What kind of materials are available to fix holes in teeth?

The most common material for about a century has been silver and copper mixed with mercury with a little tin.  This mixture is called amalgam or simply silver filling.

Silver has anti-microbial propertities that helps prevent bacterial growth.  The copper and tin control the amount of expansion and contraction that occurs to reduce the number of teeth that crack with filling expansion.

The most controversial part is the mercury.  Mercury in its purist from can dissolve other metals to form an alloy at room temperature.  This makes it unique.

Unfortunately, when mercury combines with other materials like fats or carbohydrates, it can be more easily accumulated from the environment.  Many fish have accumulated enough mercury in their tissues that eating too much fish can be bad for you.

Mercury released from silver fillings has been extensively studied and concluded to be safe.  The amounts released are very, very little and the form of mercury is not easily combined with our tissues.

Neverthe less, many people prefer not to have silver fillings for fear of even the smallest amounts of mercury, because the fillings are dark, and because they can crack teeth after many years.

The next most common filling material is composite plastic.  A composite is a mixture of several materials and the materials mixed for this filling is plastic and extremely finely ground glass.

Recent concerns about bis-phenol A in plastic packages has caused some concern about the plastic in fillings.  Dental fillings use bis-phenol B.

The advantages of Composite fillings:

• they look great
• have the ability to stick to tooth structure,
• wears well
• it insulates from hot and cold,
• there is no problem biting metal foil.

The disadvantages of composite fillings are:

• they are very sensitive to getting wet during placement,
• that they can stain,
• they are not as strong,
• the bond to enamel may break down over time and allow bacterial to seep under the filling.

Some alternatives to composite are glass ionomer fillings, ceramic or gold cast inlays, or crowns.

Glass ionomer fillings are made of polyacrylic acid and finely ground glass particles that contain fluoride.  There have not been any reports of toxicity of these materials.

They are most commonly used for temporary fillings or fillings that are difficult to keep dry.  Many third world countries use glass ionomer fillings placed by non-dentist technicians to stop decay for many years. 

The disadvantages of  glass ionomers are:

• They can be brittle and crack
• They wear down fairly quickly

Advantages of glass ionomers are:

• Easy to place
• Release fluoride to reduce decay
• look tooth-like
• insulate from hot / cold / foil

The least common alternative to fill cavities is the use of customized precision-ground ceramic materials cemented in place with composite or pure gold fillings pounded into the hole or cast and cemented.

These are all very expensive and with the exception of the pure gold foil, they are cemented in place and have the same complications of composites mentioned above.

What it all comes to is that preventing a cavity is infinitely better than fixing one.

Post from: Great Grins

Filling Materials

1.   Preventing dental accidents is usually better than dealing with the sometimes serious problems that can occur with a fall or blow to the mouth.

Mouthguards are a proven method of preventing knocked out or broken teeth.  The inexpensive ones you can buy at the sporting goods store seem to do an adequate job for most uses.

If you are in a sport like boxing or martial arts, you may want to get a custom made one to ensure maximum protection.  We can take an impression of your teeth and make a mouthguard that will help you breathe well and still protect you from a hard right cross.

2.  If a tooth gets chipped enough that the middle bleeds, you need to see your dentist right away.

Bleeding from the middle of a broken tooth generally means that the nerve has been exposed and although it may not hurt immediately, once it gets infected, it will abscess and become more painful.

3.  A tooth that gets knocked out should be replaced in the hole it came from immediately.

There are living cells on the root surface that MUST be kept alive or the tooth will eventually be lost .

If the root is dirty, gently wash it off but avoid tap water; milk or spit work better.

Have fun this summer but be careful.

Post from: Great Grins

Summer Safety

The Oregon Dental Conference in East Portland hosted the first major presentation on Green Dentistry, according to the speaker, Mr. Kevin Henry.

This course discussed LEED certified building that reduces Volitile Organic Compounds that outgas into the air.  Receiving a LEED Platinum certificate is extremely difficult so the recommend continuous improvement step-by-step.

Suggestions to help improve environmental impacts from our Portland & Oregon City pediatric dental offices include:

• sterilizing dental cleaning tools instead of throwing them away
• buying in bulk rather than using individually packaged items
• avoid paper towel use by using sanitizing hand gel
• provide regular cups instead of paper cups
• use biodegradable toilet paper
• use cloth bibs and chair covers instead of plastic
• wash clothes with sterilize cycle on Energy Star washer
• if plastic is used, collect and recycle
• wipe off surfaces with an enzymatic cleaner (OptiStatim by Scicam)
• reduce water use by putting aerators on faucets
• buy Green computers (www.epeat.net)
• recycle old computers (www.earth911.org)
• turn off anything with a remote or transformer plug
• opt out to cancel junk mail at www.donotmail.org
• ask for digital versions of magazines and bills
• send electronic greeting cards
• print on both sides of paper

Two good resources for environmentally sound dental practices:

• www.sfgreenbiz.org
• www.ecodentistry.org

There are so many families from Portland, Clackamas, West Linn, Lake Oswego, Milwaukie, Oregon City, and Gladstone that care about the environment and want to reduce their carbon footprint. 

Our offices can help by doing more to reduce our carbon footprint, reduce our use of landfills, reduce water use, and contribute to a healthy environment.

Post from: Great Grins

Going Green 2

There will be lots of great courses on important dental topics. Governor John Kitzhaber, MD will give the General Session presentation on Rethinking the US Health Care System.

I plan to attend lectures on Laser Dentistry and Going Green in the Dental Office.

We have been using the BioLase MD dental laser for nearly a year and found it to be useful for cutting off extra gum tissue around braces without anesthestic, for clipping tied tongues with almost no bleeding, and for cutting out decay on teeth with little or no anesthestic shots.

Most of the kids are surprised with the popping sound but are happy to avoid a shot for their fillings. Click here for more on Lasers.

There seems to be a movement in dentistry to pay more attention to the environment with the lecture at the Oregon Dental Conference dedicated to this topic.

I have already written about our intention to reduce our impact on the environment with the article on Going Green. The Oregon Dental Conference is moving in that direction by providing all the session handouts in an electronic form to avoid wasteful printing.

East Portland’s Oregon Convention Center is a great location because many dentists can take the MAX to get there and avoid both car exhaust pollution and parking fees.

Post from: Great Grins

Continuing Education

Well, I believe that is everyone’s responsibility to help preserve the earth’s energy resources. See EnviroMom for more info. Also, we are converting to a paper-less dental office this year.

The two actions go hand-in-hand because we go through an incredible amount of paper every year just filling out forms and keeping track of every filling, orthodontic procedure, crown, and dental cleaning.

If we could keep all that information on the computer, we would save the trees used to make the paper and the gas used to produce and transport it.

Installing solar cells is helpful to replace the electricity used to run the computers. Now is especially a good time to put solar energy cells in Oregon because of the generous tax credits the Oregon and Federal goverments provide business owners.

Our East Portland pediatric dental office has a steep concrete tile roof and it is not well suited for solar cells. Our Oregon City pediatric dental office is much better suited because of its flat roof and lack of nearby trees.

Other ways we are trying to conserve natural resources is to use fewer disposable plastic covers on our dental chairs, sterilize and reuse instruments rather than throw them away, and use more bio-degradable products. (See Going Green 2)

If every pediatric dentist and orthodontist does their part, we can save enough trees and oil to support a healthy environment and healthy kids.

Post from: Great Grins

Going Green