matthew
d. wittmer
contact
me
sustainingtraces "at"
gmail.com
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No
more amalgam fillings: invest in porcelain inlays
In
2005 I began reading up on the history dentistry to better understand
why and how metals have been used for filling material in
teeth.
What I found was that there has been a divided opinion of the use of
the common “silver amalgam” fillings for quite some
time,
basically since the formation of the American Dental
Association.
The long-term cumulative effects of metals in the oral cavity have been
debated ever since their use in America (Wentz 2004). I found
that there are alternative dentists, cosmetic dentists, mercury-free
dentists and of course what I had always utilized—traditional
dentists. The dentists I grew up visiting had given me
several silver amalgam
fillings and had not ever offered alternative materials when it came to
fillings. I had not asked for
alternatives at the time either--I blindly trusted their clinical
judgement with my health. Upon moving to California, I began
to
see that in dental offices it is now law that the exam rooms post
warnings about filling materials as required by Proposition
65 (Brown
and Hansen 2000, p. 50; I saw these warnings posted in dental offices
in Glendale
and Pasadena, California. They were always framed and hanging
next to the patient dental chairs).
I continued to whittle away at the issue of amalgam fillings and read a wonderfully insightful book on the issue by Dr. Myron Wentz, called A Mouth Full of Poison: The Truth about Mercury Amalgam Fillings. It revealed the history of amalgam metals in dentistry. Wentz is a microbiologist who currently runs an alternative health clinic in Rosarito, Mexico called Sanoviv. I consulted many other dentists about alternatives to metal fillings and asked each one about their filling materials and protocal in removal and restoration procedures. This research revealed sharply divided opinions from dentist to dentist. I also found that the process of removing these fillings from my teeth could be harmful unless safety protocol is taken. Most sources report that amalgam fillings are typically comprised of about 50% mercury. Mercury releases fumes with an increase in temperature, which is generated by eating hot foods or drinks, as well as the through the generation of friction resulting from simply chewing food. Dental drilling or polishing causes the most friction (Brown and Hansen 2000; Wentz 2004). The International Academy of Oral Medicine and Toxicology has a complete safety protocol for amalgam removal; however, finding dentists who recognize or are even aware of this protocol was a whole different ball of wax. Some dentists will use slower drills with cool water to reduce friction. Some also use a vacuum system to divert fumes away from the patient and completely out of the office altogether. A rubber dam also prevents material from going into the mouth and being swallowed. The dentist who placed most of my fillings advised me against removing them; however, other dentists were happy to perform the procedure with and without any degree of the IAOMT safety protocol. It's validity appears to be based on your - and your dentist's - core belief about the whether or not the materials are harmful to begin with. As far as finding alternative filling materials, the one I found most frequently offered is a composite, white material that has aluminum in it. Estimates on this material's longevity stretch only two to five years before beginning to break down (Dentist in Pasadena told me this when he gave me one). Porcelain was what I felt was the most biocompatible, as it closely mimics tooth enamel (various California dentists told me this in personal consults to discuss filling materials in the summer of 2005). Recent developments in porcelain have increased it's core strength as a filling material. Instead of blindly following one dentist's recommendation, I began to base my trust more on what coincided with my personal research and my own gut level common sense when it came to the discrepancies between material, approach and removal procedures. This was considerably more proactive, time consuming (and at times daunting) than the years I had blindly trusted dentists to make choices for me, but with this extra effort came a greater degree of knowledge and involvement about clinical decisions that were directly impacting my physical health. A few dentists were resistant and argumentative when I asked simple questions. Traditional dentistry tends to employ traditional materials and practices. More contemporary applications in dentistry deviate from some of these materials and standards and they tended to be much more accomodating with handling and answering questions. Due to the improved technology of modern dentistry, the out of pocket expense tends to be much higher; however, more plans, such as Delta Dental, are increasing their reimbursement for these services. I eventually found a dentist that provided the best protocol for what made sense to me through the aid of a web site that had listings of dentists who maintain a mercury free practice. The director of this clinic I selected had written a book about biocompatible materials, alternative practices and diet and has been a pioneer in the field of using a variety of different lasers for preventative dental treatment (Dr. Richard Hansen). This clinic provided an intra oral exam with a microscopic camera that revealed to me, visually, several fissures in my teeth that were extending from or around my amalgam fillings. This was largely because no adhesive or bonding procedure is used when applying silver amalgam fillings. The material is poured directly into the tooth after it’s been prepped. As it sets up in the tooth it can be easily be sculpted to fit the tooth's outer contour (this is also true of the white fillings). This mixture of metals in the amalgam fillings, when heated or cooled, will expand and contract slightly. Over time this stress weakens the tooth because silver amalgam fillings are not bonded to the tooth; they merely conform to the inner shape of the hole they are filling (Pers. comm. with my dentist at Hansen's clinic, August 8, 2005). CEREC technology now alleviates this issue. Once a traditional filling has been removed, the tooth is lightly sprayed with a photo sensitive powder and scanned with a camera that creates a three-dimensional computer image of the tooth and it’s recessed area. The image can be viewed from any angle. The dentist uses a computer program to draw on the computer screen to create an inlay for the cavity. This is done in a matter of minutes and is not unlike tools in a Photoshop program. See below for the before and after images that map out the shape of the porcelain inlay. The blue line around the hole was drawn with a mouse.
Then a small piece of high-fire porcelain is placed in a milling machine and within 10 minutes the machine uses two diamond bits to mill out an exact replica of the cavity’s size and shape. This piece then snaps into the hole in your tooth, fitting almost perfectly! It is then fused to the tooth with a laser. The porcelain is biocompatible, so no more shocks or sensitivity with forks, foil from wrappers from the old fillings. Plus the porcelain comes in all shades of color so it will match the exact color of your tooth. Im my case, I opted to go with the natural color of my tooth, as I was and am not interested in tooth whitening. Since the inlay is fused with the tooth, it doesn’t work against it when pressure is applied through chewing, like the amalgam fillings can.
Reworking a Root Canal I also had an old root canal reworked to have an all-porcelain crown to replace the crown I had which was made of nickel (it had porcelain fused on top of the nickel). I had the old material used to fill the root of the tooth—called gutta percha— replaced with a material called Mineral Trioxide Aggregate. The MTA is extremely alkaline and more biocompatible than the gutta percha. The old gutta percha is a latex that is mixed with several types of metal (including barrium) so the dentist can see his handy work on an x-ray (Pers. comm. with my dentist at Hansen's clinic, August 8, 2005). This procedure took a few trips to the clinic due to the difficult nature of extracting the old material which had hardened over time.
References
McGuire,
Tom. 1994. Tooth Fitness: Your Guide
to Healthy
Teeth. Grass Valley, California: St.
Michael’s
Press. |
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© All images on this site copyright by Matthew D. Wittmer |
