Dental Medicine

Welcome and thank you for being brave enough to enter this section.

Contrary to popular opinion, dentistry isn't all about pain. A combination of recent advances in technology and techniques have eliminated a considerable amount of the pain associated with current dental procedures.

Mercury Concerns with Amalgam Fillings
Like all other materials in the world, mercury (Hg) has the potential to be hazardous if not managed properly. Mercury is common in the environment and is taken into the body in one form or another through water, air and food on a daily basis. The contribution of mercury derived from dental amalgam to the overall body burden has been the source of much controversy but appears to be rather low. The important perspective is that mercury enters the body everyday no matter what restorative filling materials are present in the mouth. Under normal circumstances, that mercury is biochemically processed and excreted. As long as levels are low, there is no threat for mercury toxicity.

Early claims of mercury problems appeared as soon as dental amalgams were first used in the United States. The original amalgamation process (mixing of mercury and metals to form amalgam) was demonstrated by a chemist in France. In 1833 two English entrepreneurs, the Crawcour brothers, realized the practical importance for Dentistry, carried the idea to New York, and promoted the material as an inexpensive and convenient restoration.

In the 1920's a series of challenges to dental amalgam use occurred when there were inferences that mercury was not tightly bound in dental amalgams.

The next serious controversy arose in 1980 when Dr. Hal Huggins publicly condemned dental amalgam. Dr. Huggins, a practicing Dentist in Colorado, was convinced that mercury released from dental amalgam was responsible for a number of diseases affecting the cardiovascular and nervous system. Patients claimed recoveries from multiple sclerosis, Alzheimer's disease, and other afflictions as a result of removing their dental amalgam fillings. For almost a decade, a loyal following of patients and dentists expanded the call to ban dental amalgam. Research in the United States and other first world countries has demonstrated clearly that there was no basis for any of these claims.

In 1991, the general American public was widely exposed to the controversy when it was reported by a major television program (60 Minutes).

In response to numerous public questions, the profession, the National Institute of Health-National Institute for Dental Research (NIH-NIDR), the Food and Drug Administration (FDA), and several other groups held forums involving world-famous scientists and clinicians to reexamine the issue. Although these experts agreed dental amalgam research was needed and should continue, they concluded that there was no basis for claims that dental amalgam was a significant health hazard. They strictly recommended that dental amalgams not be removed for that reason. However, the controversy is far from over. There continues to be claims of hazards published in both local papers and nonscientific journals and occasionally in scientific journals as well. However, all published research demonstrates clearly that there is no cause-and-effect relationship between dental amalgam restorations and other health problems.

1. Charles AD: The story of dental amalgam, Bull Hist Dent 30:2-6, 1982
2. The mercury in your mouth, Consumer Reports 316-319, May 1991
3. Odom JG: Ethics and dental amalgam removal, J AM Dent Assoc. 122(7):69-71,1991

Dental Caries
Dental caries (tooth decay) and periodontal disease are probably the most common chronic diseases in the world. Dental caries has affected humans since prehistoric times, but the prevalence of this disease has greatly increased in modern times. This increase is strongly associated with dietary change. Evidence of a decline in prevalence began in the late 1970's and early 80's.

Caries
Caries is an infectious microbiological disease of teeth that results in localized dissolution and destruction of the calcified tissues. It is important to understand that cavitations in teeth (destruction of the tooth surface, creating a cavity) are signs of bacterial infection.

Carious lesions occur under a mass of bacteria capable of producing a sufficiently acidic environment to demineralize tooth structure. A gelatinous mass of bacteria that adheres to the tooth surface is termed dental plaque. The plaque bacteria metabolize refined carbohydrates (sucrose) for energy and produce organic acids as a byproduct. The acids generated then cause a carious lesion by dissolution of the tooth's crystalline structure. Caries lesions progress as a series of exacerbations and remissions as the ph or acidity at the tooth surface varies with the changes in plaque metabolism. Saliva offers a buffering capacity that aids in raising the pH levels (high ph=less acidity) during a carbohydrate exposure. Which is why chewing sugarless gum is good for you after a meal. It stimulates salivary flow, without the negative effect of sugar on the oral environment.

Caries Prevention
This section will discuss strategies in preventing dental caries that if mastered, could prolong the health of your dentition. We will discuss diet first. Mature plaque exposed frequently to sucrose rapidly metabolize it into organic acids, resulting in a significant and prolonged drop in plaque pH (increased acidity). Sucrose can be found in foods such as soda, candy and any sugar containing foods. Caries activity is most strongly stimulated by the frequency, rather than the quantity, of sucrose ingested. Evidence of new caries activity in teens and adults indicate the need for dietary counseling. The goals of counseling are to identify the sources of sugar in the diet and reduce the frequency of ingestion.

Oral hygiene
Plaque free tooth surfaces will not decay! Daily removal of plaque: by tooth brushing, dental flossing, and rinsing is the single best measure for preventing both caries and periodontal disease. Your local dentist should be consulted on the proper technique and frequency for your case. Generally, flossing followed by brushing using a soft toothbrush with blunt-tipped nylon bristles twice daily.

Fluoride Treatment-Fluoride in trace amounts increases the resistance of tooth structure to demineralize (decay) and is therefore an important consideration for caries prevention. The availability of fluoride to reduce caries risk is mostly achieved by fluoridated community water systems, but may also occur from fluoride in the diet, toothpaste, mouth rinses, and topical applications. (Contact your local dentist to determine if community water if fluoridated.)

Periodontal Disease
Gingivitis (inflammation of the gingiva) is the most common form of gingival disease. Inflammation is almost always present in all forms of gingival disease, because bacterial plaque, which causes inflammation, and irritating factors, which favor plaque accumulation, are often present in the gingival environment. Slowly progressive periodontitis is the chronic or long term inflammation of the gingiva (gums), pocket formation and bone loss. Tooth mobility and pathologic migration of gingival tissues appear in advanced cases. Although slowly progressive periodontitis can be preceded by long-standing chronic gingivitis, its destructive features are usually seen at age 35 and beyond. Slowly progressive periodontitis is caused by dental plaque. The accumulation of plaque can be facilitated by a large variety of local irritants such as calculus, faulty restorations, and food impaction. The disease is either generalized or localized to certain areas or teeth. The severity of lesions can vary in different sites but is usually correlated with the amount of plaque.

A combination of debridement and systemic antibiotic treatment can reduce bleeding on probing, pocket depth, and incidence of active lesions and can suppress or eliminate periodontal bacteria. Mechanical debridement with scaling and root planing results in a dramatic reduction in the recoverable counts of most bacteria that cause periodontitis. Surgical treatment may eliminate the marginal tissues that might be invaded by plaque as well as modify the shape and position of the gingival tissues to facilitate daily plaque removal. Contact your local dentist if you suspect that you have periodontitis (gum disease).