Besides routine cleanings today, all the other patients were there for fillings. I got to witness fillings in various places on teeth, and see how older fillings made of certain material eventually chip or cause other problems.
Some patients have older fillings that are made of silver. Silver fillings, especially in the back teeth can cause cracks in the tooth because the repetitive movement of chewing and biting causes the silver to move down and out within the tooth. This movement causes horizontal cracks in the tooth, which can then indirectly reach one of the four corners of a tooth and cause an entire corner to chip off (see diagram below that illustrates this cracking process). When this happens the entire silver filling must be replaced, and then the part of the tooth that chipped away must also be filled. Dr. Sims replaces and fixes these fillings with composite fillings rather than silver because this material will generally last longer and not chip and it also has a more aesthetically pleasing appearance.
Today I also got to see a patient who has a filling in the same spot in all but about 8 teeth. After numbing the patient Dr. Sims took me to review the patient’s x-rays. These x-rays along with the patient’s chart obviously showed that there was a reoccurring pattern the patient was following to cause these cavities to happen. Dr. Sims informed me that this problem was in fact a constant usage of drugs. Dr. Sims explained to me that this continued use of drugs caused. The small cavities at the base of almost all of his teeth were caused by continued drug use, and the majority of these fillings have been reopened and refilled numerous times. This problem will persist and without the stopping of drug usage and without proper hygiene care these cavities will continue to happen. Out of all the cavity fillings I have seen, these were the first where an extra step was required in filling them. Because these cavities are located directly next to the gum line, a coated piece of string is temporarily placed between the tooth and the gum line. This string is coated in a layer of chemical that attempt to prevent the gums from bleeding (out of irritation) during the filling. The string’s main use however is to push back the gum to provide more space to fill the cavity and to ensure that the entirety of the cavity is filled as well. This tiny string was removed from the patient’s gums as soon as the filling was complete, but I was intrigued by the level of ease with which the gums swallowed the string and then put them right back out when the procedure was finished. This patient only had three cavities filled today and still has several that need to be filled, and will need to be treated in the near future.
In other news today besides all of the fillings I witnessed, I was able to watch Dr. Sims provide a patient with a new crown for one of his front teeth. This patient has crowns all across his upper mouth, and also has a partial on either side of his lower mouth. Last week I saw this same patient receive a crown that was not the right color match. So, to see the lab change the color of the crown was quite interesting to me as I got to see the difference it can make in a patient’s mouth when the crown has a color or shape change.
The final patient that I saw today had the most beautiful set of teeth that I have witnessed up to this point in the office. This patient was just in the office for a routine check-up and cleaning, and I was astonished at how perfect her teeth were. This patient is a 21 year old female and on her chart she had not a single cavity anywhere throughout her mouth or anything that would be considered bad. I was able to look at her x-rays and I thought it was amazing that she was able to not have a cavity all of this time.
Today I saw both the very best, and the very worst set of teeth that I have seen so far at the office. Dr. Sims placed fillings in several teeth in several locations throughout the mouth, and it was interesting to me that although all the treatments were for fillings, different materials and tools were needed for each respective filling, depending on where the tooth was throughout the mouth. Besides my learning about dentistry today, I witnessed something slightly tragic at the office. The trusty radio that has been continuously providing background music throughout the office ever since the office opened has been only receiving some signal and the sound has been going in and out since I have been in the office. And today, I believe we might have seen the end of the old trusty radio. I am sad that tomorrow is my last day working at the office, and I am sad that there will be no music to go along with it, but I hope that tomorrow is the best day yet!