Judgement decisions of the dental variety

    submitted by Dr. Michael Spadafora, D.D.S., Bucks County Dental Design,

    Judgement calls are a part of everyone’s work life. Decisions about how to approach a problem or resolve a conflict are essential to being in a business of any kind. In the dental field, these decisions can have lasting implications to the patient’s dental and overall health.

    One decision that your dentist faces regularly is how to restore a tooth that has new decay or an old filling (amalgam or composite). While this appears to be basic dentistry, multiple factors enter into the decision. The dentist will evaluate the extent and location of the decay, the optimal material for the restoration (for instance gold, porcelain, composite or amalgam), the age and health of the patient, and the likelihood of the restoration’s longevity.

    Crowns will often be the answer when the dentist approaches old fillings that are beginning to erode and cause problems.   New decay is sometimes found around the old filling, making the tooth more susceptible to breaking or cracking.  Additionally, if a tooth has had a root canal (causing the existing tooth to become brittle), a crown is usually recommended to protect the existing tooth structure from fracturing. The crown “surrounds the tooth,” thus protecting it, and is a reliable solution for teeth that have significant decay.

    The selected dental material contributes to the success of a dental restoration. While amalgam (silver) fillings have been around for many decades, it is the least appealing material for a tooth restoration. Amalgam fillings can serve as a wedge in the tooth, making the tooth more susceptible to cracking.   An amalgam restoration is better than tooth decay, however, so if that is the only option for the dentist, he will usually do it. Composite (white) fillings bond to the tooth structure making the tooth stronger. While composite fillings are more technique sensitive, take longer to prepare and the materials are more expensive, the finished product has a high likelihood for success.

    Forefront in the dentist’s thought process is the likelihood for success and the anticipated longevity of the restoration. This is clearly a judgement decision (based on knowledge, experience and training) which is the intangible benefit of having a dentist who you know and trust.

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