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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Evidence is lacking on adhesive bonding for amalgam fillings

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c. Spectrum Family Dentistry, under CC Licence

Tooth decay is a common problem affecting both children and adults. Cavities form in the teeth by the action of acid produced by bacteria present in dental plaque or biofilm. A number of techniques and a variety of materials can be used to restore or fill teeth affected by decay. One of the most commonly used and comparatively cheap filling materials is dental amalgam (a mixture of mercury and metal alloy particles). The review authors sought to evaluate the added benefit of using an adhesive to bond amalgam to tooth structure to see if bonded fillings would last longer and perform better. 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