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It is
known that mercury vapour concentrations
are highest when amalgam fillings are placed or removed. We believe
that using our amalgam removal protocol reduces the risks from
replacing old amalgam fillings substantially however common sense
suggests that if you are replacing a large number of restorations that
they should not all be carried out simultaneously.
Teeth
with old fillings may be entirely pain free even if the old filling is
leaking or has decay present under it. An x ray in
advance of the filling can often provide a clue that the filling is deep
or close to the nerve however the assessment can really only be made
once the old filling is removed and the dentist can observe the
remaining cavity.
If
there is decay under an old filling the
nerve inside the tooth may be mildly inflamed but pain free.
One way to imagine this is as if any “Pressure” inside the
tooth can "escape"
through the leaking filling. It is only when a
well fitting bonded restoration is placed that the inflamed nerve is
“sealed” and pressure builds up within the tooth that pain and nerve
death can result.
Thankfully this is reasonably rare, studies show that somewhere between
5 and 15 % of all teeth receiving crowns or very
large fillings will ultimately follow this path. If this
happens then a choice needs to be made
between preserving the tooth with a root canal treatment or removing
the tooth. In our experience when we
use rubber dam during the removal
of old fillings and their replacement
the incidence of tooth death appears to be
towards the lower end of the quoted
range.
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