It’s one of the most universal recommendations in all of public health: Floss daily to prevent gum disease and cavities.
Except there’s little proof that flossing works.
Apparently the federal government has been recommending flossing since 1979 in a Surgeon General’s report as well as the “Dieteary Guidelines for Americans.” However, anything that the federal government recommends is required to have an adequate evidence base to be considered.
It turns out that flossing hasn’t really been researched very much. In order for the federal government to recommend something it has to be able to point to a pretty serious body of research. Earlier this year the federal government removed it’s recommendation for flossing with little fanfare. After the AP requested the evidence the feds used to recommend flossing…they caved.
If you take a look at the research base, they’re right to have caved. The best studies on flossing that they have are not convincing. They kind of had to remove the recommendation to be consistent with their standards. I understand what they did and cannot fault them.
Here’s the thing…there will be no rush to research flossing. The research design would be difficult and expensive and I doubt that there is the will for it.
All this said…#Istandwithfloss.
I can hear what you’re thinking: “Mead, you claim to be interested in evidence and science! How can you possibly recommend flossing to patients if the federal government retracted their recommendation! The science says it’s no better than brushing alone!”
Let me explain myself.
Everyone’s teeth are covered with a layer of gunk called biofilm. It doesn’t matter how well you brush them and floss them, they’ve got biofilm on them. When dentists and hygienists accuse you of not taking care of your teeth they call this biofilm “plaque” and they get all bent out of shape that you have lots of it on your teeth. We’ve been instructing patients to do their very best to remove this plaque from their teeth for as long as we’ve been in the profession.
The goal is to remove as much of the biofilm as you can.
So you brush. And that can remove a lot of the biofilm. But there are places your toothbrush can’t get to. What is a person to do? The research says flossing doesn’t work.
So I guess you should just leave that gunk sitting in between your teeth, right?
Do me a quick favor. Grab a long piece of floss and wrap it around your fingers. Slide that floss in between a few pairs of teeth, wrap it in a “c-shape” and gently stroke up and down. Then take that floss out and take a good hard look at it. Is it clean as a whistle or does it have a bunch of gunk on it?
If you’re like virtually every patient I’ve seen, it will have a little gunk on it.
So why do #Istandwithfloss?
The problem is the research, not the flossing. Maybe the design of the studies hasn’t been adequate. That’s a huge problem in medical research. Often times we think we’re measuring one thing when we’re not measuring that at all. You’ll notice that the evidence hasn’t recommended against flossing either. Flossing has been an accepted recommendation by dentists and hygienists for so long that it is no longer a hotbed of research inquiry.
Getting back to what a dentist or hygienist should recommend to patients: if our goal is to remove as much biofilm from our teeth and gums as possible, flossing does that. I don’t actually need peer reviewed research to observe that.
There is a word that I really like. That word is “plausible.” Plausible is defined as:
(of an argument or statement) seeming reasonable or probable.
The idea that flossing helps remove biofilm, which in turn helps reduce a person’s risk for cavities and gum disease is plausible. An idea that is plausible, even if it doesn’t have tons of great evidence, is worth keeping around.
Flossing is not expensive nor is it risky. It observably removes biofilm from in between the teeth that brushing cannot always get. And even though our current level of evidence does not allow the federal government to recommend flossing, it is still likely a worthwhile effort.
That’s why #Istandwithfloss.
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Every dentist has experienced it before. Patients refuse x-rays because they don’t want to be exposed to too much radiation. What is “too much radiation?” That’s a great question.
Medical professionals have been taught since the 1940’s that medical and dental imaging carries a tiny chance of increasing a person’s cancer risk, no matter how low the dose. The model that we were taught is called the “linear no-threshold model” (LNT) and it basically claims that any dose of radiation, no matter how small, carries an increased risk of causing cancer. As dentists, we are supposed to weigh this tiny (but not zero) increase in risk against the benefits of whatever x-ray image we wanted to see.
New research published in the American Journal of Clinical Oncology has re-evaluated the original research that we based the LNT model on and has found it to be unconvincing. The original research was performed by exposing fruit flies to various doses of radiation. The damage at each level was measured and the research made the assumption that there is no completely risk-free level of radiation.
In the LNT model, the well-established cancer-causing effects of high doses of radiation are extended downward in a straight line to very low doses. The LNT model assumes there is no safe dose of radiation, no matter how small. However, the human body has evolved the ability to repair damage from low-dose radiation that naturally occurs in the environment.
Basically, the radiation doses that were studied in the 40’s were much to high to extrapolate into low dose medical uses of radiation. We’ve based our concerns about x-ray radiation on doses that are much higher than those experienced by patients. The recent paper was specifically about CT scans, which actually have a much higher exposure to radiation than dental x-rays.
As a profession, dentistry has gone out of its way to expose patients to as little x-ray radiation as possible. But many patient still balk. The effectiveness of x-rays for dental diagnosis cannot be underestimated. But not only are they effective, current research suggests that they are completely safe.
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If you were born in the paleolithic era, you could expect to live to be 33 years old. The global average life expectancy in 2010 was more than double this number at 67 years. Advances in hygiene, food production, medical care are among the reasons for this and we should all be thankful for this.
His hips are the last thing on his mind.
But on the bright side for the cavemen…they didn’t need hip replacements. If you were 35 years old you were likely the oldest person in your tribe and had probably outlived everyone you’ve ever known. But you hadn’t really lived long enough to wear your joints out.
Fast forward to the United States in the early 21st century and you’ll find that 2.3% of Americans have had a hip replaced and 4.6% have had a knee replaced. More than a million joint replacements will be done this year and that number continues to grow. Hip and knee replacements are surgeries that improve a patient’s quality of life in a big way. And we Americans are all about quality of life!
I want you to picture your lower molars. Your lower “first molars” came in somewhere around 6 years old. So for that same 50 year old we talked about above, these teeth have been tolerating chewing, hot coffee, cold ice cream and the occasional unpopped kernel of popcorn for 44 years. Think about that. 44 years! How old is your car? If you’re like most people it’s probably less than 5 years old and maybe 10 on the outside. But if you’ve got your first molars, they’ve been laboring for you since you were 6 years old!
This molar has a long life to live…if it gets a little help.
Teeth wear out, too. If you happen to be particularly kind to them (avoiding sugary or acidy foods, not grinding your teeth, not chewing ice cubes, not smoking, not drinking super hot liquids followed by freezing cold ice cream, etc.) they may well last your entire lifetime. But if your dentist tells you you’re going to need a crown, don’t feel too bad. Crowns are kind of like the knee replacements of dentistry. Dentists can give that tooth a new life with a procedure that’s a heck of a lot easier than a hip replacement! Even more…if you happen to lose a tooth, we can replace that tooth with an implant that looks and functions almost exactly like the real thing!
If you were a caveman, your first molars would have only had to last about 27 years. And since cavemen didn’t have refined sugars in just about everything they ate, most of them did just fine. You are not a caveman. Your life expectancy is very likely well over 70 years old. You are going to wear your parts out. That’s not disease. That’s the awesome nature of living twice as long as a caveman!
The next time your dentist diagnoses you with a cracked tooth that needs fixing you shouldn’t be upset at all. Let it be a reminder that you are benefitting from all the advances that the cavemen didn’t have.
And get that crown done. Those molars have to last a long time yet!
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Joint replacement surgery changes lives. For some people having a knee or hip replaced can end years of pain and struggle. The procedure has become quite common and many dental patients in our office have had it done.
Orthopedic surgeons and dentists have been telling themselves and their patients a story about artificial joints and the risks involved with dental treatment after having one. The story goes kind of like this:
Dental treatment causes oral bacteria to get into the bloodstream. These bacteria find their way to artificial joints and if they do, they can get horribly infected. Sometimes the infection can cause the artificial joint to become so bad that it fails and needs to be replaced. This is a serious and expensive side effect. The solution to this problem is premedicating with an antibiotic before you have any dental work done. That will make it so any oral bacteria that make it into the bloodstream are killed off before they can get to the artificial joint.
At first glance, this story makes sense. You definitely don’t want an artificial joint to become infected. Since we know that dental work can cause oral bacteria to get into the bloodstream, having dental work is clearly the problem. Right?
Well…not really. The story might not be true. In fact, there is no scientific evidence that artificial joints are more susceptible to infection after dental work. The story seems plausible but just doesn’t line up with our available evidence.
Some would say, “the complication of an infected joint is so severe that taking a dose of antibiotics is a small price to pay to keep us safe.” It turns out that there is also no scientific evidence that taking any particular antibiotic can keep an artificial joint from becoming infected. Furthermore, it’s worth mentioning that taking antibiotics isn’t a risk-free event, either. Allergic reactions can happen even in people who have had no reactions taking the same medication in the past. On top of that, every time you take an antibiotic it affects the natural balance of all the good bugs that inhabit your body as well. If you’ve ever gotten a yeast infection after taking an antibiotic, you know exactly what I’m talking about! Furthermore, the overuse of antibiotics promotes bacteria that become resistant to the antibiotics which is bad for everyone!
So this is what we’ve been battling with in dentistry. The standard for joint premedication has been take 2000mg (2g) amoxicillin an hour prior to your dental appointment. However, it is somewhat typical for a patient who is supposed to take their premedication to forget to take it. In fact, it happens often. At least weekly in my experience. So then you try and decide whether you should send them home and reschedule their appointment, give them the premedication at the office or just skip it. We sure could use a little bit of guidance from professional organizations, right?
In 2012 the American Dental Association (ADA) and the American Association of Orthopaedic Surgeons (AAOS) published some guidelines. Some vague guidelines. Frustratingly. Vague. Guidelines. You can read about these guidelines in a blog post I wrote back in 2012. Essentially the guidelines stated that although there isn’t any scientific evidence to support the use of antibiotics prior to dental treatment in joint replacement patients, each case should be considered separately. The opinion of the surgeon, patient and dentist were essentially equally valid. There was not a strong “you should do this” or “you shouldn’t do this” attached to the 2012 guidelines.
I have been trying to explain to joint replacement patients that the evidence goes against the need for premedication. However, these patients have been taking antibiotics for their artificial joints for years and years. They have been told by surgeons, dentists, hygienists and all sorts of other health care providers that they are truly at risk if they don’t. Many patients wanted to continue the antibiotics for dental treatment “just to be sure.” And who could blame them? Many dentists weren’t willing to take the (essentially nonexistent) risk either. Our policy had been that the patient just needed to get a letter from their orthopedic surgeon stating that the surgeon felt premedication was necessary and we’d write the prescription. This was a compromise that I was willing to make so long as we were stuck with these wishy washy guidelines.
In early January 2015, the American Dental Association finally weighed in strongly on the controversy:
“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”
Not perfect, but pretty good in my estimation. The factors that may require premedication now are people who have previously had complications with infected artificial joints as well as patients with immune system compromise.
There should be rejoicing in the streets! Think of how much less often patients will have to take antibiotics! But alas, I’ve already run into patients with concerns. I completely understand this because it’s tough to change what we’ve been doing for so long. For now, we’re going to talk to patients and explain that they really don’t need antibiotics. But we’ll keep in touch with their orthopedic doctors, too. Change happens slowly, but I think the new guidelines are a big step in the right direction!
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We’ve got teeth for chewing, that’s for sure. And chewing means you’re getting more nutrition out of the food you consume. So that makes sense.
We also need teeth for speaking. If you’ve ever talked to a 7 year old who was missing some front teeth while waiting for their new ones to come in, you may have noticed that some of their “sss” sounds and “fff” sounds were a little off.
But what about smiling? Do we smile only as a side effect for having thisawesome chewing and speaking apparatus?
The first question you might ask might be, “do any other animals smile?” The answer to that question is “kind of.”
Since people can communicate with the spoken or written word, we rely less on “nonverbal” communication than other animals. But any husband who’s ever asked their noticeably angry wife “what’s wrong?” and gotten the answer “nothing” knows…words don’t always communicate the complete meaning.
Animals communicate in a wide variety of ways. From the song of the humpback whale to the intricate dance of one bee explaining to its hive where the best flowers are, animals are amazing communicators. Often, parts of their body have become specialized to communicate. Take a beaver’s flat tail. When alarmed, one beaver can tell many other beavers of danger just by smacking that flat tail on the water. If you’ve ever heard that noise, you can see how effective it is!
Dogs and other canines are amazing nonverbal communicators. They have a body that’s perfectly designed to communicate with members of their pack and even the humans that come into their social circles. They’ve got tails that can wag, expressive ears, hair that can stand up or lay flat and they’ve also got long, noticeable teeth that can easily be displayed! However, if you’re seeing a dog’s teeth, you probably understand that they’re smile doesn’t mean the same thing as your grandmother’s!
Clearly, in humans smiling is built into our DNA. Teeth aren’t just for chewing and speaking. Teeth are for SMILING! If you aren’t happy and confident about your smile, I want to help! The team at Mead Family Dental can help you achieve the smile you’ve always wanted. We offer interest free payment plans that can fit most any budget. Give us a call at (989) 799-9133 or email me at email@example.com and we’ll get you smiling again!
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Everyone knows that tooth decay is caused by bacteria in your mouth. The bad bacteria eat the sugar that you ingest and poop out acid onto your teeth. This acid eats holes in your teeth and those holes are the cavities that dentists fix. That’s what we’re good at. Fixing cavities. We do it all day long.
Does your dentist just find cavities and fix them? Or does your dentist punch tooth decay right in the face? I do!
“Take that, tooth decay!”
How do it do it? I destroy that bad bacteria and support the good bacteria. It’s almost like the bacteria are those aliens from “The Avengers” and I’m like the Hulk. Or maybe the Captain America. Yeah. Probably more like Captain America.
But instead of a gamma ray enhanced strength or a shield made of vibranium, I use chemical warfare. Specifically, I use the Carifree system. Carifree is different than any other toothpaste, mouth rinse or dental hygiene tool I’ve ever seen. Carifree kills bad bacteria with a strong antimicrobial. But the products also treat the pH of your mouth, remineralize tooth structure that’s started to break down and even provide a source of Xylitol. All these different things contribute to a healthier, less decay-prone environment in your mouth.
Removing decay and fixing cavities is called the “surgical model.” When you have a filling it’s actually a micro surgery on your tooth. Treating the bacteria and the biofilm on the surface of your teeth and gums is sometimes called the “medical model” of tooth decay treatment. When you use a system like Carifree, it’s actually medicine to treat the bacteria on the surface of your teeth that cause decay. Most dentists aren’t familiar with this “medical model” and limit their treatment to surgical interventions. By adding the the medical model to a high risk patient, we can effectively limit how much “surgery” we need to do in the future.
Do you have new cavities each time you have your teeth cleaned? Are you tired of having to have cavities treated? Let us help you fix your tooth decay problem. Come see us and we’ll team up to punch tooth decay in the face!
Did you find this post heroic? Spine tingiling? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! Especially ones that want to punch tooth decay in the face! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at firstname.lastname@example.org. I always answer my own emails!
Have you ever had a new filling or crown placed that felt kind of foreign? It was smooth as silk, it wasn’t pointy and the bite felt just right. But yet, it was different. Your tongue acted like it would never get used to it, constantly running circles around the newness of it.
Do you remember what happened to it? Yup. You forgot about it. A day or two later, it didn’t feel new. How does that work? I mean, two days ago you were pretty sure that you were going to need to call the dentist. There had to be something wrong with this weird new filling. But now you’re not even sure what tooth it is. How bizarre is that?
It’s actually not bizarre at all! In fact, it means your nervous system is working just perfectly.
Neural adaptation or sensory adaptation is a change over time in the responsiveness of the sensory system to a constant stimulus. That’s a very fancy way of saying, “you just get used to it.” Our nervous system is constantly taking in all kinds of sensory data. What we hear, what we see, what we smell, taste and feel are all giving constant input to our brain. The thing is, not all of this information is all that important at any given time. So the brain has to be able to filter out the stuff that isn’t important while keeping track of the sensory information that is.
Once the brain and nervous system has figured out which information isn’t important at the moment, or salient, it can filter this information out. That way the brain can focus on more important sensory input.
"this is going to be cold!"
My favorite example of this adaptation has to do with swimming in the lake. Each 4th of July weekend for as long as I can remember my cousins and I spend as much time as we can in the lake. Even in early July, when the temperature is in the mid-80’s that lake always feels really cold. At first. If you creep into the lake slowly, just a couple steps at a time, it stays excruciatingly cold. But the longer you’re in, and the more of your body gets wet, the less cold the water feels. Pretty soon, we’re splashing around in the water like it was a bathtub. What happened? Did the water change temperature? Probably not. We just got used to the temperature.
There are probably great survival reasons for our brain to be wary of the shocking cold we feel when we make our way into the lake. We have to maintain our temperature between certain parameters and if our brain feels like this is threatened, it’s going to continue to sound the alarm. After you spend a little time in the water and your survival doesn’t seem threatened, the temperature stops being such a salient stimulus. Your brain begins to focus on other things, like the squishy bottom of the lake or your cousin attempting to dunk you.
So, back to that new crown or filling. It feels new and weird for a little while because it’s a constant and different stimulus to what your brain had been used to up to that point. The longer it stays there without causing a big problem, the more your nervous system discounts the stimuli coming from the touch receptors in your lip, cheek and tongue. Over time, the new filling begins to feel like the norm. Most of the time my patients have gotten very comfortable with their provisional (temporary) crowns and will have to go through the same process with their new crown.
So the next time you have some dental work done and your tongue keeps telling you that there’s something funny going on, just remember that it’s just like jumping into the lake. After a little while, you’ll get used to it!
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“Al, I’ve seen the phrase ‘levels of radiation that are so small as to be insignificant’ used a fair bit in the last few years. Particularly in relation to the Japanese disaster and the observation of levels of radiation around the world due to it…I think it would be instructive to have hard numbers to compare to background and other common sources that are considered safe.”
I agree. I’ve been explaining how safe x-rays are to patients for so long, I’ve kind of forgotten about the actual amounts of radiation that we expose them to. So let’s talk a little bit about radiation.
Electromagnetic radiation like visible light and x-rays travels in waves. And I have a cool graphic of it.
Electromagnetic radiation, or EMR, is any form of energy that travels in a wave. Visible light, radio waves, microwaves and x-rays are all forms of EMR that are common to us. The different types of EMR are characterized by their wavelength and frequency. Longer wavelength radiation like radio waves and have a lower frequency and are considered “low energy.” The shorter the wavelength the higher the frequency of the energy and generally these are “higher energy.” Very high energy like x-rays and gamma rays that can cause an electron to break away from an atom are considered ionizing radiation. These are the kinds of radiation that can cause health problems. Too much ionizing radiation can cause damage to the DNA in a person’s cells, which can lead to tumor formation and even cancer. The high energy state of x-rays is also what makes them so useful for seeing structures inside the body. Visible light is stopped by the skin and soft tissues around your bones and teeth, but x-rays can penetrate through them to show us things that we cannot see with visible light alone.
Harm from radiation sources is “dose dependent,” which means that more is worse. So in order to maintain safe levels of radiation in the dental office we need to know what kind of dose that we’re giving. The dose of radiation is measured in millirems or mrem. You can actually calculate common radiation doses using this chart from the American Nuclear Society.
So what is a “safe” level of radiation dosage? According to the American Nuclear Society the average level of radiation per person in the United States is 620 mrem/year. The safe allowable dose for people that are exposed to radiation in their work (nuclear plant workers, radiology technicians) is 5000 mrem/year.
Here are some examples of radiation dosages for different common exposures:
1 bitewing or PA dental x-ray: 0.5 mrem
2 hours in a jet plane: 1 mrem
1 panoramic dental x-ray: ~3 mrem
living in a stone, adobe or concrete house (instead of wood frame): 7 mrem/year
a full mouth set of dental x-rays: 9 mrem
chest x-ray: 10 mrem
1 pack of cigarettes each day: 36 mrem/year
chest CT scan: 700 mrem
whole body CT scan: 1000 mrem
These numbers reflect conventional film x-rays. Many dentists use digital x-ray technology which needs significantly less radiation to make x-ray images. In some cases the amount of radiation needed is 80% less than conventional film radiography, which would yield even lower radiation doses.
How much is too much?
Even though dental x-rays have an incredibly low dose of radiation, it makes sense to limit the amount of radiation as much as possible. Patients with a proven track record of low decay rate are an example of a type of patient that may not need diagnostic x-rays each year. Other diagnostic methods like high magnification with intense lighting, evaluating saliva flow and dietary evaluation can help determine a patient’s risk for new decay. For patients who have experienced cavities recently or new patients that don’t have a track record with their dentist, taking dental x-rays on a regular basis is necessary diagnostic tool.
So what’s a patient to do? How do you know if an x-ray is necessary? You need to ask your dentist. And if you don’t feel like your dentist is hearing you, perhaps you need to find another. Having a relationship with a dentist whose opinion you trust is a great way to know that you’ve found a good balance between too many x-rays and not enough information to prevent dental problems.
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You brush your teeth to get the plaque off of them, right? And if you remove the plaque then you won’t get cavities, right?
The model dentistry has been explaining to patients forever is that plaque causes cavities and that if you can just remove the plaque then you’ll have healthy teeth. Unfortunately, it’s really not that simple.
Unless you’ve just had your teeth cleaned, like 2 minutes ago, your teeth are actually covered in a biofilm. It happens if you brush three times a day and floss like a maniac or if you haven’t seen a toothbrush in years. Biofilms form on most any surface that’s wet. Slime on the hull of a boat, coated rocks in a stream and the plaque covered surface of teeth are all examples of a biofilm.
Biofilms are actually microscopic communities of bacteria and the slimy matrix they make to stick to surfaces. A biofilm will “mature” over time and then spread. The plaque that dentists and hygienists talk about is actually a biofilm that’s large enough to be seen with the naked eye. Dental plaque/biofilm is actually made up of many types of bacteria. Some of the bacteria (Streptococcus mutans, for instance) found in this biofilm are the bad guys that can eat sugar and turn it into acid which can then cause tooth decay. Other bacteria (Streptococcus sanguinis) found in the plaque are actually known to make the biofilm less hospitable to the acid loving bacteria. So it doesn’t necessarily follow that biofilm = cavities. Someone who does a good job of brushing and flossing will generally keep the size of the biofilm smaller and potentially makes the biofilm “healthier” by increasing the % of bugs that don’t produce acid.
less beautiful and more common biofilm
O.K. Doc…I’m following you. Not all plaque is bad plaque. So why can’t they get rid of the bad bugs and leave the good bugs? Well, I’m glad you asked! There was a preliminary study out of UCLA about a mouth rinse that can do just that! Since it’s a preliminary study that means that real clinical trials to prove efficacy haven’t been done. They have some promising results on a small group of patients treated with a mouth rinse that can supposedly target S mutans (the bad bugs) in the plaque. According to one article there will be clinical trials starting in 2012.
If you like this post, I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1” on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at email@example.com. I always answer my own emails!
What’s the deal with silver fillings? Why is it that we see news stories every once in awhile questioning the safety of dental amalgam? The answer, in a nutshell, is Mercury.
The element Mercury (Hg) is highly toxic. Think broken thermometers and fluorescent light bulbs. Avoiding Mercury exposure is highly recommended. As an element, Mercury is poisonous.
Another element, Chlorine (Cl), is also highly toxic. Yet, when combined with the element Sodium (Na) you get a chemical that is common, safe and in reasonable doses, delicious. Common table salt is a chemical compound called Sodium chloride (NaCl) and is perfectly safe to eat in moderate amounts. But no one in their right mind would go out of their way to ingest Sodium or Chlorine on their own. The same goes for Mercury.
“Silver fillings” aren’t really fillings made of Silver. They are a combination of Mercury, Silver, Copper, Tin and other trace metals. Silver fillings are placed by thoroughly mixing these ingredients. The ingredients mix and form an alloy of the metals. This alloy is different than any of the ingredients individually. In other words, there isn’t just Mercury, Silver, Tin or Copper in there. It’s a whole new chemical compound made up of all of these metals. It’s kind of like concrete. You start with cement, sand, stone and water. The final product is concrete. You can’t go back and take the ingredients out of concrete without breaking down the concrete chemically.
The bottom line is that there’s no such thing as “Mercury fillings.” Dental amalgam has Mercury in it that is chemically combined with other metals to form an alloy. One of the properties of Mercury is it’s ability to form an alloy like this at room temperature.
Can dental amalgam “leak” Mercury? Yes. There can be a very slight release of mercury from amalgam fillings. A study conducted by measuring the Mercury vapor levels inside the mouth over a 24-hour period in patients with at least nine amalgam restorations showed the average daily dose of inhaled mercury vapor was 1.7 µg (micrograms), which is approximately only 1% of the threshold limit value of 300 to 500 µg/day established by the World Health Organization. So there is Mercury released from fillings, but it’s a very tiny amount.
What about Mercury exposure from dental amalgams causing diseases? The American Dental Association has weighed in regarding the safety and efficacy of dental amalgam. Scientific evidence concludes that the use of dental amalgam is safe. There is no evidence to support removing silver fillings in an effort to cure or prevent other diseases.
Dental amalgam has undoubtedly saved millions of teeth in its 100+ years of use. Until relatively recently there haven’t been inexpensive options to restore teeth that could hold a candle to silver fillings. They’re durable as heck and they’re relatively easy and inexpensive to place.
Are there any problems with dental amalgam? I actually see two.
They’re ugly. When polished they can be shiny and smooth, but they don’t look like a tooth. They look like metal, which they are.
In order to place a silver filling you need to remove a lot of tooth structure. In a tooth that’s never been filled before, this means that you’re cutting away more tooth structure than you need to.
To me, those are the main down sides to using dental amalgam. Perhaps these down sides deserve their own post (stay tuned!) I place very few dental amalgams any more because I’m confident that I can place an excellent bonded resin restoration (a.k.a: composite) in any situation that I might have used amalgam.
But my reasons for using composite fillings has nothing to do with Mercury. In my mind, the Mercury is a non-issue.