THE price that one would pay to have a single filling done by nearly one hundred private dentists in Guyana is approximately 15 percent of a month’s salary of the average worker. Therefore, the average person would undoubtedly find it grievous if after such an investment the filling fails to live up to expectations. The situation is indeed calamitous if one considers that there is no guarantee for dental work done. So I will explore two major failures of fillings.

The persistence of toothache after a filling has been done and the problem of a filling falling out soon after its completion are the two most common delinquent factors encountered in restorative dentistry. It is relatively common and unfortunately wrong to be incited to have a simple filling done because of a toothache. Whenever a toothache drives someone to the dentist that person starts off at a disadvantage, implying that the successful outcome of treatment is not certain. This is because pain, especially severe pain, represents a signal that the pulp ( vascular nervous package) may be endangered.

Unless a patient is below 16 years of age, in which case the dental pulp exhibits a remarkable capacity to combat and overcome virtually any form of aggression, pulpitis (infection of the pulp) generally results in irreversible degeneration of the pulp. Incidentally, root canal therapy then becomes the required treatment. Needless to say, this is probably the most expensive of all routine dental procedures.

It, therefore, follows that a filling should be done in a tooth before any form of pain steps in. That is why it is so important that persons should have regular dental checks so that the dental practitioner may detect a carie in its incipient stage. In so doing, not only would the condition have the best chance of success, but the patient would be relatively certain to get the desired results from the treatment received.

Fillings sometimes become loose and fall out. There are basically two reasons why this happens. First, the filling material was not retained in the cavity simply because the cavity was not adequately constructed to hold the material in. In other words, the cavity was expulsive instead of retentive. A retentive cavity is just like the unique aperture in a cardboard puzzle in which the correct piece (filling material) fits exactly into the aperture and cannot be longitudinally retracted when hardened. It is the dentist’s responsibility to configure (drill) the cavity into a retentive shape (wide at the bottom, narrow at the opening) so that the hardened material cannot fall out.

Second, on occasions fillings fall out because the area of the tooth adjacent to the filling material becomes soft due to decay. Such decay is referred to as secondary caries, micro-leakage, seepage, or infiltration, and results in the cavity effectively becoming bigger than the block of filling material inside it. Usually, these failures occur more than three days after the procedure.

Persons need to understand that the tooth/ material junction is generally incapable of totally prohibiting the penetration of bacteria and saliva into what is really a deep crack. So in theory, if one brushes a tooth’s crown which has intact enamel, once, then one must brush a crown with a filling 10 times as thorough as those without a filling. Is it not natural for a mother to take more care of a sick child than one that is healthy?