A new study has suggested that a dental patient who has a filling risks the possibility of tooth decay in adjacent teeth, whether or not there is already some damage there. The study from Norway found that fillings were not a cure for tooth decay and might help to cause problems rather than solve them.
This longitudinal study was designed to find risk factors for tooth decay on teeth situated by new fillings. It was also aiding a bigger study which examined how long fillings lasted. Participants from the main study were chosen to have the condition of teeth adjacent to a recent filling monitored. Where there was more than one filling, only one was chosen to be checked regularly. The checks on patients' teeth were carried out for an average of four years, the teeth were sound or only had a little enamel decay at the start of the study and were given a rating at the end of the research to record how successfully the filling had treated the decay.
The researchers collected background information on the participants and also checked their oral hygiene and the amount of decay already in their teeth. They also noted information about the particular tooth including its type, where it was in the jaw and which side and the details of the filling. Details on the supervising dentist were also noted including their age and use of a protective shield. Dentists were asked to rate their patients’ oral hygiene and 750 people took part in the study.
The researchers found that 60% of people experienced some decaying to the enamel of surrounding teeth, either to the outer enamel surface or to the dentine underneath. If the participant already had some enamel decay on the adjacent teeth, then they were 40% more likely to see the decay progress into the dentine tissue below the enamel. Teeth on the right of the mouth, if the participant was right-handed and back teeth were more at risk of decay, particularly if the participant’s oral hygiene was rated poor or medium. These findings suggested that poor dental hygiene could be a key factor.
The dentist who provided treatment could also be a factor. The patients of one dentist had an increased risk of adjacent teeth developing decay while other dentists seemed to offer a decreased risk. The researchers recommended that dentists should be aware of the risks of surrounding teeth developing decay and suggested that they consider use of non-operative treatment or preventative strategies which they could evaluate at every follow-up. The study was not designed to provide a direct cause, however.
Current recommendations suggest that in order to maximise dental health, people should brush their teeth twice a day, use dental floss once a day, use a fluoride mouthwash as part of their dental hygiene routine and limit sugar intake. Encouraging children to develop good oral hygiene and visit the dentist from an early age will also help to prevent dental caries. Patients need to take recommendations from their dentist as to how often they will need a check-up.
Filling a tooth is the best known way to halt decay and prevent further problems such as the decay spreading further, gum disease which can lead to loss of teeth and complications such as abcesses. It is preferable that patients develop good oral hygiene so that fillings can be kept to a minimum.
Kopperud SE, Espelid I, Bjørg Tveit A, Skudutyte-Rysstad R. Risk factors for caries development on tooth surfaces adjacent to newly placed class II composites – a pragmatic, practice based study. Journal of Dentistry. Published online August 30 2015