The notching of abfraction

Bite adjustment

Natural looking restorations

What Is Abfraction?

Abfraction is the commonly seen condition of notching of the teeth near or even under the gum line. Though a combination of hard toothbrush bristles and improper brushing techniques can cause enamel to be lost at the gum line, this is not the cause of abfraction.

When your bite is slightly off, it's common that one tooth may hit sooner than the rest. This causes undue stress on the involved teeth and they begin to flex. It's this continual flexing and stress that, over time, causes the enamel to separate from the inner dentin layer, forming the familiar looking notch associated with abfraction.

How do we correct abfraction?

There are two steps involved in solving the abfraction problem. First, we need to adjust your bite. We may have to adjust only the tooth in question, or we may have to adjust all your teeth. Chewing forces must be evenly distributed among all your teeth. We may have to have you back several times as we carefully fine-tune your bite.

The second phase involves restoring the damage by bonding a filling in place. White, natural looking fillings can fill in the damage and restore the tooth to nearly its original color and shape.

Dealing with an abfraction problem early by adjusting your bite and placing a filling prevents further damage and restores your teeth to their normal shape and color.

Visible cavity

Decay can spread

A hidden cavity

What Are Cavities?

How cavities form

Plaque, a sticky film of food and bacteria that is constantly forming on your teeth, is the culprit when it comes to tooth decay. Bacteria that naturally exist in plaque break down the starches and sugars in the food you eat. A chemical reaction occurs, and as a result, an acid is produced. Like all acids, the acid produced in your mouth is corrosive, which means that it dissolves other materials. Your teeth are the victims of this corrosive action; the acid dissolves their protective outer enamel layer, eventually creating holes in your teeth (cavities).

Regular checkups are a must

Cavities first form in the hard, protective enamel layer of your teeth. Beneath the enamel is a softer layer called dentin. If a cavity wears through the enamel and reaches the dentin, it can grow much more quickly and threaten the inner layer of the tooth, containing its nerves and blood vessels. This part of your tooth is called the pulp chamber.

If the decay is allowed to penetrate the enamel and dentin and gets into the pulp chamber, it's likely that we'll need to perform root canal treatment. That's why regular checkups and professional cleanings are so important; they allow us to restore your tooth while the cavity is still small and confined to the outer enamel layer.

Diagnosing cavities

Sometimes, we can detect cavities just by looking at your teeth, but to find cavities in their early stages when they are very small, we use a dental explorer and X-rays. A dental explorer finds cavities on the surfaces of your teeth; the explorer catches or sticks in the tiny pits created by cavities. X-rays locate cavities between teeth where the explorer can't reach.

Repairing and preventing cavities

To repair a tooth with a cavity, we usually remove the decayed portion of the tooth and replace it with a filling, provided the damage is not extensive and there is still plenty of healthy tooth structure remaining. However, preventing decay in the first place is the preferred solution! We'll be happy to work with you so you'll learn to keep your teeth free of plaque and decay.

Bacteria between the
tooth and filling

Expansion caused by moisture

Inspecting fillings

Leaking Silver Amalgam Fillings

Even when a filling isn't loose or obviously broken, it may still have problems. For a filling to protect your tooth, it has to seal out bacteria. When a filling has begun to let bacteria into the tooth, we say that the filling is leaking.

What is a leaking filling?

A common misconception is that a silver filling will last forever. Amalgam is one of the most durable filling materials, but amalgam fillings don't last forever. Some may last for more than a decade, but others can begin to fail in as little as five years.

What causes a filling to leak?

Many conditions in the mouth can cause an amalgam filling to leak:

Amalgam fillings swell when they absorb the natural moisture in your mouth. This expansion creates a wedging effect in the tooth that can fracture or break off tooth structure.
This expansion can also lift the surface of the filling slightly in the tooth, creating a gap at the margin between the filling and the tooth.
Temperature changes in the mouth can make the amalgam both expand and contract, creating many small gaps or micro-fractures in the tooth or filling.
As amalgam fillings age, they turn black and the edges of the fillings wear away.

Replacing the filling

Because a leaking filling no longer protects the tooth, more decay and other more serious problems may occur. When this happens, it's important to replace the filling with another restoration.

We'll inspect your fillings every time you come in for a checkup and recommend a new restoration at the appropriate time.

Bacteria

Acid causes decay

How Teeth Decay

Our goal is to help you prevent tooth decay and keep your natural teeth for a lifetime. That's why we want you to understand the process of tooth decay, from start to finish. Armed with this knowledge, you can take steps to stop tooth decay in its tracks.

Bacteria and sugar are the culprits

Thousands of bacteria exist in everyone's mouth. Most of these bacteria are beneficial. But there are two types of bacteria, mutans streptococcus and lactobacillus, that are the primary culprits in the tooth decay process. If you're not brushing and flossing regularly, or if your oral environment is out of its natural balance, these bacteria reproduce quickly in your mouth, establishing huge colonies whenever they're given the opportunity to feast on foods that contain sugar.

Sugars, which are the building blocks of starchy foods like pasta, crackers, bread, and sweets, can build up on your teeth if you don't brush regularly. This sugar buildup is one component of plaque, a sticky film of saliva, food debris, and bacteria that's constantly forming on your teeth. If it's not removed, plaque mineralizes and can turn into rock-hard tartar in as little as 24 hours.

To survive and multiply in your mouth, the decay-causing bacteria feed off of the simple sugars that are produced from the starches you eat. This causes a chemical reaction in which the sugars are broken down into simpler elements. One of these elements is an acid. As you probably know, acid breaks down many things, including your tooth enamel. Every time you eat a starchy food, your teeth are bathed in this acid for 20 minutes or more.

The process of decay

The acid slowly dissolves the hard, protective enamel layer on your teeth, forming a demineralized area that appears as a white or brown spot on your tooth. That spot is the first visible sign of tooth decay. If the area does not remineralize, it will progress until a hole, also known as a cavity, develops on the surface of your tooth. It's vital that we treat your tooth decay early, before it can penetrate the surface of your tooth. Once a cavity has entered the softer dentin layer of your teeth, it can grow more quickly and may lead to a much more complicated and expensive set of problems.

How to avoid decay

Brush regularly

The good news? You can cut down on the frequency of acid production in your mouth by limiting the number of times you eat each day. Also, when you brush and floss properly and regularly, there's very little plaque on your teeth. Consequently, the number of decay-causing bacteria on the surfaces of your teeth will be dramatically reduced, and in turn, they won't be producing the enamel-destroying acid. You should also use toothpaste that contains fluoride, which will strengthen your tooth enamel so it's more resistant to decay. And what about the times when you can't brush? You'll need to use other methods, like rinsing with water or a fluoride mouthrinse or chewing sugarless gum, to minimize the acid attacks and protect your teeth.

Overhangs

Fillings absorb moisture

Overhangs fray floss

What Are Overhangs?

One of the keys to the long-term success of your restoration and the health of your gums is the accuracy of the fit. This is especially true where the restoration meets the tooth.

When everything is ideal, there is a seamless transition where the tooth and the filling or crown meet. When a restoration is too bulky where it meets your tooth, we call it an overhang. Overhangs can cause a lot of damage in a short amount of time because they:

Trap food and bacteria
Make it difficult or impossible to floss
Can contribute to periodontal disease and cavities
Can cause long-term bone loss

What causes overhangs?

Over time, silver amalgam fillings can absorb moisture and change from their original shape. Challenges and technique problems at the time of placement may also be the cause of overhangs. Whatever their origin, overhangs must be corrected. In most cases, this requires removal of the old filling or crown and replacement with a new one that fits properly.

Overhangs are a serious problem and a threat to the health of your teeth and gums. Let us know if you ever have difficulty flossing, or if your floss catches or tears. We can avoid many serious problems by finding and replacing any restorations that have overhangs.

Worn resin filling

Resin bonding

Custom-made crown

Worn Anterior Resins

Why do we replace worn anterior plastic fillings?

Everything wears out, and white plastic fillings are no exception. As they age, white plastic fillings in front teeth absorb moisture, swell, and begin to leak.

The tight seal between the filling material and the natural tooth is what protects it from further decay. When this seal is lost, the filling no longer fully protects the tooth, and cavities can develop. When the fillings are small, we can replace them with new white plastic fillings. But sometimes the damage that results from worn fillings is more extensive.

Repairing extensive damage

When you bite together, the edges of your teeth are subjected to a tremendous amount of force. If you have a relatively large filling on a front tooth, biting pressure could cause a portion of the tooth to break away. To strengthen it and protect it from future damage, we may need to place a crown on your tooth, or restore it with a technique called bonding.

What is bonding?

Bonding is a procedure in which we use tooth-colored resin to restore and reshape a damaged tooth. We can usually bond a tooth in one visit, because the resin is applied directly to your tooth and hardened with a harmless, high-intensity light.

What is a crown?

A crown, on the other hand, takes at least two appointments to place, because it must be crafted in a dental laboratory. A crown adds more strength to the damaged tooth because it covers the tooth completely and causes the biting force to be evenly distributed. We'll usually recommend a crown if the tooth has been extensively damaged.

Everything wears out, and tooth-colored resin fillings are no exception. As they age, resin fillings in back teeth absorb moisture, swell, and begin to leak.

Resin wears out

Replacing a filling

Placing a crown

Worn Posterior Resins

Everything wears out, and tooth-colored resin fillings are no exception. As they age, resin fillings in back teeth absorb moisture, swell, and begin to leak.

Replacing small fillings

When we recommend a restoration to replace your worn resin filling, we'll consider both the size of the filling and the amount of healthy tooth structure that remains. We can replace a fairly small filling with another resin filling, but you should know that it will eventually wear out and have to be replaced again.

Restoring large fillings

When you bite together, your teeth are subjected to a tremendous amount of force. If you have a fairly large filling on a back tooth, this biting pressure could cause a portion of the tooth to break away. To strengthen it and protect it from future damage, we may need to place a crown on your tooth.

How is a crown placed?

It takes at least two appointments to create a crown for you, because it's custom made to precisely fit your tooth. First, we'll prepare the tooth, and take an impression. Using this impression, a model of your mouth is created; your crown is fabricated on this model. You'll wear a temporary crown to cover and protect the prepared tooth while your custom crown is being fabricated.

Worn silver fillings

Large fillings may
cause fractures

A porcelain crown

Replacing Silver Fillings

Everything wears out, and your silver fillings are no exception. They have to endure an incredible amount of biting force each day, and as they age, their appearance and function degrade.

Over time, amalgam fillings often absorb moisture, causing them to swell and break away from the tooth. When this happens, your tooth is no longer sealed and protected from decay. Food and bacteria can become trapped in this space, enabling cavities to form.

What material will be best for restoring a worn silver filling? When we recommend a restoration to replace your worn silver filling, we'll consider both the size of the filling and the amount of healthy tooth structure that remains. We can replace a fairly small filling with another silver filling, but you should know that eventually, it will probably wear out and have to be replaced again.

Silver fillings have some disadvantages that should be considered when it's time to replace your filling.

Silver fillings are less attractive than tooth-colored fillings.
Amalgam expands and contracts in response to temperature changes in your mouth. This can eventually cause the filling to fracture your tooth, so a crown might be required to restore its appearance and functionality.
Silver fillings are vulnerable to metal fatigue and will likely corrode and leak as they age, which can cause new decay to develop underneath the filling. The leakage can also give a gray appearance to the entire tooth.

Replacing large fillings

If your worn filling is fairly large and less of your natural tooth structure remains, there's an increased likelihood that your tooth could fracture, or even break away entirely. If this is the case, we'll recommend a gold or porcelain onlay or crown to strengthen your tooth and restore its function, preventing more serious problems from arising in the future.

Brighter then White