Want 6 Almagams Replaced With Composites And....

[brian123]

bonded. can someone reccommend the best place or is it one place goof for the reconstructive work and another for the cosmetic element

also is it possible to get all this done in five days???

also amalgam removal is is possible that is could cause the surrounding shell of the tooth ot crumble when it is removed

cheers

[bjsanook]

First, why do you want to replace the amalgams with composites? Are they falling apart? Or is it the hype of "amalgam" causing medical issues?

I ask because everytime you cut out an old filling you will cut some tooth with it. So, small fillings become slightly bigger.

Also, some peolpe don't do so well with composites. There are issues with sensitivity due to the chemicals in the bonding agent. Also, larger composites will "pull" the tooth together as they shrink during the initial set, The patient will experience pain, much like a high silver filling. Biting pain, cold sensitivity. Last, composites are usually only good for up to 10 years, with very good hygiene. Why?, because they are glued in, the seal will over time erode from saliva, sugars, bacteria etc. I see a large number oof patients, mostly with bad hygiene, who come in with very large recurrent decay under the composite. Many end up needing root canals.

I'm not saying composites are bad, just be aware of the pro's & con's of them.

Root canals? Three in 5 days. Can be done, but find an endodontist to do them with the newest tools. A GP can do them, but higher potential post op problems.

My advice is one of the larger centers which have multi-discipline doc's on site. They can treatment plan you and set it up for the 5 days. You want it done at least a day before you leave in case of problems.

Good luck.

BJ

[taxexile]

i second all of the above.

replacement of amalgams with composites is sometimes like opening a can of worms , for small occlusal fillings (fillings in the biting surface of the tooth , if the cavity is not a deep one , then replacement is usually ok , anything larger,deeper or involving the surfaces inbetween the teeth and problems can arise later.

if the appearance of the amalgam is not to your liking , then they can be improved with fine polishing to a silver like finish.

replacement of the whole filling with ceramic inlays is a better way , but an expensive way , and not all dentists have the technology or experience to use that technique.

the best material without doubt is gold , in the form of inlays , but not everybody is comfortable with the appearance or the cost. well placed gold inlays in a mouth that is well looked after with brushing , flossing and fluoride mouthwashes can last a lifetime.

with most things dental ,the advice is if it aint broke , dont fix it. constant fiddling and replacements unless really necessary can often lead to a chain of events that end up expensive and uncomfortable. if your amalgams are not broken , leaking or showing caries underneath on x ray , then leave them be.

the health 'scare" over amalgam was a lot of hype and nothing has ever been proved.

[Nawtilus]

'I see a large number oof patients, mostly with bad hygiene'

Hmmm....with a name like BJsanook I am thinking 2 lines of employment here, which one should I run with ??

[wallyc]

bonded. can someone reccommend the best place or is it one place goof for the reconstructive work and another for the cosmetic element

also is it possible to get all this done in five days???

also amalgam removal is is possible that is could cause the surrounding shell of the tooth ot crumble when it is removed

cheers

Brian, you are getting excellent advise ... replacing the amalgams could cause you more and expensive problems ..... as said "if it aint broke ...."

About the 3 root fillings. Do you mean you have caries at the gum line on 3 teeth ? If so, these would be filled most likely with a Glass Ionomer filling as this is a non-stress area and they will last a long time and will be cosmetically pleasing. Similar to a composite and more suited for the gingival area. If this is what you were refering to, then it seems hygiene in that area might be a problem and the extra fluoride release properties of Glass Ionomer would be a benefit.

wallyc

[Sheryl]

Agree with all the above advice. As to where to go, I have been consistently happy with Bangkok Dental Hospital (sukhumvit Soi 49) in terms of both quality and price, and they have a multi-disciplinary team so everything can be done in one location. They're very nice and will do their best to accomodate your schedule. However if root canal is needed I doubt 5 days is possible.

They have a website.

Edited September 30, 2006 by Sheryl

[h90]

yes where possible take ceramic or gold instead of composits, but don't use gold and amalgam in the same mouth......

First, why do you want to replace the amalgams with composites? Are they falling apart? Or is it the hype of "amalgam" causing medical issues?

I ask because everytime you cut out an old filling you will cut some tooth with it. So, small fillings become slightly bigger.

Also, some peolpe don't do so well with composites. There are issues with sensitivity due to the chemicals in the bonding agent. Also, larger composites will "pull" the tooth together as they shrink during the initial set, The patient will experience pain, much like a high silver filling. Biting pain, cold sensitivity. Last, composites are usually only good for up to 10 years, with very good hygiene. Why?, because they are glued in, the seal will over time erode from saliva, sugars, bacteria etc. I see a large number oof patients, mostly with bad hygiene, who come in with very large recurrent decay under the composite. Many end up needing root canals.

I'm not saying composites are bad, just be aware of the pro's & con's of them.

Root canals? Three in 5 days. Can be done, but find an endodontist to do them with the newest tools. A GP can do them, but higher potential post op problems.

My advice is one of the larger centers which have multi-discipline doc's on site. They can treatment plan you and set it up for the 5 days. You want it done at least a day before you leave in case of problems.

Good luck.

BJ

[taxexile]

but don't use gold and amalgam in the same mouth......

rarely any problems using those materials together in the same mouth.

If so, these would be filled most likely with a Glass Ionomer filling as this is a non-stress area and they will last a long time and will be cosmetically pleasing. Similar to a composite and more suited for the gingival area.

agree mostly , but there are stresses in that area , especially if the cervical erosion is deep.

enamel prisms can shear off due to the slight bending of the tooth when chewing leaving deficient margins , its not so easy to get a perfect cosmetic result with glass ionomer, even with the latest hybrid ionomers , but if there is enough depth in the erosion area a g.i.base layer with a composite surface layer applied can improve the aesthetics , the g.i.surface is hard to polish smooth and if in contact with the gingiva can cause a mild gingival inflammatory response , but this is hair splitting.

great to see a few dentists here on thai visa.

[Firefan]

Great info here. Thanks. I have had a broken composite filling replaced (w. composite) and now, even after 3-4 weeks, it still is overly sensitive and hurts when I chew. Anything the dentist or I can do about that or can I just wait it out and hope it improves? Cheers!

[taxexile]

if it is just sensitivity to cold , and it only lasts a few seconds then in all probabilty it will settle down.

sensitivity to heat , that lasts more than a few seconds , or results in a throbbing sensation within the tooth should be investigated further.

discomfort on chewing could possible be caused by a high spot on the filling (i.e. a premature contact point on the filling...... when you close your teeth together , all the bumps and valleys and cusps of the teeth will intermesh and contact with the bumps and cusps of the opposing teeth at the same time , if you have just had a filling placed , sometimes the filling is not carved or shaped correctly , so that when you close together , the high spot on the new filling contacts prematurely..... before all the other contacts are made. this results in you giving that tooth a hefty whack each time you close , and after a while the tooth will get sore. its an easy and simple matter for the dentist to check for premature contacts and high spots and ease them off. sometimes its only a matter of a few microns , and you might not be aware of it until after a few days when you notice some toothache.)

if you are still having real discomfort after 3 or 4 weeks i would be inclined to go back to the dentist and ask him to check it.

explain to him the exact nature of the discomfort ( to cold , to hot , to hot and cold , on chewing , after chewing i.e. after biting together painlessly the discomfort appears as you disarticulate the teeth , throbbing pain , lasting for how many seconds etc.etc.etc.) all these sensations have different causes and will help the dentist towards a correct diagnosis of your problem

[meadish_sweetball]

In my experience the doctor will have you try chewing once the composite filling is complete. If you do not signal any pain or discomfort they'll let you go. The problem is, it isnt until you have tried to chew a stringy piece of beef that you truly know if the filling was done correctly or not.

I have had to go back to the dentist twice because of chewing discomfort. There was no additional charge for correcting the filling.