Dental Education Lecture: Filling Complexity

We discuss tooth sensitivity after filling last lecture.  It appears that filling is not so simple.  We are going to talk more about complexity of filling today.  To keep our teeth healthy (Fig.1), we need to floss on a regular basis. Otherwise, cavities develop on the sides of adjacent teeth (black, Fig.2).  We should fill them as early as possible (gray, Fig.3).

Inside each tooth is the nerve (arrow, Fig.4), which is a sensory organ of the tooth.  When the cavity grows large, the nerve may be affected.  You may have severe pain or no pain at all.  The infected nerve does not cause problems because "abscess" has a way to alleviate itself.  The abscess secretion goes out through the cavity (arrow).  If we happen to fill the cavity with an asymptomatic abscess, you are most likely experiencing pain after filling.  It is much safer to do root canal (therapy, brown in Fig.6) before placing a filling.

Sometimes you go to a dental office for filling, but the dentist wants to do cleaning first.  Why?  Healthy gums are pink in color (Fig.7) and do not bleed so easily.  If we do not practice good oral hygiene, we may have cavities and gum diseases at the same times.  Diseased gums are red in color and easily bleed when we brush (Fig.8).  Bleeding is not easily controlled (red dots in Fig.9) when the dentist is doing filling next to inflamed gums.  Filling material is not so sticky to the tooth in blood pool that the filling may come out sooner than expected (arrow).  Also due to the presence of blood pool, the doctor cannot see very well.  He may leave a small amount of cavity untouched or may  not fill completely the space between tooth and filling so that a new cavity may set in later. To get a quality filling, we had better have clean done first by removing tartar (yellow in Fig.8), let gums heal and then finish filling.

Xin Wei, DDS, PhD, MS 1st edition 01/27/2009, last revision 04/18/2012