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Are My Fillings Leaking?

June 15th, 2017

ARE MY FILLINGS “LEAKING”?

When I do examinations, I often use the term “leaking” to describe the condition of old silver-amalgam fillings to my patients.  What leaking means in this case is that the seal between the tooth and the filling material has been lost, at least to some degree.  When amalgam (silver filling material) is first placed into the tooth, a coat of sealer called “varnish” is painted on the internal surface of the cavity preparation right before the silver is “packed” into the hole.  The “cavity preparation” is the hole in the tooth that is left after the decay is removed and the varnish is a sticky substance that is very similar to the type of varnish that would be placed on wood to give it a protective coating.  The varnish actually does two things.  1) It seals the inner part of the tooth called dentin that has small nerve endings, and 2) it allows a seal to form between the filling material (amalgam) and the enamel.  It is this seal that starts to “leak” after decades of exposure to the mouth environment.

The first sign that the filling has started to leak is a faint grayish discoloration of the enamel around the filling.  The gray, or sometimes almost black discoloration, is the result of fluids from the mouth causing corrosion of the silver within the amalgam filling.  Amalgam is a mixture of silver, tin, copper, and mercury. Silver tarnishes black when it is exposed to oxidation; a common example of this is the black residue that forms on silverware after being stored in a cabinet for years.  Polishing can remove this black residue from silverware but it permanently stains tooth structure.  It more deeply stains the dentin layer of the the tooth because dentin is more porous than the hard enamel layer.

The dark staining of the tooth is unsightly, however the bigger concern is the decay that inevitably follows this leaking process.  If fluids are allowed to get between  the tooth and the filling material, so are bacteria, which are responsible for tooth decay.  Therefore, it’s safe to assume that if you have a filling that’s been in your mouth for 20 years or more, and it’s got a dark “halo” around the edges, that there is bound to be decay under that filling as well.  Because the long-term health of a tooth is directly proportional to how much healthy tooth structure remains, it’s prudent to have those leaky fillings replaced as soon as possible; once the leaking starts and allows the decay process to begin, it won’t stop on its own.  The filling must be completely removed so that the decay can be excavated from the tooth and a new filling can be placed.  In most cases, the new filling material would be a white material called composite, which has its own limitations, but does not cause this dark staining of the tooth.  In some cases, where there is a significant amount of tooth loss due to decay, an onlay or crown may be placed rather than a filling.

Although amalgam fillings do eventually start to leak, and need to be replaced, it’s remarkable how long this material can last.  Because of it’s dark color, tendency to eventually stain teeth, propensity to create cracks in teeth, along with other minor drawbacks including concerns about the mercury within the material, amalgam is being slowly phased out of dentistry.  My guess is that we won’t see much of it being used after the next 10-15 years.

TEETH IN A DAY... REALLY?

October 23rd, 2016

My patients, personal friends, and others that know I’m a dentist often ask me, “ Is it really possible to get new teeth in a day?”.  The answer is “Yes!  It is possible!”.  The question is likely due to the huge amount of marketing from dentist who provide this service.   This type of service has been around for years and was typically provided only by dental specialists such as prosthodontist, oral surgeons, and/or periodontists.  With recent advances in technology and specialized training, many general dentists, including myself, can offer this service without the need to be referred to a specialist.  Of  course, there may be some cases where treatment by an outside specialist is indicated, due to special circumstances.

When people are referring to “teeth in a day”, they are referring to a procedure whereby all the remaining teeth are removed, four to six dental implants are placed in the jaw bone, then a denture is fastened to those implants with small screws that only the dentist can remove.  With such a denture that is attached to implants, patients are able to leave the office and smile with confidence.  They know that their denture will not move or come out of the mouth.  When 4 dental implants are used for this type of procedure, this procedure is referred to as “All-on-Four”;  In other words, all the teeth of one “arch” is supported by a denture connected to 4 implants.  It offers the most cost-effective way to support a “fixed” denture to implants.  The number of implants used is affected by the quality and quantity of bone present in the jaw bone as well as other factors driven by patient desires, prosthetic design, and the patient’s budget for such treatment.  Here are some questions that people commonly have about teeth in a day:

Q: Am I a candidate for teeth in a day?

A:  This is a procedure that is done for people who have the majority of their teeth in one or both arches failing; this could be due to gum disease, advanced dental decay, or other problems which make restoring the remaining teeth impractical.  This is typically determined on a patient’s first visit to the office, when the doctor does a thorough examination to determine the condition of the teeth, gums, bone, and jaw joints.  The doctor will discuss all other options that are available so the patient can decide what’s best for them.

Q: How long does the procedure take?

A: If only one arch (all upper or lower teeth) is teated, the procedure can be done in about 4 hours.  If both arches are treated, then the procedure can take the entire day.

Q: Will I be awake for the appointment?

A: Most patient undergo the procedure while awake, using a “local” anesthetic such as lidocaine.  Some patients choose to be asleep for the procedure.  In this case, an anesthesiologist is brought into the office to assist the doctor during the procedure.  This way the dentist can concentrate on the surgical procedure while the anesthesiologist focuses on keeping the patient asleep and comfortable.

Q: What are the benefits:

A: Replacing damaged,diseased, and poorly functioning teeth with a high tech implant-supported denture builds confidence and self-esteem.  Most patients have a dramatic improvement in their overall health not only because they feel better about their appearance, they also tend to choose healthier foods such as fruits, vegetables, and meats that they were not able to chew before.  The all-on-four technique may also be less costly than other types of implant-supported dentures or bridges.

Q: How long will it last?

A:  Of course with any medical procedure there can never be guaranteed results, however I can comment on typical success rates in healthy individuals.  A 2011 study in the Journal of the American Dental Association showed a success rate of just over 99% with up to 10 years of follow up.  The success of each individual case depends on many factors including but not limited to the patient’s oral hygiene habits, the biting force of the individual, the quality of the materials used, and the clinical expertise of the dental clinician.

Q: How do I know if I have good enough bone for implants?

A: During the examination appointment, the doctor will take a 3-dimensional x-ray of the patient’s mouth called a Cone Beam Computerized Tomogram (CBCT) or “Cone Beam CT”.  This  allow the doctor to see the thickness and bone quality of the jaw bones as well as see important anatomic landmarks used to properly place the dental implants in the jaw bone(s).

Q: Will I be in pain after the procedure?

A: Most patients experience little or no discomfort after the procedure.  Typically patients manage any discomfort they may have with over the counter pain medications such as Aleve, Advil, or Tylenol.  In some situations stronger pain medications are prescribed.

Q: How many appointments are required?

A: Although it only requires one appointment to remove the bad teeth and place the new  implants and denture, there are typically about 5 total appointments required over a 3 month period.  The first appointment is for diagnosis and planning, the second appointment is to remove remaining teeth and place the “interim” denture, the third appointment is for the final moulding of the jaw and implants so the permanent denture can be made, the fourth appointment is to try-in and evaluate the permanent denture, and the 5th appointment is for follow up.

Is Fluoride Bad?

July 18th, 2016

The honest answer is, "That depends!".  Just like anything that we ingest, such as sodium chloride (table salt), small amounts are beneficial to our health and large amounts can be toxic to the body.  Fluoride is ion that is found naturally in ground water.  It's in very high concentrations in some places, like Texas for instance, and much lower levels in other areas of the country.  When it's concentration in water is lower than 0.7 mg/L, it has no benefit for cavity protection of teeth and obviously is not toxic to the body either.  That's why some communities choose to add it to their municipal drinking water supply. When it's concentration is above 1.2 mg/L, there is no added benefit for cavity protection and it may have unwanted side effects such as tooth discoloration and possible toxicity at ultra-high levels.  Therefore, it certainly would not make sense to have more added to the municipal water supply in some areas of the country.

Here is a link to a website which gives answers to the many questions that people have about the health effects of fluoride:  www.ilikemyteeth.org/fluoride

WHY DO I NEED AN EXAM BEFORE MY CLEANING?

May 28th, 2016

WHY DO SOME DENTISTS REQUIRE AN EXAM BEFORE A CLEANING?

Lots of people call our office and want to schedule for a dental cleaning.  That’s probably one of the most common reasons for people requesting an appointment when someone does not have any pain, discomfort, or a broken tooth.  We require that an examination be completed prior to anyone having their teeth cleaned.  That may seem like an added expense and inconvenience for a lot of people who “just want a cleaning”, but there is good reasoning behind this policy.  The reason is because, by law, we cannot provide any sort of treatment without first having a diagnosis.  Before any patient has their teeth “cleaned”, we must first make a diagnosis of their gum health.  In other words, we must know if periodontal disease (gum disease) is present, as the treatment for someone with healthy gums is completely different than for someone with periodontal disease.  The assumption that most people make on their own is that some sort of pain or discomfort would be a telltale sign of gum disease, and therefore they would know if they had gum disease.  This assumption is ABSOLUTELY WRONG!  Gum disease is no different than many other common health problems, as far as their difficulty in diagnosis, because these problems don’t cause pain.  Here are some examples.

Common Health Problems which are BAD, and Don’t Cause Pain:

  1. HEART DISEASE.  Arteriosclerosis, the progressive constriction of the small blood vessels throughout the body and within the heart itself doesn’t cause pain.  Undiagnosed heart disease can lead to heart attacks, and possibly death.  It’s a great idea to see a doctor for a periodic examination to make sure you don’t have heart disease.
  2. MELANOMA.  Malignant Melanoma, a type of skin cancer that typically looks like a freckle on the skin, is the most dangerous type of skin cancer known.  Its’ diagnosis is made based on a biopsy of the skin, as the disease causes no pain, discomfort, or even a single sensory clue that it is present.  Better get those moles checked by a doctor!
  3. GUM DISEASE.  Also referred to as Periodontal Disease, this silent and painless disease of the gums and its’ underlying bone, is present in half of the US population (according to a 2012 CDC study).  Early gum disease is essentially imperceptible to a patient and is diagnosed by a dentist or dental hygienist by either x-ray analysis and/or a periodontal charting, whereby the depth of the small crevice formed by the gum tissue around each tooth is measured.  Advanced gum disease may be perceptible to a patient when the teeth become mobile (wiggly) within the bone/gums, but generally does not cause any discomfort or pain.  That’s why it is so important to see the dentist/hygienist on a regular basis!  Without these regular checks, gum disease cannot be diagnosed and the health of your teeth and gums are at risk!

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