Dental claims and dental negligence law is a very specialist area. Our experienced dental negligence lawyers understand the anxieties, concerns and frustration that may be caused by negligent dental care and treatment as well as the added inconvenience and expense of corrective treatment. Our dental negligence solicitors are sympathetic and knowledgeable about the situation you may find yourself in.
Our specialist team have helped many people make successful claims and receive compensation for their injuries and also for any corrective treatment that may be required.
Please note that the information here is mostly only applicable for adult, permanent teeth. Deciduous (baby) teeth may have different treatment needs.
What is a filling?
When tooth decay has been diagnosed, it must be removed in order to stop it spreading further in the tooth. The resulting space must be replaced with something that restores the normal shape and contours of the tooth and gives the tooth strength to continue functioning in the mouth.
There are two main types of filling material – the silver coloured amalgam and the white or tooth coloured materials. All of these have different pros and cons and so are generally used in different situations, depending on the need for appearance and strength.
Although the silver coloured amalgam filling may not be everyone’s choice on the basis of its appearance, it is a very strong and hard wearing material and it is very tolerant of the moist conditions in the mouth.
Conversely, some white or tooth coloured materials, which bond to the tooth (in particular, the composite filling materials), are very sensitive to moisture. As with any bonding technique, it is essential to ensure there is no moisture contamination as this will prevent/weaken the bond and leave the tooth at risk of further decay and/or fracture.
When placing composite fillings, there must be complete moisture control – any saliva contamination will greatly increase the risk of the filling breaking down and tooth decay occurring in the microscopic space between the filling and the tooth surface.
Ideally, ‘rubber dam’ should be used to ensure total moisture control when placing composite fillings. Rubber dam is a protective sheet that is fitted over the tooth so that the tooth sticks through the sheet, but the rest of the mouth is underneath it. Although many people don’t like the thought of rubber dam, it is actually rather brilliant – the dentist works on the tooth above the sheet and the patient is free to waggle their tongue and swallow as much as they like it!
Glass ionomers are another white or tooth coloured filling material. Although it is much less sensitive to moisture (so much so that it is often used in children’s teeth!), it does not give such good cosmetic results as the composite materials.
Another bonus for Glass ionomers is that they release fluoride and so when used as a filling material (or as a base for a deeper filling), it may help to strengthen any tooth structure, which has an increased risk of tooth decay.
However, all tooth coloured filling materials on the outer surfaces of teeth will gradually take up the stains from tea, coffee, red wine etc. Although simple polishing can usually remove this staining, sometimes the filling may need to be replaced.
Problems with dental fillings
When a filling is placed, it should not increase the risk of further decay, any damage or injury to the nerve of the tooth or increase the risk of gum disease.
When the space for the filing is very deep into the centre of the tooth and/or is very close to the nerve and blood supply of the tooth, a ‘lining’ (a base or undercoat filling) should be placed in order to insulate the nerve against thermal changes that may be transmitted through the main filling material. Some lining materials can also encourage stronger dentine (tooth structure) to develop around the nerve.
The use of a lining material may help to give the nerve a chance to recover after it has been affected by tooth decay, and this may be sufficient to prevent the need for root canal treatment at that time.
Whatever filling material used, it is important to shape the filling to the contours of the natural tooth – particularly if the filling is near the gum line or between teeth.
If a filling is not properly contoured, this can result in overhanging margins or food trap areas, which are very difficult to keep clean and increase the risk of tooth decay under the filling or gum disease developing.
Although the location and position of some tooth fillings make it technically difficult to create smooth margins at the initial appointment, it is important to check the margins of all fillings and to smooth the margins and/or recontour the filling as necessary. In some instances, the filling may have to be completely replaced.
When placing a filling on the biting surface of a tooth, it is very important to check that the new filling fits into the bite pattern. If the filling is proud, the repeated additional biting forces may cause the tooth to be tender and/or may cause the filling to break.
If a large filling keeps breaking, it may mean that a crown is required to hold the tooth together and prevent a catastrophic fracture in the tooth, which may make extraction the only treatment option.
Dental negligence claims arising from fillings
The most common claims involving fillings include the following:
- Repeated fracture of a filling
- Fracture of a tooth, leading to loss of the tooth
- Exacerbated toothache, which requires additional treatment/root canal treatment after a filling has been placed
- Pain when biting on a filling, for which no cause, diagnosis or treatment has been offered
- Difficulties with food trapping, which causes an area of gum disease
- Poor appearance of fillings in the anterior teeth
- Tooth decay occurring around fillings, despite good oral hygiene and diet
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