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Stewart Shernan
Stewart Shernan,
Category: Dental
Satisfied Customers: 373
Experience:  Owner, Practitioner at Stewart D. Shernan, DMD
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I would like an honest, professional opinion about whether

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I would like an honest, professional opinion about whether or not I should get a filling replaced. It is a molar tooth (# 19), 2nd tooth from the back. I have gotten 2 different opinions so far. Tooth is asymptomatic, and does not hurt at all when I bite down. It is a large filling. Almost 10 years ago, the tooth was filled. Two years ago, a partial repair (filling) was made to the upper left side for no reason other than the dentist recommended it. This same dentist is recommending that I get the entire filling redone. I do not know whether “business is bad,” or whether this is, in fact, the best way to go.

Hi there,

Fillings need to be replaced if there is decay in the area of the filling or if the margins of the filling are worn or broken. If the margins are worn or broken, material and bacteria can leak underneath the filling causing further decay and damage to the tooth. There is often no pain associated with a filling that is in need of replacement. It is reasonable that a filling that is 10 years old and has been repaired is in need of replacement. I would suggest you ask your dentist the reason for replacing the filling and he should explain this to you. Presumably he'll explain the sound reasoning of his treatment suggestion.

Please let me know if you need any additional information. If not, please leave a positive rating.

Cheers,

Dr Shernan

Customer: replied 1 year ago.
Dr. Shernan,Could you please look at the attached 6 files (x-rays) and let me know if there is decay in the area of the filling or if the margins of the filling are worn or broken?Thank you again,
Lynn

Hi Lynn,

Yes - There is clear evidence of a fracture or decay on the mesial (front side) of #19 evident on the xray. It does, in fact, need a replacement filling.

Let me know if you need any additional info from me. Otherwise I'd appreciate a positive rating.

cheers,

Dr shernan

Customer: replied 1 year ago.
Thank you, ***** ***** Just a couple more questions, if you don't mind:1) In looking at S 20, is the evidence of the fracture or decay on the right or left side? Is the fracture the horizontal line on the right, by chance?2) Is the fracture or decay into the dentin? If the decay has not gone to the dentin, is it usually "just a matter of time" before that happens?3) The first dentist also is recommending a crown. The 2nd dentist said that would be "over-treating." Any opinion on whether or not to crown the tooth? Or, is it better to wait? Trying to get more of a long-range plan.Sorry for all these questions. I'm just trying to determine better the honesty and professionalism of these dentists, and think more long term, all of which is difficult as a non-dentist!Thanks again for your expertise and patience with my questions!Gratefully,
Lynn

Hi Lynn,

No worries - it's good for a patient to have plenty of information to make the correct treatment choice.

On image R56.jpg there is apparent decay or fracture toward the front of the filling. It's not possible to determine if the problem is on the right or the left based on an xray, which is a two dimensional image taken from the side of your tooth. And definitive diagnosis can only be made by including an examination with the patient in the chair.

But the filling is both deep and extensive. Judging solely from the xray, the tooth is borderline for needing a crown. A conservative approach would be to place a filling only. However, this tooth may fracture over time due to the existing extent of the tooth's damage & filling. A more proactive approach might be to do a crown, but that is, of course, more involved and more costly. This is a decision that, ultimately, must be made by yourself - with the input of a dentist in whom you have confidence.

Please let me know if you need additional information from me. Otherwise, best of luck - and please leave a positive rating.

Cheers,

Dr Shernan

Stewart Shernan and other Dental Specialists are ready to help you
Customer: replied 1 year ago.
Thanks a million, Dr. Shernan. Looks like you're in the Boston area? I'm in Baltimore. Wish your practice was here, as I would definitely make an appointment. You are so knowledgeable, and I greatly appreciate all your help. Best wishes to you!With gratitude,
Lynn

Glad to help Lynn. I enjoy my part in this too.

Best wishes with your treatment,

Dr Shernan

And if you ever have additional dental questions, just ask for me - I'm happy to help.

Cheers,

Dr shernan

Customer: replied 1 year ago.
Hello Dr. Shernan,I saw a new (3rd) dentist today for a consultation on tooth # 19 and had a couple questions:* He had me bite and grind on wooden sticks 3 times (checking different areas), and asked if I felt any pain (which I did not). Guess this is the protocol for checking for vertical fractures/cracks?* He said there was "no evidence of decay on the tooth," but you said there is. I'm confused! Can you explain this?* He recommended a crown as a preventive measure. He did not recommend replacing the filling though. Said I would just be "back to where I started." What are you seeing that he is not? Or, it this an example of where an examination trumps an x-ray?Thanks so much for any additional instruction!Kind regards,
Lynn

Hi Lynn,

Yes, you're correct - a clinical exam coupled with xrays certainly trumps xrays alone. On one of your images there is an apparent "radiolucency" - a gray area that usually suggest decay on the mesial of tooth in question. But clinical examination might well suggest otherwise. In either event, preparing the tooth for a crown will reveal and eliminate any decay present. Sometimes the only way to be certain is to remove the older filling material and examine what is under it. Placing a crown on the tooth is the best way to be proactive about saving the tooth.

And yes, the bite testing is the proper protocal for testing for a fracture.

Hope this helps - and be well,

Dr Shernan

Customer: replied 1 year ago.
Dr. Shernan, that helps me. Thanks so much! Just remembered this: the dentist today took a bite wing x-ray of this tooth, so he must have been referring to that x-ray when he said "there was no evidence of decay." This experience has been a bit of a "whirlwind." Thanks again for your kind and expert assistance through it all. May God bless you! :)

You are most welcome, Lynn. I'm always glad to help.

Cheers,

Dr Shernan

BTW - if I've answered your question to your satisfaction, I'd appreciate a positive rating.

Thanks Lynn,

Dr Shernan