Cavity Filling - Long Island City, NY
A Comprehensive guide to cavity fillings
Table of Contents:
What does a cavity look like?
Tooth decay in between the teeth
Tooth decay on top of the teeth
How long do tooth fillings last?
What are cavities?
How to know if you have a cavity.
How to treat cavities.
Other reasons for needing a filling
Reverse a cavity
Is it because you've never seen one before? Or maybe you want to know because you think you might have one and you are wondering if you should come see one of our long island city dentists for a consultation.
Well, look no further because we will show you exactly what they look like. We will try to give as many different examples as possible with multiple tooth decay pictures.
Cavity on the side of the tooth
Cavity on top of the tooth
Decay inside an old dental filling. This will require a cavity repair.
Cavity in between teeth
All of the photos from above are all real live photos taken at our long island city dental office by Dr David Chen. We hope that they are sufficient in answering your question of what do cavities look like.
But just to summarize and drive the point home, the cavities can come in all different sizes from large ones to even a small cavity.
They are typically a different color from your natural tooth structure. As you can see above, most of the time they are brownish or blackish in color while your tooth is more white and yellow. Sometimes they can appear extra white like in the photo of the in between cavity. The outside is very white but right next to the border you can see a brown spot. That is actually the tooth decay penetrating through the enamel and making it into the dentin. Once this process occurs, it is now an irreversible cavity.
Regardless of the discoloration of tooth structure, the cavities may or may not be accompanied by an actual hole. The actual hole in the tooth is called a cavitation. Usually when we see that, we can expect it to be a lot bigger than what it seems once we drill into it and excavate the decay.
Sometimes the dental decay can even penetrate through an existing resin filling. You can see in one of the photos where there is a dark spot inside of the tooth colored filling.
Decay that are in between the teeth
We would like to offer a word of caution because sometimes the caries can be undetectable to the naked eye. They can only be diagnosed by taking dental radiographs.
This is what the two top teeth look like. You don't see any visual teeth decay right? There are no discolorations nor are there any holes to be seen. Both of them look like perfectly good chompers!
Some people think that just because their teeth look visually and feel fine, they must not have any dental issues.
But wait a moment, take a look at the xrays of these two teeth. See the two dark spots on the two top teeth? You guessed it, those are the cavity in between the teeth. We also sometimes call them kissing cavities because they are right next to each other.
Typically on xrays, the "whiter" the object, the more solid it is. Anything that is "dark" is basically air. As you can see this patient has some old fillings which are extra white.
Teeth are suppose to be solid so they do show up as white but notice how the cavities show up as dark spots on the xray. This means that the tooth in that particular spot is becoming less solid, kind of like swiss cheese!
As a bonus, do you see some decay on one of the bottom teeth? We marked it for you.
Now let's see what happens when we begin the cavity removal in between the teeth. Will we find sugar bugs?
You see those two white spots? That is decalcification of the enamel. It is when the enamel is getting weaker and becoming less solid. It is demonstrated by darkness on the xray.
Let's drill a little bit more.
After going a bit deeper, are you seeing the brown spots next to the white? That is the dental decay penetrating into the tooth.
Let's clean out the decay some more.
Would you look at that! All of the decalcified parts and the brown parts are now fully cleaned out. Please excuse the bit of bleeding on the side since it was close to where the gums were!
This tooth is now decay free and ready to be restored with a composite filling.
Since we're having so much fun, would you like to see another example from start to finish this time?
It will be a cavity that is on top of the tooth
Here we go. Can you spot where the sugar bugs are?
Hopefully it was pretty obvious to you but it is literally right on top of the premolar and it is discolored as well, a hallmark of dental decay.
Let's begin the excavation.
This is what it looks like when we open it up but as you can see there is still a lot more brown and soft tooth structure left in there.
We need to clean it out some more.
Now that looks much better. All of the discolored dentin has now been removed. You see how the color looks more like the natural surrounding tooth?
Are you wondering how are cavities filled? We restore the tooth with a white filling.
The cavity filling has now been completed. Looks much better than what we started with right? We hope you learned all of the tooth decay stages with the photos from above since we documented it from start to finish.
Now all you have to do is just brush it and floss it like any other tooth in your mouth. You don't have to do anything extra or special to take care of your tooth fillings. Just treat it as if it was any other old tooth!
But wait, I know what you're thinking... are you wondering how long do fillings last?
How long dental fillings last will depend on a couple of factors such as what type of material it is made out of and the individual's eating habits.
If you are the type of person that eats a lot of hard foods such as ice cubes, nuts, crabs, and etc then you will most likely wear the fillings away faster. You will probably increase the likelihood of chipping or fracturing it if you continue to eat very hard foods.
There is also a difference between the types of filling materials, most notably the silver dental fillings vs the white fillings.
These are made out of a composite resin. They are typically white or in a color that mimics your natural tooth.
They also get bonded onto your tooth so they are less likely to fall off because of the additional chemical bond. This is also the reason why the general public will sometimes refer to this procedure as dental bonding.
If properly taken care of, we've seen the composite bonding last from five to ten years or even more.
They also do not contain any metal or mercury so for those who are particularly health conscious, this filling material would be the choice for you.
These are the old school fillings because they've been around since before the composite bonding was even created.
They are composed of mostly mercury and silver with a little bit of tin, zinc, and some other trace metals.
Most notably they look like metal or silver and that may be a cosmetic concern for some individuals but the plus side is that they are very sturdy and can last a long time. We've seen some that have been in the mouth for 10-20 years even!
They are also not bonded in. How do the fillings not fall out you ask? They are actually held in by undercuts that are made in the tooth! So technically the amalgams just sit there and is locked into the tooth by mechanical retention.
Examples and more information about amalgams
This is what the mercury fillings look like. Definitely not as pretty as the tooth colored fillings but they tend to be very sturdy. There are downsides to them though...
If the silver fillings are of a pretty decent size, sometimes they can cause crack lines in the tooth as you can see above. It has two crack lines. This is because the filling is made of metal and metal will expand and contract as it goes through temperature changes from hot to cold and back. It just ever so slightly does this and sometimes it is enough to cause the crack lines.
When we see crack lines like these, our LIC dentists do recommend to have them removed and replaced because we do not want them to get worse. I hope you can imagine what can happen if the cracks keep growing bigger! The removal process is pretty straight forward, you literally just drill them out.
One last point to be cognizant of is that they are made of approximately 50% mercury. Due to current health trends around the world, the general population has been mercury adverse and many people would prefer to not have excess mercury within their body. It is not uncommon for individuals to avoid mercury all together such as abstaining from the consumption of large seafood.
Here is a little tooth trivia bonus!
Sometimes the amalgam can leech out and enter the surrounding soft tissue such as your gums and cause what is known as an amalgam tattoo. This is typically seen more often with a back tooth cavity filling. We haven't seen too many in the anterior portion of your mouth, maybe its because we don't really use silver fillings for the front teeth. The condition is harmless and not painful but it may be alarming when patients notice it for the first time.
What is a cavity?
Oh no, we are so sorry! We've been showing you what intraoral photos of cavities look like in the mouth but we didn't go over what the definition of it was.
The true definition of a cavity is a hole and a dental cavity simply means that it is a hole in a tooth. We tend to use that word interchangeably with caries. Caries is what dental professionals call it and it is a disease.
This disease cannot be cured nor can it be eradicated. It must be managed just like how you cannot cure diabetes but just manage it. Therefore if you were looking for some miracle vaccine, we would advise you to look no further because tooth decay cannot be eliminated permanently nor will cavities go away on their own.
Without further ado, let's jump into how we can make some caries on our own! That is right, we will tell you the recipe to form one.
The Four Factors needed to cause a dental cavity.
The bacteria are the worker bees that actually cause the hole.
We cannot eliminate bacteria completely but we can reduce their numbers on a daily basis by brushing twice a day and flossing before bed time. Last but not least, get a professional dental cleaning every 6 months! Please check our page on gum health for more information on plaque and calculus.
This is the fuel that feeds all of the bacteria.
If the bacteria don't get to eat then they don't do any work so please try to minimize your sugar intake throughout the day.
Don't forget that cocktails and alcohol tend to contain quite a bit of sugar! Another hidden source of sugar would be any type of carbohydrate based food such as pasta even though they don't taste sweet.
A host or rather a human is needed for the bacteria to colonize and infect. If there are no teeth then there is no cavity to be made.
Good oral hygiene habits are hard to beat. Brushing twice a day and flossing before bedtime will keep the sugar bugs at bay.
Toothpaste with fluoride and an electric toothbrush are both highly recommended.
Cavities do not develop overnight instantaneously but rather over an extended period of time.
Therefore it is imperative to be consistent with our oral hygiene. You can slip up every once in awhile but too many times is no good.
Just to expand a little bit on the above four factors.
You need all four factors to create caries with the emphasis on need. If you are missing either one of them then the cake will never leave the oven so to say.
If you kill the host or the host loses all of their teeth then there would be no caries.
If you don't eat any sugar or carbohydrates then its also not possible to form one. In fact if you don't eat anything at all, it would be impossible to get one!
The bacteria cannot be eliminated and will always be present in your mouth. They've been colonizing your mouth since the day you were born. It is presently not possible to sterilize your mouth to be bacteria free even though your parents might've been threatening to rinse your mouth out with bleach since you were a kid.
The last important factor is time because Rome wasn't built in a day and neither are cavities.
Putting all of these together we can summarize it into a concise actionable take home point.
Dental cavities are a result of a low pH over time.
We were talking about sugar specifically but actually any type of food or substrate that will drop the pH in your mouth will produce a favorable environment for the bacteria to work. This means anything sour, spicy, or acidic will do the trick. Are you wondering how it works when there is no sugar? It is because the other types of food that you may be having with the meal will contain sugar! For instance you could be having some bread and butter with your glass of red wine. The only way to prevent a cavity is by practicing abstinence.
Do I have a cavity?
Great! Now you know what they are and pretty much with what they look like but are you curious as to what symptoms they may elicit to notify you that you have a cavity?
Sensitivity to sweets may be an early warning sign that you may have one forming. Although this is not the most accurate indicator for if you potentially have one because most people are not able to sense the sweet sensitivity. Only a small percentage of the population can feel the sensitivity at all. So even if you are not feeling anything, you're still not caries free.
Most small cavities actually do not cause any pain whatsoever. They will very quietly grow undetected for a long period of time. The only way to catch these if you don't feel any symptoms would be to see the dentist. Our long island city dentists will catch them for you by visual examinations along with xrays.
Large cavities that are close to where your nerve is may cause you a toothache. This will be a throbbing type of pain. Some may people describe it like a heartbeat that is pulsing.
This is an xray of a medium sized cavity. Take notice of the size of the dark spot.
This is an xray of a very large one along with some smaller ones. Notice how the big one is very close to the nerve.
As you may have noticed in these examples, they can only be diagnosed by radiographs so it is very important to go to your biannual check ups.
Cavity filling procedure and the steps to filling a cavity
Once you have confirmed that you have caries, you should get it treated as soon as possible so that it doesn't grow big enough to cause you pain.
Our motto is to stay ahead of the pain rather than follow behind it!
Treatment for tooth decay is primarily by getting a cavity filling by your dentist
Do fillings hurt and how do dentists fill cavities?
I'm sure you're wondering that but for nearly all of the procedures that we do, you will be numb for it. We will give you a local anesthetic called lidocaine. In the past, the more widely used product was novocaine and some people still refer to it as such even to this very day. They both still function very similarly!
Once you are numb, we can begin the cavity filling procedure. The numbness should last for about 2-3 hours even after the procedure but if it lasts longer than that, you may have prolonged numbness.
Filling a cavity first begins with removing the decay with our highspeed handpiece. This instrument spins very quickly and squirts out a lot of water to keep the tooth cooled. Due to the high RPM, it generates a lot of heat so it requires cooling. That's the reason there is a lot of water!
The tooth should now be clean and ready to fill. For white fillings, the teeth will be bonded chemically to a composite dental resin. We will treat it first with a conditioner, followed by a tooth primer, and finally with a dentin bonding agent.
Then we start layering on the composite resin. The dental composite is actually very malleable at room temperature, similar to cookie dough. You can push it and adapt it to the tooth at varying angles and shapes. Then each layer needs to be cured by a dental curing light.
The curing light basically hardens the resin via various wavelengths. The light can emit different colors depending on the brand of light that you use but ours is light blue.
Our office uses the best light on the market and consequently the most expensive one as well because we think it is worth it. We use the VALO grand. It emits a custom multi wavelength LED at a high intensity light of 385-515 nm. It also produces power up to 3200 mW/cm2. Last but not least, it is made of aircraft grade material so its indestructible even if we drop it on the floor!
Our favorite feature of it is that it can do a three second cure. The vast majority of products on the market need a 10-20 second cure per layer. Think of all the time that we can save with this. It also shortens the procedure time for you as well. Now you don't have to spend over an hour for your tooth filling appointment. We can typically get it down to about 30-45 minutes per appointment.
Why this saves so much time is that you have to cure in multiple layers and if you add up all of the 20s it becomes a substantial amount of time.
Why do we layer composite? This is because the light can only cure a certain thickness to begin with. The thicker the layer, the less likely the light is able to fully penetrate through the filling material. Last but not least, if you do a big glob at once, there is shrinkage stress that can cause post-operative sensitivity from the filling. The material will typically shrink towards the light.
We do many layers so that we can minimize your tooth sensitivity afterwards and all of this is possible because of this amazing curing light. Sometimes the sensitivity can get very bad and you can have a throbbing tooth pain that comes and goes. It is worthwhile to place multiple layers!
Once the material is fully set and hard, we can start adjusting the filling by polishing it down so that your occlusion is normal. What we mean by this is when you bite down and the filling doesn't feel high. We check your bite with an articulating paper that leaves a blue mark on your tooth. The blue spots demarcate the high spots. It may be hard to tell if the bite feels right or not during the procedure because you're numb so if you feel like you have an uneven bite after the numbness wears off, please come back in so that we can adjust it for you. It would only take about 15 minutes at most.
Just for clarification, the bite may be ever so slightly different but it shouldn't be uncomfortable. It can be different because sometimes we may change the shape of the filling and restore it to its ideal morphology. As long as it doesn't cause you discomfort and it feels about 99% close enough, you should be good to go!
That's it for the cavity filling procedure. Did we answer your question of how are cavities treated? If not, please drop us an email and we can expand upon it.
Don't forget, you do have to wait before you can eat after a cavity filling. Wait for the numbness to wear off at least.
Other reasons for needing a filling
There are times when you might need a filling even if you don't have any dental caries.
You don't like the shape of the tooth
To cover up the surface of the root from gum recession causing cold sensitivity
Chipped tooth or broken tooth
A lot of people can chip their teeth through normal wear and tear activities such as eating hard foods. We've seen people bite into an unsuspecting olive pit or a fork causing a chipped tooth. We understand that having a chipped front tooth may make it difficult for you to smile but thankfully a chipped tooth can be repaired.
How to fix a chipped tooth
The damaged enamel can be repaired with some simple teeth bonding if it is a small chip. Of course you would need to schedule a visit with the dentist for the chipped tooth treatment and hopefully with one of our dentists in long island city!
The entire treatment is the same as the tooth filling process, its just that the reason for getting it is different.
A lot of times, the chipped tooth repair process does not require any local anesthesia since the damage is usually confined to the enamel.
The surface of the tooth just needs to be roughened up.
Next, a conditioner is applied, followed by a tooth primer and bonding for the tooth.
Finally we place a tooth colored composite resin to restore the dentin and enamel.
Now you are basically done and just need the composite to be polished and contoured.
You're probably wondering, how much does it cost to fix a chipped tooth?
The cost to fix the broken tooth is actually the same fee as it would be if you got a cavity filling or a cavity repair. The process is exactly the same so there is no reason why the cost would be different. There is one exception though and that is if you want a composite veneer.
What is a composite veneer?
If you don't like the shape of your tooth you can get some dental bonding to change the shape of it. It is akin to cosmetic surgery for your tooth. We like to call these composite veneers and yes they are different from porcelain veneers.
The main difference between them is the type of material that they are made out of. The composites are made of a resin while the porcelain veneers are made of porcelain. Consequently, the veneers need to be fabricated in a laboratory while the dental composites can be completed from start to finish in the office.
The similarity is that both of them are bonded onto your teeth but typically, the porcelain will have better color stability over the long run.
Composite veneer cost
The fee for a composite veneer bonding is actually different from regular fillings. This is because it requires a lot more work. Typically you have to sculpt the entire facial portion of the tooth or the front part of the entire enamel surface. This requires a lot of bonding material.
The fee will be more than a regular tooth filling but it will be less than a porcelain veneer or a porcelain crown.
Teeth having cold sensitivity
Sometimes your teeth may experience sensitivity to cold. The cause is often linked to gum recession, which may be caused by aggressive brushing in combination with a hard toothbrush or from clenching and grinding your teeth. Both will potentially give you the same result.
Just to emphasize, your mouth is a very delicate place and the gums are even more delicate so please do not use a hard brush and switch to a soft toothbrush. The only reason they sell hard toothbrushes is because people buy them and not because it is actually needed in this world. We will cover more of this later!
Once the gums recede, the root of the tooth will be exposed which will make the tooth sensitive to cold. The gums are akin to wearing a coat during the winter time. If you walk outside with no coat on of course it would be cold. If you have receded gums then of course it would be sensitive to cold. The root is very sensitive. Treatment for this consists of using a toothpaste for sensitivity or bonding to cover up the root surface of the tooth.
If the cold sensitivity is very bad, we may refer you to the gum specialist for gum grafting. This procedure will harvest a a patch of your gum from the roof of your mouth and augment the area where there is recession.
Alternatives to conventional fillings
You may be wondering... but doc what if I don't want a filling? Can you reverse a cavity?
It is possible to reverse a cavity but only the very small ones. The explicit criteria for it is that it has to be what we call an incipient caries. These are decay that are located solely in the enamel. If the caries has breached through the enamel and into the dentin, then it is no longer reversible and has become irreversible.
If yours fit the criteria and you want to proceed conservatively, you can monitor it for now by getting check ups every 6 months. You should also stay on top of your oral hygiene regime by flossing and brushing. It is also very important to use a fluoridated toothpaste. A simple toothpaste with fluoride will help reverse the cavity.
How does fluoride reverse cavities
YES, you heard me correctly the first time and I will repeat it again.
FLUORIDE CAN REVERSE TOOTH DECAY.
Fluoride will reverse small cavities or incipient caries via the process of remineralization. Our bones and teeth are composed of a naturally occurring mineral called Hydroxyapatite. This mineral contains a lot of calcium phosphate. If you recall, calcium is good for your bone and also good for your teeth.
Hydroxyapatite actually makes up over 90% of the foundation of our enamel and approximately 60% in the case of our bones. Fun fact: Your enamel is the hardest substance in your body.
The remineralization process occurs by replacing the hydroxyl ions, -OH groups, with a fluoride ion F-. Once this occurs the Hydroxyapatite becomes Fluorapatite. This new structure leads to increased stability of the crystals as well as increased hardness. Both of these new effects combined will protect your enamel against the effects of a low pH environment in your mouth. Remember that caries thrives in a low pH environment!
This is why it is important to use a fluoridated toothpaste. Sometimes if it is necessary, we can even give you a prescription toothpaste, which basically has an even higher concentration of fluoride. Alternative if you want fluoride free, you can check out hydroxyapatite toothpastes.
Last but not least, don't forget to just decrease carbohydrate intake! That can probably solve all your problems but it still doesn't hurt to have an extra layer of protection by using fluoride.
Historically, studies have shown that communities with non-fluoridated water supplies tend to lead to increased need for dental care. That is not to say that it is absolutely necessary to have fluoride but rather that you must be extra vigilant if you are to go sans fluoride.
Mohs Hardness Scale
While we are on the topic of hydroxyapatite, we should review why enamel is the hardest substance in the body! Your enamel actually has a mohs scale of hardness of a 5.
What is mohs hardness scale?
It is a qualitative scale from the range of 1 to 10 characterizing the scratch resistance of various minerals. Basically enamel sits right in the middle but to give you an idea for comparison for the scale:
Calcium; Fingernail (2.5)
Gold, silver, zinc, aluminum
Iron, nickel, steel
Tooth enamel, zirconium
Are you surprised that your enamel is harder than steel and even gold? With that being said, it is more brittle than steel though. This means that your metal fork will not scratch your enamel no matter how hard you try. If you bite down hard into the metal fork, it will cause a chipped tooth though. Unfortunately, it usually results in a chipped front tooth since that is where you're biting with.
Don't feel like going to the dentist after that happens... are you wondering about how to fix a chipped tooth at home? Unfortunately you can't fix it on your own.
Temporary Tooth Filling
There are temporary fillings for teeth which you can purchase at your local pharmacy. They are to be used solely for emergencies where you can't get to the dentist and your filling fell out.
More times than not, the individual using it does it incorrectly so it is never as effective as it could be. You should really clean out the tooth really well first and then put it in but you also have to make sure that the bite is okay. Afterwards you should definitely not floss in between if it is in between so that you do not accidentally dislodge the temporary.
More commonly, most dental offices do use temporary fillings but they are used in between appointments for root canals. The root canal specialist will typically put a temporary filling in your tooth so that you can return to your general dentist for the permanent restoration. They put a temporary in there so that it can be removed more easily. A permanent one would take a long time to remove.