Back in 1992 I attended a lecture which convinced me to stop using amalgams, the mercury-silver fillings that look black in people’s mouths. Besides the obvious concern of mercury toxicity to both patients and myself, was the fact amalgams weaken the tooth and set it up for fracture. Tooth colored bondings, on the other hand, help hold the tooth together, and have the obvious esthetic advantage. While the American Dental Association maintains dental amalgams are safe, several European countries have outlawed them. It should be stressed however, there is no proof that having the amalgams removed will improve any ailments. While it is true mercury is toxic, there are no conclusive studies that link the mercury in dental amalgams to any specific diseases. That being said, we still chose to stop placing the silver-mercury fillings and offer the better alternatives instead. Our patients are happier, and so are we!
No doubt given enough time researchers will find everything we love to eat is no good for you. The latest research on French Fries has touched off a panic with the discovery of Acrylamide in the fries. It seems in high amounts, acrylamide causes cancer in lab animals (reminds me of the cyclamates scare in the 80’s). Like all things, it really is a matter of amounts, and the amounts given the lab animals was in greater excess than what humans would consume. Then consider, all foods cooked at elevated temperatures have chemical changes, including the formation of acrylamide! Since man discovered fire and cooked his first mastodon burger, acrylamide was present. So, do we worry about the latest findings? At least no one has shown French fries are bad for your teeth…yet!
Halloween and candy have become synonymous. As a dentist, one would expect me to rail against the evils of sugar. While the fermentable sugar in most candies is cavity causing (cariogenic), there are other factors in the equation of cavity formation: immune response and home care being very important too. But frequency of consumption is also a major factor, for with each incident of eating fermentable sugar, such as sucrose, the bacteria in your mouth produce acid which lasts about twenty minutes. This acid attacks the tooth to cause the hole known as a cavity. It would be better to eat 10 lbs of candy in one sitting, then to have one little candy bar and break off a piece and eat it (20 minutes of acid attack), and then break off another piece an hour later and eat it(20 more minutes of acid attack, and then have another piece an hour later (20 more minutes of acid attack)…well you get the picture. It is frequency, not quantity that counts with respect to caries (the disease process causing cavities). Now, despite this, the acid production can be minimized by good flossing, and brushing after eating sugary substances. So enjoy your Halloween candy: just eat it with less frequency, and brush afterwards!
Gastric reflux can have a negative impact on oral health. While soft tissues can try to heal after an acid burn, hard tissues such as the enamel of your teeth, are dissolved away irreparably through acid erosion. Patients who have been diagnosed with GERD (gastroesophageal reflux disorder) at least should be aware of the possibility of enamel loss, though prescription and over-the-count medications can help control and even prevent the damage. But what about patients who have not been diagnosed with GERD? Does this mean they are not at risk of enamel erosion. Unfortunatley, some patients have low enough levels of reflux which do not seem to warrant a diagnosis of GERD, and yet show the dental evidence of acid erosion. The acid causing the erosion can be from internal causes such as builimia or reflux disorders, or external, such as the large consumption of acidic beverages such as soda. Discounting external sources (not many people drink several cans of soda every day, or suck on lemons regularly) many patients show the dental signs of erosion which can be attributed to low level, and sometimes undiagnosed, reflux problems.
What is important is that unlike the soft tissues of the body which can replenish itself, once enamel is eroded away it is gone for good. The danger then, is when the erosion becomes so severe; it jeopardizes the health of the tooth. As the erosion progresses, it encroaches upon the pulp, or “nerve” of the tooth. If the nerve gets irritated or dies, it will need a root canal, which in turn necessitates a crown (cap) for the tooth. So what begins as a little notch of erosion can end up killing the tooth and becomes quite costly. Most frequently, the erosions are seen by the gumline where the enamel is thinnest and most vulnerable to erosion. These notched surfaces can reasonably treated when small by placing a filling, typically a tooth colored bonded composite restoration, or “bonding” for short. In addition, your doctor may recommend a medication to control and prevent the release of stomach acids. The use of antacids is of little benefit in prevention, but may be of value when a person is aware of the presence of acid in the mouth.
It is important then, to see your dentist, in addition to your gastroenterologist to make sure all is being done to prevent damage to your teeth.
The ADA reported on recommendations made by the American College of Obstetricians and Gynecologists in which they advised it is safe for pregnant women to see their dentists during their pregnancy. This includes routine cleanings, X-rays, fillings, and treatments such as root canals and extractions. In addition, dental anesthetics, with or without epinephrine have been deemed safe during pregnancy.
Oral health is important, and disease should not be left untreated. Some oral diseases are transmissible, such as caries, which can be passed from mother to infant. Delaying treatment can cause increased problems and costs. Early prevention is always advisable. A healthy mother has a better chance of having a healthy baby!
We have been amalgam free for over twenty years now. Ever since I attended a lecture given by John Kanca on bonding and avoidance of amalgam fractures back in 1992, I put my stock of mercury and silver on the shelf and used the composite resin: tooth colored, bonding materials. With one exception, most of the different brands have held up very well. I dropped amalgam from use, not from any fear about toxicity or safety, but for biomechanical reasons. I do believe amalgam is safe when properly placed by a clinician. However, there is no question amalgams weaken teeth and can set them up for fractures. Bonding composite can be more conservative, and can help hold a tooth together better. However, even bonding (resins/composites) have their limitations, and there is concern about bis-phenol A in the oral environment. Gold still remains the most biocompatible material, and has the longest longevity. Of course, not many people want to show off the “bling” in their mouths, and would rather show it off on their wrist, ears, lapels, etc.
The future of dental restorative materials may fall by the wayside, With stem cell harvesting, the future may bring the genetic manipulation to the forefront and relegate tooth repair to the rear.