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Medical Forum / General / Dentistry / March 2005Leaky silver fillings going undetected??
I have a mouthful of old amalgam fillings, that are in various states of deterioration. Trying to learn more about what I'm facing, I found the following on a dentist's website: http://dentalcarestamford.com/video2.htm Is this use of magnified video something I should expect the average dentist to be doing? Is this a verified way of finding decay under amalgams, that would otherwise go undetected by using a dental pick. Should I and the millions of others with similar situations be concerned that we have ticking time bombs in our mouths? Jeff >I have a mouthful of old amalgam fillings, that are in various states >of deterioration. Trying to learn more about what I'm facing, I found [quoted text clipped - 8 lines] > >Jeff Its magnified .... but that is okay as I suspected it already. Jeff wrote: "I have a mouthful of old amalgam fillings, that are in various states of deterioration. Trying to learn more about what I'm facing, I found the following on a dentist's website: http://dentalcarestamford.com/video2.htm Is this use of magnified video something I should expect the average dentist to be doing? Is this a verified way of finding decay under amalgams, that would otherwise go undetected by using a dental pick. Should I and the millions of others with similar situations be concerned that we have ticking time bombs in our mouths?" All that a video camera can do is look at your teeth. A dentist is already looking at your teeth when you have a dental exam. The only thing that a video does is to allow YOU to see your teeth a little better, because you can't see your own teeth from the dentist's advantageous viewpoint. Since the dentist can see your teeth already, without the video camera, he can evaluate shadows, cracks, and margins of old fillings. This is all easily accomplished without a video camera. So what is the purpose of the video? A video can be used to help educate the patient, and to show the patient what the doctor has already discovered without the camera. A dentist has studied diagnosis for years, and it would be foolish to think that this knowledge can be imparted to a patient in ten minutes. A good dentist merely uses a video to help describe the visible portions of dental conditions, as the patient can't be expected to really understand the significance (or insignificance!) of what is seen. On the other hand, in unscrupulous hands, a video could be used to "sell" a patient on treatment that may not actually be necessary. Since the patient does not really know what he is looking at, any little craze mark or normal shadow could conceivably be used to convince the patient that a given treatment is necessary. This is why the character and honesty of the dentist is so important. Choose your dentist on the basis of his reputation and his abilities, not on his possession of high-tech toys. Any fool with money can buy lots of impressive equipment, but only a skilled dentist who is concerned about your health can actually deliver quality care which is both necessary and appropriate to your condition. Stay away from those who brag about their equipment more than they discuss the best ways to preserve your long-term dental health. More often than not, most patients really don't need to have all of their fillings replaced at the same time. Best regards, - dentaldoc > Stay away from those who brag about their equipment more than they > discuss the best ways to preserve your long-term dental health. More > often than not, most patients really don't need to have all of their > fillings replaced at the same time. Bravo! SP  SignatureNot a real Addy, yet Ok, maybe it ( the video ) falls into the "toy" catagory, unless it is able to add diagnostic value ( via the magnification ). And I agree that being able to trust the dentist's judgment is more important.. However, I was hoping someone would comment on the issue (?) of leaky amalgam fillings, and their detection. The site I refererred to appeared to me ( the layman ) to be focused on educating the patient. Now in a perfect world, we would have complete trust in our health care providers, because they would be all-knowing wizards of incomparable skill &craftsmanship, and paragons of virtue. There are certainly dentists out there who come close walking on water, if you know any in the Eugene area please give me a name:). Short of that I'll settle for the three "c's", competent, caring, and careful ( as in not fracturing my tooth that needs a refilling, so it requires a crown, like what happened with a previous dentist. Can I positively blame the dentist? No, I just got the feeling he was a little bit in too much of a hurry.). So, can someone please answer my questions. Are leaky dental amalgams a signifigant issue? Can decay go undetected by X-rays, because the filling masks the decay? Thanks for your time. Jeff > Ok, maybe it ( the video ) falls into the "toy" catagory, unless it is > able to add diagnostic value ( via the magnification ). And I agree [quoted text clipped - 16 lines] > > Jeff Briefly: ALL fillings leak. Modern (dispersed phase) amalgam alloys leak less than older alloys. Bonded resin leaks less than unbonded resin (which leaks very badly indeed). Usually amalgam leaks initially after placement, and then leakage decreases. Decay can be masked by the filling on x-ray, though as a practical matter if x-rays are taken correctly any decay will be caught at a reasonably early stage. Steve SignatureCut the nonsense to reply > > happened with a previous dentist. Can I positively blame the dentist? > > No, I just got the feeling he was a little bit in too much of a [quoted text clipped - 7 lines] > > ALL fillings leak. Modern (dispersed phase) amalgam alloys leak less than older alloys. This is not necessarily true. Did you see see the link I posted about the instability of 'higher' copper amalgam? I can post it again as well as other articles if necessary. Also, even base rates of vapor emission where found to be 50 times higher on these amalgams. Bonded resin leaks less than unbonded resin (which > leaks very badly indeed). > Usually amalgam leaks initially after placement, and then leakage > decreases. What do you mean by usually? What is the worst case? I'd also be interested to know if you had any data to support that claim 5-10 years after a filling is placed. Just because release rates decreases in the first few months doesn't mean it can't go back up again when corrosion sets in. I believe that is what is being demonstrated by the videos. Decay can be masked by the filling on x-ray, though as a > practical matter if x-rays are taken correctly any decay will be caught > at a reasonably early stage. I highly doubt that because I know that many cases of osteomyletis do not show infection even with panorex and sophisticated thin sliced scans when infection is found clinicaly. Why? Because infection does not necessarily always destroy bone so it can still reflect x-rays. I think the premise that all infection can be detected by the kind of x-ray equipment in use is a false one. In fact when I had one of my fillings removed there was a tremendous amount of decay up to the nerve. Not only didn't it show on the x-ray but neither did it show up on a previous x-ray. Also, later a CT of my left maxilla later showed a large radiolucency which didn't show up on 2 sets of x-rays or a panorex! > > happened with a previous dentist. Can I positively blame the dentist? > > No, I just got the feeling he was a little bit in too much of a [quoted text clipped - 7 lines] > > ALL fillings leak. Modern (dispersed phase) amalgam alloys leak less than older alloys. This is not necessarily true. Did you see see the link I posted about the instability of 'higher' copper amalgam? I can post it again as well as other articles if necessary. Also, even base rates of vapor emission where found to be 50 times higher on these amalgams. Bonded resin leaks less than unbonded resin (which > leaks very badly indeed). > Usually amalgam leaks initially after placement, and then leakage > decreases. What do you mean by usually? What is the worst case? I'd also be interested to know if you had any data to support that claim 5-10 years after a filling is placed. Just because release rates decreases in the first few months doesn't mean it can't go back up again when corrosion sets in. I believe that is what is being demonstrated by the videos. Decay can be masked by the filling on x-ray, though as a > practical matter if x-rays are taken correctly any decay will be caught > at a reasonably early stage. I highly doubt that because I know that many cases of osteomyletis do not show infection even with panorex and sophisticated thin sliced scans when infection is found clinicaly. Why? Because infection does not necessarily always destroy bone so it can still reflect x-rays. I think the premise that all infection can be detected by the kind of x-ray equipment in use is a false one. In fact when I had one of my fillings removed there was a tremendous amount of decay up to the nerve. Not only didn't it show on the x-ray but neither did it show up on a previous x-ray. Also, later a CT of my left maxilla later showed a large radiolucency which didn't show up on 2 sets of x-rays or a panorex! One of the best features of the intra-oral camera is to magnify the tooth being examined. The doctor can see much more at this magnification. The loupes worn over the doctor's glasses will typically magnify up to 3.5x, while the camera will easily do 10-14x. I routinely use mine to examine the inside of teeth after the old filings are removed. This way I can find fractures and other problems which are too minor to see with loupes. As far as your fillings are concerned,,,,,,, there is no way to tell you anything specific about your case without seeing you in person, (or at least seeing the x-ray images and the intra-oral camera images). A lot of dental decay does NOT show up on dental x-ray images. There are a lot of variables involved. Diagnosing dental decay requires many different tools. X-ray images, looking by eye, examining under magnification, exploring the edges of old fillings with a metal instrument, testing enamel grooves with a low power laser, etc. Most patients who have a mouth full of fillings will need 2-4 fillings replaced at the same time. Many patients who avoid dental care for many long years will need all their filings replaced when they finally get in to seek care. And,,,,,,,,,,,,,,,,,, lots of patients will only need one filling replaced every 15 years. X-ray images are shadows of the teeth and bone. If the energy is blocked (say by a metal filling), nothing will be visible behind it. In that case, yes the decay can be present, but not seen on the x-ray image. > Ok, maybe it ( the video ) falls into the "toy" catagory, unless it is > able to add diagnostic value ( via the magnification ). And I agree [quoted text clipped - 16 lines] > > Jeff > One of the best features of the intra-oral camera is to magnify the tooth > being examined. The doctor can see much more at this magnification. The > loupes worn over the doctor's glasses will typically magnify up to 3.5x, > while the camera will easily do 10-14x. I routinely use mine to examine the > inside of teeth after the old filings are removed. This way I can find > fractures and other problems which are too minor to see with loupes. No here is the problem. I traded a dentist who used magnifers for one who didn't. Consumer tip, don't check to see what kind of personality the dentist has. Check the type of glasses they use! > As far as your fillings are concerned,,,,,,, there is no way to tell you > anything specific about your case without seeing you in person, (or at least > seeing the x-ray images and the intra-oral camera images). A lot of dental > decay does NOT show up on dental x-ray images. There are a lot of variables > involved. Diagnosing dental decay requires many different tools. X-ray > images, I agree. But I would be curios to know what these variables are other than the filling blocking the x-ray. Would you also agree that if an x-ray cannot always detect decay/infection in the tooth it cannot always detect it in a root canal? >> fractures and other problems which are too minor to see with loupes. > >No here is the problem. I traded a dentist who used magnifers >for one who didn't. Consumer tip, don't check to see what kind >of personality the dentist has. Check the type of glasses they >use! I trade you .... one dentist for two hygienists! > One of the best features of the intra-oral camera is to magnify the tooth > being examined. The doctor can see much more at this magnification. The > loupes worn over the doctor's glasses will typically magnify up to 3.5x, > while the camera will easily do 10-14x. I routinely use mine to examine the > inside of teeth after the old filings are removed. This way I can find > fractures and other problems which are too minor to see with loupes. No here is the problem. I traded a dentist who used magnifers for one who didn't. Consumer tip, don't check to see what kind of personality the dentist has. Check the type of glasses they use! > As far as your fillings are concerned,,,,,,, there is no way to tell you > anything specific about your case without seeing you in person, (or at least > seeing the x-ray images and the intra-oral camera images). A lot of dental > decay does NOT show up on dental x-ray images. There are a lot of variables > involved. Diagnosing dental decay requires many different tools. X-ray > images, I agree. But I would be curios to know what these variables are other than the filling blocking the x-ray. Would you also agree that if an x-ray cannot always detect decay/infection in the tooth it cannot always detect it in a root canal? > One of the best features of the intra-oral camera is to magnify the tooth > being examined. The doctor can see much more at this magnification. The > loupes worn over the doctor's glasses will typically magnify up to 3.5x, > while the camera will easily do 10-14x. I routinely use mine to examine the > inside of teeth after the old filings are removed. This way I can find > fractures and other problems which are too minor to see with loupes. No here is the problem. I traded a dentist who used magnifers for one who didn't. Consumer tip, don't check to see what kind of personality the dentist has. Check the type of glasses they use! > As far as your fillings are concerned,,,,,,, there is no way to tell you > anything specific about your case without seeing you in person, (or at least > seeing the x-ray images and the intra-oral camera images). A lot of dental > decay does NOT show up on dental x-ray images. There are a lot of variables > involved. Diagnosing dental decay requires many different tools. X-ray > images, I agree. But I would be curios to know what these variables are other than the filling blocking the x-ray. Would you also agree that if an x-ray cannot always detect decay/infection in the tooth it cannot always detect it in a root canal? > The site I refererred to > appeared to me ( the layman ) to be focused on educating the patient. I would go back and re-read Bill's previous post. If you take it in to heart, you will find that this site is 'coming it to ya' just a tad. I used the Laser till it broke, and you cannot 'Laser Bond' any filling. In fact there is at least one researcher that says that this process OVER-ETCHES the dental substrate, and so WEAKENS the bond. Also, the Laser will spark with the traces of Amalgam that linger in the bottom of cavities, damaging the Laser. If this process is at all necessary, it should be possible to do it more completely using good ol' air abrasion. Again, I repeat: GO BACK and re-read Bill. Thank You SP SignatureNot a real Addy, yet |
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