Q: I’m a tough guy on teeth and I haven’t been good about going to the dentist but three year ago, after many years of not going, I went back. I had tons of decay and the dentist who was just out of school and had taken over for my old dentist started to treat my ill maintained mouth. I don’t know how many appointments but lots. I got big fillings and crowns it seemed everywhere.
Then one day she said I have to send you to the surgeon for some extractions. Before I knew it, I had an appointment. The surgeon got me in quick and out came three teeth that left a gap as big as a mac truck.
Problem was, I really didn’t know why. It was frustrating so I explored my options. I didn’t have much bone but was able to get dental implants in the lost teeth spots. Once the dental implants take I’ll get crowns on them, but last week a big piece of one of my back teeth broke off. I knew I had to have a crown on it and one other but my bank account isn’t as healthy as it was before I started all my treatment. I saw a new dentist and he said I need two crowns and maybe three because my bite he said was very hard and I was eating a bottom tooth right through one of the big fillings the dentist put in a year ago. When I asked if there was something temporary that could be done he said he didn’t know. “I might be able to do two crowns but not three,” he said. Is there something that can be done? I just need some time to boost up my bank account.
A: Those who clench often do so at all hours of the day. White fillings are not good materials for clenchers, they lose substance faster than any other material. Since the early eighties (1980), silver amalgam has been used less and less until now it is rarely used. Over the years, white resin materials have evolved and in many situations, they perform quite well – but not for those who grind and clench.
Gold fillings are the best replacement for silver amalgam for those who clench/grind. In your case, my recommendation would be to do one crown after the dental implants heal and have silver amalgam placed as a temporary in the other two teeth. It will require someone trained in amalgam placement as it is not taught in most dental schools any longer. That person will know how to shape and repair the tooth that is eating away at its opposing tooth (your lower molar). The cost will be less than three crowns and save your teeth from further breakdown. Then, when you can afford crowns, those silver filled teeth can be properly replaced.