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Medical Forum / General / Dentistry / December 2005Tooth Ache
Last week or so my dentist finished replacing my silver fillings with the new stuff, the stuff that looks like teeth, with work on the top left, third from the back. Since the next day that tooth has been hurting when I bite down on something soft, and it has also been a little bit sensitive to heat and cold. So I went back today and he did something he called "adjusting the bite", you know, bite down on the carbon paper, grind side-to-side, drill a little bit, there ya go. Oh, and here's some Sensodyne toothpaste, get rid of the tartar-control stuff 'cuz it makes teeth sensitive. So how long am I supposed to wait for it to stop hurting? Because I had some pizza for supper tonight and it was a *bitch* to chew. He said "check back in 5 or 6 weeks" but there's no way I'll be able to stand this for 6 weeks. Is he blowing me off? Did he screw up the filling, leave a gap in there or something, and just not want to admit it? If I wait six weeks does the "warranty" wear off? I don't want to pay $236.00 twice on this single tooth. Should I call my insurance company? Get a second opinion? Any advice would be appreciated, thanks in advance. ** Captain Infinity ...faster than the speed of dark > Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 22 lines] > > Any advice would be appreciated, thanks in advance. If you can't take the pain tell him you want a referal for an oral surgeon. Sensodyne usually takes around 2 weeks to work but the stuff never made my mouth feel fresh. Two months ago I had pain after having a cavity filled, it spread to the muscles in my face, then my whole head started pounding I felt like I was going to pass out when I walked. I went to 3 specialists and it ended up being a neurological problem. Compared to me your problem doesn't sound so bad. .. Garondo Marondo! I had a similar problem 20 years ago and it lasted for several months. I did not have Sensodyne at the time so I don't know if it would have helped. And nobody could see a problem with the filling. The filling was replaced 15 years later and had sensitivity on that tooth again for a couple of months. > > Last week or so my dentist finished replacing my silver fillings with > > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 35 lines] > .. > Garondo Marondo! > > Any advice would be appreciated, thanks in advance. > > If you can't take the pain tell him you want a referal for an oral > surgeon. IMO, this is _not_ an problem for the Oral Surgeon's skills. It is for the resorative dentist. If the problem persists, it is then an Endodontics problem. SP  SignatureTake out the TRAASH to reply > Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top > left, third from the back. There are some possibilities here, but only an examination in real life will tell us the truth in your case. You may need RCT, you may need to have the filling adjusted one more time, you may need to have the filing removed and redone. IF the filling needs adjustment or to be redone, your dentist should not normally bill you for that. RCT obviously will incur an additional fee. Sometimes the tooth has been traumatized too much already in its life before we get to it and the minor trauma of having the tooth treated again will cause enough swelling inside the hollow portion of the tooth to cut off its blood supply and the tissues inside die. Therefore, RCT. Signature/ Amatus / > Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 26 lines] > Captain Infinity > ...faster than the speed of dark >> Last week or so my dentist finished replacing my silver fillings with >> the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 10 lines] >tooth to cut off its blood supply and the tissues inside die. Therefore, >RCT. Now where have I heard that before ? ...:-) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > > Last week or so my dentist finished replacing my silver fillings with > > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 10 lines] > tooth to cut off its blood supply and the tissues inside die. Therefore, > RCT. This statement should be part of an informed consent with signature agreement before the topical anesthetic is even placed. Neither dentists nor patients insist enough on the fact that, unfortunately, the tooth may indeed ALREADY BE SICK. Tho W_B's patients must be tired of hearing this schpiel, they KNOW what is going on and what may happen. 'Course, W_B is a weird-o who howls at the full moon, but that's another story. SP SignatureTake out the TRAASH to reply >> > Last week or so my dentist finished replacing my silver fillings with >> > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 23 lines] > >SP Sad but true, I am a Lycanthrope. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com "Last week or so my dentist finished replacing my silver fillings with the new stuff, the stuff that looks like teeth, with work on the top left, third from the back." ______________________________- Why did the fillings need replacement in the first place? - dentaldoc > "Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 4 lines] > > - dentaldoc That was my first thought. >"Last week or so my dentist finished replacing my silver fillings with >the new stuff, the stuff that looks like teeth, with work on the top >left, third from the back." >______________________________- > >Why did the fillings need replacement in the first place? Because he needed the money, I guess. ** Captain Infinity ...faster than the speed of dark Good question. I've had more than one patient that I've had to 'rescue' from painful teeth that didn't need any work done in the first place. One fellow (who is still a patient) had an occlusal amalgam crumble out of #18 (he was quite a clencher too). The dentist talked him into replacing all of the rest of his amalgams with composite also. (this all happened more than 10 years ago) Evidently the guy was not a good 'bond-o-dontist' and this patient's teeth hurt any time that he chewed or drank anything hot or cold. He showed up in my office because his girl friend had been a patient of mine for years. The patient was pretty distrustful of dentists at this point. I thought that I could make things better, but I didn't want to make promises that I couldn't keep. I started out replacing two fillings on the lower right (I used composite also). This helped those teeth greatly, so I proceded to replace the other 6-8 fillings that were bothering him. After a few weeks I had him comfortable. I tried to talk to the other dentist (suburban dude), and talk about the problem this patient was having, but he quickly took an agressive, defensive posture. I got nowhere fast. After all he stated (OK, almost yelled), "I've been doing posterior composites *THE SAME WAY* for the last 15 years! Some sensitivity is normal". I thanked him for his time and said good-bye. Dartos > "Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 4 lines] > > - dentaldoc >After all he stated (OK, almost yelled), "I've been doing posterior >composites *THE SAME WAY* for the last 15 years! Some sensitivity is >normal". I love it ! Signature/ Amatus / > > Good question. I've had more than one patient that I've had to [quoted text clipped - 34 lines] >> >> - dentaldoc I have to laugh about it too. There was no hope of further communication. If he messed up this guy, I'm sure he was screwing up a few others too! Hey!, he could still be doing posterior composites the same way after 25 years now. Hopefully someone has talked him into trying SE Bond or something. Dartos >>After all he stated (OK, almost yelled), "I've been doing posterior >>composites *THE SAME WAY* for the last 15 years! Some sensitivity is >>normal". > > I love it ! Signature/ Amatus / > > I have to laugh about it too. There was no hope of further communication. [quoted text clipped - 6 lines] > > Dartos I bet he never changes. Signature/ Amatus / > > I have to laugh about it too. There was no hope of further communication. > > [quoted text clipped - 7 lines] > > I bet he never changes. Az I sed; I don't believe choice of material is the major factor here. Technique and knowing how much time you need is the major factor here. SP SignatureTake out the TRAASH to reply > I have to laugh about it too. There was no hope of further communication. > [quoted text clipped - 5 lines] > > Dartos Butt, again, you yourself personally have said that you went back to the older posterior composites after finding out (as many have, and Karl Leinfelter has often said) that the newer posterior resins are not living up to thier promises. I tend therefore to think that this other 25 year guy has not had a good technique for placement since the beginning. It is not simply a question of using or not using flowable rezzzins. Up here in Igloo-O-Rama, Compozzite rezzins cost more than Ammmalgams, bonded or not. There is a reason: it takes more time: you have to clean the cavity better; have to place the matrix just so; you have to let the acid etch do its thing, you have to let the bonding soak in and replennish it, you have to place a bit of composite at a time and let it cure, and after you adjust the thing and all, you have to zap it with the light again just to finish the job. If your contact is weak, you have to cut a box and tighten it. Gawd... the patient has time to grow a beard.... .... and she was only nineteen when she sat on the chair..... 'Wonder what Scotttt Perkins would think 'bout that... SP SignatureTake out the TRAASH to reply > He showed up in my office because his girl friend had been a patient > of mine for years. The patient was pretty distrustful of dentists at [quoted text clipped - 3 lines] > teeth greatly, so I proceded to replace the other 6-8 fillings that were > bothering him. I would-a placed some Fuji 9 over ClearFil SE and let that settle down with a bit of Seal 'N Shine over that. Later when (if) it started to wear, I'd grind down the Fuji 9 to the thickness of a good base and Composite over that. Why the Fuji 9? It is a really good sedative dressing. For the smaller cavities, you may not ever have to composite over it. SP SignatureTake out the TRAASH to reply > "Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 4 lines] > > - dentaldoc 'Cuz the dentist put the Intra Oral camera on 'em and showed 'em to the patient and said somthin' like: *Geezzzz if those were in my mouth, I'd be worried.... see those margins???? they are LEAKING. You need to get them replaced before they get worse... Umm.. execpt that BIG ONE over there... it'll end up at the Endo's office if I take THAT one off...* I have gone thru a few Ammmmmalgam polishing burs (the 24 bladed round burs) in my day over there at the Little Shop of Horrors, and there are a few old Ammmmalgams that are still there 'cuz I could re-close the slight opening at the margins. 'Guess that's why I don't drive a Porsche..... :-/ SP SignatureTake out the TRAASH to reply > Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 3 lines] > something soft, and it has also been a little bit sensitive to heat and > cold. I always disencourage my patients to take composite, but when they insist, I always follow their requests. My experience: amalgam ("silver") had beter clinical results, is stronger and lasts longer. When properly placed (with some Life (calciumhydroxide paste) and a sublayer of f.e. GIC), it´s the best. Restaurations placed with the total etch principle can hurt a bit, especially when deep. The acid can reach the pulpa through the denine tubuli and if not, the monomers of the resin can. Deep restaurations are always accompanied by a sublayer, whether it's composite or amalgam. People have to know composite ("white stuff") is shrinking when cured. So there will be a little gap, especially if the bonding ("glue") is not thick enough (cfr. Elastic Bonding Concept). Bacteria can reach the tubuli and enter the pulpa ---> PAIN. There is a trend to ban all amalgam. I've given up to convince Amalgam Crusaders, who diss up stories of crippled people who remove the amalgam fillings in their teeth and go dancing the same night, of their wrong. The people who believe them are punishing themselves. I never replace fillings, but when filling a new one and specifically asked for composite, I just fill it after giving a warning. I've never had a patient who had unexpected pain after an amalgam filling, I had multiple after composite in the posterior area. So the people are punishing themselves. *Sadistic laugh* The reason why I never replace fillings is simple: by removing them, you unevitably do a little damage to the teeth. You don't have to believe stories about "biological dentists", this are mainly dentists who create artificial work by absense of it (and you know how this comes, don't you?). They are not specialised in clean removals, since a complete clean removal is not possible. Your nerve can be touched and pain is the result. So to make a long story a short one: -You've probably been hoaxed by an Amalgam Crusader -Your pain can be caused by bacteria from leakage -Your pain can be caused by etching -Your pain can be caused by abundant removal of tooth substance I don't think the cause is the occlusion ("filling too high"), since the guy handled that and this is a very easy thing to correct with a burr and a carbon paper. Let me argue in a friendly tone, If such things are possible in Usenet. Never place cement bases under amalgams as they compress more than the metal does and lead to fractures through the amalgam. CaOh has been shown to NOT effect the long term health of a tooth. Total etching does not injure pulps unless you leave it on for a few minutes. And, if you routinely have pain after placing posterior composites, your technique needs modification. Having said that, I seldom place posterior composites unless I am treating incipient lesions. I place amalgams for small fillings when the patient wants the cheapest thing I have. I do tons of posterior ceramic restorations with total etch which are less than a mm from the pulp with no base, and the patients report zero sensitivity after treatment. I don't mean this to belittle or to say I am better, but to encourage conversation to improve both you and me. Signature/ Amatus / >> Last week or so my dentist finished replacing my silver fillings with >> the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 46 lines] > guy handled that and this is a very easy thing to correct with a burr and > a carbon paper. > Let me argue in a friendly tone, If such things are possible in Usenet. Why not? > Never place cement bases under amalgams as they compress more than the metal > does and lead to fractures through the amalgam. That's the first thing I heard about that. Is there some literature about this? I know pure amalgam restorations can handle more stress, but that placing a base is drastically influencing the lifespan of a filling is new. I've have seen fillings placed by a peer that are there for 20 years. With a classical zinc phosphate base. How do you solve the problem of the sensitivity to temperature when you don't place a base? > CaOh has been shown to NOT > effect the long term health of a tooth. That's again not my clinical experience. Especially in primary teeth CaOH placement has a good effect on the long term health of the tooth. I have to admit I'm not so certain about permanent teeth, but I've managed to save some pulps with indirect capping. > Total etching does not injure pulps > unless you leave it on for a few minutes. And, if you routinely have pain > after placing posterior composites, your technique needs modification. But I don't. 99% of composite fillings are OK. I just have more succesfull amalgam restorations. Etching gel is applied for 30 secs. I can show you several cases of postoperative pain caused by etching... For 30 seconds of course... That's why I place a base first and then etch the tooth if the cavity is deep. > Having said that, I seldom place posterior composites unless I am treating > incipient lesions. I place amalgams for small fillings when the patient > wants the cheapest thing I have. I do tons of posterior ceramic > restorations with total etch which are less than a mm from the pulp with no > base, and the patients report zero sensitivity after treatment. Well, ceramic restorations are not frequent over here. Only crowns, but inlays ans onlays are abit old fashioned... I don't think we can mix those two up, ceramic and composites. But the etching gel: a mm is very near. Which concentration do you use? This intreages me > I don't mean this to belittle or to say I am better, but to encourage > conversation to improve both you and me. But of course. And I appreciate all feedback as much as you do. >> Let me argue in a friendly tone, If such things are possible in Usenet. > [quoted text clipped - 8 lines] > is new. I've have seen fillings placed by a peer that are there for 20 > years. With a classical zinc phosphate base. In fact this is true. Even back in the dark ages of my dental school, we were told that Ca(OH)2 wouldn't hold up as a base, but that it could serve as a liner. But we were advised to use zinc phosphate cement for bases. I have removed many an old amalgam to find an intact zinc phosphate or copper cement base underneath, Steve > How do you solve the problem of the sensitivity to temperature when you > don't place a base? [quoted text clipped - 32 lines] > > But of course. And I appreciate all feedback as much as you do. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > In fact this is true. Even back in the dark ages of my dental school, we > were told that Ca(OH)2 wouldn't hold up as a base, but that it could serve > as a liner. But we were advised to use zinc phosphate cement for bases. > I have removed many an old amalgam to find an intact zinc phosphate or > copper cement base underneath, If you look closely to see why the filling failed, you can usually track it to metal fractures over the cement base. Studies show CaOh will actually disappear eventually under a restoration. It will leave an empty space. So a thick layer of CaOh is much worse than the Tenacin base. Signature/ Amatus / > >>> Let me argue in a friendly tone, If such things are possible in Usenet. [quoted text clipped - 54 lines] >> >> But of course. And I appreciate all feedback as much as you do. >>In fact this is true. Even back in the dark ages of my dental school, we >>were told that Ca(OH)2 wouldn't hold up as a base, but that it could serve [quoted text clipped - 6 lines] > disappear eventually under a restoration. It will leave an empty space. So > a thick layer of CaOh is much worse than the Tenacin base. I'm talking about Zn phosphate bases, not dycal. I have not noticed any difference in cause of failure between these and other amalgams (without ZOP bases). Of course, I'm not seeing too many bases anymore. I agree with you that dycal is useless as a base. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 The same studies that looked at CaOH addressed the sensitivity claims of ZnPO under amalgam. They found no benefit to the base. Next time you see a really old amalgam that needs to come out, check with magnification for fractures in the metal. After removing the amalgam, trace the caries on the dentin and enamel to see where it came from. Signature/ Amatus / >>>In fact this is true. Even back in the dark ages of my dental school, we >>>were told that Ca(OH)2 wouldn't hold up as a base, but that it could [quoted text clipped - 14 lines] > > Steve > The same studies that looked at CaOH addressed the sensitivity claims of > ZnPO under amalgam. They found no benefit to the base. > > Next time you see a really old amalgam that needs to come out, check with > magnification for fractures in the metal. After removing the amalgam, trace > the caries on the dentin and enamel to see where it came from. We were taught not to place zinc phosphate directly on dentine either (and for the same reason--phosphoric acid). We used copal varnish. I can assure you that there was less thermal sensitivity under deep amalgams that had bases placed. I'm not talking about chemically-induced sensitivity. I don't see many zinc phosphate bases anymore. In any case, recurrent decay seems to arise most frequently from marginal failure, or in cl II amalgams fractures across the isthmus. The decay usually arises exactly where one would expect it too--at the marginal failure or fracture. Most of the fractures across the isthmus occur in my experience due to too shallow prep in the area of the axio-pulpal line angle, a sharp axio-pulpal line angle, or a combination of both. I have never noticed a higher incidence of fractures in teeth with cement bases (unless they are so thick that there is insufficient thickness of amalgam). However, it has been literally years since I have placed a cement base for insulation. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > However, it has been literally years since I have placed a cement base > for insulation. > > Steve ... It has been years since I've played the bass too... Oh!!! Sorry.... I'll stop wandering off.... SP SignatureTake out the TRAASH to reply > The same studies that looked at CaOH addressed the sensitivity claims of > ZnPO under amalgam. They found no benefit to the base. > > Next time you see a really old amalgam that needs to come out, check with > magnification for fractures in the metal. After removing the amalgam, trace > the caries on the dentin and enamel to see where it came from. How much magnification do you need to see this? Thanks SP SignatureTake out the TRAASH to reply >How much magnification do you need to see this? Loupes should be enough. I use 3x. Amatus >> The same studies that looked at CaOH addressed the sensitivity claims of >> ZnPO under amalgam. They found no benefit to the base. [quoted text clipped - 7 lines] >Thanks >SP > >How much magnification do you need to see this? > > Loupes should be enough. I use 3x. > > Amatus Hmmmm.... I'm on 2,5 Orascoptics... 'Guess it's not enough... However, I don't put bases under Am... Etch, SingleBond 2 coats, let it soak in 15 secs with no light on it, wipe the corners and the horizontal line angles, blast with light, check it's shiny everywhere, and Am. If the cavity floor is OK, I would thing so will the Am be. .... So mote it be... SP SignatureTake out the TRAASH to reply I use 2.5x and can vouch for AC's superior ability at spotting this. He taught me well, so now I look for this too. >>How much magnification do you need to see this? > [quoted text clipped - 13 lines] >>Thanks >>SP -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I use 2.5x and can vouch for AC's superior ability at spotting this. > He taught me well, so now I look for this too. [quoted text clipped - 4 lines] > > > >Amatus 'K... I think it is time for me to go to three or 3.5. I usually spot amalgams that are contracting away from the tooth. I put the DiagnoDent in those opening margins, and if it squeaks more than 30 or so, I advise getting 'em out before the caries starts to destroy the inside of the walls. This usually gets me a tooth that had insipient caries on the buccal or lingual wall. Those areas that have visible Am Fx are usually due to poor cavity design on the floor of an isthmus, or sharp line angles or things like that. I'll have to study this a bit to see where the destruction heads under those cracks. This is a big thing for me, since those Am's are usually HUGE MODBL or MODL with pins in 'em, and that tooth is often the last one taking force in the posterior of that quadrant. Being able to tell the patient ( who is not $$$$ ) that that filling is not just worn down but actually failing, and basing that on something I can actually show the patient is vital. I don't often pop off an Am only to realize that it could have stayed in a couple more years, but it _does_ happen occasionally. Thanks SP SignatureTake out the TRAASH to reply > I usually spot > amalgams that are contracting away from the tooth. I don't think amalgam is capable of contracting. Material (either tooth or amalgam) can fracture from the margins. > Those areas that have visible Am Fx are usually due to poor cavity > design on the floor of an isthmus, or sharp line angles or things like > that. I'll have to study this a bit to see where the destruction heads > under those cracks. Yes, you will have amalgam fractures where the underlying preparation suddenly changes width (or depth) with sharp internal line angles. However, if the prep was adequate and you see fractures through the metal, you will most often find a base under the metal. I took two of them apart yesterday. The "other" dental school in our State taught to use a cement base for a few years longer than "ours" did. With the inability of many practitioners to read studies and stay current, we still see the occasional amalgam with a cement base under it. Usually with more caries under the base than anywhere else. Signature/ Amatus / > >> I use 2.5x and can vouch for AC's superior ability at spotting this. [quoted text clipped - 28 lines] > Thanks > SP > > I usually spot > > amalgams that are contracting away from the tooth. > > I don't think amalgam is capable of contracting. Material (either tooth or > amalgam) can fracture from the margins. Well then those Fx are where I'm putting the Diagnodent to try and guage how far in the fx margins are going in there, and whether I am justified in blasting the thing off, knowing I am risking further tooth injury, and also knowing that in most cases, my Tx options are another Am or Composite. > > Those areas that have visible Am Fx are usually due to poor cavity > > design on the floor of an isthmus, or sharp line angles or things like [quoted text clipped - 5 lines] > cement base under it. Usually with more caries under the base than anywhere > else. Well, we here are guilty of that: I invariably find Zonalin under my old Ams, and I don't find too much decay under that. The decay is usually between the walls and the Am. Thanks SP SignatureTake out the TRAASH to reply >Well then those Fx are where I'm putting the Diagnodent to try and guage >how far in the fx margins are going in there, and whether I am justified >in blasting the thing off, knowing I am risking further tooth injury, >and also knowing that in most cases, my Tx options are another Am or >Composite. Re-read your directions on the diagnoDENT. It is riot very effective right next to an amalgam. Amatus >> > I usually spot >> > amalgams that are contracting away from the tooth. [quoted text clipped - 24 lines] >Thanks >SP change riot to not. >>Well then those Fx are where I'm putting the Diagnodent to try and guage >>how far in the fx margins are going in there, and whether I am justified [quoted text clipped - 35 lines] >>Thanks >>SP Dude, you are a riot ! Not ! 8^]] >change riot to not. > >>Re-read your directions on the diagnoDENT. It is riot very effective >>right next to an amalgam. / -- Whamatus wubbabubbazG@RBAGEyahoo.com > change riot to not. Sounds like a Rock band's name... SP SignatureTake out the TRAASH to reply And many more with layers of black scuz and mushy Dycal®. <G> Dartos > In fact this is true. Even back in the dark ages of my dental > school, we were told that Ca(OH)2 wouldn't hold up as a base, but that [quoted text clipped - 3 lines] > > Steve A big smiley face before we start debating :-) >> Never place cement bases under amalgams as they compress more than the >> metal does and lead to fractures through the amalgam. [quoted text clipped - 4 lines] > new. I've have seen fillings placed by a peer that are there for 20 years. > With a classical zinc phosphate base. The cement is more compressible and you will usually find these restorations failing due to fracture throgh the amalgam rather than marginal breakdown. > How do you solve the problem of the sensitivity to temperature when you > don't place a base? Studies have shown that the sensitivity to cold after an amalgam with or without base was identical. The base seems to make sense, but it was never actually studied in a double-blind study until about 16 years ago. It was shown to not be useful. It would take some hunting to find the articles. I just checked my file of scanned articles, and it is not one of them. >> CaOh has been shown to NOT effect the long term health of a tooth. > > That's again not my clinical experience. Especially in primary teeth CaOH > placement has a good effect on the long term health of the tooth. I have > to admit I'm not so certain about permanent teeth, but I've managed to > save some pulps with indirect capping. CaOH has a place in immmature teeth. The acidity of the product is said to provide antimicrobial properties. Again, studies in the past ten years have shown it does not directly stimulate any secondary dentin formation like we were taught twenty years ago. With indirect pulp capping, the CaOH serves to kill most of the bugs on the leathery caries you leave behind. Natural dentinal formation in response to the _caries_ then thickens the area so you can return and finish excavating caries for the final restoration. >> Total etching does not injure pulps unless you leave it on for a few >> minutes. And, if you routinely have pain after placing posterior [quoted text clipped - 5 lines] > course... That's why I place a base first and then etch the tooth if the > cavity is deep. Drop your etch time to 10-15 seconds. The base will weaken your bond strenth significantly. I total etch dentin (15 seconds) on excavations that are 6-8 mm deep. (In the older days, I total etched for 30 seconds, and have not returned to do RCT on any of those teeth.) I then rub some Hemoseal (similar to GLuma) over the dentin to re-hydrate the dentin. This reduces post-treatment sensitivity to virtually zero. No bases, ever. If I am so close to the pulp (after caries excavation that I can see red, I will place CaOH for the 8-20 minutes it take to mill the porcelain, then flick off the CaOH prior to bonding. The CaOH will kill any bugs on that area, and protect the area form salivary bacteria while waiting for milling to finish. >> Having said that, I seldom place posterior composites unless I am >> treating incipient lesions. I place amalgams for small fillings when the [quoted text clipped - 6 lines] > two up, ceramic and composites. But the etching gel: a mm is very near. > Which concentration do you use? This intreages me Actually crowns are now out-moded again. Onlays preserve much more cuspal tooth structure, allow more of the natural flexing of the tooth, require less grinding of good tooth, don't require any core build-up, with CAD-CAM can be done in one appointment, is kinder to the tooth, and leaves you will more options in the distant future when the restoration needs treatment again. I bond my ceramic onlays with composite. I use 37% phosphoric acid to etch. The plain old boring blue stuff. You are welcome to disagree. Signature/ Amatus / > The cement is more compressible and you will usually find these restorations > failing due to fracture throgh the amalgam rather than marginal breakdown. 20 years is an acceptable period for an amalgam filling, in my humble opinion. >>How do you solve the problem of the sensitivity to temperature when you >>don't place a base? > > Studies have shown that the sensitivity to cold after an amalgam with or > without base was identical. The base seems to make sense, but it was never I had some patients with relatively superficial fillings (!), so I placed only amalgam. Afterwards they complained about sensitivity to cold. Which studies are these? > shown to not be useful. It would take some hunting to find the articles. I > just checked my file of scanned articles, and it is not one of them. It would be a great help, because I spend a lot of time on the base, who has to be perfect imho (enough size for AA, no sharp corners, not taking away all retention,...). But again, my education, discussions with peers, my experience,... The only study I found to back your words is one of 1986, but a review, which is a good thing. Since I graduated after this period, I assume my education was up to date. JADA 1986 Dec;113(6):910- > Drop your etch time to 10-15 seconds. The base will weaken your bond > strenth significantly. I total etch dentin (15 seconds) on excavations that > are 6-8 mm deep. (In the older days, I total etched for 30 seconds, and > have not returned to do RCT on any of those teeth.) I then rub some I assume we have both different clinical experiences. > Hemoseal (similar to GLuma) over the dentin to re-hydrate the dentin. This > reduces post-treatment sensitivity to virtually zero. No bases, ever. If I [quoted text clipped - 3 lines] > and protect the area form salivary bacteria while waiting for milling to > finish. Interesting. What do other dentists think of this procedure. > Actually crowns are now out-moded again. Onlays preserve much more cuspal > tooth structure, allow more of the natural flexing of the tooth, require [quoted text clipped - 4 lines] > > I use 37% phosphoric acid to etch. The plain old boring blue stuff. Yeps, the same... > You are welcome to disagree. I'm not disagreeing, I'm just suspicious since this conflicts with everything I learned from my old professors. I hope you understand this and understand why I'm not applying this until I know this routine is based on Evidence Based Dentistry. Next chance you get, where you are restoring similar teeth on opposite side of the same mouth. Place a base under one and not the other. That is what they did in the studies. Try it. Remind me in a few days if we have not hunted down the studies as I am going to get rather busy over the next few days with family stuff. Tomorrow, we are having the third installment of the Godfather Party (Mrs. A. invites more couples each time). I have two business meetings tomorrow. Lunch with Patterson Dental today. We take the kid to the symphony on Saturday morning, then, drive him to tennis, then off to a classmate's birthday party (about an hours drive North of us). Along the way, I need to adjust the clutch in my 42 year old daily driver car, check out why the dash lights are flickering, re-adjust the carburetor and choke for this cold weather we are having in Oklahoma right now, Get all the Holiday decorations down for the wife to start decorating, and still get at least two hours a day practicing my music. My teacher wants me to join up with a local civic orchestra, so I have to work hard at this point. I would really like to get about 3 hours in on Sunday with a bow in my hand. Trying to teach my fingers to drop into some second position spots without me forcing them. Signature/ Amatus / >> The cement is more compressible and you will usually find these >> restorations failing due to fracture throgh the amalgam rather than [quoted text clipped - 60 lines] > and understand why I'm not applying this until I know this routine is > based on Evidence Based Dentistry. > Next chance you get, where you are restoring similar teeth on opposite side > of the same mouth. Place a base under one and not the other. That is what [quoted text clipped - 14 lines] > to teach my fingers to drop into some second position spots without me > forcing them. For some reason this last comment reminded me of that old "Night Gallery" episode, "The Hand of Borgus Weems". http://www.scifilm.org/tv/nightgallery/nightgallery2-1-3.html Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Ouch ! Signature/ Amatus / > >> Next chance you get, where you are restoring similar teeth on opposite [quoted text clipped - 22 lines] > > Steve > Ouch ! There was also that scene from "Dr. Strangelove" where Peter Sellers wrestled with his own hand. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 How about Bruce Campbell in Evil Dead ? Signature/ Amatus / > >> Ouch ! [quoted text clipped - 3 lines] > > Steve > How about Bruce Campbell in Evil Dead ? Amazingly, I've missed that one. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I would >really like to get about 3 hours in on Sunday with a bow in my hand. Trying >to teach my fingers to drop into some second position spots without me >forcing them. Remember you are creating muscle memory. One day your fingers will dance across the finger board as you just think the melody. That's when the real fun begins. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com The fun is already beginning. Signature/ Amatus / > >> I would [quoted text clipped - 13 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >I had some patients with relatively superficial fillings (!), so I >placed only amalgam. Afterwards they complained about sensitivity to >cold. What do you do for them? I'm experiencing the same thing. ** Captain Infinity ...faster than the speed of dark Ditch the amalgam and use posterior composite *correctly* with a good bonding system. Amalgams leak badly until the gap between the tooth and filling fill with corrosion products. Or, you could use a bonding system to seal the dentin before placing the amalgam. Dartos >>I had some patients with relatively superficial fillings (!), so I >>placed only amalgam. Afterwards they complained about sensitivity to [quoted text clipped - 5 lines] > Captain Infinity > ...faster than the speed of dark this conflicts with > everything I learned from my old professors. Kind of like asking my dad for computer advice. What have you been taught about posterior composites, bonding systems, abfractions, parafunctional occlusal habits, or endo? (I don't expect you to answer all of that in one post <G>. Just a few areas where new techniques and materials can have quite an impact) 1960 style dentistry is possible and can be quite successful. 21'st century dentistry is here, and it can also be quite successful as long as it's performed well. In my world, G.V. Black preps are history. No extension for prevention. No amalgam. I conserve more tooth structure. Teeth are less sensitive with a properly bonded composite than an unbonded amalgam. Patients like their teeth to stay tooth colored. I have over 20 years of experience with posterior composites. W_B, AC, SP, and Steve Bornfeld certainly aren't new to the game either. I'm not suggesting that you immediately toss out amalgam, or anything else that you have been taught. However, I would open my ears and eyes to new ideas and materials and learn how to use them as well. Best wishes, Dartos > Let me argue in a friendly tone, If such things are possible in Usenet. > [quoted text clipped - 12 lines] > I don't mean this to belittle or to say I am better, but to encourage > conversation to improve both you and me. I really do wonder, AC, just how the rules changed. For many years we were treated to photomicrographic studies of pulpal reaction to bis-GMA resin, to acid etching, etc. It was all very intuitively right--how could 50% phosphoric acid placed directly upon dentine NOT be caustic and irritating to the pulp? Somewhere along the line the rules changed. What was it? Were those not microabscesses we were seeing in the photomicrographs? Were all of those dead pulps really not dead, but just sleeping? I am willing to accept that the received truth is just that--true because we always heard it was true. But the science was clear-cut--there are any number of old studies showing they were true. So what happened all of a sudden that people decided throwing phosphoric acid on the pulpal floor really wasn't a bad idea after all? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > So what happened all of a sudden that people decided throwing phosphoric > acid on the pulpal floor really wasn't a bad idea after all? I believe it has to do with how long the acid was left on the dentin. I have heard some lecturers now advocating as short as 5 second etch times. Signature/ Amatus / > >> Let me argue in a friendly tone, If such things are possible in Usenet. [quoted text clipped - 30 lines] > > Steve >> So what happened all of a sudden that people decided throwing phosphoric >> acid on the pulpal floor really wasn't a bad idea after all? > >I believe it has to do with how long the acid was left on the dentin. I >have heard some lecturers now advocating as short as 5 second etch times. Have switched to Clearfil SE completely. Have virtually no post op sensitivity no matter how deep. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com *IMO* A lot of this work was done by people who wanted to prove that posterior composites were bad. A lot of this work was done with high concentrations of etchant left on the dentin for much longer than we currently etch. This was followed by resins that did not bond to the dentin, or worse, no resin at all. When I first switched to posterior composites (1985), I etched enamel only for 60 seconds and used 3-M bonding resins with Heliomolar. I still had some sensitivity issues (amalgam had similar issues). I began placing glass ionomer over all of the exposed dentin before etching and placing the composites and the sensitivity issues were solved. As dentin bonding has evolved, total etch (15 seconds) and self etching (Clearfil SE Bond, e.g.) bonding systems have been developed that preclude the need for the glass ionomer liners. I work quite close to the pulp and have much less sensitivity problems than I ever had with amalgam. I have many restorations approaching (and even past) their 20 year anniversary. I do not believe longevity is an issue any more. I don't regret switching to composites at all. JME, Dartos > I am willing to accept that the received truth is just that--true > because we always heard it was true. But the science was [quoted text clipped - 3 lines] > > Steve >I have many restorations approaching (and even past) their 20 year >anniversary. I do not believe longevity is an issue any more. I don't >regret switching to composites at all. > >JME, >Dartos Did you recommend Bisco One-Step for small restorations ? If so, Have a small sample bottle, how small a restoration did you mean ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > *IMO* > [quoted text clipped - 3 lines] > than we currently etch. This was followed by resins that did not > bond to the dentin, or worse, no resin at all. It is true that early acid etching was done for longer (maybe 30 sec. or even 1 min.) than now, but I think there's no reason to believe the researchers had an axe to grind. For that matter, I distinctly remember seeing photomicrographs of pulpal degeneration under unetched resins--a caution to line all composites. Buonocore did his original work way back in the 1950s IIRC, but he probably used acrylic resin. I believe Adaptic came out in the mid 1960s, and by the time I graduated in 1976 we were still not etching or bonding routinely. We did have that UV-cured resin whose name escapes me now. Steve > When I first switched to posterior composites (1985), I etched > enamel only for 60 seconds and used 3-M bonding resins with Heliomolar. [quoted text clipped - 22 lines] >> >> Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 You need to look at a similar study done with modern DA. Signature/ Amatus / > >> *IMO* [quoted text clipped - 44 lines] >>> >>> Steve > You need to look at a similar study done with modern DA. DA? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> You need to look at a similar study done with modern DA. > >DA? > >Steve District Attorney. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Dumb A** Dental Assistant or Dentin Adhesive? Dartos >>>You need to look at a similar study done with modern DA. >> [quoted text clipped - 8 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com I graduated (believe it or not <G>) in 1979. We were just starting to acid etch all composites when I was a Senior. Surely you don't mean a Nuva Light. There was one on the clinic floor for the whole school. There were 160 students per class (mainly just juniors and seniors doing restorative in the clinic). Dartos > Buonocore did his original work way back in the 1950s IIRC, but he > probably used acrylic resin. I believe Adaptic came out in the mid [quoted text clipped - 3 lines] > > Steve > I graduated (believe it or not <G>) in 1979. We were just starting to > acid etch all composites when I was a Senior. [quoted text clipped - 4 lines] > > Dartos That's the one. We didn't bond, but we watched the pedo postgrad students use Nuva. It was a pretty color. This would have been about 1975. Steve >> Buonocore did his original work way back in the 1950s IIRC, but he >> probably used acrylic resin. I believe Adaptic came out in the mid [quoted text clipped - 3 lines] >> >> Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 As a senior in undergrad (spring '75), I worked in a dental office with a 1974 graduate who was in with his two uncles. He had a Nuva Light, and I watched him bond a denture tooth in place of #10 for his first bonded bridge. The patient was a cashier at the student union and she flashed that tooth at me all of the time. She was happy as could be. Seemed miraculous at the time. Dartos >> Surely you don't mean a Nuva Light. There was one on the clinic floor >> for the whole school. There were 160 students per class (mainly just >> juniors and seniors doing restorative in the clinic). >> >> Dartos > That's the one. We didn't bond, but we watched the pedo postgrad > students use Nuva. It was a pretty color. This would have been about > 1975. > > Steve That was the good ole days of UV lights, eh ? Yeah we had a whopping 2 per clinic side I think. >I graduated (believe it or not <G>) in 1979. We were just starting to >acid etch all composites when I was a Senior. [quoted text clipped - 12 lines] >> >> Steve -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Is he blowing me off? Did he screw up the filling, leave a gap in there > or something, and just not want to admit it? If I wait six weeks does [quoted text clipped - 3 lines] > > Any advice would be appreciated, thanks in advance. I would say the vast majority of sensitivity calms down in about 2 weeks or so. I would-a tole your dentist to put the composite curing light back onto the tooth for 10-20 seconds per bonded surface. It is still not too late to do that, and they shouldn't charge you for it. Sometimes, there is a smidgen of uncured resin in there and it can cause some sensitivity. It may also be that there is a contraction sensitivity issue. You cure this by making a cross incision into the filling (without removing the filling, just cutting it into separate parts) and the re-filling between and over that. The Laser is FANTASTIC for doing this. You crank it up to 5.25 Watts and let 'er rip right down to the dentin. ('course, near the dentin you downshift to the dentin setting). The theory is that if the stuff contracts too much while it is being placed, it tends to stress the tooth. So cutting like I say tends to allow the stress to spring back out and then re-filling will not be contracted as much. For the next ones, ask your dentist to slow down when s/he places the BONDING material. Take away the overhead light, and just let it sink into the tooth for at least fifteen seconds or so, like letting varnish soak into wood. Then, they may find that they must put another layer, if the shinyness they are supposed to see has disappeared (the bonding has worked into the dentin, and will give a nice, insensitive hybridized layer). The thing is that it takes TIME to develop a thick hybridized layer. But even for a Scott Perkins super express line dentist, 15 or 30 seconds is not long to wait. They must use a clock though, or they will underestimate the time to wait every time. If after all this, s/he is STILL having sensitivity problems, ask him/her to switch to ClearFil SE. SP SP SignatureTake out the TRAASH to reply Hi there, I feel so bad for you and unfortunately I dont have any advice for your toothache. But I can definately help you save on your next visit to the dentist. You need a great dental supplement plan that will minimize your copay. It gives you unlimited visits and savings up to 80 %. Prices are very affordable $19.95 for entire family and $11.95 for single individual. Please log on to http://www.deliveringonthepromise.com/40266026 or call me at 952-469-6494 for more information. Everyone is accepted for the plan even with preexcisting conditions. Thank you. Maja > Last week or so my dentist finished replacing my silver fillings with > the new stuff, the stuff that looks like teeth, with work on the top [quoted text clipped - 26 lines] > Captain Infinity > ...faster than the speed of dark > It gives you unlimited visits and savings up > to 80 %. Prices are very affordable $19.95 for entire family and $11.95 > for single individual. And, what dentist, released from which insane asylum, on what planet, in which star system, and in what century, .....would accept treating patients at those prices? SP SignatureTake out the TRAASH to reply . Prices are very affordable $19.95 for entire family and $11.95 >>for single individual. > .....would accept treating patients at those prices? > > SP A bait and switcher. Dartos >> It gives you unlimited visits and savings up >> to 80 %. Prices are very affordable $19.95 for entire family and $11.95 [quoted text clipped - 9 lines] > >SP Only ones that don't need to eat. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com |
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