Amalgam fillings were great... but they're not as great as the new bonded fillings.  Amalgam fillings do not seal the cavity that they fill... they are mechanically locked into the tooth... decay is detected frequently around and under old amalgam fillings.

   Dr. Bloom sees many amalgams still functioning well after 10-30 years...  Xrays may or may not detect decay under and around old amlagam fillings because the metal blocks the xrays... often, a careful visual inspection shows that there is something wrong, as shown in this photo.  These teeth may or may not have any symptoms... if present, symptoms might be sensitivity to biting hard foods, reactions to cold, or to sweets, or, if decay has reached the nerve,  they might have occasional aches or throbs... or no symptoms at alll. 

  Decay in teeth that started with large and deep fillings now require larger and deeper fillings, as shown in this photo.

  Whenever there are large, wide fillings, you will find thin, weak cusps that are susceptible to fracturing off if you bite the "wrong way" on the "wrong" thing... thin, weak cusps are "time bombs" with an unknown fuse.  Preventive Dentisry practice directs that these teeth should be crowned to restore strength and prevent cusps from fracturing off.  The first step after decay removal is to fill in the large cavities... this bonded filling is called a "build-up" and will remain at the core of the tooth when it is prepared for its crown.  The photo shows a cusp that was reduced in height so that it cannot be broken off before the crown is placed.  The crown will restore the height and bulk of all the cusps.

Teeth that have a history of large, deep decay sometimes develop an onset of problems with the nerve of the tooth... ie. the closer the decay and fillings are to the nerve, the more often we find irreversible nerve problems.  (In contrast, reversible nerve problems include the symptoms of sensitivity to cold or sweets that goes away after a filling is placed, or the symptoms that arise immediately after decay removal and a filling is placed but that subsides over the following few days to a few weeks.)

  Dr. Bloom will often allow some time after doing a large, deep build-up filling to assess the health of the tooth's nerve.  Symptoms that do not subside over the following few days to a few weeks or are severe or come-and-go without provocation or, if after provocation with hot, cold, or biting, the symptoms linger for a while before subsiding, all are indications that the tooth's nerve is in trouble.

  A crown is not a treatment for an uncomfortable tooth... a crown is a restoration for a weak tooth.

  The treatment for an uncomfortable tooth is usually to remove the troubled nerve followed by restoration with a crown.  If at all possible, Dr. Bloom prefers to find out the comfort of the nerve before placing the crown... this is the reason for a 2-8 week waiting period after decay removal and build-up.