“I have some tooth pain following a tooth extraction a couple of days ago. What is a normal amount of pain after an extraction and what is the expected healing time?

– Question from William from Zillmere, Brisbane

Dr Darryl Marsh replies:

After having a tooth extracted, some discomfort is unavoidable; the amount varies from person to person.

The degree of pain will depend on three factors:

1. The amount of damage to the tissue needed to remove the tooth. Our approach is to perform treatments gently and with minimal trauma. Research shows that patients tend to have less pain after this kind of surgery.
2. The amount of infection at the start matters. If you let an infection get worse, causing inflammation, pus, and damage to the bone, you'll likely experience more pain and have a harder time healing. This is true even if your surgeon is cautious or uses antibiotics.
3. The patient: Since everyone's pain tolerance is different, and some people can handle pain better than others, similar to how some women can give birth naturally while others find it challenging.

Reducing discomfort when having a tooth extracted

Nowadays, dental procedures like tooth extractions don't have to be painful. The local anaesthetics we use, especially newer ones like Articaine, are stronger and last longer. With these advancements, there's no need for anyone to feel pain during a dental visit.

Today, we use modern pain medication along with care filled with kindness, taking it slow and gentle. We also provide modern comforts like DVD players, noise-cancelling headphones, and comfy blankets to help patients relax.

Managing pain after tooth extraction

One of the things that we have also found to be most helpful is a mixture that one of our oral surgeon colleagues has developed. It’s a combination of an antiseptic, chlorhexidine, and vitamins and minerals and, applied to the tissues after extraction. We have found it to be effective in aiding tissues to heal and minimising pain afterwards. We believe it also reduces post-extraction problems with dry sockets and allows wounds to heal quickly with the minimum of pain and swelling.

Here are five home remedies to alleviate discomfort and gum pain after having a tooth extraction.

1. Oral Painkillers
   Following your tooth removal, you may be prescribed pain medication. Taking these as advised can ease your recovery. Additionally, over-the-counter options like ibuprofen or paracetamol are effective in managing pain. These help by reducing inflammation and easing pain.Most people find paracetamol enough, but I often recommend using ibuprofen along with paracetamol because it works better together. Usually, this pain relief is only needed for 24 hours, but sometimes it might be necessary for up to 72 hours. The type of extraction and the patient's needs are the key factors.We always let our patients know roughly how long they can expect to feel some pain after the extraction and give them guidance on how to handle it.
2. Apply Ice to Reduce Swelling
   Swelling might occur as your immune system responds to the surgery. Placing an ice pack on your cheek over the affected area for short periods can help.
3. Carefully Maintain the Extraction Site
   After extraction, blood clots form as part of the healing process to stop bleeding, prevent infection, and minimise irritation. It's crucial to follow your dentist's aftercare instructions to protect the clot, which include:
   • Replacing the gauze pad as required
   • Gently brushing your teeth, avoiding the extraction area for a few days
   • Using a chlorhexidine mouthwash as an alternative to brushing
   • Rinsing with a saltwater solution
4. Consume Soft Foods
   Eating soft foods helps prevent irritation at the extraction site. Avoid hard, crunchy, or spicy foods. Recommended soft foods include: yoghurt, jelly, smoothies, mashed vegetables etc. You can introduce other soft foods like cooked vegetables or rice after a few days.
5. Steer Clear of Certain Activities
   To avoid pain and protect the healing site, certain activities should be avoided after tooth extraction. These include:
   • Strenuous exercise
   • Using straws (which involve sucking actions) or smoking
   • Touching the wound with your tongue
   • Spitting or blowing your nose, as these actions could disrupt the healing process

I have a toothache and am worried I might have to get it taken out. Does a sore tooth always have to be extracted?

“Do all tooth extractions cost the same? Are there alternatives to having your tooth extracted?”

– Question from Jane from Everton Hills, Brisbane

Dr Darryl Marsh replies:

When you have a toothache the severity and the depth of the problem will generally determine the treatment that is required.

The worst case is that the tooth is un-saveable and that you are going to need to have it extracted but often there are other situations that are aren’t as dire or as drastic as that.

Toothaches don’t always mean the tooth has to be extracted

In many cases, the tooth can be saved with just a filling.

In other cases it might be something that is not a toothache at all, it could be a muscular problem. We had a patient at the surgery that ended up in hospital, and the severe pain she had was all coming from his jaw joint.

Don’t jump to dental conclusions!

Ultimately it is very difficult to make a diagnosis without seeing the patient. It’s also very dangerous for patients to jump to conclusions about what treatments they think they need. They may be phoning dentists to find out the cost of a tooth extraction when an extraction is not what they need at all!

Treat infections rather than extracting a tooth

Toothaches may result from an infection that can be prevented rather than needing the tooth to be extracted. The following are cases where this may be the case:

• a gum infection
• the bite on the tooth
• muscular spasms
• Trigeminal neuralgia: a nerve infection of the facial nerves.

The mouth and the head is an area which has a lot of nerves, so there are a lot of possible complications that might cause a toothache. As a dentist step number one is to spend the time to work through all the symptoms and options in a systematic and comprehensive way.

Our textbooks are full of people that have lost numerous teeth or had a dozen root canals when the teeth weren’t the problem at all; the pain was coming from somewhere else.

So does a toothache always mean extraction? No, there are alternatives to prevent tooth extraction in some cases.

Does a tooth or gum abscess always mean an extraction?

Not necessarily. A gum abscess might only require the tooth to be deep cleaned and then treated with antibiotics. Tooth abscesses can sometimes be saved with a root canal treatment.

Extraction is always an option, but it’s only one option. Extraction is rarely the only or best option.

Why extraction is not the best option for toothache?

Most often extracting the tooth is the worst option. Whilst it is the quickest, cheapest and easiest option, it’s very rarely the best long term technical option. We believe that most people who have to use dentures or implants would have preferred to keep their own teeth if that was an option for them.

Do I have to get my wisdom teeth extracted?

No, not all wisdom teeth have to be extracted. About 1 in 3 people need to have their wisdom teeth extracted so it’s not even the majority of people. Many people don’t actually have wisdom teeth. Those people that do have wisdom teeth and enough room and they can come through and be functional teeth.

Wisdom teeth need to be extracted when they’re:

• Not coming through on their own
• Impacted on other teeth
• Coming through at a funny angle
• Difficult or impossible to clean and maintain them

Another solution for wisdom teeth is if they’re not fully through the dentist can remove a bit of gum around the teeth so that the patient can keep them clean easily, I’ve done that many times in preference to removing the whole tooth because wisdom teeth can be just as useful and just as functional as any other molar.

Where do the cost variations come in for tooth extractions?

Generally the cost of a tooth extraction depends upon time and difficulty. We are reluctant to advise extraction costs over the phone without seeing the case as we don’t want anyone to get false expectations. We advise people to come in for a consultation appointment, which is not costly, and from that get a proper assessment, quote and discussion about what is happening in their case.

When tooth extractions are technically difficult

If you have an extraction that’s going to take a long time or is technically very difficult, then it is better to be referred to see a surgeon. We will always try and do what is in the patient’s best interest. If they’re case is risky and the position of the tooth is very close to a main artery or a main nerve there’s a high risk of causing collateral damage.

Those are the situations where I’ll be honest and say: “Look I’m not the person to be removing this. You’d be better off to have this done by a surgeon because they’re have the extra skills and training to deal with the complexities of this extraction.”

We had a lady in recently who had a medical condition where her skin problems meant it would have been very difficult to stitch her. In addition, she had history of allergic reactions to various medications. Extracting her tooth would have been easy but if she has an anaphylactic reaction and this comes with the risk of death. We recommended she have this extraction done in a hospital.

In other cases if a patient has had some history of difficult extractions, one possible reason might be that their teeth are fused with their bone. For us this means their tooth has to be cut out of the bone and that’s not a comfortable thing to be having done while you’re awake.

In cases such as this, just for the comfort and ease of the patient we’ll recommend that they see a surgeon at hospital, have this procedure done whilst they are asleep. It’s just a more civilised way of having things done than sitting there for 3 or 4 hours when someone’s trying to get you to open your mouth that bit wider! If you’re asleep your muscles are relaxed making it a lot easier for the surgeon because you can open wider and they can hold your tongue away without you having to swallow all the time etc.

How to tell the difficulty, risks and costs of a tooth extraction

We can generally make a fair assessment of the difficulty, risks and costs through a consultation. At this consultation we will:

• Look at X-Rays so we can see the position of the tooth
• Have a chat with the patient about their previous experiences
• Have a look in their mouth and just see how the anatomy is

After these things then we’ll generally have a good idea of what the case involves, the options open to a patient and the related costs.

The condition of the tooth matters when it comes to an extraction

If a tooth has multiple fractures then we know as soon as you touch it it’s going to crumble and we will often end up having to cut the bone away to get the tooth out. If the tooth is very badly decayed that can be a real problem because the tooth will just crumble. This will be one of the main reasons extractions can be more complicated than first expected.

Shop around, find all your options and someone you trust

When a patient comes in looking for a cost of a tooth extraction we will do our examination and then have a discussion about what we think is going on, their options and our recommendations and the associated estimate of costs. If they want to compare costs and get second opinions then I would recommend that they visit each chosen dentist to get the most accurate dental quote possible.

Got a question for the dentist? Ask here

How do I best care for my teeth during pregnancy? Does morning sickness damage my teeth?

- Question from Marie in Brisbane’s CBD, Brisbane

For a change, this article is not answered by our dentists, rather Chanelle, our very own Hygienist answers one of our frequently asked questions touching on her own first hand experiences as well.

 

Chanelle Winterburn replies:

For those of you who have not met me yet, I am a Dental Hygienist/ Oral Health Therapist at Today’s Dentistry!

At the time of writing this article I am 35 weeks pregnant with my first child. I suffered through severe morning sickness and following this experience I wanted to share some of the things I have learnt about dental health care and dental problems during pregnancy.

The effect of pregnancy on teeth, gums and dental health

My first piece of advice if you are planning to have a baby or are already pregnant, is that it is important to see your dentist early and maintain good dental hygiene throughout your pregnancy.

Pregnancy has many symptoms and side effects to all parts of your body and your oral health is no different. Pregnancy not only can lead to gum problems and an increased risk of tooth decay for the mother to be, but dental issues such as these can also affect a developing baby!

Causes of dental problems during pregnancy

A pregnant woman has to put up with many adverse side effects of a pregnancy. Here are the main ones that can cause problems with your teeth during pregnancy:

• Vomiting during morning sickness
• Food cravings – particularly indulging your sweet tooth
• Inability to brush due to gagging
• Gum problems

Gum problems and bleeding gums during pregnancy

During pregnancy, your increased hormone levels affect your body’s response to plaque. Plaque is the germ layer on our teeth.

These changes often lead to symptoms including swollen and bleeding gums, particularly when brushing or flossing your teeth. If left undiagnosed and untreated, this can lead to chronic gum diseases and tooth loss.

Research has also shown a direct link between gum disease in pregnant women and premature babies with low birth weight. It is estimated 18 out of every 100 premature births may be triggered by periodontal disease of the gums.

Tooth decay during pregnancy and morning sickness

Vomiting can damage your teeth as it coats your teeth with stomach acid. For this reason do not brush your teeth immediately after vomiting as the enamel is softer and can be more easily damaged.

Instead rinse with water and rub fluoride toothpaste on your teeth (if you can stomach the taste!). Brush your teeth at least an hour after vomiting as this will allow time for the acid to neutralise.

Food cravings and dental care during pregnancy

Food cravings and regular snacking on high sugar foods or acidic foods can cause damage to your teeth. Try and aim for low sugar snacks instead and drink water after you eat them.

Dental research around pregnancy and early childhood

Chewing gum that contains xylitol during pregnancy changes the ratio of bacteria in the mum’s mouth, thereby reducing the amount of bacteria that causes decay. Research has shown that there has then been 70% less cavities in the mouths of 5 year olds studied.

Research has also revealed that probiotics, given to your baby, in the first year of your child’s life, will not only prevent some childhood illnesses but also reduce the risk of decay dramatically for your child throughout their lifetime. There are some health benefits when probiotics are consumed during the pregnancy too. Speak to your doctor, obstetrician or pediatrician for more advice pertaining probiotics.

You are less likely to have dental problems during pregnancy if you maintain good dental health practices.

My top tips for dental care during pregnancy

1. See your dentist regularly. If you are planning to fall pregnant it is easier to get treatment and X-Ray’s done prior to conceiving. If you are already pregnant or there is a chance you might be pregnant then let your dentist know so they can take any precautions to keep your baby safe. This will also let them prioritise your urgent dental treatment around your pregnancy and the birth.
2. Brush your teeth twice daily. Good dental cleaning at home will prevent tooth decay and gum disease.
3. Floss between your teeth. Our toothbrush cannot access the areas where our teeth touch so flossing is an important part of your dental health.
4. Balanced diet. Limit sugary and acidic snacks and increase your calcium and water intake.

Got a question for the dentist? Ask here >

"I've noticed some unusual spots on my child's teeth, and after looking into it, I came across hypoplasia. Could you help me understand what this condition is and how I should address it?"

– Question from Chloe of Albany Creek in Brisbane

Oral Health Therapist, Robyn Russell replies:

What are ‘chalky teeth’?

Chalky teeth (sometimes referred to as hypomineralization) is caused by an insufficient quantity of minerals in the enamel. Our tooth's enamel acts as a kind of armour. When it isn't strong enough, we get what is known as "chalky teeth."

Roughly 1 in 6 children experience this condition. The cases can be quite different. Ranging from a minor issue, to something more significant.

Recently, researchers discovered that this tooth issue isn't always connected to cavities. The reason is not entirely clear. Although genetics may be a factor, other factors, such as environmental ones, may also be to blame.

What happens to children with this problem in terms of teeth?

Whether or not they have cavities, teeth that look chalky are likely to get worse. Because these teeth are delicate, they are more susceptible to decay. However, we're also observing that even when there's no plaque or germs causing decay, these teeth are still breaking down.

The adult molar, which appears at age 6 or 7, is the tooth that is most frequently impacted initially.

Why do parents and dentists worry so much about teeth that are chalky?

Fixing hypomineralized teeth can be tricky. The material used for fillings works best on healthy enamel. Without enough minerals in the tooth, the fillings will struggle to stick. Meaning the tooth will continue breaking.

Sometimes, we can place a crown on these teeth, depending on the situation. But if we notice them late, the teeth may be too damaged, and the only option left is to take them out.

Another significant issue is the pain and sensitivity kids might feel. We really try to make sure our young patients don't link the dentist with pain, but this condition makes their teeth super sensitive. Numbing the teeth for treatment becomes tough. Sometimes we need to do the procedure with general anaesthesia.

How can parents handle teeth that are chalky?

Early intervention is always key. Introducing regular dental visits to your kids at a young age can assist in finding problems sooner.

If detected early enough, we may be able to prevent cavities and tooth breakage in the affected teeth. We often do this by placing stainless steel crowns.

Of course, if you are ever concerned about anything with your child’s teeth, please call us so we can assist you.

FAQ:

How to fix chalky teeth?

Answer: Crowns or special ‘stainless steel crowns’ are sometimes used to help with chalky teeth. These protect the affected teeth from getting cavities and breaking until all a child's teeth are fully grown. It's important to find and treat this early for the best results.

How to fix chalky teeth in adults?

Answer: What we do for chalky teeth depends on how much damage there is. We might use things like dental fillings, enamel microabrasion, or crowns and veneers. The best thing to do is book an appointment with us so we can assess your individual situation and determine the right treatment plan from there.

The reason why my teeth feel chalky?

Answer: Your teeth might feel chalky because of something called hypomineralization, which means there aren't enough minerals in the enamel. This makes your teeth more likely to get cavities and feel sensitive. If you're feeling this, it's a good idea to book an appointment and chat to us about it.

“I have a top denture and a lower partial denture. I am very concerned about preserving my existing teeth and preventing gum shrinkage.

Not to mention that my current dentures are ill-fitting. It’s time for my six month cleaning but I am not happy with my existing dental care – I want a dentist who will listen to me and answer my questions one by one. Can you help?”

– Question from Janine of Chermside West in Brisbane

Dr David Kerr replies:

Our first recommendation would be to talk to your existing dentist about your concerns. If you are not comfortable with that, and since you are due for your six month cleaning, then it is a good opportunity to ‘try’ another dentist and see if their style of communication suits you better.

I absolutely agree with you that the most important thing is to have someone who listens to you and is able to answer all your concerns, especially because these days there are so many options available to you. It is important that you choose the best option for yourself, not just what someone else thinks is best for you.

With regard to the shrinkage of the gum, that is a natural thing that will happen with all dentures. That is why one set of dentures don’t fit and last forever. It depends on how old your current set of dentures are, but usually they will need relining every 3 – 5 years and replacing every 10 years or so. These are just averages, it does vary a lot with usage and individual shrinkage rates.

You are right to be concerned about your existing teeth. Whilst a full upper denture is one thing, a full lower denture is a completely different animal. You never get the suction and the chewing ability of a full lower denture compared to an upper one. So those existing lower teeth are crucial to retaining that partial lower denture that you already have.

The loss of teeth and starting with dentures

Most people will usually loose their back molar teeth first because that is where most disease occurs. Statistically the lower front teeth are the least susceptible to decay and therefore it is not uncommon to see patients still with their six front lower teeth.

Gum shrinkage and having teeth removed

The problem you have when teeth are removed there is not nearly enough gum and bone down the bottom as opposed to the upper, any shrinkage that occurs is more likely to affect the stability of the lower denture much more than the same amount of shrinkage would affect the upper set of dentures.

This is one of the reasons that upper dentures are generally more successful than lower ones.

A large percentage of denture wearers endure ill-fitting dentures

A lot of people who wear dentures are just not aware of the problems that can develop when your dentures don’t fit very well. This includes things like ulcerations or fungal infections. Another one we call hyperplasia, where because the denture doesn’t fit the gum properly the gum then becomes irritated, actually grows to fill that space and then becomes infected.

The other problem to be aware of is that the bone shrinkage accelerates when the dentures aren’t fitting properly because the chewing forces aren’t being effectively transferred to the bone – this mean that the bone is gradually replaced by scar tissue.

We quite often see this when someone has had their teeth removed, hasn’t been diligently getting their dentures relined and fitted properly – then the bone shrinks really quickly. This scar tissue that is left under the denture is unstable and even despite the best fitting denture it will be “wobbly“, ie still move around all over the place due to the tissue below no longer being solid. This is a huge problem, because at that point the dentures won’t sit properly or stay in place.

Our recommendations to our denture patients

Those patients of ours that still have existing teeth to take care of, we recommend they maintain 6 monthly active maintenance visits. For those patients that have lost all their natural teeth and have a full set dentures we generally recommend visiting every 12-24 months.

The likelihood of decay to existing teeth with dentures

If you have a full upper denture against a lower jaw of natural teeth then there is no more likelihood of decay than normal. However if you have a partial denture, because the denture has to clip around the existing teeth, then there is often irritation to the gum. There might also be plaque accumulation because the dentures by nature are slightly porous and therefore more bacteria attaches to them. The clips can put extra strain on the teeth, so when you bite down on the denture the teeth that they are attached to suffer from more wear and tear.

Most of the denture wearing patients that I see are not aware of most of these problems. Whilst patients are told a great deal of information ‘in-the-chair’, by nature of the stressful position they are in, they will not remember even half of what they are told. This is why we give our patients a print out with everything in it for our patients to take away with them.

“A number of years I broke a tooth and had it replaced from halfway down. I am now considering having my teeth whitened and wondered what happens with that tooth.

I do not want to have tooth bleaching done and then have that part that was replaced be a completely different colour. Can it all be the same colour as the real teeth around it with a tooth whitening treatment?”

– Question from Jane of Zillmere, Brisbane

Dental Hygienist, Robyn Russell replies:

You are in the same situation as those patients who have had crowns, veneers or bridges in the past and are now considering whether to whiten their teeth.

People often don’t notice their teeth getting darker

Quite often teeth will darken at such a slow rate that most people simply won’t notice that their teeth have become more yellow or the colours become darker and more intense over time. Often it is someone else that will notice it on you before you pick it up yourself.

It’s like balding. You don’t notice that you are gradually loosing your hair until you meet up with an old (and honest) friend or compare yourself to an old photo. The same can be said with how your teeth change colour over the years.

If you have had a crown or a veneer from many years ago then this gradual darkening change in your teeth may be more noticeable next to either the composite or porcelain that will generally remain the same colour.

If you have used porcelain for your dental work the colour will pretty much be the same as the day you had it done. This incredibly hardy material comes out of the kiln at 960 °C and in most cases has been toned to match the rest of your teeth. Veneers are also often toned within the veneer to darken slightly from bottom to top – this gives them a more natural look and they fit in with your real teeth more seamlessly.

Things to check before doing veneers or crowns

We don’t want to put the cart before the horse so when people are considering veneers or having crowns we take a moment to check in with them about the colour of their teeth.

We check if they are happy with the colour of their teeth and if they have any plans or desires to change or whiten their teeth in the next 5-10 years.

If the answer is YES then we highly recommend a teeth whitening treatment before having veneers or crowns. It is best for patients to get their teeth to their desired whiteness and then colour match your veneers or crowns to that.

Whitening will not damage these past treatments

There is no real down side to having dental tooth whitening treatments in terms of damaging past dental work. It is more of a cosmetic thing. As mentioned above porcelain (and composite resin) are extremely hardy materials that can withstand the tooth whitening process.

Considerations if you are whitening and then doing other dental treatments

The dental whitening process will dehydrate the tooth so there is a period you need to wait between when you finish whitening teeth and then doing any other treatment such as fillings or gluing crowns on teeth.

Firstly, we like to let the colour of the teeth stabilise and the hydration to normalise as it is only then that we will get a good idea of the colour that the patients teeth are in order to colour match the veneer or crown. This is generally a period of 10 days – 2 weeks.

We also wait this time period to ensure the best adhesion or bond between the newly coloured tooth and the veneer or crown. If the tooth is still dehydrated then this adhesion can be reduced if a procedure is done prematurely.

A final note about veneers and whitening – make sure yours are colourised to be natural

When you are whitening teeth, be sure to consider that different parts of the tooth have different intensities of colours, this is just an anatomical thing. The bit of tooth up near the gum is never as white as the edge that does the chewing. The chewing part of the tooth is generally thinner and the colour saturation of the tooth is less at this end.

Some people think that their teeth after whitening or veneers will come out in a uniformly white colour from top to bottom. Whereas what will happen is that they will actually maintain the normal proportions of colour and grading from top to bottom of the tooth. This is a more natural result otherwise you would be left with a result that looks like … dentures!

If you have any other questions about Dental tooth whitening then visit  Tooth Whitening page>

Got a question for the dentist? Ask here >

“Do you think people with old ‘silver’ fillings should have them removed and replaced by more up-to-date materials?”

– Question from Tony of Mango Hill, Brisbane

Dr Darryl Marsh replies:

That’s a very common question and it’s one that is difficult to give a definitive yes or no answer. Although there has been no conclusive research that shows that silver mercury fillings are harmful to your health (regarding mercury leeching), in our experience we have seen a lot of problems that occur underneath these old fillings. These are problems are not easily observed from the surface or with X-Rays and is primarily to do with decay getting under the fillings and cracks in the teeth.

Silver fillings can hide decay

Because silver fillings are opaque to X-Rays, it’s difficult to see a cavity under the filling until they are quite extensive. Research has shown that when you’re examining a patient with silver fillings, if you don’t use any X-Rays you can see 50% of what is going on and with a full set of X-Rays you will still only see about 80 – 85% of what’s going on. So there is 15% – 20% of cavities that we wont be able to see because the metal blocks out this damage.

In some cases, this can mean the difference between getting another filling or having to have a root canal treatment.

Silver fillings are also a factor in teeth cracking

Another factor to consider is the cracks in the teeth, which also won’t show on X-Rays at all. We see this commonly in people in their 40’s or 50’s. For instance Darryl had some fillings put in when he was in his teens and at his last hygiene appointment Robyn noted some cracks coming off those teeth. He has had some sensitivity, which means the cracks are getting deeper, and closer to the nerve and he will have to have those teeth crowned. In his case there’s no new decay there, it’s just a wear and tear issue that is unavoidable with aging.

Do tooth coloured fillings prevent teeth cracks or decay?

We know from the research that silver fillings do not strengthen teeth at all. So a silver filling in a tooth, essentially acts like a wedge, and when you bite down on the filling the forces are transmitted to the remaining tooth structure. If the filling is more than about a half of the width of the tooth there is a good chance that the tooth is going to crack, break or chip. If the filling is a third of the size of the tooth it is less likely but still a risk.

Because the silver filling material was usually just packed in, there is no adhesion of the silver filling to the tooth, which we get with the tooth coloured materials. This adhesion means that the chewing forces are distributed over a greater amount of tooth, making the tooth about 15 – 20% stronger with the tooth coloured compared to silver filling.

The force of biting down with the chewing is also distributed across the whole tooth structure more evenly than it is with silver filling, meaning less likelihood of tooth cracking.

The complexities of horizontal and vertical teeth cracks

If you get cracked teeth, the cracks can sometimes be horizontal, which means a piece of tooth will fall off, and that looks very spectacular, but it’s usually self limiting. The real problem is when the crack is oblique or vertical (where a tooth splits in half and goes down to the nerve). This can lead to tooth abscesses, fractures into the roots and lots of other potential complications. All of this can come with little or no warning at all.

The advantage of tooth coloured fillings in detecting dental problems

There is a lot of variation in the materials that tooth coloured fillings are made from and how they show on X-Rays, so I can’t unequivocally say they are all better to see dental problems using X-Rays.

Where their advantage lies is that on the tooth coloured fillings you can see the problems starting more easily because of staining around the edges. This means the seal between the tooth and the filling is breaking down, which is a sign that something needs to be done. With silver fillings they tarnish and corrode so its much more difficult to identify when there is a problem.

The bottom line: Replacing silver fillings depends on your dental proactivity

Ultimately, whether you replace all your fillings depends on how proactive you want to be. Some patients approach is to only come to the dentist when they are in pain and this isn’t for them.

For other people their approach might be: “My teeth are more important to me and I know it’s going to be more cost affective in the long run. Yes I have to pay more upfront, but its going to be more cost affective to fix problems when they are small rather than when they are big, so I’ll do it sooner rather than waiting till it hurts.”

The different strategies for replacing silver amalgam fillings with white fillings

The strategies I have seen people use vary and there is no ‘one size fits all’. Some people will want to do everything at once and then sleep tight knowing that it’s all sorted out. Others will pick the part of their mouth that is worst and together we will break it up into sections: do the top right this year, the bottom left next year, and so on.

If you are replacing your fillings in stages I would recommend that you replace the bigger ones first as these cause more problems. If you think of your jaw like a nut cracker, you have the hinge at the back, the forces on those molar teeth are eight times the force on the incisor teeth, so those molars are always under more load. The fillings in those teeth also tend to be bigger and better at hiding or decay or causing tooth cracks.

Got a question for the dentist? Ask here >

“I have developed a blister on the gum. It leaks a clear fluid, along with swelling and severe pain…”

“I felt a strange popping feeling in the gum, like bubbles bursting. The fluid tasted a bit like coffee and made my tongue numb...”

“My tooth has gone grey…”

– Sonia from Aspley

Tooth abscess symptoms

While I have seen some strange and unusual symptoms over the years, here are a few of the more common symptoms of a tooth abscess.

Persistent and Severe Toothache:

The most common symptom of a tooth abscess is a relentless, throbbing toothache. This pain can extend to the jaw, neck, or ear, complicating the process of identifying its origin. The pain may intensify during chewing or when applying pressure to the tooth. It often becomes so severe that it disrupts sleep and daily activities.

Sensitivity to Temperature and Pressure:

An abscessed tooth can have extreme sensitivity to hot and cold food and beverages. It is often a sharp, sudden pain that makes eating or drinking a tormenting experience. You may also experience pain when chewing or biting.

Fever:

The body's battle against the infection often leads to systemic symptoms, one of which is a fever. It's the body's natural response to combating infections. It is a clear indicator that things have taken a serious turn and medical intervention is needed.

Swelling in the Face or Cheek:

As the infection spreads, it may lead to noticeable swelling in the face, cheek, or the lymph nodes of the jaw or neck. This inflammatory response is a red flag. Often indicating that the infection is worsening. Potentially threatening more than just your dental health.

A Bitter Taste and Foul Breath:

If the abscess ruptures, it may release pus into your mouth, creating an unpleasant taste. This can result in notably foul breath. The release of pus can lead to a temporary reduction in pain. However, dental treatment is still urgently required to properly address the infection.

The best way to diagnose a tooth with an abscess is with a digital x-ray. We take this while you are in the chair with us, and we can then discuss your treatment options.

Tooth abscess treatment

I often have patients ask me, “Darryl, how can I get rid of a tooth abscess without seeing a dentist?”. Well, unfortunately you can’t. As much as I would love to give you a guide for how to drain a tooth abscess at home, it's not possible.

Treating a tooth abscess at the dentist is crucial to ease pain. But also to prevent serious complications. The most common treatment option is Root Canal Therapy. This procedure removes the infection while preserving the tooth.

If the damage is too extensive, tooth extraction may be necessary. In some cases, a dentist might make a small cut in the gum tissue to drain the abscess directly.

Alongside these procedures, antibiotics are often prescribed. This is to help fight the infection, reduce swelling, and prevent the bacteria from spreading.

It's essential to seek professional dental care immediately if you suspect you have an abscess. Timely intervention can save both your tooth and safeguard your overall health.

“I have had some problems with some previous dental work…

“I had a filling done a few months ago and everything was fine and then I started to get some sensitivity to hot/cold and now it’s a bit tender to bite on. I went back to the dentist and they tried me on a special toothpaste and that didn’t help.

Why is this happening when the filling is only 4 months old? Should I go back to the same dentist for this or should I get a second opinion?”

– Question from Peter from Murrumba Downs in Brisbane

Dr Darryl Marsh replies:

Like all medical procedures when problems crop up following a dental procedure there is not always a clear answer. Things could be a bit more complicated than they first appear.

The biological cost of any medical or dental treatment

With any dental or medical procedure there is a biological cost, regardless of whether it is a tooth, an arm or a heart. When you repair a tooth it will never be as perfect as a completely ‘untouched’ tooth.

In this instance, the decay and the bacteria that caused the decay have produced toxins and poisons that that can weaken the vitality of the nerve. Therefore when you introduce daily ‘wear and tear’ on any tooth, such as chewing, biting etc, this can combine with: decay, stress-cracks, the filling or other habits like grinding. It is that cumulative effect that can result in pain, abscessing or further problems with that tooth.

People often think that once they have a filling in a tooth, then everything is perfectly strong forever and this couldn’t be further from the truth.

What should you do with a reoccurring dental problem?

I would recommend going back and seeing the original dentist that you saw, if you are comfortable doing so. It is always good to give them the benefit of the doubt. They also have notes and records on the original problem.

For instance we take photos, to show our patients and for our own records. In situations like this these photos can be useful to see whether there were small cracks that we chose to keep an eye on, and that these have now become larger cracks and the source of the current problems.

If you find that you are not entirely sure about the reasoning given to you by your dentist then it is worth seeking one or more second opinions from other dentists. We often do this for new patients.

Should I go and see a different dentist?

The problems you are experiencing may not be down to the actions of the dentist you saw and in the first instance it is worth getting the original practitioner the opportunity to assess and rectify.

Every dentist that I know is well meaning and wants to do their best by their patients. They deserve the opportunity to take a look at the problem and talk to you about what went wrong and why.

Questions to ask when seeking a second opinion from a dentist

If you are seeking a second dental opinion I would ask seek that dentist their opinion as to why the new problem has arisen, whether they thought that was a common thing to happen and the recommended course of action.

It is also worth checking what you personally can be doing to prevent this happening to other teeth. If this sounds consistent with what your own dentist is saying then you can be comfortable with your own dentist’s prognosis.

Looking after your teeth in the long term: my very best recommendation

If you have problems with your teeth go and see your dentist at the earliest opportunity as this minimises the ‘cumulative effect’ and the possible repercussions this means for your teeth down the track.

I seen numerous statistics quoted that say that it is anywhere between 8-20 times more cost-effective to have regular check-ups with your dentist than solving problems when they arise.

When dealing with decay if it has gone close to the nerve, the dentist can do their best to clear that out but there is always a chance that the decay has gone to the nerve. That is something that only time will tell – the tooth may be fine for some time and then suddenly flare up.

This is always a chance for any patient and even happens to our patients. For example, I put a crown on one patient 4 years ago and then the tooth became sore and abscessed. In this case it had little to do with the quality of the crown and everything to do with the previous 20 year history of dental disease and the required treatment on that tooth.

Is there a ‘safe time’, after a dental treatment when it can be declared a success?

Problems after dental treatment really can arise at any time. Simply speaking a filling is not just a filling – and what I mean by that is they can’t really be described as a homogenous group.

For instance you have small fillings in big teeth that can last a decade or you’ve got big fillings in small teeth that can last a couple of years, because what gives way in most cases is not the filling – it’s the tooth! It is dependent on so many factors such as lifestyle, habits, dental history etc.

The bottom line is to find and regularly visit a dentist that you know you can trust and rely upon their advice and opinions.

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