Fillings fell out of the tooth: causes, treatment

Since the filling is one of the final stages of treatment, it is necessary to consider not only the quality of the filling itself, but also the rationality of the previous manipulations. This is necessary because many of the procedures performed directly affect the consistency and durability of the filling.

Why did the filling fall out?

There are many reasons why a filling may fall out of a tooth. This sometimes happens due to the fault of the dentist, due to the patient's carelessness, after the filling's service life has expired, etc. Often this is due to the nuances of providing dental care. The reasons why a filling may fall out are divided into 2 groups: iatrogenic and non-iatrogenic. Iatrogenic reasons are associated with the dentist's mistakes when providing medical care. Very often, doctors use budget options for filling materials that have high shrinkage and low adhesion (stickiness). With high shrinkage, the filling material decreases in volume after hardening, which causes it to "tear off" from the walls of the cavity. With low adhesive properties, the material does not stick, but is fixed in the cavity due to mechanical force. That is, the filling, repeating the shape of the tooth cavity, fits into it like a puzzle and is thus strengthened. And, although this type of fixation at first glance inspires confidence, in fact it is not reliable. This is due to the fact that micro-spaces remain between the filling and the tooth, which are an ideal environment for the accumulation of food debris and the vital activity of microorganisms. As a result, a secondary carious process occurs and the tooth tissues with which the filling contacts are gradually subject to demineralization (caries). It is also worth noting that the filling material loses its adhesive properties after the expiration date. This contributes to the disruption of the fixation of the filling and its rapid loss. Not everyone knows that the filling and the tooth are not all the elements of the filling. Between them is an adhesive system, which acts as a link between the hard tissues of the tooth and the filling material. The importance of the adhesive system cannot be overestimated, since it ensures tight contact between the tooth and the filling. The requirements for this material are high quality and an acceptable shelf life.

Now it is worth talking about the manipulations that the doctor performs during tooth restoration. The first stage is the preparation of the carious cavity. Using metal and diamond burs, the dentist removes all tooth tissues affected by caries. This procedure must be carried out very carefully, since the remains of carious dentin provoke the development of secondary caries. If such a cavity is filled even with the most expensive and high-quality composite, the filling may fall out in a few months. In this case, the carious process will continue to progress. The second stage is the creation of the correct shape of the cavity. This point is very important in connection with the mechanical fixation of the filling. Moreover, each filling material has its own requirements for the formation of the cavity and the creation of support points. There is no need to focus on the properties of individual materials in this article, but you must be sure that your doctor has this knowledge. One of the reasons why a filling may fall out is non-compliance with the adhesive protocol, or, more simply, preparation of the tooth for filling. Due to the fact that many doctors save their time and consumables, some important stages of restoration preparation may be skipped or poorly performed. However, if you see that the doctor works slowly, comments on each of his manipulations, answers all your questions in detail and is morally open to you, then you can be sure that he does his job conscientiously.

There are often situations when a doctor performs composite restoration of a tooth in cases where it is unacceptable. Most often, these are situations when the chewing surface of the tooth is completely destroyed, but the patient refuses crown prosthetics. Then the doctor, as an alternative, offers the patient a composite filling. It is important to understand that such a filling is doomed to quickly fall out, since it will not be able to accept and transmit chewing load for a long time.

One of the reasons for a filling falling out may be liquid getting on the filling material before it hardens. It just so happens that water and other liquids have a very detrimental effect on most filling materials that exist today. However, if the doctor used a cofferdam (a rubber scarf on the tooth) when placing the filling, then the likelihood that the filling fell out precisely because of contact with a moist environment is extremely small.

Many dentists spend a lot of time and effort when modeling the chewing surface of a tooth to create the most natural look for the tooth. Concentrating on the artistic application of the filling material, some specialists do not notice that they are overestimating the level of the filling in relation to other teeth. If, upon completion of treatment, the doctor does not carefully check the contacts of the teeth, and the patient does not pay attention to the unusual position of the new filling, then the tooth with the filling will be subject to increased stress. When chewing, the filling will experience vertical overload and, after reaching the strength limit, will fall out of the tooth.

Patients often complain that a filling falls out in their sleep. This is not an abnormal phenomenon and is not uncommon in dentistry. The reason for this problem is that most people have various parafunctions of the masticatory muscles. That is, a person's teeth can close and open with great force and frequency in their sleep. This leads to an overload of the periodontium and hard tissues of the teeth. Many people suffer from bruxism, which is also a representative of parafunctional activity. In this case, a person's teeth not only close with great force, but are also subject to friction. The teeth of the lower jaw are pressed against the upper teeth with great force, after which the lower jaw moves forward and to the sides. Thus, the teeth are subjected to a load that is stronger than the pressure when eating. And if there are fillings in the teeth, then due to the force of friction, they quickly lose stability. Some patients claim that they dreamed about how their filling falls out. This is quite possible, since our body always reports a possible danger to its existence. Therefore, if a filling falls out in a dream, it is quite possible that this can be figuratively reflected in dreams.

There are many risk factors that can cause a filling to fall out. The main symptom is poor oral hygiene. The cause-and-effect algorithm here is quite simple: if there is plaque, it means there is a cluster of microorganisms. If there is cariogenic flora, it means caries will occur. If there is caries, it means the filling will fall out very soon. Plaque is probably the main risk factor that most often leads to filling loss. Often, patients themselves use their teeth for other purposes: they hold bunches of grapes, needles and other objects, open glass bottles. It is also worth mentioning the careless consumption of hard food. In these cases, not only the filling may fall out, but the integrity of the tooth may also be damaged. Therefore, always follow your doctor's recommendations after treatment.

Symptoms

Not always is a filling falling out accompanied by any symptoms. But, it is quite easy to understand that a filling has fallen out. Compare the defective tooth with a symmetrical one: if the tooth on the other side is visually different and looks more complete, then most likely a filling has fallen out in the suspected tooth.

If you find it difficult to visually distinguish a healthy tooth from a defective one, then most likely the filling has not fallen out, but chipped. If it has fallen out, then patients themselves discover a “hole” in the tooth when performing hygiene procedures or running their tongue over the tooth. In addition to the cavity itself, you can feel the sharp edges of the filling or tooth. They often lead to trauma to the oral mucosa. When eating, food debris gets into the tooth cavity, they remain there until the patient discovers the cavity and carries out thorough hygiene in this place. Otherwise, the food will begin to saturate with microorganisms, which can cause inflammatory processes in the mouth, secondary caries, foul breath, etc. Also, one of the unpleasant signs is a symptom in which something cold, hot, sweet or sour “enters” the tooth. This indicates that the tooth tissues that were under the filling are currently not protected by anything and foreign substances are penetrating into them.

Very often, a leak in the connection of the filling material with the tooth is the first sign that it will soon fall out. Before falling out, the filling may become mobile. This happens when the doctor has formed a spherical cavity in the tooth for a photopolymer composite. The mobility of the filling can be felt with the tongue or when eating, when food particles (e.g., gum, toffee, caramel, etc.) stick to the filling and make it move in the cavity.

Consequences and complications

Complications caused by a filling falling out are not uncommon, so it is impossible to go without it for a long time. As a rule, all complications are related to the fact that people do not seek dental care in a timely manner. Most often, they adapt to life with a cavity in the tooth and can even tolerate toothache. They argue this by the lack of free time and lack of financial resources. However, if there are complications, much more time and money will be needed, and this must be understood. But the recklessness of people leads to the fact that after the filling falls out, the carious process progresses, reaches the pulp chamber and causes pulpitis. In this case, a person may feel that the filling has fallen out and the tooth began to hurt. The pain is most often spontaneous, intensified by cold, hot, from food debris getting into the cavity.

If the pulpitis is purulent, the patient will seek help from a dentist on the same day. But if the pulpitis is focal or general, a person can endure attacks of pain and not even ask the question "why does the tooth hurt?" As a result, pulpitis can become chronic and subsequently cause periodontitis. Thus, ignoring the symptoms of dental diseases, you can lose a tooth. Often, the loss of a filling leads to gingivitis or localized periodontitis. In this case, the gum near the causative tooth swells. When swelling is detected, it is important to immediately take action to eliminate the inflammatory process. To do this, you can rinse the mouth with a solution of chamomile, sage and other medicinal herbs. To prevent infection, you can locally use Metrogyl Denta ointment.

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Diagnostics

Home diagnostics boils down to determining the tooth pain from food and water getting into the tooth cavity. Also, it is necessary to examine the causative tooth: if sharp edges of the tooth or filling are visible on it, then there is a possibility of damage to the oral mucosa.

When you look at the cavity of a tooth, you will most likely see one of three situations: first, there will be a layer of filling material in the cavity, second, you will see intact enamel and dentin (grayish-whitish color) in the cavity, third, there will be carious damage to hard tissues at the site of the fallen filling. This will visually look like a black tooth. Any of these options requires an immediate visit to the dentist, although it is worth noting that the third course of the disease is the most undesirable. In any case, the dentist will conduct a repeated examination and use some other diagnostic methods: collection of complaints and anamnesis, general and local examination, radiography, electroodontodiagnostics (to determine the viability of the pulp).

What to do if a filling falls out?

If a front filling falls out, you should immediately examine the causative tooth. Pay attention to possible filling remains, sharp or thinned parts of the tooth. This is necessary to prevent further damage to the oral mucosa and chipping of the remaining part of the tooth. Immediately inform your doctor about the situation and before the appointment, carry out antiseptic treatment of the oral cavity as often as possible.

If a filling with arsenic falls out, you should not worry, because it is only a temporary restoration. However, there are certain nuances that need to be clarified. First, do you feel pain in the tooth? If the tooth does not hurt spontaneously, try to take some water at room temperature in your mouth and determine if there is pain in this case. If there is pain, then the pulp (nerve) is still alive and you need to visit the dentist to determine further treatment tactics (re-application of devitalizing paste or choosing another devitalization method). If there is no pain, then most likely the pulp has already succumbed to the action of arsenic paste and the remains of the material must be removed. Carefully examine the cavity and assess its condition. If there are particles of arsenic paste there, try to rinse with an antiseptic solution (chlorhexidine bigluconate, 3% hydrogen peroxide, Givalex, herbal tea solutions). If no foreign elements are observed in the tooth, then close the cavity with a cotton ball and make an appointment with a doctor.

It is also worth paying attention to the time after which your filling with arsenic fell out. The fact is that arsenic paste is applied to the pulp for no more than 12 hours for single-root teeth and no more than 24 hours for multi-root teeth (not to be confused with paraformaldehyde paste, which is applied for 7-10 days). High-quality arsenic paste necrotizes the pulp during this time. If you have not come to see your dentist within 24 hours, then visit him urgently, because with prolonged presence of arsenic in the tooth, arsenic periodontitis can develop - toxic damage to the ligamentous apparatus of the tooth by arsenic anhydride. Therefore, do not neglect the doctor's instructions, because it is not for nothing that they say: everything in moderation is medicine, and everything in excess is poison.

A permanent filling can fall out for various reasons, they were described above. The principles of first aid are that it is necessary to isolate the opened cavity as much as possible and as often as possible to carry out antiseptic treatment of the oral cavity with solutions of chlorhexidine, 3% hydrogen peroxide, Givalex, chamomile, sage. What to rinse with if a filling has fallen out, there is no particular difference. All of the listed solutions have a mild antiseptic and anti-inflammatory effect. It is even possible to use a combination of these drugs.

When you go to see a doctor, it is advisable to clarify in advance whether you will have to pay for the replacement of the filling. If the filling falls out after a week or a month, then, as a rule, dentists will perform a re-filling under warranty. But this will only happen if you have fulfilled your warranty obligations (did not allow traumatic damage to the tooth, performed regular oral hygiene). If the warranty period has expired (it may be different in each clinic), then you will have to pay for the restoration of the tooth yourself.

If you are undergoing complex endodontic treatment, it may be performed in several visits. After your canals were filled, the dentist may have placed a temporary filling until your next visit. If it fell out before you came to the dentist's office, you need to rinse your mouth with 0.06% chlorhexidine or 3% hydrogen peroxide, dry the cavity with a dry cotton swab and place a dry cotton ball in the tooth. In this case, you should not rinse your mouth too often. Liquid that gets into the root canal area can adversely affect the material they are filled with. Therefore, it is important to prevent contamination of the tooth cavity and its moisture. Change the cotton ball to a clean dry one as often as possible.

After a filling falls out, many people wonder what to replace it with. The answer to this question is very simple and obvious - nothing! Among household items, you will not find such items that could replace a filling in a tooth. This is due to the fact that filling materials have very specific properties that allow them to be firmly fixed in the tooth, not irritate the pulp tissue and not dissolve in oral fluid. Therefore, you should not try to seal the fallen filling with plasticine, chewing gum, plaster and other similar things. The most correct action is to thoroughly rinse your mouth with an antiseptic and place a dry cotton ball in the cavity of the tooth. You need to change the ball and rinse your mouth as often as possible, especially after eating.

If the filling is loose but does not fall out, the principles of pre-medical actions will be approximately the same as for a fallen filling. First of all, make an appointment with a doctor. The second principle is to rinse your mouth with antiseptics. The third is to try not to chew on the side of the dental arch where the loose filling is located. The last point is related to the fact that it is almost impossible to remove food debris from the gap between the filling and the tooth at home. Therefore, the penetration of foreign particles into the problem area must be minimized.

During pregnancy, women often experience metabolic disorders, a deficiency of minerals and vitamins. As a result, teeth become more vulnerable to caries. If you are pregnant and a filling has fallen out, make an appointment with a dentist as soon as possible. Most conscientious doctors, upon hearing that you are pregnant, will agree to see you as soon as possible. At home, you should only rinse your mouth with herbal solutions (chamomile, sage) and isolate the tooth cavity with a cotton ball. Be sure to tell your dentist again that you are pregnant. There are individual methods of providing dental care for such patients, which are more gentle.

Treatment at the dentist

If a filling in a tooth is loose but does not fall out, the dentist will have to remove it anyway. And this is a completely correct action. A loose filling cannot be strengthened or fixed in any way. Even if you try to do this, there is a very high probability that a carious process will begin under this filling. Or the filling will simply fall out after a short period of time due to poor fixation.

If a temporary filling with arsenic falls out, the doctor must determine the viability of the pulp. If the pulp is alive, it will be necessary to repeat the devitalization stage or remove the nerve under anesthesia. In the case where arsenic has managed to kill the pulp, the doctor will remove it and begin instrumental treatment of the root canals. When the canal treatment process is complete, the dentist will perform restoration and model a permanent filling.

If a permanent filling falls out of a baby tooth, the treatment will be based on when the tooth is due to fall out. If there are about 2-4 weeks left before the tooth is replaced or the filling was small, then there is no point in replacing it. However, if the tooth is expected to remain in the mouth for several more months or years, then tooth restoration is extremely necessary. After all, food will constantly accumulate in the tooth defect, the carious process will continue to progress, which will lead to further destruction of the tooth. Destruction of the tissues of the temporary tooth will entail inflammation of its periodontium, which can lead to damage to the permanent rudiment. As a result, there will be a delay or complete cessation of the development of the rudiment and, in the long term, the loss of the permanent tooth. Even if the rudiment is not damaged, an equally unpleasant process will occur - displacement or tilting of adjacent teeth. This is due to the fact that all teeth put pressure on each other to create strong and stable dental arches. If there is a gap on one side, the tooth will shift to the side where there is free space. Therefore, each baby tooth throughout its existence must retain space for permanent teeth. And to perform this function, the baby tooth must be anatomically complete, have clear and undamaged boundaries. For this reason, baby teeth must not only be filled, but also done well, taking into account their anatomical shape.

In some cases, only a part of the filling falls out. As a rule, these are parts of the tooth that are subject to chewing load, for example, the tubercles of the lateral teeth. In such a situation, the integrity and stability of the remaining part of the filling should be assessed. If these parameters are satisfactory, the remaining filling material should not be removed entirely. The doctor will partially perform the preparation, prepare for restoration, and model the missing part of the filling.

If a composite, cement or amalgam filling falls out of a permanent tooth, the treatment will depend on the clinical situation. If the filling has fallen out recently, the filling will simply be replaced. If more than six months have passed, you may be referred for an X-ray examination of the tooth. The image is necessary in this case to assess the condition of the periodontium and tooth roots. After all, neither the doctor nor you want the filling to have to be removed to treat chronic periodontitis after a high-quality aesthetic restoration. If the X-ray does not reveal any pathological changes, you will be offered a restoration method in accordance with your aesthetic needs and financial preferences. With sealed canals, the treatment plan will be approximately the same as with living pulp: X-ray, analysis of the dental image, restoration of the tooth. It is worth noting that if a filling falls out and a part of the tooth is chipped or cariously affected, you may be offered more reliable restoration methods: an intracanal pin structure, crown prosthetics, or a combination of these methods. The same solution is offered if a filling falls out with a pin. The canals are prepared for re-installation of the pin and then the choice of restoration is determined depending on the clinical picture (filling or crown).

Prevention

Preventive measures for filling loss come down to preventing the reasons for which they occur. Be careful when eating foods that contain hard parts (fish, meat on the bone, nuts, fruits and berries with seeds).

If you have a habit of opening glass bottles with your teeth, holding nails between your teeth, or biting wire, it is important to get rid of them. Also, do not use toothpicks as a hygiene item. They not only injure the tooth and gum, but also spread harmful microorganisms throughout the oral cavity. Strengthen your body's immunity, follow a diet and sleep schedule. After all, each tooth is a part of a large organism that is closely connected with all its organs. If all body systems work correctly, the likelihood of caries and filling loss will be low. Try to examine your teeth more often and visit your dentist at least once every six months for a preventive examination. This will allow you not only to avoid filling loss, but also to prevent the appearance of new ones. Be healthy!

Forecast

It is quite difficult to predict the consequences of a lost filling, as it depends on various parameters of the body. If you regularly practice oral hygiene, have few filled and extracted teeth, then most likely you have a fairly strong immune system, proper metabolism and good genetic data. Consequently, the risk of developing any dental diseases (pulpitis, periodontitis, secondary caries) is low. However, this does not mean that you should not go to the dentist after a filling has fallen out. It only means that your body is able to resist pathogenic flora longer before irreversible structural changes occur in the tooth. Also, you should always pay attention to the dental diagnosis for which you were treated. After all, a lost filling after periodontitis treatment requires an immediate visit to the dentist, and the loss of a filling after the treatment of chronic medium caries allows you to see a dentist within a few weeks (provided that you follow the rules of hygiene, diet and antiseptic treatment during this period). In any case, if a filling falls out, try to contact a specialist as soon as possible.

In this way, you will help your health to save resources, and the dentist will restore the tooth defect as efficiently as possible.