I WOULD hasten to say that, in my humble opinion, fillings constitute the main failure in dentistry, although a sizeable number of patients may bet on dentures. Unless a patient is under 16 years of age, when the dental pulp has 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. The consequences of that condition are numerous.
In any event, root canal therapy mostly becomes the required treatment for pulpitis. This is probably the most expensive of all routine dental procedures, even though, after this procedure, the life of the tooth is “numbered.”
The price of a single filling by any of over one hundred private dentists in Guyana is about a quarter of the average worker’s monthly salary. Therefore, the average person would undoubtedly be disappointed if, after such an investment, the filling failed to live up to expectations. The situation is calamitous, especially since dental work comes with no guarantee. So, I will explore two major filling failures.
The persistence of toothache after a filling and a filling falling out soon after completion are two of the most common failures in restorative dentistry. It is relatively common, and unfortunately wrong, to be led to have a simple filling done because of a toothache. When a toothache drives someone to the dentist, that person starts at a disadvantage, meaning the successful outcome of treatment is not certain. This is because pain, especially severe pain, signals that the pulp (the vascular nervous package) may be endangered.
Therefore, a filling should be done before any pain develops. That is why regular dental checks are so important: they help the dental practitioner detect caries at an early stage. In doing so, the treatment has the best chance of success, and the patient is more likely to get the desired results.
Fillings sometimes become loose and fall out. This happens for two main reasons. First, the filling material was not retained in the cavity because the cavity was not adequately constructed to hold it. In other words, the cavity was expulsive instead of retentive. A retentive cavity is like the unique aperture in a cardboard puzzle, where the correct piece (filling material) fits exactly and cannot be pulled out when hardened. The dentist must configure (drill) the cavity into a retentive shape (wide at the bottom, narrow at the opening) so the hardened material cannot fall out.
Secondly, fillings can fall out because the area of the tooth adjacent to the filling material becomes soft due to decay. This decay is referred to as secondary caries, micro-leakage, seepage, or infiltration, and it can make the cavity effectively larger than the filling material inside it. These failures usually occur more than three days after the procedure.
People need to understand that the tooth/material junction generally cannot completely prevent bacteria and saliva from penetrating what is really a deep crack. So, in theory, if one brushes a tooth’s crown with intact enamel once, then one must brush a crown with a filling 10 times as thoroughly as one without a filling. Is it not natural for a mother to take more care of a sick child than one that is healthy?
