Fillings or Extractions: What to Do for Deep Cavities?

Dental filling? Tooth extraction?

Hello, doctor.
I previously had very small cavities in my lower four molars, smaller than an ant but very deep.
When the doctor was drilling, it felt like he was almost through, and it was quite painful.
The doctor later used a "silver" material to fill my teeth, saying that it was too deep to use the white composite.
Recently, I noticed that there is a small cavity at the junction of that "silver" filling and my tooth.
If I go back for a check-up, will he drill and fill it again, or will I need to have the tooth extracted?

joyce, 20~29 year old female. Ask Date: 2011/07/11

Dr. Zeng Guanghui reply Dentistry

Hello, thank you for your inquiry.
I would like to respond to your question and provide the following advice: The four molars have deep cavities.
After removing the affected dental tissue, they will be filled with silver amalgam.
This material is used because the extent of decay is significant, and silver amalgam has a higher hardness, allowing it to withstand greater occlusal forces during chewing.
If, after the filling, you notice small cavities at the junction, please return for a follow-up examination to assess whether further treatment is necessary.
Wishing you peace and happiness.

Reply Date: 2011/07/11

More Info

When it comes to dealing with deep cavities in your teeth, the decision between fillings and extractions largely depends on the extent of the decay and the overall health of the tooth. From your description, it sounds like you have experienced significant decay in your lower molars, which can be quite painful and concerning.

Understanding Cavities and Treatment Options
Cavities, or dental caries, occur when the enamel of the tooth is eroded by acids produced by bacteria that feed on sugars in the mouth. If left untreated, cavities can progress deeper into the tooth, affecting not only the enamel but also the dentin and potentially reaching the pulp, which contains nerves and blood vessels.
1. Fillings: When a cavity is detected early and is not too deep, a dentist can typically remove the decayed portion of the tooth and fill it with a material such as composite resin (white filling) or amalgam (silver filling). In your case, the dentist opted for a silver filling due to the depth of the cavity. Silver fillings are often used for deeper cavities because they are more durable and can withstand the pressure of chewing better than some other materials.

2. Extractions: If the decay is too extensive and has compromised the structural integrity of the tooth, extraction may be necessary. This is often the case when the decay has reached the pulp, leading to infection or severe pain. If a tooth is extracted, options for replacement include dental implants, bridges, or dentures.

Your Situation
Given that you mentioned the silver filling and the presence of a new small cavity at the junction of the filling and the tooth, it is crucial to address this issue promptly. Here are some considerations:
- Follow-Up Appointment: It is advisable to return to your dentist for a follow-up appointment. The dentist will likely perform an examination, possibly including X-rays, to assess the extent of the new decay. If the cavity is small and has not progressed significantly, the dentist may be able to clean out the decay and place a new filling.

- Monitoring: If the decay is more extensive and the tooth is at risk of further damage, your dentist may discuss the possibility of extraction. However, they will typically try to save the tooth if possible, especially if it is a molar, as these teeth are crucial for chewing.

- Preventive Care: Moving forward, it’s essential to maintain good oral hygiene to prevent further cavities. This includes brushing twice a day with fluoride toothpaste, flossing daily, and visiting your dentist regularly for check-ups and cleanings. Additionally, reducing sugar intake and using mouthwash can help protect your teeth.

Conclusion
In summary, whether to fill or extract a tooth with deep cavities depends on the extent of the decay and the overall health of the tooth. Since you have already experienced significant decay, it is crucial to consult with your dentist about the new cavity and determine the best course of action. Regular dental visits and good oral hygiene practices are key to preventing further issues. If you have concerns about pain or the appearance of new cavities, do not hesitate to reach out to your dental professional for guidance.

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