Type of Filling?

Joined
May 22, 2023
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I hope someone can offer some advice as I am not sure I am being given best advice but rather being guided to private.

I have quite a lot of wear on my molars through either grinding (I don't think I do, as my other half never mentions it) or drinking diet orangeade.

Either way my dentist said she could either monitor it or I could have 3 fillings to build up the areas, she recommended white fillings privately rather than NHS metal fillings.
I said I was more than happy with NHS metal ones, she then changed tact and said the metal ones would involve more good tooth removal that the private white ones so if I wanted to go the NHS route she would recommend a temporary filling but it might not last. This made no sense to me to have a temporary filling that might fall out in 6 months.
Due to me being hesitant in agreeing to the temporary work she agreed to metal but would now, all of a sudden only need 1-2 fillings.

Being as I was left feeling I was going against her best advice & she appeared unhappy doing NHS metal fillings, saying it would involve removing more good tooth that goes against what they are trying to achieve, I was hoping to get other thoughts, it appears mad to me there is no NHS option she can recommend and only private work could fix my teeth?

In the past from my previous practice, I was always told the mental ones are not nice looking but stronger and will last longer.

I will also add, I always have a regular 6 monthly check-up and moved to this practice about 6 years ago as my last practice stopped doing a scale and polish and instead kept recommending private hygienist visits. My new practice, although not as pushy on chargeable work also wont do a scale and polish.

I could be wrong but I just keep getting the feeling all the "best advice" I keep being given by dentists is more about steering me away from NHS and charge me private fees. I used to trust my dentists would always give me the best advice.
 
Solution
You can request access to copies of your records, including xrays, specialist reports, clinical notes.
It's not as simple as amalgam Vs composite:
  • Amalgam: Like concrete, you need a fair amount of depth to make it work and this will necessitate drilling down and getting closer to the pulp (nerve) . Also, it does not adhere to the enamel of the tooth.
  • Composite: Can sometimes do it thinner than amalgam with less drilling, and will adhere to enamel and dentine. More likely to fail than amalgam or give post-op sensitivity.
In the Xrays I showed you, I referred the teenager to a prosthodontic specialist; composite was preferred for the short term ( 5-10 yrs) with ceramic after that for the long term. Very...

MattKW

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I would have to see Xrays to at least judge your degree of erosion. If you have xrays taken several years apart to show rate of wear, then this would be even better. Bitewings (perpendicular) xrays are best for this type of comparison. I attach 2 examples of a patient taken 3 years apart, and an info sheet about acidity:
  1. Pic taken 2007 when patient is 13yo. The green shows the thickness of good enamel on 2nd molar, the orange shows reduced enamel on 1st molar.
  2. Pic taken in 2010. The enamel on 1st molar is now very fine as evidenced by red arrows. This kid just wouldn't give up soft drinks.
 

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Joined
May 22, 2023
Messages
3
I would have to see Xrays to at least judge your degree of erosion. If you have xrays taken several years apart to show rate of wear, then this would be even better. Bitewings (perpendicular) xrays are best for this type of comparison. I attach 2 examples of a patient taken 3 years apart, and an info sheet about acidity:
  1. Pic taken 2007 when patient is 13yo. The green shows the thickness of good enamel on 2nd molar, the orange shows reduced enamel on 1st molar.
  2. Pic taken in 2010. The enamel on 1st molar is now very fine as evidenced by red arrows. This kid just wouldn't give up soft drinks.

Unfortunately I don't have access to the xray's, bitewing ones were done but only my dentist has access.
However it's not so much about the need for filing as I have had increasing erosion for 20 years+ and want the damage building back up.

My question is more about the type of filling material, my dentist told me if I had amalgam fillings, they would have to drill out more healthy tooth as amalgam fillings need a deeper bed than white.

white will be private and 10 times the cost of amalgam fillings.

I don't care about the appearance of my molars so I'm happy with amalgam fillings but my dentist is telling me the more costly white fillings will involve less drilling away of my healthy teeth.

I'm not sure if I'm being taken for a ride as I understood amalgam fillings , although not as nice looking were actually the stronger and longer lasting filling.
 

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MattKW

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Joined
Mar 18, 2018
Messages
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You can request access to copies of your records, including xrays, specialist reports, clinical notes.
It's not as simple as amalgam Vs composite:
  • Amalgam: Like concrete, you need a fair amount of depth to make it work and this will necessitate drilling down and getting closer to the pulp (nerve) . Also, it does not adhere to the enamel of the tooth.
  • Composite: Can sometimes do it thinner than amalgam with less drilling, and will adhere to enamel and dentine. More likely to fail than amalgam or give post-op sensitivity.
In the Xrays I showed you, I referred the teenager to a prosthodontic specialist; composite was preferred for the short term ( 5-10 yrs) with ceramic after that for the long term. Very expensive.
The appropriate treatment for you depends upon your age, the area of erosion (one tooth or many?), the depth of erosion, the closeness of your nerve to the tooth surface, and your ability to halt the erosive action ("...drinking diet orangeade").
If you can get the Xrays and tell me your age, then I can give better advice. There is rarely only ONE answer in dental care - there are options with varying degrees of success, risks, and costs.
 
Last edited:

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Solution
Joined
May 22, 2023
Messages
3
You can request access to copies of your records, including xrays, specialist reports, clinical notes.
It's not as simple as amalgam Vs composite:
  • Amalgam: Like concrete, you need a fair amount of depth to make it work and this will necessitate drilling down and getting closer to the pulp (nerve) . Also, it does not adhere to the enamel of the tooth.
  • Composite: Can sometimes do it thinner than amalgam with less drilling, and will adhere to enamel and dentine. More likely to fail than amalgam or give post-op sensitivity.
In the Xrays I showed you, I referred the teenager to a prosthodontic specialist; composite was preferred for the short term ( 5-10 yrs) with ceramic after that for the long term. Very expensive.
The appropriate treatment for you depends upon your age, the area of erosion (one tooth or many?), the depth of erosion, the closeness of your nerve to the tooth surface, and your ability to halt the erosive action ("...drinking diet orangeade").
If you can get the Xrays and tell me your age, then I can give better advice. There is rarely only ONE answer in dental care - there are options with varying degrees of success, risks, and costs.

Thank you so much, that is really helpful.

I will see if I can get my records but in the mean time I am 55yo and my wisdom teeth have been removed.
With the exception of my wisdom teeth and a crown my teeth are complete.

All of the following refers to my lower jaw as I don't think I have erosion on my upper jaw.
I have most of the erosion on the outside edge of my first right molar and second premolar (I have a crown on my right second molar).
I can feel a clear slope away to the outside of my teeth on my lower right hand side with the inside feeling (to me) full height. All the erosion is on the outer side of the teeth.

I therefore need my right second incisor and first molar building-up on the outer edge.

My erosion on my left is much more minimal but part of the inside edge of my second premolar broke off recently, this is the third build-up filling.

Thanks again.
 

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MattKW

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Joined
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Messages
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Erosion is always most evident on lower teeth because this is where the acidic drink will naturally go (gravity!). At 55yo, if you have minimal erosion AND can give up the acidic drinks, then you probably be OK.
 

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