A 1995 survey of pre-school children showed that only one in eight of those with decay had had a filling, a figure paediatric dentists find shocking. There is a widespread belief that baby teeth do not have a nerve supply, and so do not need to be filled. This is not true.
If there is decay in baby teeth a filling needs to be placed, otherwise the decay will worsen and cause pain. Baby teeth are small and hence there is less space between the outer enamel and the nerve, and therefore the decay does not need to progress far in the tooth before the nerve of the tooth is exposed causing an abscess. Treatment of a tooth with an abscess is far more challenging for a child than a simple filling.
Occasionally, if there is no pain and the baby tooth is going to fall out naturally within six months the decay can simply be observed.
Mercury-amalgam fillings are the subject of enormous controversy. Mercury is a toxic substance and some experts are concerned that it may leak out of the fillings and accumulate in the body tissues. The Department of Health has advised that amalgam fillings should not be given to pregnant women. However, the evidence against mercury-amalgams is not conclusive, and many dentists continue to use them.
Removing an amalgam filling can sometimes be more risky than leaving it in place because fine mercury particles are released during drilling. It is hard to match amalgam for its longevity and its ease of application.
We have not used amalgam since 1998 because the alternative tooth-coloured filling materials are in our hands proving to be even more reliable than the impressive results we were getting with amalgam restorations.
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