The Bond Between The Filling And The Dental Tissue

The first step when getting a filling is to make sure that you are comfortable throughout the procedure. Dentists usually do this by using an anesthetic. I’ve always found it interesting that dentists give an anesthetic to eliminate pain, yet getting “the shot” is usually a patient’s biggest fear. A local anesthetic temporarily interrupts communication between the tooth and the brain. We call it “sleepy juice” when dealing with kids because it puts the nerve “to sleep”. That way, if the tooth sends a pain signal, the anesthetic prevents the pain signal from reaching the brain – and you feel no pain as a result.
Injections have a reputation for being painful, but the truth is that the amount of pain you experience during an injection will largely depend on the skills of your dentist. Dr. Stanley Malamed, author of Handbook of Local Anesthesia has stated, “Local anesthetic administration should not be painful. Every one of the local anesthetic techniques…may be done atraumatically…Several skills and attitudes are required of the drug administrator, the most important of which is probably empathy. If the administrator truly believes that local anesthetic injections do not have to be painful, then through a conscious or subconscious effort it is possible to make minor changes in technique that will lead to making formerly traumatic procedures less painful for the patient.”
Composite dental fillings have one problematic feature, in that the bond between the filling and the dental tissue deteriorates over time in fact, sometimes by as much as 50 per cent in one year. As the bond deteriorates, it may allow bacteria to enter and this brings a high risk of further tooth decay.
Professor Tjäderhane has researched the occurrence of certain enzymes, matrix metalloproteinases (MMPs), in the dental tissue and their role in dental conditions. The MMPs break down the extracellular matrix, including collagen, which is a major component of dentin. As a result of international research collaboration, Professor Tjäderhane's research team has shown that human dentin contains the key MMP for breaking down collagen. The bonding of composite resins with dental tissue is based on the use of collagen bonds, and the tooth's own MMPs are responsible in part for the deterioration of the bond over time. By inhibiting the activity of these enzymes, the research team has succeeded in significantly slowing down the deterioration of the bond between dental tissue and a composite filling, and in some cases to prevent deterioration completely.
The best results have been obtained in clinical trials, where deterioration of the bond has been more or less completely prevented. MMP enzyme activity in the tooth can be rapidly and easily inhibited when a filling is put in place by using chlorhexidine, a substance which is already on hand at all dental practices. This means that the research results are immediately applicable in dental care for the best benefit of the patients. The research in question also strongly indicates that MMP inhibitors might help slow down tooth decay. These observations are based only on animal testing so far, so further research on the subject will be needed before pratical applications can be made available.
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