – Fillings for Teeth in Selangor, Malaysia

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The most common and well known treatment accomplished in the general dentist’s clinic is filling or restoring teeth. Although restoration (filling) of teeth involves a significant amount of time in many general practices, you are learning from this book that dentists do far more than restore teeth. However, dental caries (decay) is still common in most parts of the world, and the routine restoration of teeth continues to be a significant part of dentistry. In developing countries, dental caries among children is high. Less dental caries is present in children in developed countries, where the disease has shifted to the other end of life in the now long lived mature population. Dental caries has long been the most prevalent of all oral diseases, and you probably have some restorations (fillings) in your teeth.ย 

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Dental caries usually develops in the grooves found on the chewing surfaces of the teeth or between the teeth, but the breakdown of tooth surfaces can occur in any location on teeth where food debris is left routinely. Dental caries is not painful at first, but when pain is present while eating cold foods, sugar, or other stimulation, the degenerative process has progressed to a location close to the pulp (nerve) of the tooth. Treatment must be accomplished immediately to save the tooth. Accidents can also cause breakage of the tooth, requiring restoration similar to that required for dental caries.

Grooves on the chewing surfaces of teeth often become decayed; these are usually the first areas to be diseased.
Grooves on the chewing surfaces of teeth often become decayed; these are usually the first areas to be diseased.

What is the treatment for dental caries (decay)? At this time, one treatment is accomplished. The diseased part of the tooth is removed with a rotary cutting instrument, air abrader, or laser. You would recognise the rotary instrument as the noisy dental “drill.” When you are anaesthetised properly, you should not have any discomfort during the dental caries removal stage. 

The soft, degenerate portion of the tooth is removed by the dentist, leaving only solid, non-decayed tooth structure and a precisely cut tooth preparation that has been designed to retain the restoration (filling) and give proper support to the tooth. The larger and deeper the decayed area, the more difficult it is to treat the tooth successfully and to retain it in the mouth, and the shorter is the time that the restoration can be expected to serve you. At least once every 6 months, routine professional checkups are important for the healthy retention of your teeth.

Tooth restorations will serve for many years if the dental caries has been treated when it is small and the restoration is similarly small. Longevity estimates are made for each type of restoration later in this article.ย 

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WHAT YOU SEE OR FEEL 

Conditions, Signs, or Symptoms Related to Restorative or Operative dentistry 

1. Tooth Is Sensitive to Sweets

Anything that contains sugar, including fruit sugars, causes a sharp, continuing pain from a specific tooth site. This pain usually diminishes over time, or if you rinse well with warm (body temperature) water.

Pain caused by sweet foods usually indicates that dental caries (decay) has progressed to a point that it is near the dental pulp (nerve) of the tooth, and you need to seek professional care immediately to reduce the chances of more serious tooth damage, which might require root canal therapy. 

Depending on the size and depth of the dental caries (decay) in your tooth, one of the described types of restorations (fillings) will usually solve the problem.

2. Tooth is sensitive to cold 

Ice cream, cold drinks, and other cold foods or drinks cause pain from a specific tooth location. Warming the tooth up reduces the pain. Deep dental caries (decay) often causes sensitivity to cold. Depending on the size and depth of the dental caries in your tooth, one of the described types of restorations (fillings) will usually solve the problem.

3. Tooth Is Sensitive to Heat

Hot foods or drinks cause pain for a substantial period or until the tooth reaches body temperature again. This symptom is usually not related to dental caries (decay) but is related most often to a dead or dying dental pulp (nerve) that may require endodontics (root canal therapy).

4. Tooth Is Sensitive to Pressure

Sensitivity to pressure usually indicates a dead or dying dental pulp (nerve) that requires endodontics (root canal therapy). However, occasionally, impacted food and/or a sweet object in a decayed tooth can cause pain on pressure. Your dentist can tell for sure.

5. Hole in Tooth

Dental caries (decay) starts slowly on the outside surface of a tooth. Often, only a small external hole develops, while the internal portion of the tooth is hollow. The weakened external enamel shell then breaks away, exposing debris and discolouration in the underlying tooth structure. Such a decayed tooth usually requires immediate professional attention to reduce the chance of the need for endodontics (root canal therapy). Depending on the size and depth of the dental caries in your tooth, one of the described types of restorations (fillings) will usually solve the problem.

Typical decayed tooth has external opening caused by dental caries (decay), but internal destruction is much greater in size.
Typical decayed tooth has external opening caused by dental caries (decay), but internal destruction is much greater in size.

6. Tooth Restoration (Filling) Has Fallen Out

Most dentists place restorations that have good retention to the tooth structure, and it is unlikely that a restoration will fall out by itself. 

Sometimes, new decay begins around the edges of a restoration, undermining it and reducing its retention in the remaining tooth structure. As a result, the restoration becomes loose and may eventually fall out. A restoration that comes out usually indicates that the tooth has a significant amount of dental caries (decay) and requires immediate professional care. 

However, sticky foods such as caramels can pull a restoration out of a tooth. Depending on the size and depth of the decay in your tooth, one of the described types of restorations (fillings) will usually solve the problem.

A piece of the tooth shown has broken off. Patient cannot determine whether a decayed portion has broken off or a filling undermined by decay has come out.
A piece of the tooth shown has broken off. Patient cannot determine whether a decayed portion has broken off or a filling undermined by decay has come out.

7. Restoration (Filling) Is Loose But Has Not Come Out 

Occasionally, restorations (fillings) break, or the tooth structure around them decays further, and a restoration becomes loose in the tooth. This is an especially dangerous condition because the tooth structure cannot be cleaned well. Stagnant food debris and oral plaque collect below the loose restoration, and new decay progresses rapidly. Immediate professional care is mandatory, or the tooth will require endodontics (root canal therapy).  Depending on the size and depth of the dental caries (decay), one of the described types of restoration will usually solve the problem (p. 170).

8. Bad Taste Comes From a Tooth When Sucking on It

Dental caries (decay) in an unfilled tooth, or under an existing restoration (filling), collects food debris and degenerating tooth structure, and the result is a foul taste and odour. Dental caries this deep requires immediate professional care. Depending on the size and depth of the dental caries in your tooth, one of the described types of restorations will usually solve the problem.

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9. Tooth That Was Normal Colour Now Has Dark Spot(s) 

Dental caries (decay) undermines the external tooth enamel surface, leaving a hollow cavity underneath. Food debris, food pigments, and tooth degeneration products cause colour inside the tooth that usually shows through the external surface. Colours are usually grey, brown, and black. Immediate professional care is needed. Depending on the size and depth of the dental caries in your tooth, one of the described types of restorations (fillings) will usually solve the problem.

Upper front teeth have broken and decayed areas that require restorations (fillings). They can be beautifully restored with simple, relatively inexpensive procedures.
Upper front teeth have broken and decayed areas that require restorations (fillings). They can be beautifully restored with simple, relatively inexpensive procedures.

10. Dental Floss Has a Foul Odour When Removed From Between teeth 

A foul odour on used dental floss can be misinterpreted. Periodontal disease, dental caries (decay), or impacted food debris can cause this situation. If one of the other conditions described in this section is present, dental caries (decay) is probably the problem. If none of the other conditions is present, periodontal (gum and bone) disease may be present. 

If dental caries is present, depending on its size and depth, one of the described types of restorations (fillings) will usually solve the problem. If food is impacted, there may be a space between the teeth, requiring a restoration (filling) to help make a tight contact.

11. Notches or Slots at the Gum Line

Notches or slots at the gum line indicate worn, degenerated, or decayed tooth structure. If they are small and shallow, they should probably not be treated unless they are objectionable in appearance. If the notches or slots are decayed or large, they should be restored (filled) immediately to avoid additional damage. Occasionally, incorrect tooth brushing can cause this condition, but more frequently, microscopic bending movements of the tooth caused during chewing cause the notches at the gum line. Depending on the size and depth of the slots or dental caries (decay), one of the described types of restorations (fillings) will usually solve the problem.

WHAT YOUR DENTIST CAN DO

Treatment Available in Selangor, Malaysia

Restoration of teeth (filling teeth) is one of the oldest aspects of dentistry, dating back many hundreds of years. Some of the techniques and. materials have been used for a long time, and their service characteristics are well known. Other tooth restorations are much newer, and research is now under way on their serviceability.

Restorations for teeth can be broken down broadly into metallic and tooth coloured restorations. When teeth that are visible during smiling (incisors and canines) need to be restored, tooth-coloured materials are usually used, but when teeth in the back of the mouth (premolars and molars) need to be restored, either metallic or tooth-coloured materials can be used. The choice is the decision of the patient in consultation with the dentist.

There is now considerable interest in tooth-coloured restorations because many people prefer to eliminate metal from their mouths for one or both of the following reasons: (1) better appearance or (2) alleged, but still relatively unproven, negative health characteristics of metals in the body.

Most dental restorations have been silver amalgam, a material that has been used for more than 150 years. However, it is poor in appearance and has other negative characteristics, which are discussed later in this article. Tooth-coloured composite resin (plastic) is now the most commonly used restoration for front teeth, and its use in back teeth is growing rapidly. The following descriptions will allow you to compare the various types of restorations for teeth.

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1. Silver Amalgam

The most well known and commonly used of all dental restorative materials for back teeth is silver amalgam. It is not acceptable from an appearance standpoint for front teeth. Although it is unsightly and has been indicted for alleged health hazards because of the mercury it contains, silver amalgam continues to be used by the majority of dentists. Most health organisations worldwide accept amalgam as a safe tooth restoration. This material contains silver, tin, copper, and zinc, which are mixed with mercury to form a plastic, compact-able mass. 

When placed into a tooth preparation (refined hole), the material sets to a firm consistency within a few minutes, allowing dentists to shape and carve it. Final strength requires about 24 hours.

A. Advantages: Silver amalgam is the lowest in cost and the longest used of all restorative materials. It is known to serve well for many years in small to moderate size tooth preparations (cavities). It is strong; in fact, it is stronger than natural teeth. Most dentists can place it easily and rapidly.

B. Disadvantages: Silver amalgam ranges in colour from shiny silver to grey to black; none of these colours matches tooth colour at all. Additionally, over a period of years the silver amalgam imparts a grey colour to the surrounding tooth structure, making those teeth that contain silver amalgam look different in overall colour from natural teeth. When the silver amalgam is removed from teeth that have turned grey, the natural tooth colour returns almost immediately.

Silver amalgam cannot be used for teeth that need to match tooth colour, or for those that have been destroyed significantly by dental caries or breakage. 

C. Risks: Although highly controversial, dental silver amalgam has been criticised by some individuals and groups as being toxic because of its mercury content. A growing percentage of dentists in Malaysia will not use this material. All national and international dental societies have affirmed that silver amalgam is safe and should continue to be used, but vociferous groups of anti-amalgam people condemn it.

Several silver restorations are shown. They have been in service 10 to 20 years.
Several silver restorations are shown. They have been in service 10 to 20 years.
A, Smooth, brightly polished silver filling. B, Grey, dull but serviceable silver fillings. C, Black, tarnished silver fillings, with significant tooth discolouration.
A, Smooth, brightly polished silver filling. B, Grey, dull but serviceable silver fillings. C, Black, tarnished silver fillings, with significant tooth discolouration.
Old silver fillings. B, Silver fillings removed and teeth prepared for tooth-coloured restorations. C, New restorations made of resin (plastic) are beautiful, and grey colour has disappeared from teeth.
Old silver fillings. B, Silver fillings removed and teeth prepared for tooth-coloured restorations. C, New restorations made of resin (plastic) are beautiful, and grey colour has disappeared from teeth.
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Many teeth that have had silver amalgam restorations crack over a period of years. In some teeth a portion of the tooth breaks off; others break internally, requiring more comprehensive therapy. Treatment of a cracked tooth varies from a simple restoration (filling) or a crown (cap), to a root canal and crown (cap), to extraction. To help prevent future cracked teeth, many dentists are using new materials to bond the silver to the tooth structure. If a tooth is broken down significantly and your dentist suggests a stronger restoration than silver amalgam (such as a crown [cap]), that suggestion should be accepted.

D. Alternatives: Most dentists now use plastic as the most common alternative to silver amalgam. Other alternatives include cast gold inlays and onlays, tooth-coloured inlays and onlays, or crowns (caps).

E. Cost: Silver amalgam costs less than all other filling materials, but low cost should not influence you toward this restoration if other techniques are suggested because they may be better for your specific situation 

F. Result of Non-treatment: Untreated dental caries (decay) will eventually destroy much of the tooth, kill the dental pulp (nerve), and require significant expensive therapy to overcome the problem.

2. Cast Gold Inlays and Onlays

For nearly a century, cast gold inlays and onlays have been regarded by many dentists as the best, longest-lasting method to repair teeth. Inlays fit within the biting surface of the tooth, whereas onlays cover the top of the biting surface. Many of these restorations serve for most of a patient’s lifetime. However, they are difficult to accomplish, expensive, and highly demanding of the dentist’s skill.

A. Advantages: These restorations may be designed to add strength to weakened teeth by covering weakened portions of teeth. Gold alloys used in dentistry may be designed to wear nearly exactly the way opposing natural tooth enamel wears. This advantage is significant, because opposing teeth are not worn away rapidly. High-quality cast gold restorations have a long service potential.

B. Disadvantages: Because of the necessity to make the gold inlay or onlay outside of the mouth in a laboratory, two appointments are necessary. The tooth must first be prepared (trimmed) to remove the decay or old restoration, to allow the inlay or onlay to be placed into or onto the tooth; at a second appointment the restoration is cemented into place. These restorations require significant shaping and cutting of the tooth. Therefore, gold alloy restorations are not as conservative as silver amalgam restorations. Gold alloys are gold in colour and are not acceptable to most people in areas of the mouth where they are visible. Their use is generally limited to back teeth.

C. Risks: There are no known risks to these restorations, with the possible exception that a very few people may have slight reactions to the metals in gold alloy (e.g., gold, silver, copper, zinc, palladium, platinum).

D. Alternatives: In smaller restorations, silver amalgam or composite resin (plastic) are alternatives. For larger restorations, cast gold has no known equivalent except in some form of crown (cap). If a tooth-coloured restoration is preferred, tooth-coloured inlays and onlays provide a beautiful but less proven alternative.

E. Cost: These restorations are expensive because of the dentist’s time and effort involved, and the cost of the gold alloy. They are five to eight times more expensive than silver amalgam restorations.

F. Result of Non-treatment: Untreated dental caries (decay) will eventually destroy much of the tooth, kill the dental pulp (nerve), and require significant expensive therapy to overcome the problem.

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A, Patient's upper teeth with previously placed silver amalgam fillings (restorations). B, Patient's mouth has been restored with cast gold restoration. C, Notice that gold does not show to a significant degree. These restorations should serve most of the patient's life.
A, Patient’s upper teeth with previously placed silver amalgam fillings (restorations). B, Patient’s mouth has been restored with cast gold restoration. C, Notice that gold does not show to a significant degree. These restorations should serve most of the patient’s life.
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3. Composite Resin (Plastic White Fillings)

From a cost standpoint, this tooth-coloured restoration is closest to silver amalgam, but composite resin restorations must be placed nearly perfectly to provide adequate service. They can compete with silver amalgam in small to moderate size tooth defects. Many new materials now make these restorations much better than in the past. These are the most common restorations for front teeth.

A. Advantages: These restorations are tooth-coloured and non-metallic. When placed over etched enamel, they will bond the remaining tooth structure back together.

D. Disadvantages: These restorations must be placed perfectly for

optimal service. All materials in this category wear more under biting ads than do metal restorations. However, when appearance is a primary factor, they should be used.

C. Risks: A small percentage of teeth into which this material has been placed is sensitive to temperature or pressure after the placement. This sensitivity usually goes away, but a few teeth require endodontic (root canal) therapy because of continued sensitivity. Composite resin wears faster than metals; this characteristic can cause the need for replacement sooner than metals.

D. Alternatives: Where appearance is not a factor, silver amalgam is the most used alternative, but gold inlays and onlays , tooth-coloured inlays and onlays, and crowns (caps) may also.be considered.

E. Cost: These restorations may cost up to two or three times more than the cost of silver amalgam restorations in back teeth, but they are relatively inexpensive for front teeth. The higher cost is related to the extra skill required to place these restorations.

F. Result of Non-treatment: Untreated decay will eventually destroy much of the tooth, kill the dental pulp (nerve), and may require significant expensive therapy to overcome the problem.

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A, Silver filling (restoration) in tooth. B, Same tooth restored with tooth coloured restoration has been in service 10 years. C, Upper front tooth with old discoloured filling (restoration). D, Old restoration has been removed. E, New plastic (resin) restoration has been placed in the tooth. It will serve many years.

4. Tooth-Coloured Inlays and Onlays

Several types of tooth-coloured inlays and onlays have been developed primarily for use in larger defects in back teeth. These are used in place of a crown (cap) or filling (restoration). They are made of porcelain, other ceramics, or resin (plastic). These materials are made in a laboratory and are cemented into place using a liquid plastic form of cement. Two appointments are required for their completion. These are beautiful restorations, matching tooth structure nearly exactly, but they have not been used long enough for optimal research knowledge about their long term characteristics.

A. Advantages: Tooth-coloured inlays and onlays are highly pleasing in appearance and may bond teeth together. They require less removal of ‘tooth structure than a crown (cap).

B. Disadvantages: These restorations are not as strong as metallic restorations, and occasional breakage may be expected. They have been used in dentistry for comparatively few years, and knowledge about their long-term service characteristics is lacking.

C. Risks: Tooth sensitivity, short or long term, may be present in a few of these restorations. If tooth sensitivity persists, endodontics (root canal therapy) may be necessary, but this is infrequent. Some tooth-coloured restorations break during service because they are not as strong as those made of metal. If breakage occurs, the restoration can be remade. Because these restorations have not been used as long as metallic restorations for back teeth, knowledge about long-term service is not complete.

D. Alternatives: For back teeth, metallic restorations are the major alternatives. Silver amalgam and cast gold restorations are strong, acceptable alternatives but are not as pleasing in appearance.

E. Cost: Usually, these restorations require two appointments and some relatively complex laboratory work. The necessary expertise and effort requires a cost that is near or equal to that of cast gold restorations, or about five to eight times more than silver amalgam restorations.

F. Result of Nontreatment: Untreated dental caries (decay) will eventually destroy much of the tooth, kill the dental pulp (nerve), and may require expensive therapy to overcome the problem.

A, Black silver filling to be replaced. B, New restoration replacing silver filling is beautiful and functional

SUMMARY

Restorative or operative dentistry is a major portion of dentistry, because dental caries (decay) has been the most common oral disease. However, most people are not aware of the numerous alternatives for restoring (filling) teeth. Some of these alternatives–composite resin and tooth coloured inlays and onlays-match tooth colour well, and clinicians are optimistic about their service potential. Metallic restorations–silver amalgam and cast gold–have been well proven from many years of use and provide known longevity and service. When a significant portion of a tooth has been destroyed, typical restorations (fillings) may not be possible, and crowns (caps) may be necessary. Almost all general dentists and many prosthodontists perform restorative or operative dentistry.

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