With all the new tooth-colored fillings for cavities, it's easy to overlook metal amalgam. While this mainstay of dental care for over a century might not be as attractive as composite resins or glass and resin ionomers, it still has the advantage of strength and durability.
Amalgam is a stable metal alloy usually made up of silver, tin, copper and mercury. The metals are proportioned and mixed precisely to guard against “free” mercury molecules, which could pose a health hazard. The mixture is pliable at first, but then sets hard once molded into the prepared area of the tooth.
Besides strength, amalgam's other advantages include low cost, high resistance to wear and biocompatibility (not toxic to the body or allergy-producing). At the same time, it can require more tooth structure removal to accommodate a filling and cause higher sensitivity to temperature for a while after installation. Its main disadvantage, however, is appearance — it's now considered unacceptable from an aesthetic point of view to use it in visible areas like the front teeth.
Because of this, materials resembling natural tooth color are coming into vogue, especially as their strength improves. Still, dental amalgam continues to play a useful role, especially in less visible back teeth with higher chewing forces.
One past concern about dental amalgam is the inclusion of mercury in the alloy. As mentioned before, mercury is hazardous in a “free” form when not knit microscopically with other metals; as such it can emit a vapor that could enter the bloodstream and damage the nervous system. But after several studies by various organizations, the American Dental Association has concluded amalgam's precise mixture prevents the mercury from taking this form: although some vapor is given off during chewing it's far too low in concentration to pose any danger.
Dental amalgam continues to be an effective choice for fillings. Whether it's the right choice for you will depend on the type and location of a tooth to be filled, and whether durability is a higher concern than appearance. If we do recommend an amalgam filling, you can be assured it's a safe and lasting choice.
If you would like more information on your choices for dental fillings, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Silver Fillings — Safe or Unsafe?”
If you’ve lost some teeth you may eventually want to replace them with dental implants. Implants by far are the restoration of choice due to their life-likeness and durability. But those advantages don’t come cheaply — implants can be expensive especially for multiple teeth.
If you’re forced to wait financially for implants, you still have other intermediary options like a removable partial denture (RPD). The conventional RPD has a rigid acrylic base colored to resemble gum tissue supported by a metal frame with attached prosthetic (false) teeth at the missing teeth locations. They’re held secure in the mouth through metal clasps that fit over the remaining teeth.
But these conventional RPDs can sometimes be uncomfortable to wear and don’t always cover the bottom of the gum completely. If this is a concern, you might consider an alternative: flexible RPDs. The base of this RPD is made of a form of flexible nylon rather than acrylic plastic. They’re much more lightweight but still fit securely in the mouth with thin plastic extensions rather than metal clasps. The base can also be more easily formed to cover areas where gum tissue may have receded.
While flexible RPDs hold up better to wear and tear than their conventional counterparts, they must still be maintained like any other appliance. They can accumulate plaque (bacterial biofilm) responsible for tooth decay and periodontal (gum) disease, so daily thorough cleaning is a must. And if there fit becomes loose they can be more difficult to reline or repair than other types of dentures.
They also share a common weakness with other dentures — they can’t prevent and may even stimulate bone loss. As bone ages, old cells dissolve and new ones form to take their place. As we eat and chew our teeth transmit the forces generated through the teeth to the bone to stimulate it to grow. RPDs and other dentures can’t transmit this stimulus, so the bone replaces much slower to the point that the bone volume can diminish.
That’s why it’s best to consider any RPD as a temporary solution until you can obtain an implant for a more permanent and bone-friendly option. In the meantime, though, an RPD can provide you with a great solution for both form and function for missing teeth.
If you would like more information on RPD choices, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Flexible Partial Dentures: An Aesthetic Way to Replace Teeth Temporarily.”
Everyone has to face the music at some time — even John Lydon, former lead singer of The Sex Pistols, arguably England’s best known punk rock band. The 59-year old musician was once better known by his stage name, Johnny Rotten — a brash reference to the visibly degraded state of his teeth. But in the decades since his band broke up, Lydon’s lifelong deficiency in dental hygiene had begun to cause him serious problems.
In recent years, Lydon has had several dental surgeries — including one to resolve two serious abscesses in his mouth, which left him with stitches in his gums and a temporary speech impediment. Photos show that he also had missing teeth, which, sources say, he opted to replace with dental implants.
For Lydon (and many others in the same situation) that’s likely to be an excellent choice. Dental implants are the gold standard for tooth replacement today, for some very good reasons. The most natural-looking of all tooth replacements, implants also have a higher success rate than any other method: over 95 percent. They can be used to replace one tooth, several teeth, or an entire arch (top or bottom row) of teeth. And with only routine care, they can last for the rest of your life.
Like natural teeth, dental implants get support from the bone in your jaw. The implant itself — a screw-like titanium post — is inserted into the jaw in a minor surgical operation. The lifelike, visible part of the tooth — the crown — is attached to the implant by a sturdy connector called an abutment. In time, the titanium metal of the implant actually becomes fused with the living bone tissue. This not only provides a solid anchorage for the prosthetic, but it also prevents bone loss at the site of the missing tooth — which is something neither bridgework nor dentures can do.
It’s true that implants may have a higher initial cost than other tooth replacement methods; in the long run, however, they may prove more economical. Over time, the cost of repeated dental treatments and periodic replacement of shorter-lived tooth restorations (not to mention lost time and discomfort) can easily exceed the expense of implants.
That’s a lesson John Lydon has learned. “A lot of ill health came from neglecting my teeth,” he told a newspaper reporter. “I felt sick all the time, and I decided to do something about it… I’ve had all kinds of abscesses, jaw surgery. It costs money and is very painful. So Johnny says: ‘Get your brush!’”
We couldn’t agree more. But if brushing isn’t enough, it may be time to consider dental implants. If you would like more information about dental implants, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implants” and “Save a Tooth or Get an Implant?”
Today, many people are taking positive steps to reduce the risks posed by major health problems like cancer, cardiopulmonary diseases, hypertension, and diabetes. But there’s one disease that makes the top-ten list of worldwide health conditions, and yet isn’t thought about as much as many of the others. That malady is severe periodontal (gum) disease — and according to a new study, it’s the sixth-most prevalent health condition in the world.
The study, released by the International and American Associations for Dental Research, reveals that some 743 million people around the world — about 11 percent of the global population — suffer from severe periodontal disease; that percentage hasn’t changed significantly since 1990. The study also shows that while an individual’s chance of developing this condition rises gradually with age, there is a steep increase in people between 30 and 40 years old, with a peak at age 38.
If severe periodontal disease is such a major concern, why isn’t it “on the radar”? A 2010 report from the U.S. Surgeon General, titled “Oral Health: The Silent Epidemic,” gives some clues. For one thing, diseases related to oral health don’t always produce dramatic symptoms: Even tooth loss, for example, is sometimes (wrongly) regarded as an inevitable consequence of aging, when it’s more often the result of disease or injury. For another, these conditions disproportionately affect people whose voices aren’t always heard: children, the elderly, and the disadvantaged.
Severe periodontal disease is clearly a challenge to the public health. But what can you do as an individual? Plenty! The good news about periodontal disease is that it is largely preventable, and very treatable. Prevention is chiefly a matter of maintaining good oral hygiene.
Have you flossed lately? Is your brushing technique up to snuff? Do you avoid sugary snacks and beverages (especially between meals), and visit your dentist for regular checkups? If so, you’ve taken some major steps toward preventing periodontal disease. But despite their best efforts, it is difficult for some people to control periodontal disease without extra assistance. That’s where a periodontist can help.
Periodontists are concerned with treating problems of the gums. We use a number of methods to combat periodontal disease — including removing plaque bacteria, restoring healthy tissue, and educating people about how to maintain better oral hygiene at home. Your general dentist may refer you to a periodontist if warning signs are noticed, but you don’t need a referral to come in for an exam. If you notice the symptoms of periodontal disease — redness or inflammation of the gums, a bad taste or odor in your mouth, or any amount of bleeding when you brush — then it may be time to have your gums checked.
Most of us wouldn't think of buying a new car without a “test drive.” It's a serious investment, so you want to make sure you're comfortable with your new ride.
Like an auto purchase, the plan you and your dentist agree on to cosmetically enhance your teeth and gums — a “smile makeover” — is a significant investment. Wouldn't it be nice to “test drive” your future smile before you undergo any procedures?
Actually, you can — two ways, in fact. For one, your dentist could use computer imaging software that alters a photo of your face to show how your smile will appear after dental work. These computer enhancements are a great planning tool for making decisions on the look you want to achieve.
But even the best computer images only provide a static, two-dimensional representation of your new smile. It can't capture all the angles and movement dynamics of any proposed changes. That's where the other way, a trial smile, is a true test drive — you can see your future smile in action.
With a trial smile, your dentist temporarily places tooth-colored material called composite resin on your teeth to simulate the proposed changes. The resin can be shaped and sculpted to create a life-like replica that you'll be able to view in all three spatial dimensions. What's more it will give you a chance not only to see what your new smile will look like, but to actually experience how it feels in your mouth.
Creating a trial smile is an added expense and it's only available during your consultation visit — the dentist will need to remove the resin before you leave. But you'll still be able to get a good impression of what your final smile will be like. You'll also be able to take photos you can show to family and friends to get their impressions of your proposed new look.
A trial smile allows you to know beforehand what your dental work investment will provide you, and even fine-tune your makeover plan before work begins. With this particular kind of “test drive” you'll have greater assurance that you'll be happy and satisfied with the end results.
If you would like more information on trial smiles, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Testing Your Smile Makeover.”
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