Dental amalgam—also known as “silver fillings”—has been used for nearly a hundred years to treat cavities. There are several reasons why this mixture of metals has been the go-to material among dentists: Malleable when first applied, dental amalgam sets up into a durable dental filling that can take years of biting forces. What’s more, it’s stable and compatible with living tissue.
But there’s been growing concern in recent years about the safety of dental amalgam, with even some wondering if they should have existing fillings replaced. The reason: liquid mercury.
Mercury makes up a good portion of dental amalgam’s base mixture, to which other metals like silver, tin or copper are added to it in powder form. This forms a putty that can be easily worked into a prepared cavity. And despite the heightened awareness of the metal’s toxicity to humans, it’s still used in dental amalgam.
The reason why is that there are various forms of mercury and not all are toxic. The form making headlines is known as methylmercury, a compound created when mercury from the environment fuses with organic molecules. The compound builds up in the living tissues of animals, particularly large ocean fish, which have accumulated high concentrations passed up through their food chain.
That’s not what’s used in dental amalgam. Dentists instead use a non-toxic, elemental form of mercury that when set up becomes locked within the amalgam and cannot leach out. Based on various studies, treating cavities with it poses no health risks to humans.
This also means there’s no medical reason for having an existing silver fillings removed. Doing so, though, could cause more harm than good because it could further weaken the remaining tooth structure.
The most viable reason for not getting a dental amalgam filling is cosmetic: The metallic appearance of amalgam could detract from your smile. There are newer, more life-like filling options available. Your dentist, though, may still recommend dental amalgam for its strength and compatibility, especially for back teeth. It’s entirely safe to accept this recommendation.
Periodontal (gum) disease is a bacterial infection, which if left untreated could cause gum recession, bone loss and eventually tooth loss. Caused mainly by plaque left on tooth surfaces from poor hygiene practices, the deeper the infection spreads below the gum line, the more difficult it is to treat.
One possible scenario involves parts of a tooth’s root structure known as furcations. These are branching forks formed during the early development of teeth with multiple roots where they take different paths from the base of the crown. As gum disease spreads around the root it may cause different degrees of bone loss at the point of the branch.
It’s imperative when treating gum disease to uncover and remove any bacterial plaque or calculus (hardened plaque deposits) found, including below the gum line. To address bacterial plaque at the root level, it’s important to first determine if bone loss has involved the furcations (where the roots separate, also referred to as a “furcation invasion”) and to what degree.
We usually classify this degree of involvement in three classes: Class I, the invasion has created a groove in the furcation, but minimal significant bone loss; Class II, the bone loss has extended into the furcation by at least two millimeters; or Class III, the bone loss extends completely from one end of the furcation to the other (or “through and through”).
Depending on the class, cleaning plaque and calculus from furcations and then maintaining them thereafter can be quite challenging. We may need to use specially shaped hand instruments known as scalers or curettes to reach and clean root surfaces, or ultrasonic scalers that use high-frequency vibrations and streaming water to loosen and flush away plaque debris. It may also prove helpful, though limited, to apply antimicrobials or antibiotics to the area to help limit the levels of bacteria.
Disease damage around furcations may also require surgical treatment to encourage new tissue and bone growth in the area. Surgery can also help make the area more accessible to future cleaning and maintenance, both for you and us. Renewed hygiene practices on your part and regular cleaning and checkups with us will help ensure that the situation involving your tooth roots can be kept under control and your tooth preserved for many years to come.
Miley Cyrus's rise to fame began when she was cast in the Disney series Hannah Montana. She played the title character, Hannah Montana, a famous singing star hiding her true identity, ordinary girl, Miley Stewart. In her real life at the time, Miley Cyrus had her own little secret—she was undergoing orthodontic treatment to straighten her smile.
Like many teenagers (as well as many adults), Cyrus's dental bite wasn't in proper alignment. She could have gone the traditional way by straightening her smile with braces fixed to the front of her teeth. It's an effective treatment, but the metallic hardware can overwhelm a person's appearance.
With her various roles in the public spotlight, Cyrus and her family wanted an effective but out-of-sight method for moving her teeth. They chose a relatively new one called lingual braces. Unlike traditional braces, the hardware for lingual braces is fixed on the back of the teeth (or the tongue side, hence the term “lingual”).
Lingual braces can correct any bite problem labial (“lip”) braces can, just through different mechanics of movement. Its main appeal is that the hardware is hidden behind the teeth, so only you and your orthodontist need know you're wearing braces.
There is also less risk of damage to the mouth or the braces themselves if you're in a sport or profession where you're at high risk for facial blows. And unlike patients with traditional braces, you'll have an unobstructed view of your progress over the course of treatment.
Lingual braces do tend to cost more than traditional braces. Some patients also have difficulty at first with speaking and tongue comfort, though most grow accustomed to the braces within a couple of weeks. Because lingual braces are relatively new, there's been a limited number of orthodontists offering it.
But lingual braces are just one of the ways to straighten teeth. Modern dentistry offers several ways to give you your dream smile. If you have dental problems or would like to improve the look of your smile, please contact us or schedule a consultation, and we can discuss your options. To learn more, read the Dear Doctor magazine articles “Lingual Braces” and “The Magic of Orthodontics.”
You may think all crowns are alike—but there can be a world of difference between one crown and another. Getting the crown your dentist recommends and one that's satisfactory to you will depend on a number of factors, including what you'll ultimately have to pay.
Here are 3 things you need to know about crowns before undergoing a crown restoration.
Different materials. Although porcelain is the most life-like material used, earlier types of this glass-based material weren't strong enough to withstand biting forces, especially in back teeth. Years ago, all-metal crowns were most often used until the development of a hybrid porcelain crown with an inner metal substructure for strength. In recent years stronger all-porcelain crowns have risen in popularity. The material type that works best often depends on the tooth to be crowned—all-porcelain may work for a visible front incisor, but a porcelain-metal hybrid might be needed for a back molar.
Level of artistry. While new computer manufacturing systems allow dentists to produce patient crowns in-office, most still require the services and skills of a dental lab technician. The cost difference between crowns usually occurs at this juncture: the more life-like and customized the crown, the more artistry and time required by a technician to produce it. This can increase the cost of the crown.
Limited choices. While you and your dentist want your crown choice to be as individualized and life-like as possible, your dental insurance may limit your options. Many policies only provide benefits for the most basic crown restoration—enough to regain functionality and have an acceptable, but not always the most aesthetic, appearance. To get a higher quality of crown you may have to supplement what your policy and deductible will cover.
Deciding which crown is best will depend on where it will be needed, the level of attractiveness you desire and your insurance and financial comfort level. And your dentist can certainly help guide you to a crown choice that's right for you.
If you would like more information on restorative crown 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 “Porcelain Dental Crowns.”
First the bad news: Those nightly hair-raising sounds are indeed coming from your child’s bedroom—from your child. It’s the result of them grinding their teeth while they sleep.
But here’s the good news: the only likely harm is a lack of sleep members of your household might experience because of it. Teeth grinding is so prevalent among pre-teen children that many healthcare professionals consider it normal. But that doesn’t mean it can’t become a problem, so it’s worth monitoring.
Teeth grinding is part of a family of dental habits known as bruxism. It involves any involuntary movement of the teeth and jaws outside of their intended functions not associated with chewing, speaking or swallowing. Our main concern with any bruxism is the possibility for generating stronger biting forces than normal that could damage teeth and gums and contribute to jaw joint problems.
Teeth grinding can occur in adulthood, with stress seeming to be the major trigger for it. With children, though, it’s believed to be mainly caused by an immaturity of the child’s neuromuscular process that controls chewing. As this matures, most children will tend to outgrow the habit none the worse for wear.
But there are pediatric cases in which the generated biting forces are strong enough to cause damage. Teeth grinding is also prevalent in children who snore or breathe through their mouths, which could be a sign of a serious health condition called obstructive sleep apnea. And certain medications used to treat depression and attention deficit disorder (ADHD) may also contribute to teeth grinding.
Most of the time we can simply let the habit run its course. If, however, the child begins to experience abnormal tooth wear, headaches, jaw pain or other issues believed caused by teeth grinding, we may need to intervene. This could include a plastic night guard the child wears during sleep that prevents the teeth from making solid contact during grinding episodes. And children with signs of airway obstruction should be evaluated by an ear, nose and throat specialist.
It can be irritating or even distressing. But your child’s teeth grinding doesn’t mean you should be alarmed—only that you should keep your eye on it.
If you would like more information on teeth grinding and similar habits, 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 “When Children Grind Their Teeth.”
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