Dental Pain: Insights on Silver Fillings and Treatment Options

Q: Dental Pain: Insights on Silver Fillings and Treatment Options

Hello： <br>Q1： This still requires clinical observation and X-rays for confirmation; a diagnosis cannot be made arbitrarily. <br><br>Q2： If there are fixed or removable dentures in the mouth, the internal crowns may also contain metal components, not just dental filling materials

Inquiry Consultation

Dear Dr.
Lin,
Thank you very much for your personal responses and guidance in the articles "#179496 Follow-up Questions" and "#179425 Consultation on Occlusal Pain".
I greatly appreciate it.
I have a clear understanding of the causes of occlusal pain.
I would like to ask Dr.
Lin the following questions:
Q1.
In your response, you mentioned: "Sensitivity after silver amalgam restoration usually occurs right after the procedure.
If there are cracks, leaks, or fractures, it can cause sensitivity to temperature..." I have had my silver amalgam restoration for over ten years and currently do not experience any sensitivity to temperature.
Can I "rule out" the possibility that my silver amalgam restoration has cracks, leaks, or fractures?
Q2.
Furthermore, you mentioned: "...if there are too many different metals in the mouth, it may cause pain (due to potential difference)." I believe the materials used in my dental restorations are only silver amalgam and composite resin, with no other metal materials.
Dr.
Lin, could you please clarify: (1) If I only have silver amalgam and composite resin, could this still create a potential difference that leads to pain? (2) If there is a potential difference causing pain, does it occur only during occlusion, or can it also occur when not occluding?
Q3.
Previously, I asked Dr.
Lin about slight depressions on the surface of my silver amalgam restoration, which appear somewhat uneven.
You mentioned: "The depressions in the old amalgam may be caused by occlusal wear, and placing new material directly on top would likely result in it being bitten off again..." Dr.
Lin, I would like to ask: (1) If I directly fill the depressions with new silver amalgam to make it smooth, will the new amalgam not bond with the old amalgam, making it more likely to be bitten off again? (2) If that is the case, would the only solution be to completely remove the old amalgam with depressions and refill it entirely to achieve a smooth surface that is less likely to be bitten off? However, this approach may damage the surrounding healthy tooth structure, so is it not recommended?
I apologize for the numerous questions, and I appreciate your understanding.
Thank you, Dr.
Lin.

Axiang, 30~39 year old female. Ask Date: 2022/03/15

Dr. Lin Jiayong reply Dentistry

Hello:
Q1: This still requires clinical observation and X-rays for confirmation; a diagnosis cannot be made arbitrarily.

Q2: If there are fixed or removable dentures in the mouth, the internal crowns may also contain metal components, not just dental filling materials.
Typically, occlusion will trigger this.

Q3: (1) New and old silver amalgam will not bond in any way, so it is not advisable to handle it this way.
(2) It is recommended to completely remove the old amalgam to allow the new material to achieve what you refer to as a homogeneous integration with the tooth.
It is not that it is discouraged, but before proceeding, a careful assessment must be made, and there must be a strong indication for the need; otherwise, indiscriminate removal may lead to irreparable damage, causing additional distress for the patient.
How to restore the shape is another factor to consider.

Reply Date: 2022/03/15

More Info

Understanding dental pain, particularly in relation to silver fillings, is crucial for effective treatment and management. Your concerns about the pain associated with your dental work, especially after root canal treatment and the presence of silver fillings, are valid and warrant a thorough exploration.

Q1: Can I rule out cracks or leaks in my silver fillings if I don't experience temperature sensitivity?
While the absence of temperature sensitivity can suggest that your silver fillings are intact, it does not completely rule out the possibility of cracks or leaks. Over time, dental materials can degrade due to wear and tear, leading to microfractures that may not immediately cause sensitivity. It’s essential to have regular dental check-ups where your dentist can perform a thorough examination, including X-rays, to assess the integrity of your fillings. If you experience localized pain, it could still indicate underlying issues such as pulpitis or periodontal problems, even if temperature sensitivity is not present.

Q2: Regarding the potential for electrical differences between silver and composite resin fillings:
1. Can silver and composite fillings cause electrical differences?
Yes, the presence of different metals in your mouth can create a galvanic effect, leading to discomfort or pain. However, the extent of this effect largely depends on the specific materials used and their placement. If you only have silver and composite fillings, the likelihood of significant electrical differences causing pain is lower than if multiple metals were present.

2. When does this pain occur?
Pain due to electrical differences typically occurs during biting or when pressure is applied to the teeth. However, it can also manifest as a dull ache when not biting, particularly if there is an underlying issue with the dental pulp or surrounding tissues.

Q3: Addressing the issue of surface irregularities in silver fillings:
1. Can new silver fillings bond with old ones?
New silver fillings do not bond well with old silver fillings. If you attempt to fill in the irregularities without removing the old material, the new filling may not adhere properly, leading to a higher risk of fracture or dislodgement. This is because the surface of the old filling may not provide a suitable bonding surface for the new material.

2. Should I remove the old filling entirely?
Ideally, if the old filling has significant wear or irregularities, it is best to remove it entirely and replace it with a new filling. However, this approach does carry the risk of damaging adjacent healthy tooth structure. Dentists often weigh the benefits of preserving tooth structure against the need for effective restoration. If the filling is structurally sound but just has surface irregularities, polishing or minor adjustments might be sufficient.

Conclusion
In summary, dental pain can arise from various factors, including the integrity of fillings, the materials used, and the overall health of the tooth and surrounding tissues. Regular dental visits are essential for monitoring the condition of your fillings and addressing any emerging issues promptly. If you continue to experience pain, it may be beneficial to seek a second opinion or consult a specialist in endodontics or restorative dentistry. They can provide a more detailed assessment and recommend the best course of action tailored to your specific situation. Always prioritize communication with your dental care provider to ensure that your concerns are addressed effectively.

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