Dental MythBuster #13: A Dental Filling Will Last Forever

Fortunately, this dental myth does not come up very often. When it does, the myth usually comes up when I have to deliver news along the lines of “I have a concern about one of your fillings.”

Most patients understand that dental fillings are usually not lifelong permanent solutions. But some patients don’t. Like many other medical devices and appliances, fillings don’t last forever.

Problems with Dental Fillings

There are all types of problems that can occur with dental filings. Below are some examples:

broken mercury amalgam filling in a tooth

A broken silver amalgam filling. This will need to be replaced.

The tooth above shows two premolar teeth, both with amalgam fillings. One of the fillings has cracked. There are many reasons why it cracked – but they go beyond the scope of this post. However, to summarize, after being chewed upon several hundred thousand times, it has finally failed.

high quality photo of broken lower molar tooth with a filling

Here, both filling and tooth broke!

In this photo, a large portion of both tooth and filling broke. In this particular case, the filling had been there for over 20 years, but the remaining tooth structure was so weak it finally gave out. In this case, this patient needed a crown.

In addition to the above two examples, dental fillings can fail for many other reasons. And many will fail due to a combination of multiple factors.

What other medical appliances last a lifetime?

On occasion, I will come across a patient who is particularly disturbed that one of their fillings done during the Clinton presidency needs to be replaced. I will often politely respond by referencing other medical appliances:

cardiac pacemaker is like a filling and can last seven years

On average a pacemaker lasts seven years.

What do the above 3 devices all have in common? These are all manmade devices designed to replace or repair damaged or missing human tissue. And that is exactly what a filling is.

When I mention these examples, most patients begin to understand fillings typically have a finite lifespan. And then the myth is busted…

How Long Should a Filling Last?

This is difficult to answer since there are so many factors at play. I’ve seen fillings last over 40 years while others fail within 1 to 2 years. The factors can include:

  • Type of material (silver amalgam vs. resin composite).
  • Location in the mouth.
  • Oral hygiene.
  • Sugar intake.
  • Occlusion (how the teeth come together).
  • Skill level and attention to detail of the dentist who placed it.

So, while occasionally a filling can last a lifetime, that is not the norm. Just like nearly all other medical appliances and devices, they can and do wear out. It is a myth that all fillings will last forever.

Dental MythBuster #12 – I can’t have a cavity because there is no hole in my tooth!

This Dental MythBuster is slightly unfair, as it relies upon the slang term cavity that has been used for decades. However, it is still a myth, and like all dental myths, this myth needs to be identified and busted!

Let’s start by looking at a photo:

high res photo showing teeth with dental decay but not cavities

Photo showing decay on front teeth but no “cavities” present.

If you look at the above photo, everyone would agree that something is not right. The brown/grey areas where the teeth touch one another look awfully suspicious. When I informed this patient that she needed fillings with those teeth, she looked at me perplexed and said “Why… I can’t feel any cavities there?!?”

I hear this dental myth about once per week in my office. Once I show either an x-ray or photo of the cavity, they understand immediately. Wouldn’t you if you saw the above photo?

Cavities, Caries, and Decay

Part of the reason why this dental myth exists is because there is some confusion and misuse of various dental terms. And we dentists are part of the problem! Let’s look at definitions:

Dental Caries – also known as dental decay, this is an infectious disease leading to the progressive destruction of tooth structure. This is seen in the photo above.

Dental Cavities – a carious lesion or hole in a tooth. Although this term is used quite often, it is generally considered to be a slang term.

So, what does an actual dental cavity look like? See below:

photo showing teeth cavities visible in the actual mouth

Two cavities present. In this case, there are actual holes in the teeth!

In the above photo, you can see actual holes in the teeth. These are areas of dental decay that have progressed to the point where the tooth surface actually collapsed in, creating a cavity. This patient was actually able to feel and see the cavities.

Another Dental Myth Goes Down

So far, we’ve seen two photos: one showing decay without holes and one showing decay with holes.

In both cases, the patients required fillings and/or other work to restore. I don’t think anyone would disagree with that.

So, let’s dispel this myth with this simple statement:

Dental cavities can be present with our without actual holes in your teeth. You don’t need an actual hole in your tooth to need a filling.

So if your dentist tells you that you have decay (or cavities) and you can’t see or feel a hole, it doesn’t mean there is no cavity. It is definitely there. Ask your dentist to show it to you on an x-ray or have him/her take a photograph of it. I do it all the time.

I hope you enjoyed this post. I’m already working on Dental MythBuster #13!

A dental visit without Novocaine or Epinephrine?

lidocaine local anesthetic with epinephrine used at the dentist

Lidocaine with Epinephrine is the most common formulation in the U.S.

Since starting this blog in October 2012, readers have posted hundreds of comments on all aspects of dentistry. While the comments vary significantly, there is one subject area that is consistently popular. And it also happens to be the most dreaded part of a dental visit: the numbing shot!

This is not surprising, given that over 1 million local anesthetic injections are administered in dental offices per year in the United States alone. And did I mention how everyone hates the shot? People love to Google things they hate!

This post covers two areas that readers on this blog have commented about as well as questions that I receive on an almost daily basis in my practice in Orange, CT.

Epinephrine in Local Anesthetic

Patients are always curious about epinephrine (a.k.a. adrenaline) used in local anesthetic. First off, there is no such thing as an epinephrine allergy, a myth I thoroughly debunked in Dental MythBuster #10 – I’m allergic to epinephrine.

photo of epinephrine capsule used for injectionStill don’t believe me? Dr. Stanley Malamed, considered the world’s foremost expert in local anesthesia in dentistry, writes “allergy to epinephrine cannot occur in a living person” in the textbook he authored.

Can you get an injection at the dentist that does not contain epinephrine? Of course! Nearly all dentists should carry at least one type of local anesthetic without epinephrine. The most common is either 3% mepivacaine (brand name is carbocaine) or 4% prilocaine (brand name is Citanest Plain). Keep in mind that if you do receive local without epinephrine, the numbing feeling will not last as long and will be less profound.

If your dentist does not have that type of anesthetic available, you may want to consider switching offices.

Occasionally, you may receive an injection at the dentist and your heart races. This occurs when some of the epinephrine from the local anesthetic enters the bloodstream. It may feel a bit unsettling, but for most people, this is temporary and completely harmless. But this does not mean you are allergic to ephinephrine! See this page for more on that dental myth.

No Novocaine While Drilling?

First off, dentists no longer use novocaine, something I wrote about here. Interestingly, prior to the invention of novocaine, cocaine was actually used as a local anesthetic. It was quite effective, but there were some undesirable side effects as you can probably imagine.

photo of tooth cavity that needs lidocaine for fillings

These cavities are too big to be filled without any local anesthetic.

Many have commented on this blog asking if they can have dental work done without having local anesthetic administered. The answer is yes. Except in certain circumstances, the local anesthesia is for the comfort of the patient and is not required for the procedure. However, doing dentistry on a patient who is experiencing pain is not good for anyone involved!

In certain cases, I will however recommend that we attempt without any local anesthesia. These are circumstances when the cavity is very small and restricted to the outermost layer of the teeth. In these instances, little to no sensation is transmitted to the nerve of the tooth. Patients don’t feel anything except a little vibrations. They then leave happy because they didn’t receive a shot and therefore will not be numb for the next three hours.

However, if the prospect of potentially feeling a tiny bit of pain during the procedure scares you, do not ask your dentist to skip the local anesthetic.

What should you do?

For all the readers who have posted comments on these two subjects, keep in mind these two points:

  • Epinephrine is found in most formulations of dental local anesthetics, but you can always get local anesthetic without it.
  • It is possible to have dentistry done on you without local anesthetic. However, you should ask your dentist if the area to be worked on is small. If not, you will feel it!

Dental MythBuster #11 – You can get Gum Disease from Kissing Someone

Photo of people kissing and getting gum disease

Is he about to give her gum disease?

This dental myth is not as common as some of the other ones I have seen, such as the novocaine myth, the epinephrine allergy tale, and many others. However, it is still something that I encounter on a fairly regular basis.

This myth is the belief that gum disease can somehow be caught by kissing someone who already has the disease.

What is gum disease?

Gum disease, more formally known as periodontal disease, are a series of conditions that affect the gum and bone tissue holding in the teeth. While there are some uncommon variations, the most common types are gingivitis and periodontitis.

Without proper treatment, over time, the disease can destroy the tissue holding in the teeth. And as a result, the teeth can ultimately loosen up and/or become infected, resulting in the loss of those teeth. Note that this is a completely different disease than cavities (also known as dental decay or caries).

Causes of Gum Disease

A photo is worth a thousand words, so let’s take a look:

Photo of lower teeth with significant calculus (tartar) and gum disease

Lower front teeth being viewed from the tongue side. Calculus, aka tartar, has built up between the teeth leading to gum disease.

The above photo shows the #1 cause of gum disease: poor oral hygiene leading to a buildup of plaque and calculus on the teeth above and below the gums.

This patient is one I saw in my office in Orange, CT. His gums tissue was red and inflamed and would bleed whenever they were touched.

Besides oral hygiene, there are other factors that can contribute to gum disease:

  • Smoking
  • Certain medical conditions such as diabetes, HIV, leukemia, and many others
  • Some medications that cause dry mouth
  • Certain genetic traits
  • And many other factors

What’s Love Got to do with it?

Inflamed gums leading to periodontal disease seen in Orange, CT

This did NOT come from kissing someone!

Nothing! Gum disease is not caused by kissing someone. While it is true that kissing can spread oral bacteria from one person to another, this act does not cause a person to develop gum disease.

Did the plaque at the gum line on the photo to the left come from the person this patient just kissed? No!

While it may be tempting to blame your ex for the conditions of your gums, this is one thing you can’t pin on him/her!

Until the next Dental MythBuster…