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?”
On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.
“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”
Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.
Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.
A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.
Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.
So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.
If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”
Sometimes dental conditions point to health problems beyond the teeth and gums. An astute dentist may even be able to discern that a person’s oral problems actually arise from issues with their emotional well-being.Â In fact, a visit to the dentist could uncover the presence of two of the most prominent eating disorders, bulimia nervosa or anorexia nervosa.
Here are 3 signs dentists look for that may indicate an eating disorder.
Dental Erosion. Ninety percent of patients with bulimia and twenty percent with anorexia have some form of enamel erosion. This occurs because stomach acid — which can soften and erode enamel — enters the mouth during self-induced vomiting (purging), a prominent behavior with bulimics and somewhat with anorexics. This erosion looks different from other causes because the tongue rests against the back of the bottom teeth during vomiting, shielding them from much of the stomach acid. As a result, erosion is usually more severe on the upper front teeth, particularly on the tongue side and biting edges.
Enlarged Salivary Glands. A person induces vomiting during purging by using their fingers or other objects. This irritates soft tissues in the back of the throat like the salivary glands and causes them to swell. A dentist or hygienist may notice redness on the inside of the throat or puffiness on the outside of the face just below the ears.
Over-Aggressive Brushing. Bulimics are acutely aware of their appearance and often practice diligent hygiene habits. This includes brushing the teeth, especially after a purging episode. In doing so they may become too aggressive and, coupled with brushing right after purging when the minerals in enamel are softened, cause even greater erosion.
Uncovering a family member’s eating disorder can be stressful for all involved. In the long run, it’s best to seek out professional help and guidance — a good place to start is the National Eating Disorders Association (www.nationaleatingdisorders.org). While you’re seeking help, you can also minimize dental damage by encouraging the person to rinse with water (or a little baking soda) after purging to neutralize any acid in the mouth, as well as avoid brushing for an hour.
If you would like more information on the effect of eating disorders on oral health, 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 “Bulimia, Anorexia & Oral Health.”
Physical pain is never pleasant or welcomed. Nevertheless, it’s necessary for your well-being—pain is your body telling you something isn’t right and needs your attention.
That fully applies to tooth pain. Not all tooth pain is the same—the intensity, location and duration could all be telling you one of a number of things that could be wrong. In a way, pain has its own “language” that can give us vital clues as to what’s truly causing it.
Here are 3 types of tooth pain and what they might be telling you about an underlying dental problem.
Sensitivity to hot or cold. If you’ve ever had a sharp, momentary pain after consuming something hot like coffee or cold like ice cream, this could indicate several causative possibilities. You might have a small area of tooth decay or a loose filling. You might also have an exposed root due to gum recession, which is much more sensitive to temperature or pressure changes. The latter is also a sign of periodontal (gum) disease.
Acute or constant pain. If you’re feeling a severe and continuing pain from one particular area of your teeth (even if you can’t tell exactly which one), this could mean the pulp, the tooth’s innermost layer, has become infected with decay. The pain is emanating from nerves within the pulp coming under attack from the decay. To save the tooth, you may need a root canal treatment to remove the decayed tissue and seal the tooth from further infection. You should see your dentist as soon as possible, even if the pain suddenly stops—that only means the nerves have died, but the decay is still there and threatening your tooth.
Severe gum pain. If there’s an extremely painful spot on your gums especially sensitive to touch, then you may have an abscess. This is a localized area of infection that develops in the gums either as the result of periodontal (gum) disease, or an infection spreading from the tooth pulp into the gum tissues. You’ll need to see a dentist immediately for both pain relief and appropriate treatment (including a possible root canal) to heal the abscessed tissue.
If you would like more information on tooth pain and how to treat it, 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 “Tooth Pain? Don’t Wait!”
We’re all familiar with “naughty” and “nice” lists for food: “nice” items are beneficial or at least harmless; on the other hand, those on the “naughty” list are not and should be avoided. And processed sugar has had top billing on many people’s “naughty” list for some time now.
And for good reason: it’s linked to many physical ills including obesity, diabetes and heart disease. As a favorite food for oral bacteria that cause dental disease, sugar can also increase your risk for tooth decay or periodontal (gum) disease.
Most people agree that reducing sugar in their diet is a great idea health-wise. But there’s one small problem: a great many of us like sugar—a lot. No matter how hard we try, it’s just plain difficult to avoid. Thanks perhaps to our ancient ancestors, we’re hard-wired to crave it.
But necessity is the mother of invention, which is why we’ve seen the development over the past half century of artificial sweeteners, alternatives to sugar that promise to satisfy people’s “sweet tooth” without the harmful health effects. When it comes to dental health, these substitute sweeteners won’t contribute to bacterial growth and thus can lower disease risk.
But are they safe? Yes, according to the U.S. Food and Drug Administration (FDA). The agency has approved six types of artificial sweeteners for human consumption: acesulfame K, saccharin, aspartame, neotame, sucralose and rebaudioside A. According to the FDA any adverse effects caused by artificial sweeteners are limited to rare conditions like phenylketonuria, which prevents those with the disease from safely digesting aspartame.
So, unless you have such a condition, you can safely substitute whatever artificial sweetener you prefer for sugar. And if dental health is a particular concern, you might consider including xylitol. This alcohol-based sweetener may further deter tooth decay—bacteria can’t digest it, so their population numbers in the mouth may actually decrease. You’ll find xylitol used as a sweetener primarily in gums, candies and mints.
Reducing sugar consumption, couple with daily oral hygiene and regular dental visits, will certainly lower your risk of costly dental problems. Using a substitute sweetener might just help you do that.
If you would like more information on sweetener alternatives, 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 “Artificial Sweeteners.”
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