Restorative Fillings

In the face of advanced materials and techniques in dental restoration, restorative fillings may appear as more traditional and rather out-dated means of restoring natural teeth. Still, their usefulness is acknowledged on account of their qualities like strength and durability. These qualities do count when filling back teeth, which have to exert the greatest chewing forces.

Some of the common restorative materials used very often are: Composite: also called white fillings or cosmetic fillings Glass ionomers: Fluoride releasing Resin ionomers: Combination of composites and glass ionomers Amalgams: Also called silver fillings Ceramics: porcelain Indirect composites Metals etc.

Factors Involved in the Choice of Restorative Fillings

Following factors mainly determine what kind of restorative fillings you need to choose:

• Oral and general health of the patient
• Composition of the filling material
• Place and mechanism of filling
• The chewing load on the tooth where filling is needed
• Duration and number of visits needed for restoration

Direct and Indirect Dental Restorations

Direct restorative fillings require a single visit in which the filling is placed immediately into a prepared cavity. The dentist prepares the tooth and places the filling, followed by adjusting the restorative and the job is finished. These fillings include:

• Dental amalgam
• Glass ionomers
• Resin ionomers
• Resin composite fillings

Indirect restoration requires at least two visits. The first visit includes preparation of the tooth and making an impression of the area that is to be restored. In the next visit, the filling (coming from the dental lab) is placed and adjustment is made. Types of fillings include:

• Gold alloys
• Base metal alloys
• Ceramics
• Indirect Composites

Composite Fillings

Composite fillings, also called filled resins, consist of a mixture of glass or quartz (silica) filler placed in a resin medium. As a filling it appears as tooth-colour. Composite fillings exhibit the following properties:

• Good durability
• Resistance to fracture
• Withstanding moderate chewing pressure
• Adhesively holding in cavity
• Making a smaller filling than amalgam
• Requiring longer to be placed than amalgam filling

Glass Ionomers Glass ionomers are translucent mixtures containing acrylic acids and fine glass powders. These are used in cavity filling, especially cavities found on the root surfaces of teeth. A little fluoride is released by these fillings which is useful against tooth decay. Since their resistive power is low, they are used in places where chewing load is not very high .

Resin Ionomers

These are also made from glass filler with acrylic acids and acrylic resin. They exhibit low to moderate resistance to fracture. Like glass ionomers, they too are used for small, less-load bearing fillings like those between the teeth.

Amalgam Fillings

Amalgam fillings are the most popular of all restoratives. It is an alloy containing mercury, copper, silver, tin, and a few minor elements. Amalgam fillings can withstand great chewing loads and are also useful in restoring deep fillings below gum line. Some concern has been raised about the mercury content of these fillings but authorities in health (FDA, WHO, and others) have found it to be safe. Their greater popularity rests on several reasons like:

• Durability
• Ease of use
• Greater resistance to wear
• Relatively inexpensive in cost

Gold Alloys

These alloys consist of gold, copper and a few other metals. Together these form a strong and effective filling, crown or a bridge. Their primary use lies in inlays, on lays, crowns and fixed bridges. Gold alloys are known for:

• High resistance to corrosion and tarnishing
• High strength and toughness against wear and fracture
• Requiring the removal of minimum amount of healthy tooth structure
• Feeling gentle to opposing teeth
• A drawback to gold fillings is that their colour does not look like natural teeth.

Base Metal Alloys

These are high strength and toughness, non-noble metal alloys having a silver appearance. They show high resistance to corrosion, tarnishing, fracture, and wear. Some people may have allergic sensitivity to base metals. Also, some initial discomfort may be encountered from hot and cold.

Ceramic Materials

Ceramic fillings require a minimum of two visits. These include porcelain, ceramic or glasslike fillings and crowns. These are highly resistant to wear but prone to fracture under stress and on impact.

Indirect Composites

These filling materials are similar to those of direct restoration fillings. Their colour is like those of teeth. These fillings do not excessively wear opposing teeth. They show less strength and durability than porcelain or metal restorations. In addition, they wear and discolour relatively easily.

Regular Dental Hygiene

Help keep an eye on your mouth to avoid emergency problems & privacy procedures in the future. 

Regular dental hygiene proves an effective way of keeping yourself and your family worlds away from tooth decay and gum diseases.





At The TOOTH CENTRE,PORUR, CHENNAI,  our patients are enrolled in a 3-6 monthly maintenance program where we see them every 3-8 months for an examination, clean and scale, floss, fluoride treatment and if necessary x-rays. This way we ensure our patients have minimal plaque levels and do not accumulate excessive tartar, which is difficult to remove with everyday brushing and flossing.

  Brushing

This is the single most important thing that you can do for your teeth and gums. Brush twice daily in downward strokes for upper teeth and upward strokes for lower teeth. Children can use circular motion.
Everybody should brush twice a day once in the morning after breakfast and in the night before going to bed.

Flossing

As brushing removes plaque from the surfaces of teeth flossing helps to maintain hygiene and remove plaque from in between the contact points of teeth. If you find flossing difficult why not visit us and we shall teach you easy ways to make it fun with newer techniques like flossetes

Mouthwash

There are over 20 different mouthwashes available in the supermarket today and choosing the right one can sometimes be a bit of a hassle. A good way to choose a mouthwash is use an everyday brand that has a antiplaque agent in it along with some fluoride. Always remember that mouth rinses are only an adjunct to brushing and flossing and by themselves cannot fulfil oral hygiene needs.
If you are concerned about a particular problem like bad breath or multiple black spots or decay it is recommended you consult us before trying any cosmetic mouthwashes.

Diet and Dental Health

Diet is intimately related to dental health. Here are some general guidelines about food and dental hygiene.

• Avoid excessive sweets, sticky foods, and between meal snacks (after which you don't brush your teeth).
• Go for teeth-friendly snacks like fresh fruits, vegetables, cheese, and crackers.
• Minimize sweet drinks during and after meals.
• Do not let your baby sleep with a baby bottle with milk or sweet liquid in it (plain water is ok). Teach your child to drink from a cup as soon as he/she is able to do so.

Diabetic Patient

 A diabetic patient visiting our clinic requiring dental treatment-
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 What are the factors that you should discuss with the Dentist? 

 

  And what are the factors that the dentist will consider in your management?

 

 

 

 

 Factors which should be discussed with a diabetic patient include:

· * The nature of his diabetic condition, whether it is properly controlled or not, and the line of diabetes control this patient is following

· * The associated chronic complications he/she might be suffering

· * The incidence of acute complications before

· * The nature of the dental treatment required and the most appropriate type of anesthesia, and the associated management of diabetes mellitus.

· * Special precautions before, during and after the dental appointment

· * History taking related to possible dental complications associated with diabetes mellitus

We must determine whether the patient is suffering from type I (insulin dependent diabetes mellitus) or type II (Non insulin dependent diabetes mellitus) or less commonly type III which develops in pregnant females. 

Type I has an early onset in life and it mainly develops as a result of reduced release of insulin from the beta cells of islets of Langerhans in the pancreas. It is mainly treated by the administration of insulin. It is common in Caucasians, Europeans especially in Finland and Sweden.

Type II has a late onset, usually beyond the age of 45. It develops mainly as a result of increased resistance of the peripheral tissues to the action of insulin. It is mainly treated with oral hypoglycaemics. 

Type III develops in pregnant females mainly in the second and third trimester. It develops because of the interference of the placental hormones with the action of insulin. This type of diabetes disappears after delivery. However, this female patient is more liable to develop type ii diabetes later in her life. 

It is important to recognize whether the patient is well controlled or not. We can ask him about the last time his blood glucose level was measured. 

In general a fasting blood glucose level over 250 mg/dl is considered to be uncontrolled. A better indicator of the over all control of diabetes mellitus over the last three months is the blood level of glycoslated hemoglobin (HBA1c or HBA1). 

Ideally it should be within the range of 4.5%. Up to 4.8% it is still considered acceptable. If it is over 6.1% the patient is clearly uncontrolled.

 Normal adult hemoglobin binds to glucose and it persists in the body over the entire life span of the erythrocyte. Therefore it is considered as a good indicator of the cumulative control of blood glucose level. Another long term essay for the control of diabetes mellitus is fructosamine level.

Management of diabetes in general has the following targets: establish a normal blood glucose level, prevent acute complications and prevent chronic complications. Management might consist of:-

· * Dietary control

· * Increased physical activity

· * Food should be given to be in harmony with the level of physical activity

· * Insulin or oral hypoglycaemics to help in the regulation of blood glucose level

· * Frequent monitoring of blood glucose level and glucose in urine

We should determine which line of management the patient follows

· * The patient might be on dietary control alone. In such a case, if the patient is well controlled; he can undergo minor surgical procedures under local anesthesia without special precautions. In moderate surgical procedure that requires general anesthesia; the patient can undergo the surgery without special precautions other than monitoring the urine glucose level on 2 hours basis till feeding is restores.

* In major surgical procedures, the patient should be hospitalized where he is going to be prepared with insulin injections.. 
*We may need you to have basic investigations like Blood and Urine Sugar levels, as well as other tests like HbA1c(for estimating diabetic control), before undergoing a procedure.
*Associated cardiac /renal failure and Neuropathy, if present, should be managed and a Fitness for Procedure obtained from the Specialist concerned, before reporting back for undergoing the procedure.