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Medical Forum / General / Dentistry / December 2004

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What's your advice on this problem?

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MRL@PSFC.MIT.EDU - 22 Dec 2004 20:50 GMT
One of my bottom back molars needed a filling near the gum line.  After that
it was very temperature sensitive.  After a few months, the problem still was
there, so I went back to the dentist, and he replaced the filling, but there
was no change in symptoms.  I waited many months this time, before finally
going back when the symptoms worsened, and this time he replaced the filling
with material that usually is used for temporary fillings.  The sensitivity
eventually subsided, and it felt much better, albeit still with an occasional
twinge or throb, but nothing that really bothered me.  I left the temporary
filling in for several months, before going back and asking for a non-metallic
filling.  The dentist said that the filling was near the gum line, where there
is water and blood, and that non-metallic fillings need totally dry areas to
set properly.  So the best he could do was to first apply a resin coating
underneath the filling.  This was done, but I'm back to having a sensitive
tooth again, with frequent throbbing.  A bit better than the earlier times,
but still very bothersome.

Is it true, that a non-metallic filling would be impossible to properly
install in such an area, where part of the filling ends up under the gum line?
I've read of dentists who say they no longer use amalgam fillings, so I would
think it is possible.  If so, I would be willing to try to have it done, in
order to avoid a root canal.  But would a permanent non-metallic filling be
comparable in sensitivity to the temporary filling material?  And would there
be any risk involved, and how would that compare to the risk of possible
complications from a root canal?  I especially want increasing the risk of
needing  a crown on that tooth, as I don't do very well adapting to changes in
my teeth.  The dentist was pretty sure that I wouldn't need that done right
now, but I've read that a root canal can weaken a tooth, and increase the need
of a crown at some point.  Any opinions?  Thanks.
Mark & Steven Bornfeld DDS - 22 Dec 2004 21:00 GMT
> One of my bottom back molars needed a filling near the gum line.  After that
> it was very temperature sensitive.  After a few months, the problem still was
[quoted text clipped - 24 lines]
> now, but I've read that a root canal can weaken a tooth, and increase the need
> of a crown at some point.  Any opinions?  Thanks.

    It is likely given all the drilling and re-drilling that the pulp is
degenerating and a root canal treatment will be needed eventually.
    It is in fact difficult to place resin fillings where the tooth cannot
be dried, or where there is bleeding.  However, this can be taken care
of if you are willing to have a crown lengthening procedure on the
tooth--that is to trim a bit of gum (and possibly bone) away to expose
the most gingival extent of the cavity.  It will also be healthier for
your gum as well.
    As far as the sensitivity, it is true that gumline cavities tend to
develop sensitivity.  While there is less chance of being thermally
sensitive with a resin filling, there can be pulpal irritation from the
material itself and the bonding procedure unless very careful technique
is followed, and perhaps even then.  Furthermore, assuming the temporary
filling was some form of zinc oxide and eugenol, the eugenol must be
very carefully removed for proper bonding.  This all has the potential
to disturb the pulp further.  Unfortunately, there are no other options
I can think of, other than perhaps waiting for symptoms to subside
further.  Even if they do, there is no way to guarantee that the pulp
will not degenerate later.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

W_B - 22 Dec 2004 21:24 GMT
> Even if they do, there is no way to guarantee that the pulp
>will not degenerate later.
>
>Steve

Sounds to me this may have already happened.

RCT + Crown.
--

W_B

Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
MRL@PSFC.MIT.EDU - 23 Dec 2004 00:30 GMT
Thanks for the very complete answer, so quickly!

In a previous article, Mark & Steven Bornfeld DDS <bornfeldmung@dentaltwins.com> wrote:
->    It is likely given all the drilling and re-drilling that the pulp is
->degenerating and a root canal treatment will be needed eventually.

I should mention that the dentist was surprised at the amount of sensitivity,
because he felt that the filling was not very deep at all.  That's why the
first time, he decided to simply try replacing the filling, rather than
recommending a root canal.

->    It is in fact difficult to place resin fillings where the tooth cannot
->be dried, or where there is bleeding.  However, this can be taken care
->of if you are willing to have a crown lengthening procedure on the
->tooth--that is to trim a bit of gum (and possibly bone) away to expose
->the most gingival extent of the cavity.  It will also be healthier for
->your gum as well.

Interesting, but I suspect there's not much more to expose.  Because I had
orthodontic work about a decade for a TMJ problem, and one of the major
changes, was that the molars were raised from the gums, so there probably
isn't too much of the tooth below the gum line.  I discovered that after my
recent cleaning, that the molar on the other side became sensitive near the
gum line.  I asked my dentist about it, and he said that there was a bit of
root exposed, probably because of the ortho work.

->very carefully removed for proper bonding.  This all has the potential
->to disturb the pulp further.  Unfortunately, there are no other options
->I can think of, other than perhaps waiting for symptoms to subside
->further.  Even if they do, there is no way to guarantee that the pulp
->will not degenerate later.

Yes I was worried about further work on the tooth itself causing problems.
Not to mention that even if a non-metallic filling could successfully be
applied, there's no guarantee that the pain won't return in future.

I sure wish there was a better diagnostic tool to know if the pulp was
degenerating or not, as then I could make a more informed decision.  I think I
will wait until after the holidays, and if no change, I'll go for the root
canal.  Thanks a lot!
Mark & Steven Bornfeld DDS - 23 Dec 2004 01:00 GMT
> Thanks for the very complete answer, so quickly!
>
[quoted text clipped - 36 lines]
> will wait until after the holidays, and if no change, I'll go for the root
> canal.  Thanks a lot!

    No one diagnostic modality is fool-proof.  A good rule of thumb for
thermal sensitivity is that if the tooth is sensitive to hot and/or
cold, and after application the pain is sudden, immediate and duration
of only a couple of seconds, the nerve will USUALLY recover.  If it
throbs for a few minutes, the nerve is probably in trouble.  Pain to
biting pressure after a gumline filling is frequently a sign of abscess
in the presence of thermal sensitivity of some duration.
    Many dentists have electronic pulp testers that while not fool-proof
can give evidence of hyperexcitability due to hyperemia/ pulpitis, or
decreased excitability due to necrosis.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Jan - 23 Dec 2004 01:11 GMT
>Subject: Re: What's your advice on this problem?
>From: MRL@PSFC.MIT.EDU
[quoted text clipped - 43 lines]
>will wait until after the holidays, and if no change, I'll go for the root
>canal.  Thanks a lot!

Then you will have a dead tooth is your mouth.

http://www.zip.com.au/~rgammal/RCTframeset.htm

http://www.ericdavisdental.com/root_canals.htm

http://www.whale.to/d/root2.html

http://www.drshankland.com/rootcanal.html

http://webpages.charter.net/kyarbrough/rootcanals.htm

http://www.dentistry-toothtruth.com/faq.htm

http://www.cfsn.com/maz/

http://cnorman.best.vwh.net/blazing/dental.html

http://rheumatic.org/teeth.htm

http://www.zip.com.au/~rgammal/root_therapies.htm

http://zap.intergate.ca/root.html

http://www.toothwisdom.net/

http://www.dentistryholistic.com/education.html

http://www.hugnet.com/Root_Canals.html

http://www.karlloren.com/ultrasound/p25.htm

http://www.hallvtox.dircon.co.uk/hallvt.html

Root Canals. A tooth has miles of tiny canals running through the root. A dead
or root filled tooth will have bacteria in these canals. There is no way of
removing the bacteria once they are in there.

http://www.toothwisdom.net/

Toxicity from Root Canals

The next subject to be discussed are root canals and their possible source of
toxicity. Approximately twenty five million Americans undergo root canal
therapy every year in an effort to prevent the loss of teeth that have
abscessed. The root canal is the left portion of the tooth which houses the
vital organs such as the nerve and blood vessels. The dentist endeavors to
clean and sterilize this canal and fill it with a sterile, non toxic inert
material. This usually renders this tooth serviceable and non painful; however,
the entire inner hard core of the tooth is made of dentin which has several
million dentinal tubules. These tubules allow the circulation of lymphatic type
fluid to circulate from the vital organs of the root canal to the outside of
the tooth. This is a viable circulatory phenomenon which has a purpose. It
services the periodontal ligament as well as the sensory aspect of the nerve
and blood centers in the root canal. If the body chemistry is healthy, the flow
of lymphatic fluid is from the root canal to the outside of the tooth. This
creates an irrigation for the tooth and usually prevents the accumulation of
plaque to form. When the body chemistry is not healthy, then the circulation is
from the outside of the tooth to the inner root canal. This allows for no
irrigation, but rather an accumulation of plaque to form. There are many more
reasons for maintaining the integrity of the circulation in the dentinal
tubules. Root canal therapy completely destroys this integrity, and what
happens to the non-circulating fluid in these tubules? This fluid as it ages
becomes stagnant and becomes a toxic substance. This porous structure now
becomes a septic mass emanating poisons into the body. Is this what you want?
Mercury amalgams are said to be the caskets of the body. Root canals are said
to be the cadavers of the body.

I do not recommend root canals for anyone. Each individual has a right to their
decisions. Many people simply do not wish to lose a member of their body. I
respect this, and I always discuss the consequences.

The next area of discussion is whether the root canal filling actually
sterilizes the apical end of the tooth. There are so many lateral canals at the
root end of the tooth where bacteria can harbor that it is unlikely that a
complete aseptic condition exists. This, however, is a debateable subject.
Again, the complete acceptance of root canal therapy as a viable substitution
for extraction is completely and whole heartedly supported by organized
dentistry. You are in violation of the code of ethics if you speak out against
root canal therapy. When I was a practicing dentist, I always let the patient
make that decision after explaining all pros and cons.

FOR IMMEDIATE RELEASE:

- Hide quoted text - - Show quoted text -

>California Judge Approves Landmark Warning on Mercury Use in Dentistry.

>(San Francisco, CA) - For the first time anywhere, dentists will be
>required to post a warning about the dangers of mercury in their dental
>fillings. A California Superior court judge finalized the language for
>the warning to be posted in dentists' offices here today.

>The warning will read as follows:

>Notice to Patients, Proposition 65:

>Warning on dental amalgams, used in many dental fillings, causes exposure
>to mercury, a chemical known to the state of California to cause birth
>defects or other reproductive harm.

>Root canal treatments and restorations including fillings, crowns and
>bridges, use chemicals known to the state of California to cause cancer.

>The U.S. Food and Drug Administration has studied the situation and
>approved for use all dental restorative materials.

>Consult your dentist to determine which materials are appropriate for your
>treatment.

>The exact language of the warning was argued and then finalized before
>Superior Court Judge James A. Robertson II between the California Dental
[quoted text clipped - 3 lines]
>mercury dental fillings and root canals. The agreement also allows non-CDA
>dentists to opt in to the agreement and post the warning.

>The warning is the result of a lawsuit filed by The Law Offices of Shawn
>Khorrami on behalf of As You Sow, a not-for-profit foundation dedicated to
>advocacy and activism in the public interest.

>"This is the first admission by organized dentistry that amalgams pose a
>potential health risk," says Shawn Khorrami, lead attorney. "The only
>problem is that it's about 100 years too late."

>This California consent judgment follows on the heels of recent lawsuits
>filed in Georgia, Texas, Ohio and Los Angeles, California charging that
[quoted text clipped - 6 lines]
>risks to certain users. Mercury, a highly toxic substance, is the most
>widely used substance in dental fillings today.

>The use of mercury-based thimerosal in vaccines also has been the source
>of the recent controversy in the Homeland Security legislation.

>Khorrami filed the lawsuit against Roger Fieldman D.D.S., Inc., the
>Citadel Dental Group, Inc. dental offices, dental laboratories and
>private dental schools and training programs with more than nine
>employees. The suit won the enforcement of Proposition 65, Safe Drinking
>Water and Toxics Enforcement Act [Health & Safety Code § 25249.6].

>Proposition 65 requires that a clear and reasonable warning be provided to
>persons prior to their exposure to a chemical known to cause cancer or
>reproductive harm. This statute lists mercury, contained in dental
>amalgam, as a substance that can cause reproductive toxicity. The lawsuit
>was based on the absence of warnings to patients treated with amalgam
>restorative materials in dental offices.

>The judgment on Proposition 65 mandates that all dental offices with more
>than nine employees provide warnings on the dangers of Mercury dental
>fillings to patients. Those in non-compliance could incur a fine of up to
>$2,500 per day.

>Press may contact: Jackie Gladfelter at 650-218-1856 or D. Infusino at
>415-225-7970; call Attorney Shawn Khorrami at 818-947-5111.

>###

Jan
Cresta de Gallo - 23 Dec 2004 01:17 GMT
ignore the troll
> >Subject: Re: What's your advice on this problem?
>>From: MRL@PSFC.MIT.EDU
[quoted text clipped - 238 lines]
>
> Jan
Jan - 23 Dec 2004 05:03 GMT
>Subject: Re: What's your advice on this problem?
>From: "Cresta de Gallo" spiral@escargo.com
>Date: 12/22/2004 5:19 PM Pacific Standard Time
>Message-id: <_J-dnV7r5u-rgFfcRVn-3Q@wideopenwest.com>
>
>ignore the troll

From a poster who has made exactly 2 posts, and don't know what a troll is.

I didn't write the websites, take note of who did.

>> >Subject: Re: What's your advice on this problem?
>>>From: MRL@PSFC.MIT.EDU
[quoted text clipped - 238 lines]
>>
>> Jan
Joel M. Eichen - 23 Dec 2004 13:25 GMT
>>ignore the troll
>
>From a poster who has made exactly 2 posts, and don't know what a troll is.
>
>I didn't write the websites, take note of who did.

The barber from toledo ... the insurance salesman from Tempe Arizona
...... that's who wrote the websites.

Why did they write the websites ....... (cue the Barry Manilow music
in the background, please) ....??

To sell booklets!

Joel
StovePipe - 31 Dec 2004 07:15 GMT
> >ignore the troll
>
> From a poster who has made exactly 2 posts, and don't know what a troll is.
>
> I didn't write the websites, take note of who did.

You don't exactly write good English syntax, either....
SP

Signature

Not a real Addy, yet

Joel M. Eichen - 23 Dec 2004 13:24 GMT
>Then you will have a dead tooth is your mouth.

This is getting spooky. What means "DEAD?"
Cresta de Gallo - 23 Dec 2004 00:51 GMT
A plastic filling in that location will usually need some of the gum tissue
cut away.  You need a root canal.
> One of my bottom back molars needed a filling near the gum line.  After
> that
[quoted text clipped - 43 lines]
> need
> of a crown at some point.  Any opinions?  Thanks.

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