Dental Fillings: Addressing Concerns About Silver Fillings

Inquiry Consultation

Dear Dr.
Tseng,
I would like to ask you a few questions regarding my dental situation.
I have a large silver amalgam filling on the edge of my upper left second molar (adjacent to the first molar).
Today, I noticed a small, uneven depression on the occlusal surface of the filling.
The area is not large and the depression is not deep.
This filling has been in place for about 20 years.
Additionally, I had a routine dental cleaning and examination last month, and there were no cavities found.
Currently, I do not have any discomfort with that tooth.
Here are my questions for you:
Q1.
In your opinion, could the uneven depression on my silver amalgam filling be due to years of occlusal forces causing some wear or degradation of the filling surface? Or could there be other reasons for this?
Q2.
If I decide to address the uneven depression on my silver amalgam filling, can a new amalgam be directly placed into the depression to make the surface even? Or would it be necessary to completely remove the old amalgam and replace it with a new filling?
Q3.
Can I ask my dentist to polish the uneven depression on the surface of the amalgam to make it smooth? Or is it better to leave it alone and allow natural wear from chewing to gradually smooth it out?
Q4.
In your opinion, does the uneven depression on my silver amalgam filling require proactive treatment (such as removing the old amalgam and replacing it or polishing the surface), or can I simply monitor it and address any issues if they arise?
Q5.
Following up on the previous question, if no treatment is performed, what potential harm could come to that tooth? For example, could the amalgam filling become more prone to chipping or breaking?
Thank you, Dr.
Tseng.

Axiang, 40~49 year old female. Ask Date: 2023/03/29

Dr. Zeng Guanghui reply Dentistry

1.
Long-term chewing of food can cause wear on dental restorations, even leading to surface depressions, especially when frequently consuming hard items.

2.
If there are cracks on the surface of the amalgam restoration and the tooth feels sensitive, it is recommended to excavate the amalgam and perform a complete replacement.

3.
If the surface depression is prone to trapping food debris, polishing the surface may be considered.

4.
In cases of restoration fractures or tooth sensitivity, it is advisable to replace the restoration.

5.
There is a possibility that the depressed area may experience greater occlusal forces, leading to complete fracture.

Director Tseng Guang-Hui, Dental Department, Nantou Hospital.

Reply Date: 2023/03/29

More Info

When it comes to dental fillings, particularly silver amalgam fillings, there are several important considerations regarding their longevity, potential issues, and the best course of action when problems arise. Your concerns about the small depression or irregularity on the surface of your silver filling are valid, especially given that it has been in place for over 20 years.

Q1: Causes of Surface Irregularities
The irregularity you are observing on the surface of your silver filling could indeed be attributed to years of chewing and grinding. Over time, the forces exerted on the filling can lead to wear and tear, resulting in small depressions or uneven surfaces. Other factors that may contribute to this include the natural expansion and contraction of the filling material due to temperature changes from hot and cold foods, as well as potential corrosion of the amalgam itself in the moist environment of the mouth.
Q2: Treatment Options for Surface Irregularities
If you decide to address the irregularity, there are a couple of options. One possibility is to apply a new layer of amalgam directly over the existing filling to smooth out the surface. However, this approach may not always be ideal, as the bond between the old and new material may not be strong enough to ensure longevity. The more traditional method would involve removing the old filling entirely and replacing it with a new one. This allows for a thorough examination of the tooth structure beneath and ensures that any potential decay or damage is addressed.

Q3: Polishing the Filling
Polishing the surface of the filling is another option that can be considered. A dentist can use specialized tools to smooth out the irregularities without the need for complete replacement. This can be a less invasive approach and may be sufficient if the filling is otherwise intact and functional. However, if the irregularity is significant or if there are concerns about the integrity of the filling, a more comprehensive treatment may be warranted.

Q4: Need for Active Treatment
Whether or not you need to take active steps to treat the irregularity depends on several factors. If the filling is still functioning well, with no signs of decay or discomfort, it may be reasonable to monitor the situation. Regular dental check-ups will help ensure that any changes are caught early. However, if you notice any sensitivity, pain, or if the irregularity worsens, it would be prudent to seek treatment sooner rather than later.

Q5: Potential Risks of Inaction
If left untreated, the irregularity could potentially lead to further issues. For instance, food particles might become trapped in the depression, increasing the risk of decay. Additionally, if the filling begins to crack or break down further, it could lead to more extensive damage to the tooth, possibly necessitating more invasive treatments such as root canal therapy or extraction.
In conclusion, while your silver filling may not require immediate action, it is essential to keep an eye on it. Regular dental visits will allow your dentist to monitor the condition of the filling and the underlying tooth structure. If you have any concerns or if the situation changes, do not hesitate to consult with your dentist for a thorough evaluation and appropriate treatment options.

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