Teeth restored using atraumatic restorative treatment may be more likely to fail, but evidence is low quality

Dental caries (tooth decay) has been considered the most common global disease. Conventional methods (drill and fill) involve the use of electric drills to clear away decayed areas of tooth before filling. Local anaesthetic (painkiller) is normally injected to prevent pain during the procedure. Conventional treatments require highly trained dental health personnel, access to electricity, appropriate tools and are more expensive. These factors may limit access especially in underdeveloped regions of service provision. Atraumatic Restorative Treatment (ART) is an alternative approach for managing dental decay, which involves removal of decayed tissue using hand instruments alone, usually without the use of anaesthesia (injected painkiller) and electrical equipment. Continue reading

Lining the cavity to protect the tooth pulp: what’s the evidence?

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Tooth decay is the most common disease affecting children and adults worldwide. If left untreated, acid produced by bacteria in the dental plaque or biofilm forms cavities or holes in the teeth. A number of techniques and a variety of materials can be used to restore or fill teeth affected by decay. One of these materials is tooth-colored, resin-based composite or RBC. This material is increasingly used as an alternative to amalgam (a mixture of mercury and metal alloy particles).

Since the 19th century liners have often been placed in cavities in the teeth under the filling material. The liners are thought to protect the living pulp of the tooth from filling materials themselves and also from their potential to allow more heat or cold through than the natural tooth would. Although RBC filling materials are thought to be similar to the natural material of teeth in terms of how they conduct heat, sensitivity to temperature change is sometimes still an issue for people after treatment.
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Should you use a crown or a filling to restore a root-filled tooth?

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Photo by Rosario Van Tulpe, reproduced under Creative Commons licence

Root filling is a fairly routine dental procedure in which the injured or dead nerve of a tooth is removed and replaced by a root canal filling. However, the restoration of root-filled teeth can be quite challenging as these teeth tend to be weaker than healthy ones. A dentist may use crowns (restorations made outside of the mouth and then cemented into place) or conventional fillings (direct filling with materials such as amalgam or composite/plastic resin). Although crowns may help to protect root-filled teeth by covering them, conventional fillings demand less in terms of time, costs and removal of tooth structure. Continue reading

Amalgam fillings versus resin composites

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Photo copyright Jeffrey Dorfman, released under the Creative Commons Attribution-Share Alike 3.0 Unported license.

There is some controversy over the best materials to use when restoring or filling holes caused by tooth decay in permanent teeth at the back of the mouth. Amalgam fillings are cost effective and have been used for over 150 years. However, their use has declined over recent years, partly because of the way they look and because of the perceived risk from the mercury they contain. Tooth-coloured (composite resin) fillings are frequently used in the front teeth and in the teeth at the back of the mouth. But which is better overall? This Cochrane review compares the two restorative materials in adults and children with permanent teeth. Continue reading

Faulty metal-based fillings – to repair or to replace?

Amalgam fillingDental fillings have a limited life span, and this research looks at whether it is better to repair or replace faulty or degraded fillings made of dental amalgam (a mix of various metals and mercury) in molar teeth. Traditionally, faulty fillings have been replaced, however this approach can lead to further loss of the tooth as the cavity is emptied and then refilled. Repairing the faulty filling is a different approach, which may be more cost effective and cause less pain and anxiety for the patient. Continue reading

Is it better to repair or replace faulty non-metallic fillings?

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Resin composite filling

Fillings are used as part of general dental treatment to rebuild teeth after a patient develops tooth decay or damages the surface of their teeth in some way. Tooth-coloured filling materials (resin composites) have increasingly been used as an alternative to traditional amalgam or metallic fillings. As with any filling material, these fillings have a limited life-span and eventually problems will occur when they break down or become faulty. In the past, faulty fillings have been replaced, however this approach may lead to the loss of further bits of tooth as the cavity is emptied and refilled. An alternative approach is to repair the faulty filling. Repairing fillings can take less time, and may be less distressing for patients as sometimes they can be done without the patient having to undergo an anesthetic. Pain, anxiety, time and cost may all be lessened by repairing fillings rather than replacing them. Continue reading

Lack of high level evidence on the effects of antibacterials in resin-based fillings

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Should we be using resins containing antibacterial agents to fill these cavities?

When tooth decay or caries has caused a cavity to form in a tooth a range of materials can be used to fill it. These include resin composites, glass ionomer cement, amalgam and compomers. Tooth decay that may develop next to or underneath a filling at a later stage is a common concern in dental practice and may reduce the life span of these fillings. It is thought that the inclusion of a substance that kills and preventions the growth of bacteria in some dental fillings could help prevent the development of secondary caries. Continue reading