Our teeth really take a lot of abuse over a lifetime. Day after day and year after year, our teeth subjected to the expansion and contraction from hot and cold food and beverages, the chewing forces of the jaws (up to 900 lbs. per square inch), and any habits we might be doing to them in waking or sleeping hours, such as clenching and grinding or chewing hard crunchy foods. Often times the biggest cause of damage to teeth is chemical, as in acid destruction caused by dental bacteria, more commonly known as plaque. Tooth Decay is in fact one of the leading causes of tooth loss and the American Diet has the highest sugar content on the entire planet! The more sugar that we eat, the more bacteria can eat the sugar and multiply and the more they multiply and attach to and grow on teeth the more acid they can release on the tooth causing it to rot.
Restorative Care is needed when a tooth must be rebuilt to the original size, shape, and structure with the use of a restorative material. Materials used to restore teeth have changed radically over the years, but typically can be classified into two categories: Direct and Indirect restorations. The type of material required to fix the tooth can depend on specific conditions such as:
- Is the cavity a first timer or is it recurring
- Are you replacing a failing restoration (old, leaking filling)
- Has tooth structure been worn away (Grinding or Clenching)
- Did the tooth or filling fracture or break
- Is the tooth structure surrounding the filling too thin or unsupported (large fillings)
- Did acid erosion cause loss of tooth structure (Gastric reflux disease, Too much soda, fruits)
- Is there a crack running internally through the tooth
Restorative Dentistry is the diagnosis and management of diseases of the teeth and their supporting structures and the rehabilitation of the dentition to the functional and esthetic needs of the individual. Typically restoration of the teeth is required when the tooth is broken down and as risk for being unrepairable.
Direct restorations are fillings placed immediately after preparing a cavity in a single visit. Today they are primarily composite (resin) fillings and amalgam (silver/mercury) fillings. Typically, the dentist prepares the area, fills the area and adjusts and polishes the restoration in the same visit.
Composite is a filling material that is a combination of silicate (glass) particles and acrylic resin combined to create a tooth colored restoration. These are typically the most common type of filling material used today and the great advantage is that they can be bonded to the tooth on a microscopic level. This material has evolved more than most other dental products over the years. They can be placed in a tooth and hardened with a photo curing blue light or self-cure on their own in a tooth. They can be used to fix cavities, replace old fillings, repair chipped or broken tooth structure, repair a cracked tooth, be placed as a direct veneer to change the size, shape, and contour of the tooth, or even build up a tooth that has worn down. It is an amazingly strong versatile material.
An alloy that consists chiefly of Silver mixed with Mercury and variable amounts of other metals including copper, tin and zinc. Amalgam fillings contain roughly 50% Mercury, by weight, and appear silver in color when first placed.
Is it safe?
One reason for this question is the consideration that when these fillings are placed or removed and when chewing on these fillings small amounts of elemental Mercury vapors are released. People can inhale or ingest these vapors and absorb them into their systems. Mercury is a known toxin and has been shown to cause adverse effects to the brain and kidneys. Numerous federal agencies have evaluated scientific studies evaluating links between health problems and Amalgam fillings. According to the Centers for Disease Control and Prevention Fact sheet published in 2001, “current scientific evidence does not show that exposure to mercury from amalgam restorations poses a serious health risk in humans, except for an exceedingly small number of allergic reactions. Second, there is insufficient evidence to assure the public that components of alternative restorative materials have fewer potential health effects than dental amalgam including allergic-type reactions. Third, there are significant efforts underway in the U.S. to reduce the amount of mercury in the environment. And finally, as stated previously, amalgam use is declining due to a lessening of the incidence of dental caries and the increasing use of alternative materials.”
Despite the position of numerous government agencies in the United States, other countries have banned or proposed restrictions on the use of Amalgam fillings including Sweden, Denmark, Germany, Norway and Japan. Although some of these countries are banning or restricting use of this material to diminish both human exposure and environmental release of mercury and not because of any documented health effects.
Our policy is that we believe in most instances we have better more effective and safer alternative filling materials. That is not to say that we do not occasionally use this material. There are specific instances in which this material may be more suitable based on the circumstances. However, the vast majority of restorations we place in our practice are non-amalgam fillings. We do respect our patient’s decisions and choices to make their own informed decisions regarding amalgam fillings.
Indirect Restorations are typically restorations that require 2 or more visits to place in our office. Some offices use single visit CAD CAM Crown milling technology to produce these in one visit, however at this time ours does not. Typically, the first visit involves preparing a tooth, taking an impression and fabricating and placing a provisional restoration. This can be a veneer, a crown, or a bridge, or an inlay or onlay. The material these can be made of are Porcelain/Ceramic, Gold, or Composite. At a subsequent visit the restoration is tried in, adjusted, and cemented into place over the prepared tooth or teeth.
This material is used to make all-ceramic veneers, crowns, inlays, bridges, or onlays that are tooth colored and is highly esthetic. Today’s porcelain restorations are also highly fracture resistant. This material can also be fired or baked over a metal substructure (PFM) to provide additional strength for longer span restorations such as bridges. This material has strength through thickness, so one down side is that sometimes these restorations are not as conservative in preserving tooth structure.
Gold Alloy crowns, inlays, onlays, or bridges are very durable restorations that hold up exceedingly well, giving longevity of service and require less removal of tooth structure allowing for more conservative preparations. The only downside is that they are not esthetic and the material cost is high, due to the cost of precious metals.