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Medical Forum / General / Dentistry / December 2006Teeth drying out due to fillings?????
I've been going to the same dentist for over 10 years. Never in that time have I had any cavities or problems, and during every exam he has told me how everything is good. But on my last visit, he said I should replace my old (22 yr old) amalgam fillings with a newer material. I asked if they were leaking or broken, and he said no, that they were fine except that over time they can dry out my tooth and make it more susceptible to cracking. (BTW, he never mentioned mercury poisioning). So after talking to other people who go to this dentist, they all said he recently advised them to do the same. It is not expensive after insurance, so that is not a factor for me. But I do want to know if it is necessary first. I can't find anything about this on the internet. Thanks in advance. > I've been going to the same dentist for over 10 years. Never in that > time have I had any cavities or problems, and during every exam he has [quoted text clipped - 12 lines] > > Thanks in advance. "Dry out" your tooth? You sure you heard right? That takes the cake, frankly. Get a second opinion. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Yes I heard right, because I had the same reaction as you did and asked him to repeat himself. He also said the filling leaches out into the tooth and will stain the tooth. It is the back teeth, so I don't care about looks, but the stain is a sign that the tooth is dried out and will eventually crack. It is odd that he would not have mentioned this before, as I go every 6 months. I assumed it was some new research. > > I've been going to the same dentist for over 10 years. Never in that > > time have I had any cavities or problems, and during every exam he has [quoted text clipped - 24 lines] > Brooklyn, NY > 718-258-5001 Run, don't walk to a different dentist ! >Yes I heard right, because I had the same reaction as you did and asked >him to repeat himself. He also said the filling leaches out into the [quoted text clipped - 33 lines] >> Brooklyn, NY >> 718-258-5001 > Yes I heard right, because I had the same reaction as you did and asked > him to repeat himself. He also said the filling leaches out into the [quoted text clipped - 4 lines] > It is odd that he would not have mentioned this before, as I go every 6 > months. I assumed it was some new research. I'll go out on a limb and say he was researching a new boat. Look--if you're philosophically opposed to amalgam--say so. The patient can agree or disagree. The only thing I can think of that might have some tenuous connection to reality is the oft-quoted truism that amalgam expands on setting, and this can fracture teeth. That's SETTING expansion--what the amalgam did 22 years ago when it was placed. There is absolutely NO reason to think that it will fracture 22 years later. Neither is staining a reflection that the tooth will crack. All amalgams stain--that is a reflection on the material itself and the tarnish that is a normal process in the weeks after an amalgam is placed. It is NOT a reflection of the state of hydration of the teeth. SHEEEEEEESHHHHHHHHHH!!! Steve >>>I've been going to the same dentist for over 10 years. Never in that >>>time have I had any cavities or problems, and during every exam he has [quoted text clipped - 24 lines] >>Brooklyn, NY >>718-258-5001 SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Yes I heard right, because I had the same reaction as you did and asked > him to repeat himself. He also said the filling leaches out into the [quoted text clipped - 4 lines] > It is odd that he would not have mentioned this before, as I go every 6 > months. I assumed it was some new research. It is certainly common for teeth to crack and fracture away from old amalgams. I don't believe amalgam has any water sorption qualities that would cause your tooth to 'dry out'. However, drilling them out for grins also carries a risk. With regular carbide burs, the cracks could be enlarged by the treatment. It is also no guarantee that new fillings will make the teeth *significantly* more resistant to cracks and fractures. We all remove lots of old amalgams. Most of us replace them due to recurrent decay, actual fractures, and sometimes just for esthetics. I really don't care if the filling has been in the mouth for 1 year or 30. I use a diamond bur to reduce vibrations and 'chatter', do not enlarge the preparation more than necessary, and use a good bonding agent for the new filling. IOW's, I agree with Steve. D If you've been going to this dentist for 10 years and never had a problem such as decay that went unnoticed and you now need a root canals on several teeth, then I'd say this dentist was taking good care of you. If he now thinks your amalgams need servicing due to age or better materials for him to be able to make sure your teeth stay healthy then what's wrong with that???? Isn't that what you want, to know what is going on with your teeth and that they stay healthy???? Just because he used laymen language to try and explain something to you so that you can understand doesn't mean he is doing you a disservice. I think if you are asking these questions here vs your dentist means that there is a communications breakdown and you are losing trust in this dentist as a result. Switching dentists can be a risky thing as philosophies of treatment can be significant. you go to 20 different dentists you will have 20 different treatment plans for your mouth. > > Yes I heard right, because I had the same reaction as you did and asked > > him to repeat himself. He also said the filling leaches out into the [quoted text clipped - 26 lines] > > D > If you've been going to this dentist for 10 years and never had a > problem such as decay that went unnoticed and you now need a root > canals on several teeth, then I'd say this dentist was taking good care > of you. If he now thinks your amalgams need servicing due to age or > better materials for him to be able to make sure your teeth stay > healthy then what's wrong with that???? Alex-- I am inclined to think that English is not your first language (though you write it very well), so perhaps this scenario isn't impressing you in the same way it is me. I simply can't see this as "layman's language". Steve Isn't that what you want, to > know what is going on with your teeth and that they stay healthy???? > Just because he used laymen language to try and explain something to [quoted text clipped - 37 lines] >> >>D SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > If you've been going to this dentist for 10 years and never had a > > problem such as decay that went unnoticed and you now need a root [quoted text clipped - 57 lines] > Mark & Steven Bornfeld DDS > http://www.dentaltwins.com > Brooklyn, NY > 718-258-5001 As a layperson here are some thoughts that could use some clarification and verification from the professionals as these are mainly guesses on my part. I don't think there is any evidence presented to date that indicates amalgam fillings dry teeth out (true?)... However: -Upon aging, dentin has a tendency to become drier and more brittle, for ex. collagen located in other tissues becomes stiffer and more brittle as we age... (correct or incorrect?) -Amalgam fillings corrode over time and can stain the surrounding enamel. (correct or incorrect?) -Perhaps when amalgam stain is observed by the clinician, s/he may presume: 1) amalgam is aged & corroded perhaps to the point of receding enough to allow microeakage and increased decay potential 2) perhaps this staining occurs more readily as the teeth age and dehydrate "naturally" (plausible or implausible?) -So perhaps putting this altogether, the clinician thinks it is time to replace these amaglams and since composite materials have been vastly improved over the last 20 years, s/he thinks composite is the way to go. (plausible or implausible?) Just some thoughts from a layperson, Sue > As a layperson here are some thoughts that could use some clarification > and verification from the professionals as these are mainly guesses on [quoted text clipped - 4 lines] > for ex. collagen located in other tissues becomes stiffer and more > brittle as we age... (correct or incorrect?) I don't know, honestly. This isn't really a simple question either. Enamel is over 98% inorganic, and (IIRC) even dentin is as much as 95% inorganic. The tendency to fracture is greatly influenced by the direction of enamel prisms. This has been a guiding principle of cavity preparation at least since the time of G.V. Black. It is clear to me that some fractures start in the dentin, and those under amalgam frequently start that way. I have an idea that this may be related to delayed fatigue due to internal expansion of amalgam, but I don't know this for a fact. Still, the majority of fractures I see start in the enamel--and usually this is because a dentist has violated the principles Black laid out well over a century ago. > -Amalgam fillings corrode over time and can stain the surrounding > enamel. (correct or incorrect?) Amalgam fillings tarnish as a surface phenomenon. This actually is a good thing--the tarnish has been shown to decrease microleakage at the margins. However, amalgam has poor edge strength and over time there tends to occur a "ditching" in the margin. This tendency was decreased (but certainly not eliminated) with the introduction of so-called "dispersed phase" alloys 30 or so years ago. What was dispersed was small particles of copper, which improved the mechanical properties at the margin. There is no question that amalgam stains, and this stain can perfuse the dentin significantly. > -Perhaps when amalgam stain is observed by the clinician, s/he may > presume: 1) amalgam is aged & corroded perhaps to the point of receding > enough to allow microeakage and increased decay potential 2) perhaps > this staining occurs more readily as the teeth age and dehydrate > "naturally" (plausible or implausible?) I can't speak for this dentist, and doubt I would want to. I try not to presume. I do not remove every amalgam with a ditched margin. There are no doubt dentists whose criteria for retaining vs. replacing a restoration are more stringent than mine. Personally, mine are not set in stone. I will be more aggressive about changing a questionable restoration in a patient who comes in for a checkup every 10 years or so whether they need to or not than I will for a patient who religiously keeps their 6 month appointments. The price of making the wrong decision is much lower for the patient who I see regularly. There should be a reason for replacing a filling--decay, fracture, patient thinks the filling looks bad. I will sometimes indulge a patient who just doesn't want amalgam in their mouths anymore--though for sure I inform them of the risks of replacement (mostly chance of pulpal reactions). But the explanation given to this patient (unless there has been a serious miscommunication) is just too far out. > -So perhaps putting this altogether, the clinician thinks it is time to > replace these amaglams and since composite materials have been vastly > improved over the last 20 years, s/he thinks composite is the way to > go. (plausible or implausible?) You are clearly more charitable than I. ;-) Steve > Just some thoughts from a layperson, > > Sue SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Does Amalgam dry out teeth? Plausible Busted Confirmed. Now thats a question for the myth busters. :) > > As a layperson here are some thoughts that could use some clarification > > and verification from the professionals as these are mainly guesses on [quoted text clipped - 70 lines] > Brooklyn, NY > 718-258-5001 |
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