The Cosmetic Dentistry Blog

Dr. Hall,
I saw another question about pain after having white fillings. My scenario sounds exactly like the one you outlined, where I wanted white fillings (after my wife had several at her dentist that looked great) and my dentist seemed reluctant. I had two done a week ago and have a constant aching on the side of the mouth where they were done.  The dentist warned me about the possibility of infection from saliva and seemed very reluctant when I said I wanted white fillings. The procedure was quite painful. Now I have this aching. Is it likely to clear up on it’s own? I am reluctant to call this dentist back. I am using Advil to help with the pain.
- Mark from Washington

Mark,
Thanks for a great illustration of something I try to teach our visitors — don’t try to push your dentist out of his or her comfort zone. When dentists know how to do these white fillings properly, they far prefer them to the old silver/mercury amalgam fillings. And when they are done right, there is no contamination from saliva.

We have a page on our web site devoted to the reasons for having pain after new white fillings.

If your dentist is reluctant to do a procedure that you want, in most cases it’s wise to back off.

I would recommend getting these fillings replaced by a dentist who knows how to do them right. If they were indeed contaminated during the bonding process, not only have you allowed bacteria to get in the little tubules of the dentin of your teeth, but the filling is not sealed against continual contamination. You may be able to get insurance coverage for this, but even if you can’t, I wouldn’t risk further harm to your teeth.
- Dr. Hall

Related links:
Tooth pain after filling
Silver fillings – many dentists call them silver fillings, but they have more mercury in them than silver. I like to call them amalgam fillings, which is the more correct term for a mixture of silver and mercury.
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Dear Dr. Hall,
Your web site is very helpful and well organized!

I read the Blog question dated July 31, 2007 “Should I let my dentist replace my fillings?” and in my case the cosmetic dentist I just had a consultation with wants to replace my four amalgam fillings (there is nothing wrong with them).

He says that they may crack in the future and he wants to perform a T-Scan after the fillings. He also said that if these fillings are not done now, but changed later, the T-Scan would have to be performed again to measure the proper occlusion.

Should risk replacing these fillings now? What if he cracks a tooth and then I have the added expense of a crown!

Sincerely,
Evelyn from California

Dear Evelyn,
I am suspicious. But please understand that I have limited information here and can only give you my impressions. Maybe you really need these fillings and all of these things you say. I don’t know. But I’m suspicious. At least your dentist is honest enough to tell you there’s nothing wrong with the teeth.

You could say, about any tooth that has an amalgam filling, that the tooth MAY crack. In fact, teeth without any fillings at all MAY crack. I’ve seen that happen. MAY is a pretty loose word. I think you need more than that.

When I did exams, I looked for cracks that were starting to form and already present, and if we saw that, we would do a new bonded white filling to strengthen the tooth, or, if the existing filling was large, we would do a porcelain onlay or a dental crown.

I am suspicious of any dentist who recommends replacing fillings when he or she can see nothing wrong. To me, this is a patient’s option and the dentist shouldn’t try to sway the patient one way or the other.
- Dr. Hall

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Dr. Hall,
Is it neccesary to remove my silver fillings and replace them? A dentist I recently visited advised doing this at a cost of $3600.
- Tina from Texas

Tina,
Replacing them with new silver fillings? Or with white ones?

Over time, your fillings can become leaky fillings. They deteriorate with age and need to be replaced. Or, especially with amalgam fillings, they can crack or become corroded.

A dentist shouldn’t recommend replacing existing fillings unless there is something wrong with the fillings. If they are leaking, then bacteria will seep into the tooth in the crack between the filling and the tooth and will cause tooth decay to start to form under the filling, which can be serious. So my answer is that it depends. Yes, replace them if there is something definitely wrong with them. Otherwise, don’t.

Another possible situation is that sometimes patients want to have all their old silver amalgam fillings taken out and replaced with white fillings, but that is a personal choice by the patient, and I don’t think a dentist should try to talk you into something like that. It’s a completely optional procedure.
- Dr. Hall

Can you have silver fillings taken out and replace them with white fillings?
- Tim from Massachusetts

Tim,
Yes, you can have silver amalgam fillings taken out and replaced with white fillings. People do it all the time. But go to an expert cosmetic dentist who knows what he or she is doing. Most dental schools do not teach the very specialized techniques that are required for doing white fillings on back teeth, and, as a result, patients find out the next day that all their new fillings hurt, and it’s a big problem.

There are a number of reasons for replacing old silver amalgam fillings. The white ones look better, of course. Also, it is easy for tooth decay to hide under silver fillings and the dentist can’t see it. White fillings bond to the teeth, so they leave the teeth stronger. And they are more comfortable, when they’re done right.
- Dr. Hall