Why do fillings “fall out” ?

I believe a big part of my job as a dentist is to explain to the patient what is happening in their mouth in terms they can understand. Some of my patients need a complete technical explanation from a mechanical engineering perspective. They want to hear about dental material tolerances, material biochemical structure, bio mechanical limitations , occlusal loads et cetera. Some patients want me to explain it in a more parochial way albeit being very specific with why fillings fail or succeed. And still other patients just want me to tell them the problem and give them a few good ways to fix it. I must approach each type of patient differently but ultimately relaying the same information for them to make an informed decision on how to proceed. And finally, regardless of my explanations, whatever treatment they accept needs to fix the problem with the limitations I described to them. In other words, I need to fix their problem  because they don't want to keep coming to my office to address the same issue over and over again.

I am frequently told by my patients how my hygienist "pulled" their filling out, or how their filling just "fell out" with out them even chewing on anything hard, or how they have soft teeth that "don't hold" fillings well. As I hear these comments from patients, I first think to myself that they are just relaying to me their perception of what is going on in their mouth. I can relate, as I must sound similar when I explain to my automobile mechanic or plumber or electrician how I am experiencing the problem I called them about.

Most Dentists I know are very patient and enjoy explaining the technical aspects of dental treatment to patients. When I encounter these situations, I  examine and educate my patients in three areas.

First, I assess their problem by listening to them before I look in their mouth. I try to have a general idea and diagnosis or at least a list of potential problems of the patients' tooth before looking at an x ray or looking in their mouth. I was taught well at Temple Dental School to take a thorough history prior to examining a radiograph so as not to prejudice my diagnosis.

Second, I do a thorough examination of their chief complaint. I may notice many factors contributing to the problem or several issues in addition to the reason they came to my office.However, I limit my immediate discussion to their main problem which made them come to see me. By doing this, I make sure that the patient feels heard by me and that I solve the problem to which is causing them concern.

Thirdly, after taking a history and doing my examination, I remove my gloves, sit down in front of them and restate, in their words, the problem they are having. This allows them to make additions or corrections to what I thought I heard from them. It also establishes  that I am thoroughly listening to them. After the patient confirms my restatement of their chief complaint, I explain my findings. If they have more than one issue causing the problem, I list them in order in which I think the problem is causing their discomfort. 

So when a patient says that their " filling just fell out, the Hygienist pulled the filling out or their teeth are too soft to hold fillings", I tell them:

1. A filling doesn't just fall out. They is always a reason for that occurrence. The filling may have a cavity under it which is soft and therefore the filling came out because it no longer rested on a solid surface. The filling may have been placed in a situation that a failure is expected. I mean that if a dentist places a filling when a crown is needed, then it is asking too much of the filling to hold up the load. A 2×4 is a good piece of lumber unless a Carpenter expects it to support a load to heavy for its size. Or perhaps they have a para functional habit that keeps hitting the filling and causing it to fail. In this case I will need to adjust any biting inferences in order for the filling to last. 

2. They can't floss a filling out. If they can dislodge a filling by flossing then it needed to be replaced.

3. The mouth is a difficult environment. Teeth go through thousands of chewing cycles a day in a wet field. The teeth are exposed to extremes in temperature from ice water to hot coffee or tea. So dental materials have to be able to withstand many forces in less than idea circumstances. So if they were not chewing on something hard when their filling came out, then the filling actually failed at some point previously and just happened to come out when they were only eating "mashed potato's".

In summary, our jobs as dentists are to listen to your dental complaints and ascertain the cause and propose a solution that will fix your problem. We need to explain it in a way that you understand and give you all your choices with the probable outcomes for those choices. If you need a second opinion to a complex or a simple concern please call my office, Smile Solutions by Emmi Dental Associates, 302-999-8113.