Are White Fillings Harmful to Kids?

Recently, white fillings (tooth colored)  came under fire for possibly contributing to poor behavior in kids. The media has highlighted that the BPA (bispenol A) containing fillings had a small but significant correlation to behavior issues in children.  The point not highly emphasized was that the level of BPA released from whiteReno Dentist - Tooth Colored Fillings fillings in the mouth was not measured.  It is not known what, or if, any chemicals are actually being released from these fillings. “It’s generally assumed that the amounts leached are tiny”1 Children with multiple white fillings, according to this study, constantly scored up to 6 points worse on a behavior survey answered by their parents.1  Effects from BPA have been noted as being “far from clear,” even looking back to a story from Reuters late October 2011. 

Important Points to Consider about Dental Fillings:

1.  Dental caries is a preventable disease by practicing good oral hygiene habits, limiting exposure to dietary acids (citric acid) and sticky sugars (dried fruits), and keeping regular dental cleaning appointments.

2. White fillings are primarily a silicate glass which is bound by a resin containing small amounts of BPA, which levels of BPA release have not been measured.

3. Silver Amalgam fillings are an alternative to white dental fillings, but a little more tooth is removed in the preparation.  Though it is one of the most researched dental materials and deemed safe by the ADA, they contain small amounts of mercury, and these fillings have been known to discolor and darken teeth. 

4. Any concerns you may have should be discussed with your dentist.

References:

Tooth fillings made with BPA tied to behavior issues

BPA tied to behavior problems in girls: study

Osteoporosis and Bisphosphonates – Bone Loss is Not Your Only Concern

Oral health is not commonly found in the forefront of everyone’s mind when we think of osteoporosis. For those at risk for osteoporosis, it should be something you not only discuss with your doctor but your dentist as well. Loss of bone in the mouth leads to loss of teeth, which makes it more difficult to properly nourish your body. There are many treatments used to address osteoporosis, but some such as Bisphosphonates severely impact you mouth. Bisphosphonates, such as Fosamax, Boniva, Actonel, and Reclast place a person at risk of developing osteonecrosis of the jaw which means a person’s gum tissue is not fully covering the bone leaving it exposed to the oral environment. This condition is difficult to treat, so if you need to be placed on Bisphosphonate treatment it would be best to see your dentist beforehand to make sure there are not any compromised teeth or teeth that need to be removed. The trauma associated with tooth extraction combined with use of bisphosphonates can lead you down the path of non-vital bone. While the exact cause is unknown, it is thought to be due to possible infection, the jaw’s limited ability to repair itself, or decreased vascularity of the jaw. Bisphosphonates reduce your bone’s ability to turn over so the constant production of bone reduces the blood supply due to the increased bone density. Recently it has been noted that use of bisphosphonates may increase a person’s risk of dental implant failure. A study conducted at the New York College of Dentistry found that women with dental implant failure were about 3 time more likely if they were taking oral bisphosphonates. Managing osteoporosis is a team effort and you should be seen by your dentist on a regular basis to preserve your oral health.

For More Information:

Implant failure may be related to bisphosphonate use

Osteonecrosis of the Jaw (ONJ)

All Ceramic Crowns vs. Gold Crowns

The other day I was talking with a colleague and he asked me if I really felt confident placing all ceramic restorations for posterior teeth such as molars. We graduated from a dental school that taught heavily, that gold is the best restoration for teeth. Gold has great properties that make the cast restoration strong, as well as kind to the opposing teeth and soft tissue. Gold use to be considered esthetic and a symbol of status in some cultures, but as times change patients want white teeth and in some cases metal free restorations. Historically ceramic has been known to be abrasive on opposing teeth and at risk for fracture, but materials and manufacturing are constantly improving making a ceramic restorations a more reliable choice when restoring teeth. Since all ceramic restorations are relativelTwo Molars that have been treated with two all ceramic IPS e.max crownsy new to dentistry, compared to gold and silver, there is limited but promising research for all ceramic restorations. The porcelain that has traditionally been stacked on metal copings can withstand a force of 140 Mpa, and has been used for decades. The all ceramic crowns made from a monolithium disilicate referred to as IPS e.max can withstand forces of 360-400 Mpa. That is more than twice the strength of the porcelain that has been used in the past. Since there is not a metal coping under the ceramic structure of the IPS e.max, there can be better esthetics due to improved translucency, and the restoration can be bonded to the tooth.

In the International Journal of Prosthodontics from January/February 2012, a 10 year study was published finding a survival rate 93.5%. Patient satisfaction was also evaluated and it showed that 96% rated them excellent while the other 4% rated them as good. Though it is tough to compete with the durability of gold, people want something that is white and going to last a long time and IPS e.max is rapidly becoming a material of choice. Reported by Millennium Research Group, 40% of all ceramic restorations are fabricated by CAD/CAM technology and by 2015 it is projected to be 70%. All ceramic restorations are here to stay and thanks to technology like the CEREC and E4D people can get more of their dental work done in one visit instead of having to come back two weeks later after battling a temporary crown. More examples of IPS e.max restorations can be seen in our photo gallery to the right.

For more information check out:

  1. Journal of the American Dental Association
  2. All-ceramic Restorations Shine in Long-term Study
  3. Ceramic Restorations to Top Market by 2015

Tooth pain: Don’t wait till it is too Late

All too often, we see patients that have had some sensitivity and ignore it until the tooth pain keeps them from sleeping or functioning in their daily life. Tooth pain can mean several things such as deep cavity, a cracked tooth, clenching or grinding, periodontal disease, a sinus infection, and impacted wisdom teeth. Each source of tooth pain has a different treatment to correct the discomfort. The focus of this posting is the progression of decay, when it should be treated, and the more extensive treatment required to save the tooth if it is allowed to progress.

Tooth Ache caused by a Cavity:

 Generally patients do not realize that the initial onset of tooth decay is a painless, chalky white spot. Depending on a person’s oral hygiene habits this spot can be maintained and sometimes reversed. Once the cavity spreads to the dentin the tooth decay is best treated by removing the infected tooth structure and replaced with a filling.If left untreated the tooth decay will continue to spread and often create an annoying sensitivity to cold, sweets and sometimes pressure. At this point the pulp in your tooth is inflamed from the irritation of the bacteria getting close to the pulp. Most of the time, the symptoms can be resolved by removing the tooth decay and filling the tooth. The problem with a cavity this size is the tooth is considerably weakened by the amount of infected tooth that needs to be removed. The point that too many people address the tooth pain is when the cavity reaches the pulp and there is severe sensitivity to cold or heat that lingers, pain to pressure and tapping. The lingering sensitivity to hot or cold indicates to us that your pulp is irreversibly inflamed or necrotic (dead). At this point the tooth needs all tooth decay removed an root canal therapy to clean out infected tissue and to seal the canals from the rest of the body to treat the tooth pain.

Tooth decay due to a rapid onset of dental caries.

 After the symptoms are treated we then look to restoring the tooth which commonly involves building up lost structure and placement of a crown. Every case has its own special qualities about them and it is always recommended to save what you can, but on occasion you may be faced with having to lose the tooth.

Weight Loss Could be Good for Your Oral Health

Those of you that have a resolution to lose weight, you will be benefiting your oral health as well. Check it out! http://goo.gl/MDnzt

Not all Candy is Created Equal : Sweet vs Sour

 We all know that something sticky and sweet is not a treat, well now we can add sour candy to that list. During our daily battle to improve our population’s dental health, we advise our patients to avoid various foods or treats that can have a negative impact on their dental health. In the midst of one such day, I stumbled upon an article that mentioned sour candies containing the up to a 92% greater potential to erode enamel and initiate tooth decay, than the original flavor counterpart (1). The main source of this increased risk is due to the greater amount of dietary acids such as citric acid, malic acid, and fumaric acid found in the candy. Citric acid seems to be the most commonly used acid not only in candy, but other foods and drinks that line our store shelves.

As we go through our day our busy day, the pH of our mouth fluctuates from a safe level (teeth recalcify) to a harmful acidic level (calcium is lost and tooth decay starts) every time we eat. If we are constantly snacking on candy or other foods our mouth is not given the chance to come back to the safe pH. If these snacks contain citric acid it makes maintaining your dental health a greater battle. If you need something in your mouth a sugarless gum is best because it keeps your acid fighting salivary glands stimulated. Also, snacks consisting of foods such as cheeses or walnuts can be less detrimental to your dental health.

Dental Health Tips:

1. Brush and Floss your teeth at least twice a day if not after every meal.

2. Do your best to avoid citric acid and other dietary acids in your diet.

3. Chew a sugarless gum, preferably containing Xylitol, usually a mint variety, since the fruit gums typically incorporate citric acid. Two things occur when you chew gum; saliva flow is stimulated by the gum (aiding in the buffering of acids), and the gum helps flush saliva between your teeth (aiding in bringing the pH between your teeth to a basic level that takes less time in other places in your mouth).

4. Stay hydrated with water so your salivary glands can produce plenty of saliva. Though it is good to dilute the acid by drinking water, keeping water in your mouth can increase the risk by diluting and washing away the calcium and proteins in your saliva that buffer the acids.

5.Visit your Dentist regularly so that your risk of dental decay can be monitored and any areas of dental decay can be addressed while the cavity is still small so we can save healthy tooth structure. 

Sources:

  1. Sour Worse Than Sweet for Your Teeth
  2. Journal of the American Dental Association

Your Health is a Team Effort: Know When to Premed.

We no longer live in a time where your health can be effectively managed by a single physician, like in the days of house calls. You are the world’s leading expert on your health history and it needs to be shared equally amongst physicians and dentists.  Conditions affecting your entire health affect your oral health and vice versa.  It is imperative that you keep track of the information and advice your primary care physician, your dentist, and any specialists give you, so medical risks are not over looked. It has happened on countless occasions, a patient is seated in the operatory, the health history is updated as no changes, and in conversation it comes up that the patient has recently had a surgery or been in the hospital. In many cases you just need to wait a recommended period of time before you see your dentist or dental hygienist to avoid complications. When it comes to joint replacements and cardiac health an importance of premedication comes to light. The standard protocol for premedication for an appointment with your dentist or dental hygienist is two grams of amoxicillin one hour before your dental visit.  This may vary depending on your conditions.  If you are unaware of your need for premedication and show up to your teeth cleaning without premedicating you will need to be reappointed due to your risk of infection. We all have busy lives, if we can avoid these situations you won’t need to ask for more time off from work. We all would much rather spend time away from work with family or doing something fun instead of going to the dentist. Communication between your physician and dentist will help keep your free time free. The American Heart Association and the American Academy of Orthopedic Surgeons periodically reevaluate the risk if infection, the risk of antibiotic resistance, and the risks to patients while they strive for the safest recommendation. The recommendations are constantly changing and it is important to keep in touch with both your physician and dentist.

 American Academy of Orthopedic Surgeons Recommendation for Premedication

In 2009 the American Academy of Orthopedic Surgeons released a statement noting the risk of infection and the great expense for total joint replacement redo’s and that it is up to the clinical judgment of the physician for premedication. We went from a standard that recommended premedication for 2 years after a total joint replacement, to a recommendation of premedication for life before appointments with your dental hygienist or dentist. According to the American Dental Association website the AAOS is involving the ADA in evaluation of evidence based research before their next recommendation for premedication, which should be released in 2011.

 American Heart Association Recommendation for Premedication

In 2007 the American Heart Association changed their recommendations for premedication to:

  • Artificial heart valves
  • A history of infective endocarditis
  • A cardiac transplant that develops a heart valve problem
  • Congenital heart disease.
    • The congenital heart conditions consist of unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits, a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure, and any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device.

 If you have any questions consult your dentist or physician following your condition.

For more info also check out:

American Dental Association

So you think, “It’s Just a Teeth Cleaning”

Gum Disease only effects your mouth???
Research into the relationship between oral health and systemic disease is currently uncovering greater and more diverse connections between the afflictions of the human body and maladies of the mouth. Papers are constantly being published noting connection between oral health and systemic health including the oral precursors to variety of cancers ie, throat and pancreatic cancers. The presence of certain bacteria in saliva and dental plaque, has been linked to chronic pancreatitis the precurser to pancreatic cancer in otherwise normal patients. It has been noted that dental care received by women in the early menopause may be able to reduce their risk of heart disease and other disease symptoms such as burning mouth syndrome. Periodontal disease has been linked to an increased risk of upper respiratory infections and poor cardiovascular health. We are moving from a time where people thought that their mouth was separate from the rest of their body to a time where our dental health is a window into our overall health. The conclusion: the level of health of our bodies can be assessed by examining the health of our mouths. It is not just a teeth cleaning, it is the beginning therapy to a healthy vital body and mind.

Need for a Dental Hygienist
There are many nooks and crannies in our mouth that can be difficult to keep clean with regular brushing and flossing. As a result dental plaque builds up around teeth. Over time the calcium in our saliva will mix with the multiple layers of dental plaque and form dental calculus (tartar). As dental calculus builds up, it not only provides a surface to collect more bacteria that can weaken teeth and lead to decay, but it creates a constant irritation, both chemical and physical, to the gum tissue and leads to gum disease. When a person has a teeth cleaning any dental calculus that has built up is removed and the teeth are polished. Having smooth polished teeth will reduce your vulnerability to gum disease and benefit your overall health and quality of life. How frequently a person requires a thorough teeth cleaning relates to their severity of gum disease.

Progression of Gum Disease from Gingivitis to Periodontal Disease
Leaving dental plaque along the gum line causes the gums to become red and inflamed which is the first stage of gum disease (gingivitis). This inflammation is your body’s best effort to fight oral bacteria. When dental plaque is not effectively removed it becomes fixed to the teeth as dental calculus, it can only be completely removed by a professional such as a dental hygienist or a dentist. Swelling of your gums will get to the point that your tooth brush will not reach far enough below the gum line allowing the dental calculus continue down your root. Left untreated the gingivitis will progress to periodontal disease. Periodontal disease begins when inflammation catalyzes the break down of the bone and ligaments supporting the teeth. A routine teeth cleaning by your dental hygienist is not effective at this point, you require a deep cleaning (scaling and root planing) to return your mouth to health (severe disease may require more extensive treatment). A routine maintenance performed by your dental hygienist or dentist needs to be set up to avoid a progression in periodontal disease. A dentist or dental hygienist, when seen regularly, can spot the warning signs of medical issues to come. It is not just a teeth cleaning, it is the beginning therapy to a healthy vital body and mind.

More information can be found at:                                                           Medical News Today & Inside Dentistry


 

 

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