Dental Topics
Pellicano: 915-855-2337    La Quinta: 915-591-1999

Fillings

Tooth-colored (Composite Resins)

A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible. 

The advantage to Composite fillings are not only are they more attractive because they look more natural, they also require minimal tooth preparation.  In other words, less healthy tooth structure is removed to restore the tooth. Also, a sealant can be placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth.

The disadvantage to Composite fillings are they can be subject to wear and tear from tooth grinding and from biting into or chewing on hard objects because they tend to not be as durable as Amalgam fillings (sliver fillings).

Alternatives to fillings in cases of extensive decay or if the baby tooth required a pulpotomy are crowns.  If decay is not treated, it will most likely increase in size and become a larger problem. 

Amalgam Fillings (Silver-Colored)

Dental amalgam is made from a combination of metals that include mercury, silver, tin, and copper. Sometimes described as “silver-colored” fillings, dental amalgam has been used by dentists for more than 100 years because it lasts a long time and is less expensive than other cavity-filling materials, such as Composite fillings (tooth colored). 

Because of their durability, these silver-colored fillings are often the best choice for large cavities or those that occur in the back teeth where a lot of force is needed to chew. Amalgam hardens quickly so it is useful in areas that are difficult to keep dry during placement, such as below the gum line. Because it takes less time to place than tooth-colored fillings, amalgam is also an effective material for children and special needs people who may have a difficult time staying still during treatment. 

One disadvantage of amalgam is that these types of fillings are not natural looking, especially when the filling is near the front of the mouth, where it may show when you laugh or speak. Also, to prepare the tooth, the dentist may need to remove more tooth structure to place an amalgam filling than for other types of fillings.

Is Dental Amalgam Safe?

Although dental amalgam is a safe, commonly used dental material, you may wonder about its mercury content. It’s important to know that when combined with the other metals, it forms a safe, stable material. Be assured that credible scientific studies affirm the safety of dental amalgam. Study after study shows amalgam is safe and effective for filling cavities. The American Dental Association, U.S. Centers for Disease Control and Prevention, U. S. Food and Drug Administration and World Health Organization all agree that based on extensive scientific evidence, dental amalgam is a safe and effective cavity-filling material. The Alzheimer’s Association, American Academy of Pediatrics, Autism Society of America and National Multiple Sclerosis Society—all science-based organizations like the ADA—also say that amalgam poses no health risk.

The Mayo Clinic recently stated that dental amalgam is a safe and durable choice for dental fillings. They also note that "there are several kinds of mercury. The mercury [methylmercury] found in water that can build up in fish and lead to health problems if you ingest too much is not the same type of mercury used in amalgam.

Cavity Prevention

Ultimately, the best dental filling is no dental filling. Prevention is the best medicine. 

You can dramatically decrease your risk of cavities and other dental diseases simply by brushing your teeth twice per day with fluoride toothpaste, flossing daily, eating a balanced diet, and visiting the dentist regularly.

Crowns

If you want a smile that’s your crowning glory, you may need a crown to cover a badly decayed tooth,fractured tooth, protect and strengthen the tooth, or to help restore it to its normal shape and size.

A crown can help strengthen a tooth with a large filling when there isn’t enough tooth remaining to hold the filling. Crowns can also be used to attach bridges, protect a weak tooth from breaking or restore one that’s already broken. A crown is a good way to cover teeth that are discolored or badly shaped.

A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a preformed crown is placed over the tooth. Unlike adult crowns, in which the crown is made to fit the tooth, which require 2 appointments, baby crowns are placed in one visit, because the tooth is prepared to fit the crown.

Advantages to crowns are they are incredibly strong due to the fact that they cover the entire tooth. This protects and strengthens the remaining tooth structure. They are the best chance for survival of a tooth that has had a baby root canal.

There are few disadvantages with crowns, however most children's crowns are silver in color.

Typically there are no good alternatives to crowns. If the tooth has sustained enough damage to require a crown then the best prognosis for the tooth is to receive the crown. Placing a filling on a tooth that should have a crown will likely result in fracture, recurrent decay, and loss of that tooth.

Space Maintainers

Space maintainers help “hold space” for permanent teeth. This is done with a combination of bands and wires designed to hold the remaining teeth in a position that will allow for future permanent teeth to erupt in the proper location. 

Your child may need one if he or she loses a baby tooth prematurely, before the permanent tooth is ready to erupt. If a primary tooth is lost too early, adult teeth can erupt into the empty space instead of where they should be. When more adult teeth are ready to come into the mouth, there may not be enough room for them because of the lost space. To prevent this from happening, the dentist may recommend a space maintainer to hold open the space left by the missing tooth.

The advantage to using a space maintainer is it will minimize orthodontic problems caused by premature loss of a baby tooth and the need for orthodontic remedies. 

The disadvantage is your child will need to wear the appliance until the permanent tooth erupts. If not kept clean, decay can occur under the bands.

Pulpotomy (Baby Root Canal)

A pulpotomy, also known as a baby tooth root canal, is the removal of a portion of the pulp, due to decay that has reached the nerve/pulp of the baby tooth.  

Like adult root canals, the dentist will access the nerve chamber of the tooth, and remove some of the nerve/pulp of the tooth. Unlike adult root canals, this is a very short procedure, as only part of the pulp needs to be removed, and does not require the time consuming filing of adult root canals.

Advantages of a pulpotomy are if the tooth has been symptomatic, this procedure will likely alleviate the pain, in addition to allowing for the tooth to be preserved until it is ready to fall out naturally. 

There is little disadvantage to a pulpotomy. Pulpotomies have a 90% success rate. Occasionally, the nerve of the tooth is so badly damaged that it does not respond to pulp therapy, resulting in the need for extraction of the offending tooth. Certain circumstances increase the likelihood of failure with pulpotomies, your dentist will discuss your child's situation with you during diagnosis.

The only alternative to a pulpotomy is extraction, and placement of a space maintainer. However, if it is possible to save the baby tooth, this is the best alternative because it preserves the appropriate spacing for the adult dentition.

Nitrous Oxide (N2O)

Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for their dental treatment.  Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. The gas is mild, easily taken, then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes. 

Prior to your appointment:

  • Please inform us of any change to your child’s health and/or medical condition. 
  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen. 
  • Let us know if y our child is taking any medication on the day of the appointment. This includes prescribed, over-the-counter, or herbal medications. 
  • Your child can have a light meal prior to the appointment, but no dairy.

Conscious Sedation 

Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious. 

There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child. 

Prior to your appointment:

  • Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment. 
  • You must tell the doctor of any drugs that your child is currently taking (prescribed, over-the-counter, or herbal medications) and any drug reactions and/or change in medical history. 
  • Please dress your child in loose fitting comfortable clothing. 
  • Please make sure your child goes to the bathroom immediately prior to arriving to our office. 
  • Your child should not have anything to eat or drink after midnight the night before their morning appointment. 
  • The child’s parent or legal guardian must remain at the office during the complete procedure.

After the sedation appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm. 
  • If your child wants to go to sleep, place them on their side with their chin up. Wake your child every hour to encourage them to have something to drink in order ot prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible. 
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit. 
  • Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas. 
  • Please call our office for any questions or concerns that you might have. 

Outpatient General Anesthesia

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation or I.V. sedation. 

General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed, ear tubes, or hernia repaired. This is performed in a hospital or outpatient setting only. While the assumed risks are greater than that of other treatment options, if this is suggested for your child, the benefits of treatment this way have been deemed to outweigh the risks. Most pediatric medical literature places the risk of a serious reaction in the range of 1 and 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. The inherent risks if this is not chosen are multiple appointments, potential for physical restraint to complete treatment and possible emotional and /or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection. 

Prior to your appointment:

  • Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection, or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment. 
  • You must tell the doctor of any drugs that your child is currently taking (prescribed, over-the-counter, or herbal medications) and any drug reactions and/or change in medical history. 
  • Please dress your child in loose fitting, comfortable clothing. 
  • Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment. 
  • The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure. 

After the appointment: 

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm. 
  • If your child wants to sleep, place them on their side with their chin up. Wake y our child up every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible. 
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit. 
  • Prior to leaving the hospital/ outpatient center, you will be given a detailed list of “Post-Op Instructions” and an emergency contact number if needed. 
  • Please see a list of our associated hospitals in the “Hospitals” tab at the top of our page.