Helaine Smith DMD

In a recent post I wrote for DrBicuspid.com, I mentioned that during a recent congressional review of Medicare and Medicaid services, Rep. Diane Watson (D-CA) suggested that dentists should be discouraged from using amalgam in dental fillings because “you have gas constantly escaping,” a health concern she thought should overshadow any savings in cost.

Amalgam is the technical name for silver fillings. The reason dentists debate the pros and cons of silver fillings is because amalgam fillings incorporate mercury — a substance that’s beginning to be banned in landfills as more research comes out about the effects of mercury on the eco-system.

Amalgam fillings have been in use in the U.S. since the 1830s. According to a PubMed.gov article, 19th-century dentists mixed mercury with filings from silver coins.

You can find lots of research about whether or not amalgam fillings pose a risk to your health. Some believe, the way I do, that mercury doesn’t pose a risk if it’s combined with a metal alloy. Others feel that no mercury is the best course of action.

And too, illness can strike anyone without rhyme or reason. I recently had a patient who died of ovarian cancer at the age of 42 — and she didn’t have one filling. My uncle had a mouthful of amalgam fillings and lived to 92.

The bottom line, however, is that today dentists have more materials at their disposal and don’t have to rely on amalgam to fill cavities. These materials wear better and look better.

I haven’t used amalgam or other metals in my practice for 12 years now because I found the amalgam fillings cracked patients’ teeth — whereas composite materials do not.

Some of the pros and cons of using amalgam versus composite materials are:

Amalgam
A durable material that last many years
Comprised of 50% mercury
Mercury vapor can be released into the mouth, which is harmful for those with weakened immune systems
Can cause teeth to turn gray
Amalgam expands as you age, causing your tooth /teeth to crack or break

Composite materials (or bonded aesthetic fillings)
Filling is tooth-colored
Procedure requires less tooth to be removed
Insulates better against hot and cold
Easily replaced
Sometimes not as durable as amalgam

As a consumer, it pays to research this topic and do what makes you feel comfortable. If your dentist will only support amalgam fillings and you prefer composite fillings, then get a second opinion.

Great blog post from Dental Blogs about a new study out from Eastman Institute for Oral Health Researchers. The researchers wanted to compare the hydrogen peroxide in teeth whitening products with the acid in orange juice.

The results were astounding. According to the press release:

Unlike never before, researchers were able to see extensive surface detail thanks to a new focus-variation vertical scanning microscope. “The acid is so strong that the tooth is literally washed away,” said Ren, whose findings were recently published in Journal of Dentistry. “The orange juice decreased enamel hardness by 84 percent.” No significant change in hardness or surface enamel was found from whitening.

The press release goes on to talk about how fruit juice and soda do a real number on your teeth. And since children are the main consumers of these products, it’s the one reason why tooth decay is on the rise in children.

Which brings me to a topic that is quickly becoming near and dear to my heart (in addition to getting tested for oral cancer!) — and that is, ensuring young children see the dentist on a regular basis.

I bring this up because my office manager has a new nephew and the pediatrician told her sister that her son didn’t need to see the dentist until he was four years old — well after teeth have come in and caries (cavities) begin to form. I was incensed!

According to the CDC, tooth decay affects children in the US more than any other infectious disease. Untreated tooth decay “causes pain and infections that lead to other problems such as eating, speaking, playing and learning.” I’ve also read that children with advanced tooth decay end up missing school.

In addition to ensuring your children use a fluoride toothpaste and instilling healthy diets that are low in juices and sodas, the CDC recommends that you bring young children in for their first dental assessment between the ages of one and two — and every six months thereafter.

The fact that a pediatrician didn’t know this simple fact is appalling — one reason why our health organizations need to do a better job at educating consumers.

My office manager’s sister did take her young son to the dentist — as you can see in these delightful photos!

In a recent NY Times article, Best Treatment for TMJ May Be Nothing, reporter Jane Brody relied “on narrow and outdated perspectives supplied by a small group of dentist/academicians” — an opinion expessed by one of my Las Vegas Institute (LVI) colleagues.

In a Letter to the Editor — which of course was never published by the Times (but did run on the LVI email forum) — my colleage wrote:

The information you were provided would lead one to believe that TMD (or “TMJ” as it is inaccurately called by so many colleagues) is easy to treat and self-manage or that it may all be in your mind. Your sources stated that, “TMJ problems were originally thought to stem from dental malocclusion,” and go on to say that this was an infrequent cause of the problem.

The American Academy of General Dentistry (AGD), an organization of some 40,000 of the nation’s leading general dentists, recognizes the relationship between malocclusion and headache. . . . A simple Google search for TMD on keywords such as headaches, TMD, TMJ, etc., would have taken you to many other informative sources of information regarding the subject of your article.

As one who treats patients with severe TMD symptoms, I can assure you that my patients are unable to manage the pain associated with these conditions by simply receiving counseling on their habits. Further, I find that dental malocclusion is frequently one of the principle causes of TMD. Your informant’s comments that MRI and CAT scans are among the biggest advances in diagnosis of TMD is ludicrous. Those modalities are valuable and will tell you about the status of the jaw joint, but tell you little to nothing about the causes of joint misalignment, which I frequently find to be malocclusion.

Yet another incredulous statement is that “80-90 percent of the needed information can be obtained just by talking to the patient.” Certainly a complete history is a vital part of the diagnostic process, but when modern objective evaluation tools such as electromyography to study muscle condition, computerized jaw tracking to document functional abnormalities, X-ray and MRI to study structure are ignored, it is much like saying, “Let’s do away with electrocardiograms, we can just ask the patient if he has chest pain.”

We are now in the 21st-century. It is time for the profession to recognize that occlusion and jaw function are governed by a physiological process and diagnose and treat accordingly. I am hopeful that you will do further research and publish on this topic again, this time avoiding a slanted perspective by a small self-serving group of “experts.”

All I can say is “AMEN SISTER.”

Having tried for years to get the attention of the press in the Boston area regarding oral health, I can state that the NY Times and other media simply do not care that dentists are no longer the “tooth plumbers” of years past but are today’s modern “mouth physicians.”

(In fact, healthcare IT blogger Neil Versel posted that he was told by the Boston Globe that there is no market for Healthcare IT — a $2.5 billion dollar industry. Amazing.)

No one would say that a dermatologist or opthalomolgist weren’t medical professionals.

Why then do people — and the press — have blinders on when it comes to modern dentistry?