Dental questions answered

I was advised by my dentist to have all silver (amalgam) fillings removed. He tells me they are toxic and would affect my general health. What is your opinion on this?

This is quit a controversial topic in dentistry. I don´t use amalgam and I believe removal can be beneficial for your health. Let me explain why:

Amalgam as used in dentistry is a combination of mercury, silver and tin, together with small amounts of zinc and copper. Of this mixture 50% is mercury.

Mercury is the most toxic non-radioactive element known. Mercury vapour is released from amalgam fillings and this is not disputed by any authority. Several studies have shown that the amount of mercury released can be in the range of 20 mcg-150 mcg per cubic meter air, remaining high for as long as 90 minutes after stimulation. Examples of this stimulation are the ingesting of hot drinks, grinding or tooth brushing. To get the release of mercury in perspective, latex paint which contained mercury have been taken of the market after being shown to release 2 to 3 mgc/m3.

Of the mercury vapour released by an amalgam filling, a small amount is dissolved in saliva and swallowed but the majority is inhaled. 80% of the inhaled vapour is absorbed by the lungs going straight into the oxygenated blood stream. The WHO states on this that it may cause harmful effects to the nervous, digestive, respiratory, immune systems and to the kidneys…And of course to the brain where, again according to the WHO, it may cause “adverse health effects” as tremors, impaired vision and hearing, fatigue, paralysis, insomnia and emotional instability.

To remove the toxic amalgam your dentist should use a protocol as described by the International Academy of Oral Health and Toxicity (IAOHT). Your teeth will have to be isolated by a “rubber dam” and/or special suction is needed (“Clean Up”). You will have to wear a nasal mask with oxygen to prevent the inhalation of mercury vapour inevitably generated by amalgam removal. A tungsten carbide bur “chops” out the filling, rather than diamond burs that pulverize the amalgam.

It is advisable to have your general health checked by a physician who is familiar with amalgam related health problems, and who will most probably prescribe supplements for before and after the amalgam removal.

I´ve always liked my teeth and had a lot of compliments, but lately they seem to have become darker. Also, I see some cracks and discolourations. What can I do to improve the looks of my teeth?

After a certain age, teeth tend to get a darker shade. In time the enamel becomes thinner and the underlying structure, the dentin, which has a more yellow/brownish tone, starts to shine through. Besides that, grinding, clenching and sudden temperature changes may cause hairline fractures through which colourants can penetrate and give your teeth a darker appearance, while the age-related recession of the gums may expose the darker roots of your teeth.

Whitening helps, but only to a certain extent. You must realize that the bleaching agents used in dentistry only whiten the enamel of your teeth, NOT the dentin, NOT the exposed roots and certainly NOT any restorations like fillings or crowns. It does make the enamel whiter, but you will have to do “touch ups” to keep them white.

There are several ways to cover the whole frontal surface of your teeth in order to get a more permanent brighter result and to solve the problem of the thinner enamel, the cracks and the restorations that do not whiten. By covering your teeth, you can correct the colour, the shape and the position.

First of all: Composite. This is the restoration material for “white” fillings. Instead of using it for fillings, it can be bonded to teeth in any shade you like, Advantage: Can be done in just one session, no technician involved and thus cheaper. Disadvantage: tends do discolour, needs regular polishing/correction.

Secondly: Porcelain veneers. Shells made by the technician and bonded to your teeth by the dentist. Advantage: Aesthetically beautiful, long lasting. Disadvantage: Grinding down of your teeth, 2 or 3 sessions with injections.

A third solution is the fairly new, ultra thin veneers (0.3 mm), made by the Cerinate laboratory in California called Lumineers. Advantage: Aesthetically beautiful, long lasting; no injections, just a slight polish of the tooth surface. Disadvantage: Major corrections will still need injections and more grinding.

To summarize: Whitening and composite veneers are temporary solutions, veneers and Lumineers are long lasting. Lumineers can be done with minimal to no shaping, veneers need a lot of grinding.

For more information on Lumineers, see: www.lumineers.com

I went to my dentist to make my front teeth look better and now he wants me to redo a root canal first and then do a deep cleaning to get my gums healthy before doing any cosmetic work.

Does that make sense or is this over treatment?

It sounds like you have a sensible dentist. Your teeth and surroundings, i.e. gums and jawbone, are essential parts of your body. Just making your front teeth look better in a mouth that shows other, possible health related problems is like painting a ship that is sinking slowly.

 Often, root canal treatment causes small chronic infection at the apex (root tip) of the tooth. An infection which, under normal circumstances, will not give you any problems as your defence system is easily able to fight it. When, however, for some reason your resistance becomes low (stress, flu, fatigue etc) such an infection might flair up, causing swelling and pain. It is unknown what these hidden infections do to other organs but it is suspected to negatively influence your general health.

So, in my opinion, your dentist is 100% right to attack this time bomb in your mouth before even thinking about improving your smile.

The second thing your mention, the gums, might even be more important. First of all, there is more and more evidence appearing on how infected gums influence certain organs as lungs and heart. A certain kind of bacteria that is only present in the mouth is found in the heart of 25% of all fatal heart attacks. When your gums bleed they become an entrance for bacteria into the bloodstream and spread throughout your body.

Secondly, after having your gums cured they tend to shrink as the swelling disappears. It is therefore essential to cure your gums first before having any cosmetic work done because you want to know where your gum line will end up.

You do not build a house on a swamp, the foundations are essential. The same counts for any restorative dental work, even if it is “just” cosmetics.

In your case I would stick with your dentist.