Expert: Frederick R. Liewehr DDS, MS, FICD - 11/6/2008

Question
Dear Doctor

I am a 26yo female with healthy gums and teeth in general.
5 years ago my dentist discovered 4  "very small cavities" in my back molar and put white fillings on each of them.(i didn't need any anesthetic since they were very small)
the problem is that I keep on losing my fillings! I already had to have 3 replacements for each within 4 years and each time the dentist must go deeper and deeper. as a result I have already had a root canal for one of my teeth! I have seen many dentists and none of them could give me answers to my questions.
Tomorrow I will have to book an appointment with a dentist because a small piece of one of my fillings has gone and I can see some black spot on my tooth.
I brush my teeth twice a day. i don't use chewing gums, I don't clench my teeth. I do have an acidic saliva.
Should dentists use silver fillings in my case?
Please help me. I don't want to end up with more root canals.
Many thanks

Answer
The problem is not with the material, because either amalgam or composite can be used satisfactorily. The problem is with your dentist's technique. If the cavity preparations are properly undermined, and the tooth isolated with a rubber dam to keep it dry, and all the steps are followed, your fillings should not fall out. If amalgam is used, it is less technique-sensitive. However, it cannot be placed in the enamel, it must extend to the dentin. This will require anesthesia, because the interface between the enamel and the dentin, what we call the enamel-dentin junction, is very sensitive. If you are seeing black spots, then your dentist did not remove all the decay or stain. One way or the other, your fillings should not be falling out. I would consider seeing another dentist.