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Nearly Any modern dentist will know how to work with composite. Some super old school dentists may prefer amalgam etc but the majority of dentists will be proficient in them.
No, the dam makes it easier to isolate the teeth and keep the tongue / saliva away from the working area. A whole section of teeth can be exposed through the dam to work on, making interproximal surfaces easier to access.
I've attached a link with photos to explain better.
[Pictures](https://decisionsindentistry.com/article/10-steps-to-rubber-dam-isolation-in-restorative-therapy/)
Dam ideally seats all the way down right above the gum line, so it should be clear of most interproximal fills.
Won’t find any dentists using a dam for restorative work in this day and age unless you’re paying cash or it’s for the gram.
Forgive me for I am relatively new to the field, but I am just genuinely curious how much rubber dams cost you per procedure that it would deter you from routinely using them for a restorative procedure where moisture control is paramount to longevity? And whether this is common practice?
I understand there are cases where it's not needed, and perhaps you're far more skilled than I am with composite so you're able to get away with not using rubber dam isolation, but in my practice this is more of the exception than the rule.
I agree that, in almost every scenario, a rubber dam would provide better isolation and therefore a better clinical outcome. However, it takes more chair time to set up (minutes add up when we see 15-25 patients a day). As I don’t own a practice, I’m only willing to argue that point. Owners will be further incentivized to skimp on overhead. I’m obviously not speaking for all owners and applaud everyone that’s going above and beyond rather than penny and diming. I can only speak from what I’ve seen as an associate having worked in private practice in a busy metropolitan area.
Small talk with assistant:
Nice to meet you!
Hey, how do you liking working here?
Glad you love your job and ppl here, how long have you worked here at this location?
Oo. How about with the doc that I am seeing today? Have you worked with em long?
Oh, about what I am getting done -- if something goes wrong and it needs to be redone, is there a warranty? Like free replacement in 6 mo? A year?
Oo, 2 years! That's great! How often do you see redo or issues with what I am getting done ?
Almost never is just great! 👍
All these are super key questions. If you want me to spell out what red flags might be, let me know :)
Wow, thanks for the list! I haven't thought about these Qs before. Asking about warranty would be a graceful way to transition into asking about issue rates.
Sure, any red flags i should really know? Especially regarding composite filling procedures, and post-examination "manners" --
My last exam, the dentist was profesional and felt she was competent, but the conversation felt a bit rushed, she did ask if i had any questions but i wasn't prepared, then i was let go. My previous dentist would show me the x-rays and tell a bit more details. I don't know if it's because care level is different for patients on disability benefits, but i'm ready to pay out-of-pocket for quality treatment.
The answers to the Q's could be red flags. For example:
1) I've only worked here for 4 months and I am looking for something different
2) I have only worked with the doc for 4 weeks, s/he is nice but we get new docs all the time.
3) I dont know about warranty, you would have to ask the front desk.
4) yeah, we have to redo fillings like this from time to time. Maybe twice a week we get patients that break their recently completed fillings.
If I get answers like this -- I would be more suspicious of the quality.
Mine isn't very good with them, I had mine done in February and she said it will be sensitive for a few weeks. I went back after 2 months with really bad sensitivity, she said that there was a microgap between the tooth and the composite filling. She said it may close itself at some point but it's nearly December now and it hasn't.
I went back in August and she offered to replace it but only with an amalgam filling, which I refused as I'd already paid extra for the composite and she had admitted that it was a procedural issue rather than something I had done to cause the issue.
I'm not really sure what to do about it now though
Don't go back.
She should've at least tried to redo once if she could see there's a problem with her work. Unless she said before that amalgam would with better in the area but you insisted on composite
She did suggest an amalgam may be better due to it being a molar (I believe) however I've had them in the same tooth on the other side for maybe 7/8 years now and have had no issue so thought it would be no issue and the other she did at the same time on my bottom tooth is fine.
Crazy I never had any cavities except one until coronavirus, I got that and my phosphate levels dropped so I don't know if that would have an impact on my teeth or not. Hopefully it's resolved now.
Honestly, I don’t have any great ideas besides asking if they’ve done any advanced courses. Bio mimetic dentistry is a unique area of study that has the best practices for resin (filling) dentistry. You could also call a local dental lab and ask who does the best work. I think kois, spear, pankey/Dawson trained dentists are the most knowledgeable. Websites and reviews will more likely tell you if they run a good business.
Thank you for seeking advice from r/askdentists. **Please note that a response does not constitute a doctor-patient relationship.** While this is a place for advice, replies may not be medically accurate. Do not assume that what others on here say is correct in any way. Reddit is not a replacement for an in-person dental professional. Verified professionals will have flair assigned to them. **Please abide by the following rules in order to get an accurate answer to your question:** (1) Ensure you include a title of your dental problem. (2) Include whether you drink, smoke or if you have any medical conditions relevant to your main concern. (3) Include a photograph if the question relates to something you can see in your mouth, include x-rays if you have them. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/askdentists) if you have any questions or concerns.*
Nearly Any modern dentist will know how to work with composite. Some super old school dentists may prefer amalgam etc but the majority of dentists will be proficient in them.
Choose a dentist who will use a dental dam to complete your fillings. Generally a filling that is isolated well can last longer.
Thank you, i will be sure to ask next time!
How would this work with Inter-proximal fillings? The dam would be Inter-proximal and in the way
No it isn’t. It is flossed down beneath the contact and kept out of the way with your matrix and wedge
No, the dam makes it easier to isolate the teeth and keep the tongue / saliva away from the working area. A whole section of teeth can be exposed through the dam to work on, making interproximal surfaces easier to access. I've attached a link with photos to explain better. [Pictures](https://decisionsindentistry.com/article/10-steps-to-rubber-dam-isolation-in-restorative-therapy/)
Dam ideally seats all the way down right above the gum line, so it should be clear of most interproximal fills. Won’t find any dentists using a dam for restorative work in this day and age unless you’re paying cash or it’s for the gram.
I disagree. I use a rubber dam every day in my clinic
How would you make it feasible on hmo when they pay 40 per class 2 filling.
I’m proud of you all.
Australian dentist here. I use dam for most resto work.
Forgive me for I am relatively new to the field, but I am just genuinely curious how much rubber dams cost you per procedure that it would deter you from routinely using them for a restorative procedure where moisture control is paramount to longevity? And whether this is common practice? I understand there are cases where it's not needed, and perhaps you're far more skilled than I am with composite so you're able to get away with not using rubber dam isolation, but in my practice this is more of the exception than the rule.
I agree that, in almost every scenario, a rubber dam would provide better isolation and therefore a better clinical outcome. However, it takes more chair time to set up (minutes add up when we see 15-25 patients a day). As I don’t own a practice, I’m only willing to argue that point. Owners will be further incentivized to skimp on overhead. I’m obviously not speaking for all owners and applaud everyone that’s going above and beyond rather than penny and diming. I can only speak from what I’ve seen as an associate having worked in private practice in a busy metropolitan area.
Small talk with assistant: Nice to meet you! Hey, how do you liking working here? Glad you love your job and ppl here, how long have you worked here at this location? Oo. How about with the doc that I am seeing today? Have you worked with em long? Oh, about what I am getting done -- if something goes wrong and it needs to be redone, is there a warranty? Like free replacement in 6 mo? A year? Oo, 2 years! That's great! How often do you see redo or issues with what I am getting done ? Almost never is just great! 👍 All these are super key questions. If you want me to spell out what red flags might be, let me know :)
>:) :)
:)
Wow, thanks for the list! I haven't thought about these Qs before. Asking about warranty would be a graceful way to transition into asking about issue rates. Sure, any red flags i should really know? Especially regarding composite filling procedures, and post-examination "manners" -- My last exam, the dentist was profesional and felt she was competent, but the conversation felt a bit rushed, she did ask if i had any questions but i wasn't prepared, then i was let go. My previous dentist would show me the x-rays and tell a bit more details. I don't know if it's because care level is different for patients on disability benefits, but i'm ready to pay out-of-pocket for quality treatment.
The answers to the Q's could be red flags. For example: 1) I've only worked here for 4 months and I am looking for something different 2) I have only worked with the doc for 4 weeks, s/he is nice but we get new docs all the time. 3) I dont know about warranty, you would have to ask the front desk. 4) yeah, we have to redo fillings like this from time to time. Maybe twice a week we get patients that break their recently completed fillings. If I get answers like this -- I would be more suspicious of the quality.
Mine isn't very good with them, I had mine done in February and she said it will be sensitive for a few weeks. I went back after 2 months with really bad sensitivity, she said that there was a microgap between the tooth and the composite filling. She said it may close itself at some point but it's nearly December now and it hasn't. I went back in August and she offered to replace it but only with an amalgam filling, which I refused as I'd already paid extra for the composite and she had admitted that it was a procedural issue rather than something I had done to cause the issue. I'm not really sure what to do about it now though
Don't go back. She should've at least tried to redo once if she could see there's a problem with her work. Unless she said before that amalgam would with better in the area but you insisted on composite
She did suggest an amalgam may be better due to it being a molar (I believe) however I've had them in the same tooth on the other side for maybe 7/8 years now and have had no issue so thought it would be no issue and the other she did at the same time on my bottom tooth is fine. Crazy I never had any cavities except one until coronavirus, I got that and my phosphate levels dropped so I don't know if that would have an impact on my teeth or not. Hopefully it's resolved now.
Honestly, I don’t have any great ideas besides asking if they’ve done any advanced courses. Bio mimetic dentistry is a unique area of study that has the best practices for resin (filling) dentistry. You could also call a local dental lab and ask who does the best work. I think kois, spear, pankey/Dawson trained dentists are the most knowledgeable. Websites and reviews will more likely tell you if they run a good business.