Silver Fillings Are More Expensive Than You Think

It’s hard to find many people over the age of 30 in the United States who have not had at least one silver filling in their lifetime. In fact, it’s really only been in the last 35 years that comparable alternative materials have been developed for fillings in the back teeth. Our back teeth can take a beating over a lifetime. Average chewing forces alone in the molars can exert about 70 pounds per square inch, but for people who clench and grind regularly this force can increase by 6 to 10 times as much, or more. Obviously, any material used to restore the back teeth needs to be strong and durable.

For many years, the argument for silver fillings has been based on their strength, durability, ease of placement, and cost. Silver fillings are the least expensive filling material available on the market and require the least amount of preparation work on the tooth in order to place them. Yes, silver fillings contain metals and mercury, but proponents believe that the risks of mercury exposure or metal sensitivity are low. Certainly, dental insurance companies would prefer to only pay for silver fillings rather than more expensive metal- and mercury-free alternatives. And for the low-income population without insurance or additional resources, proponents believe a silver filling is better than no filling at all.

There is some truth to that statement. However, the ease and inexpense of the initial placement of a silver filling is not the only cost associated with that filling over a lifetime. The truth is that no filling material will last forever, but silver fillings by their very nature can set up more long-term damage in the teeth than other alternative materials now available. Even if we set aside all the valid concerns about metals and mercury, silver fillings just aren’t the best materials on the market anymore.

Silver fillings are not bonded to the teeth, which means that the margins are not actually sealed. That unsealed microscopic channel between the edge of the silver filling and the tooth makes it nearly impossible to protect the margins, even with exquisite home care. Inadequate or irregular home care will definitely leave these unsealed margins extremely vulnerable to recurrent decay, causing the filling to need replacement with larger and larger silver filings over time. But that’s not the only weakness that a silver filling can present.

Silver fillings also expand and contract in relation to temperature changes in the mouth at a very different rate than the healthy tooth surrounding them. Over time, as we eat hot and cold foods, these differing expansion rates can set up fracture lines in the tooth enamel that leave the tooth even more vulnerable to recurrent decay and breakage. No filling material on the market can exactly match the expansion and contraction rate of enamel yet, but silver fillings are the most likely to set up these kinds of expansion fractures in the shortest period of time.

So if the mercury content, unsealed margins, and the expansion/contraction rate of silver fillings are all of concern, why are silver fillings still in use? The answers are simple: it’s cheaper and easier than newer, better materials. Cheaper and easier may make sense in the short term, but the more we learn about silver fillings and the long-term consequences for the health of our teeth, our bodies, and our environment, those silver fillings may be far more expensive over time than we realize.

In my practice, I have not placed a silver filling in any patient in more than 20 years. I would not place a silver filling in my own mouth, in my children, or in my grandchildren. I do agree that when the only option is a silver filling or no filling, then the silver filling is the better choice. But I do not agree that silver fillings are cheaper in any way other than the initial cost of placement. We can do better across the board and especially by our low-income population, and it is my sincere hope that by keeping the conversation open and continuing to make as much information available as possible, that someday we will.

To learn more about silver fillings and all the other options available in dental filling materials, please visit my newest resource article, A Comparison of Dental Filling Materials.

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When You Have to Lose a Tooth

Losing a tooth can be a surprisingly emotional experience for many people. Even if that tooth has been compromised for a long time, the idea of removing a piece of your body – no matter how small – can sometimes trigger complex and unexpected emotional reactions. Shock, denial, and grief are all common responses to the news that a tooth cannot be restored and needs to be extracted.

Certainly it is always better to keep the teeth you have if you can, but there are several circumstances that can arise in the mouth that make it impossible to save a tooth without jeopardizing the overall health of your body. Infections that cannot be controlled or breakage that is too deep or widespread are just two of the situations that can compromise your long-term health if the affected tooth is not removed. No matter how hard you might try to keep that tooth clean and protected, holding onto it at this point is probably doing you more harm than good.

Tooth extraction may represent the end of an effort to save your natural tooth, but it does not have to be the end of comfortable function or a beautiful smile. Modern laser-assisted extraction techniques, bone grafting, and implant placement have all transformed what was once a dead-end loss of a tooth into the gain of a restoration that may very well be stronger and healthier than your natural tooth ever was.

Extraction, bone grafting, and implant placement all sound like complex and possibly painful surgical procedures. The truth for most people, however, is that these procedures are often no more painful or difficult than getting a filling or a crown. Understanding each procedure and talking with your dentist about your specific concerns will go a long way in alleviating any apprehension you may have about each step of the treatment.

In an effort to help you begin the process of understanding these procedures, I’ve prepared several resource articles on removing and replacing teeth, including Laser-Assisted Tooth Extraction, What is Bone Grafting?, and Implants vs. Bridges. As always, I encourage you to review these materials and bring as many questions as you have to your next regularly scheduled dental appointment. Together we can face what may be the loss of your natural tooth and discover a way to transform that loss into a gain of beauty and function without the pain or infection associated with a severely compromised tooth.

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The Benefits of Botox in Dentistry

I have to admit that utilizing Botox, or botulinum A, as a therapeutic treatment for dental and TMD-related conditions was not something I ever anticipated integrating into my practice. Like many of us, my first impressions of Botox came through the huge media attention surrounding the introduction of Botox Cosmetic in 2002. I was hearing a lot about Botox parties for frown lines and wrinkles, but at that time, I had no idea that Botox had been used as a therapeutic medical treatment long before the introduction of Botox Cosmetic.

Botox, as manufactured by Allergan, is now one of three formulations of botulinum A available for medically therapeutic treatment. Botulinum A is a controlled form of the botulinum toxin, a nerve toxin produced by infection with the bacterium clostridium botulinum, commonly known as botulism. One of the most devastating effects of uncontrolled botulism is extreme muscle paralysis. Untreated, this paralysis can become deadly. However, as early as the 1950s, scientists began studying the botulinum toxin as a separate entity from the bacterial infection and discovered that, in small doses, the toxin itself could be used to reduce muscle spasm.

Through the 1960s and 1970s, scientific studies continued to explore the use of botulinum toxin specifically as a treatment for strabismus, or crossed eyes. Finally, in 1989 after nearly 40 years of scientific research, Botox (as introduced by Allergan) was approved by the FDA for the therapeutic treatment of crossed eyes and eyelid spasms.

Today, even though Botox Cosmetic still remains the most visible use of the botulinum toxin, many additional medically therapeutic applications of botulinum A continue to be researched and discovered, including dental applications.

Targeting specific muscles around the lips, botulinum A can significantly improve conditions like gummy smiles, upside-down smiles, lip lines and creases, as well as chronically puckered chins. These treatments are not permanent, but there is growing evidence to support that treatment with botulinum A over time can retrain these muscles into a state of improved relaxation and natural function.

Treating other muscles of the face, head, and neck with botulinum A have also demonstrated measurable relief for headache pain related to chronic and unrelenting tension in these muscle areas. Of course, headaches are almost always caused by multiple triggers and those factors should be concurrently addressed during botulinum A therapy. But for those patients whose muscles simply cannot seem to let go of chronic spasm, treatment with botulinum A can sometimes offer a level of relief that might otherwise not be achievable through other types of therapy.

Certainly, treatment with botulinum A is not appropriate for everyone, and it is not a permanent cure for any of the conditions I’ve mentioned. However, it can be an invaluable tool in improving pain levels and visual appearance while other more permanent treatment solutions are being pursued. If you would like to learn more about each of the specific botulinum treatments that are now available in our office, I invite you to take a look at our newest resource article, Botox in Dentistry. Current or new patients are also always welcome to ask about botulinum treatment at any regular dental appointment, or to call the office to schedule a consultation.

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The Benefits of Dental Bone Grafting

When I first started my practice back in the early 1980s, dental bone grafting was still a relatively complex surgical procedure that required live donor bone or bone marrow, usually harvested from healthy bone in another part of the patient’s body, in order to be successful. Dental implants were still a fairly new procedure, and the success rates of both treatments were variable at best, mostly due to higher risks of infection.

Today, dental bone grafting and implant placement are safer and more effective than ever before. Advances in synthetic bone materials have almost eliminated the infection risks that were so much more common when working with live donor bone. The process is much easier on the patient, requiring less surgical time and reducing post-operative pain to a minimum. In the last few years, the addition of bioactive proteins to these synthetic bone materials has improved grafting even further by speeding the process of wound healing and enhancing both bone and gum regeneration around tooth roots and implants.

Even for patients who are not considering an implant to replace a tooth that needs extraction, a bone graft now offers us the chance to preserve the shape and strength of the bony ridge long after the tooth is gone. This is important not only for the health and strength of the teeth surrounding the extraction site, but also for the possibility of implant, bridge, denture, or partial placement in the future.

The bony ridges of our jaws get their shape from actively holding the roots of our teeth in place. When a tooth root is extracted and not replaced with an implant or a bone graft, the ridge begins to resorb and reshape itself. Without that root tip, implant, or another section of bone to hold onto, the ridge will shrink in both height and width over time. The result over a period of years is often a section of bone that is narrow, short, and fragile. Implant placement becomes far more complicated in these areas, and sometimes is simply not possible.

But implant placement isn’t the only tooth-replacement option that can be complicated by thin, fragile bony ridges. Traditional dentures and partials always fit better when the bony ridge is thick and strong. Ideally, modern dentures and partials are now anchored with implants as well, in order to avoid the slipping, clacking, and messy adhesive solutions that were so common for our parents or grandparents. Even bridges placed over extraction sites can be esthetically compromised by bone resorption if the bone shrinks away from the suspended false tooth enough to show a gap. Simply put, thin and fragile bony ridges make every tooth replacement option more difficult, less comfortable, less successful, and sometimes even impossible.

A bone graft after an extraction may increase the cost of the procedure initially, but the cost of not replacing that bone over a period of years may add up to far more discomfort and expense than the initial savings justifies. I encourage everyone facing a tooth extraction to talk with your dentist about the pros and cons of proactive bone grafting in order to make the right long-term decision for your body. As always, current patients of mine are encouraged to call the office or bring their questions and concerns to any regularly scheduled dental appointment. Our goal is to offer you the most complete information about the potential long-term effects of all the treatment choices available to you, and to help you make the decision that best supports your health goals.

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Keeping Your Mouth Cancer-Free

It’s hard to offer any solid guarantees about any type of cancer prevention. Genetics and environment can certainly play a role. Some cancers have been correlated to habits like smoking, while others appear to sometimes have a viral component, and still others seem to simply come out of nowhere. But even though we still don’t know everything about why cancer starts in one person and not another, we do know a great deal about the everyday habits that can significantly increase your chances of developing cancer in the mouth regardless of other factors. In fact, as far as researchers can tell us so far, the risk factors for oral cancer are overwhelmingly related to controllable lifestyle choices.

Of all the potential risk factors for oral cancer, smoking tobacco, using smokeless tobacco products, and drinking alcohol regularly and in excess continue to be the highest-risk lifestyle choices a person can make. And for those who combine smoking or smokeless tobacco with drinking regularly, this risk is compounded significantly.

Now it is true that in comparison to the incidences of other types of cancer, statistically oral cancer is still relatively rare. However, individuals are not statistics, and for those people who do develop oral cancer, the effects can be devastating. Whole portions of the tongue, cheek, and jawbone can be lost in the most severe cases. Even with the current advances in prosthetic reconstruction, the structure of the face and the function of the jaw will never be quite the same after that kind of damage. So why risk it at all when the simple choice to not use tobacco and to drink only in moderation could be the key to preventing oral cancer from ever developing?

Unfortunately, the answers are not that simple. Alcohol and the nicotine found in tobacco both have addictive properties, and once a person starts a habit with one or both, it can be very difficult to break it. Certainly, helping our children to avoid starting these habits at all is the best first step in the fight against oral cancer. But many pre-teens, teens, and young adults still remain unaware of the risks. It is an undeniable characteristic of youth to believe in invincibility, but it is also striking how undereducated many young people still are about how the choices they are making right now could affect their health in the long-term.

Of specific concern right now is the growing use of smokeless tobacco products among teenagers. A recent study published in the Journal of the American Academy of Pediatrics, indicates that 5.6 percent of American teenagers use smokeless tobacco products. That seems like a small number, but it shouldn’t. The most recent 2012 US Census data estimates that there are 21.2 million 15 to 19 year-olds living in the United States. That means that well over a million American teenagers are likely using smokeless tobacco products right now. What is even more disturbing about the research findings is that the majority of these students using smokeless tobacco tend to perceive all tobacco products, smokeless or not, as less harmful overall.

Clearly, we need to do a better job of informing young people of all the dangers associated with excessive tobacco and alcohol use. In that effort, I have created a new resource this month discussing the multiple ways that cancer can affect the mouth so that you will be able to have more informed conversations with your children about all the potential dangers of starting these habits.

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