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Dentistry/Do I really need a filling on these teeth?

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Question
Hi (I am 59 yo male, worn teeth, worn nightgard since age 24, regular dental care):  my dentist of ~15 yrs has recommended fillings on the biting edge of 4 teeth (21, 22, 27, 28)due to wear. There is some visible wear (as if enamal is thin or perhaps worn thru, but doesn't cover more than 1/3 or less of the contact edge, and one tooth I can hardly see anything at all - maybe the head of a pin-size wear spot.  I've noticed this wear before (at least 10 yrs ago), but it hasn't seemed to change much since then; so I'm not clear on the need.  I'm concerned about the stability of these fillings on biting edge; I've had these before - on chipped front teeth, and they never last very long, requiring regular visits to repair, more removal of tooth material, and eventually cosmetic crowns.  All of my teeth have some wear, but these (21-22, 27-28), probably have less than the others (at least the ones without fillings).  At the same time, if there is a risk of letting it go, and the filling would last and hold in place, I would have no problem with it.  I realize dentists are trained and know more about this but I'm still not understanding it and unable to evaluate the need vs. risk.  Please give me your thoughts on doing fillings on the biting edges of these teeth, and what if anything I should ask my dentist (other than to explain it better to me).

Answer
Dear Steve,

Without being able to see your teeth, I cannot render a reasoned answer to your question.

Having said that, I have seen many patients with badly worn teeth.  Many with both the enamel and the underlying dentin worn through.  Some of these teeth have worn nearly to the gumline.  Some of these poor patients require many caps to restore their bite and tooth sizes.  But for most of them I will recommend the conservative placement of bonding materials on the most-worn areas.  With most of today's bonding materials, there is very little, if any, tooth loss.  Often, drilling is not needed.  Their surfaces can simply be etched and the bonding placed over the etched worn areas.  Most bonding materials release fluoride slowly.  This fluoride release tends to harden what's left of the underlying teeth. I do this to protect what's left of the already damaged teeth.  And my patients understand that I am doing this to prevent further tooth wear, and that these may wear down or chip, and need to be replaced over time.  But I'd rather they wear or chip my material than to continue to degrade their teeth.  My son is one of my best customers for these procedures.  He has been a severe tooth clencher since his teeth first grew in.  He's 37 now, and we continue to place thin layers of bonding material over his worn teeth for protection.

I can't tell you what to do.  But I can tell you that your dentist is probably recommending what is best to protect your already worn teeth.  It's up to you to decide if you want to protect them.

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Howard Finnk, D.D.S., P.A., CEO

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Organizations
American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

Publications
"How To Save Money At The Dentist" Going to press soon.

Education/Credentials
Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and Honors
Membership in The Vedder Honors Society

Past/Present Clients
HIPAA rules do not allow me to post this information.

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