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.
Radiographic (x-ray) images are an indispensible diagnostic tool in dentistry. One of the most routine and useful types of x-rays dentists take is the so-called bitewing. Here are some things you may want to know about this common diagnostic procedure.
What are bitewing x-rays?
Bitewings reveal the presence and extent of decay in the back teeth, specifically in areas where adjacent teeth touch each other. Unlike other areas of the teeth, these contacting surfaces between adjacent teeth can’t be examined visually. Bitewings can also show areas of bone loss around teeth — a sign of periodontal disease; however, they are not taken for that purpose because bitewings will not show the complete root surface that is surrounded by bone.
Why are they called that?
The name “bitewing” refers to how the film — or sensor, in the case of a digital x-ray — is positioned in the mouth: The patient bites down on a little tab or wing that holds the apparatus in place.
How often do I need them?
This is determined on a case-by-case basis, with the goal of not exposing you to any more radiation than necessary — even the minimal amount found in a series of bitewing x-rays. Your individual susceptibility to caries (tooth decay) and personal dental history will play a major role in determining how frequently you need radiographic examination — and, for that matter, how often you need to come in for routine cleanings and exams.
Are they safe?
The safety of bitewing x-rays is best illustrated with a comparison to the regular daily radiation exposure we get every day from environmental sources, which is about 0.01 millisieverts — the unit of measure we use for radiation. A series of 4 bitewing x-rays exposes you to 0.004 millisieverts of radiation — less than half of the daily exposure. Undetected tooth decay, which can spread quickly through the softer inner layers of teeth, is considered much more dangerous!
If a bitewing x-ray shows that there is tooth decay, what happens next?
If the cavity is very small, we may be able to treat it during the same appointment. If not, we will make a separate appointment to make sure it is taken care of promptly. The sooner tooth decay is treated, the better!
Thanksgiving is an appropriate time to spotlight an often unsung group: individuals providing primary care for another family member. During November, National Family Caregivers Month recognizes those caring for children with special needs or senior adults with life challenges—and part of that ongoing care includes watching out for their loved one's oral health.
Keeping teeth and gums healthy requires a concerted personal effort to prevent dental disease. While most of us can handle this on our own, some need assistance. If you're caring for someone like this, be sure you focus on two main areas: daily hygiene and regular dental visits. These are the two foundation stones for preventing tooth decay and gum disease.
The relatively simple tasks of brushing and flossing are crucial for disease prevention—but they can pose a challenge for someone with diminished physical, mental or behavioral capacity. In some cases, you as a caregiver may have to perform the task for them.
But even someone with severe limitations may be able to do these tasks for themselves with some adaptations. For one, choose a place for brushing and flossing that's most comfortable for the person (not necessarily the bathroom) and keep to a routine schedule. Above all, approach the task in a positive and playful way, especially for children.
Choose a toothbrush and flosser that your loved one can easily handle. Flossers are also available with toothbrush-sized grips for those with less manual dexterity. An older person with arthritis may need an extra-large grip or a toothbrush modified with a bicycle handle. As an alternative, both children and older adults may benefit from using an electric toothbrush. Some special needs children can have a gag response to toothpaste, so you may wish to use less or substitute it with a diluted fluoride mouthwash on the brush.
Dry mouth is a concern among many older adults, often due to the medications they take. In fact, hundreds of medications can have dry mouth as a side effect. Saliva serves the important oral health function of washing away food debris and neutralizing acid in the mouth, but when saliva production is low, it is not only uncomfortable—it greatly increases the risk of tooth decay. To help with dry mouth, encourage your loved one to drink more water during the day and ask us to recommend a product that will boost their saliva production. You can also ask their physicians about drug alternatives without dry mouth side effects.
To make dental visits easier, be sure we know about any needs or conditions that might affect their care. If possible, accompany your older family member during their visit: Because health problems often increase with age, even routine visits may be more involved.
We understand that caring for family members who need assistance can be demanding, with needs often being prioritized. We urge you to keep dental care on the high-priority list—it could make a difference with the rest of their health and overall quality of life.
If you would like more information about oral care for a family member with special needs, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Aging and Dental Health.”
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
Dental implants are considered the premier option for tooth replacement. While all implant procedures follow the same general concept — a titanium post surgically inserted into the jawbone with an attached life-like crown — the installation process can vary.
From their earliest history, implants have usually been installed through a two-stage process. In the first stage, the surgeon inserts the titanium post in the bone and leaves it “submerged” below the gum level to protect it from oral bacteria and the effects of chewing and biting. About three months later after the bone attaches to the titanium (a process called osseointegration), the surgeon then performs the second stage by re-exposing the implant and attaching a temporary abutment and crown for the patient to wear while the permanent abutment and crown are fabricated and later attached in 2-6 weeks.
In recent years, advancements in materials and design have made possible a one-stage process that allows the implant to protrude above the gum line during osseointegration and shortens the process. After the initial three-month healing period, the implant is ready for “loading” with the permanent crown.
The choice between which of these two procedures should be used for your implants will first depend on the type of tooth being replaced. A front tooth benefits from the one-stage procedure for cosmetic reasons because the surgeon can install a temporary crown to the exposed abutment during osseointegration (as long as the temporary tooth isn’t in functional contact with other teeth). An implant for a back tooth, on the other hand, doesn't have a large cosmetic demand so those one stage procedures usually end up with an exposed healing abutment but no temporary crown.
The strength of the bone is also a factor. Some bone tends to be softer, particularly in the back of the mouth. There’s a chance the implant could move in this softer bone, adversely affecting the outcome. For this reason, the two-stage procedure can be the preferred approach for posterior teeth as it offers more protection from movement.
You can be sure we’ll consider all these and other factors during your initial examination, and then advise you on the best approach. Above all, we want to make sure — whether a one-stage or a two-stage implant process — the result is a smile you can be proud of.
If you would like more information on dental implants, 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 “Staging Surgery in Implant Dentistry.”
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