by Gary M. Verigin, DDS, CTN
When you have a cavity or an infected or broken tooth, the choice of dental material used to fix it is probably the last thing on your mind. Mostly, you just want to get the tooth fixed and any associated pain taken away. And many dentists are happy to work this way. Seldom consulting their patients, they choose materials based on their own criteria – or just from habit – without considering how the material might affect the individual’s overall health once it is placed in his or her mouth.
Now, if you were going to build a house, you wouldn’t use just whatever materials were convenient or familiar. For starters, you’d have to think about the environment. Though there might be plenty of material available, the little grass shack that’s perfect on a South Seas island would hardly survive the elements of a northern Canadian winter. You’d also need to think about the dwelling’s use: if you needed room for a family of seven, a one room, plywood lean-to simply wouldn’t do.
The conscientious dentist must consider similar factors when it comes to the selection of dental materials.
The truth is, there are a wide variety of materials available for filling and repairing teeth. Some are better than others. Some that may be perfect in one application might not work as well in another. As a consumer, you have the right to consult with your dentist about which materials will be placed in your mouth. You have the right to work with your dentist to make an informed choice – one that supports your overall health, satisfies your aesthetic desires and makes good economic sense.
Of all current dental materials, four kinds are acceptable: composite, gold alloys, porcelain and ceramic. While mercury amalgam and glass ionomers are widely used, I don’t recommend them. Glass ionomers are far less durable than composite, while mercury amalgam is highly toxic and can severely compromise a person’s physical and mental health.
The ideal dental material will be durable, stable, nontoxic and have aesthetic and functional qualities that best suit the specific dental situation.
Aesthetic considerations involve how the restoration looks when placed in the mouth. Ideally, it should blend with the surrounding natural teeth. Being unnoticeable to others, the dental work won’t distract or detract from what you’re saying when you are in close speaking space with others. Your smile should look as youthful as when you were a schoolkid.
Also important is the material’s durability and the estimated longevity of the restoration. Although composite, gold, porcelain and ceramic restorations do cost more and take more time to complete, over the long haul, they can be much more economical. They are more durable and more broadly biocompatible. Some of the newest ceramics are even as strong as gold and as durable as enamel. If weaker or less stable materials are used, the restoration likely will need to be replaced much sooner. Worse, for some, elements released from the material can create long term systemic health problems. This often happens with mercury amalgam. Whenever you chew on amalgam fillings, vapor is released, adding to the toxic load of the body and creating conditions for illness. The same can happen with other materials. Further, if you habitually gnash, grind or brux your teeth, it can affect not just the teeth but the bone and TM joints, as well. So behavior and use also play a role in the selection of dental materials.
Yet other factors to consider include where the damaged tooth is positioned and which part of it is damaged. These factors, as well as the condition of the surrounding teeth, matter in terms of contour, shape and alignment. Each specific dental situation presents its own technical and structural demands. Some materials are better suited to meet them than others. The restoration must also be crafted to articulate and occlude properly with the opposing teeth: the bite must come together comfortably, its pressure centered within the confines of the teeth above or below the restoration, as well as within the restoration itself.
The most important consideration of all is biocompatibility. Just as no ethical physician would treat an infection by injecting penicillin without first finding out if the patient is allergic to it, no ethical dentist should place material in a person’s mouth without first learning if he or she is sensitive or reactive to it. The material could have toxic effects or autoimmune components. Fortunately, evaluations can be done quite readily with a small blood sample. To determine biocompatibility, lab technicians observe how a person’s immunoglobulins (antibodies) react to the various organic and inorganic chemical groups of each material being considered.
Discussing all of these factors with your dentist can help you make the most informed decision about your dental options. Doing so, you minimize the chance of needing restorative re-treatments due to incorrect material choice. Not only is this important for economic reasons; again, it’s vital in ensuring your overall long-term health.
Inside every tooth is the pulpal complex. It’s like the hard drive of your computer. Just as a hard drive contains all the circuitry that makes your computer work, so the pulpal complex houses the microcirculation within the tooth – the “circuitry”’ that keeps the tooth alive. It’s an intricate system of nerves, blood and lymphatic vessels and connective tissue. Every time a tooth undergoes repair work, no matter how careful the dentist is, this delicate system is negatively affected by the trauma of the drill, whether conventional or laser. Simply put, the fewer times you need dental repair or surgery, the less trauma experienced by the intricate circuitry of your body. The less trauma, the more your body can concern itself with its everyday business of keeping you alive and healthy.