22Jun

The dilemma that I face when recommending these restorations (which I have had placed in my own teeth) has to do with the intent residing within the oath I signed upon becoming a dentist which states, “First, Do No Harm…” in juxtaposition to the patient’s desire to have natural tooth color, which is understandable.  I know that when I drill off a lot of tooth structure I may be inviting a root canal treatment which could occur around treatment time, or delayed, maybe for years.  And a root canal treatment on a back tooth is not a guarantee of its safety for the future.  I have seen many back teeth fracture underneath the best of crowns requiring the tooth’s removal.  Now we’re looking at an extraction, root replacement implant and new crown.

Some of the new porcelain materials are stronger, look great and fit better than those of the past, however they haven’t as yet compiled the track record of gold which has been used for over 100 years.  However, in most cases, mercury amalgam fillings can be replaced with conservative cast gold restorations in a very inconspicuous manner.

I believe that it is very important to consider all parameters involved when making decisions concerning the health and longevity of one’s oral system, not only regarding safety in removing mercury amalgam fillings, but the type of materials used in replacing them, the quality of the dental laboratory, and the individuality of the patient.  I want to honor my patient’s desires, however I also want their decisions to be influenced by facts that will allow them to make a properly informed one prior to even taking the first step.

*Dr. McBride received awards for excellence in gold technology in dental school and has been trained by Dr. Richard V. Tucker as a member of the Richard V. Tucker Study Club.

                                 

 TESTIMONIAL OF MY PATIENT WITH ORIGINAL GOLD WORK IN PLACE FOR 30 YEARS:
“I trusted Dr. McBride’s judgment from the beginning in his dental recommendations.  I had a lot of cavities as a teenager and young adult, and first of all he taught me how to stop getting them. Then he restored my teeth with conservative cast gold restorations which he said would be least traumatic to the teeth nerves and the most long lasting treatment available if done properly. I guess they were in that they have kept my teeth strong and healthy for over 30 years and I have had no cavities, re-treatment of his work or root canals on any of my teeth since I started with him. I love my smile – you can’t see any of the gold –but what’s more, they will probably last a lifetime. Treatment that’s done right the first time pays off year after year and is one of the best investments I’ve ever made in my health. Thank you Dr. McBride.”  –Pam R.

 

10Jun

After bite alignment procedures, if needed, an appropriate material would be recommended to give the teeth repaired the best chance of never needing repair again.  This is important because each time a tooth is repaired, the nerve within it is traumatized and these traumas, like x-rays, are cumulative.  Following is a typical history of incidents that occur during the lifetime of a tooth.  First the tooth has a cavity (decay) which traumatizes the nerve (pulp) as bacteria enter it even with a moderate sized decay.  Then the decay is drilled out along with some healthy tooth structure to provide undercuts so that the filling won’t fall out, as mercury amalgam fillings have absolutely no adhesive qualities – they actually just sit in the tooth.   And then they expand and contract at a different rate than the tooth, which cracks from internal expansion that eventually causes tooth structure to break away as seen with this tooth.

Fortunately, the pulp issue inside the tooth has healing resources - a blood supply and a lymphatic system - that counteract the inflammatory process from the bacterial invasions (decays) and trauma of the removal process.  The plot thickens though, as the process continues with the tooth breaking from being weakened from a previous filling(s) and/or has another decay and needs repairing again – more trauma to the pulp. Small decays to be filled or mercury amalgam fillings to be replaced can be restored with direct bonded tooth-colored restorations in one appointment.  However, when a large amount of tooth structure is missing from decay or the presence of large mercury amalgam fillings, especially in back teeth where the pressure is greatest, this type of filling material has less of a longevity factor as its strength factor is limited compared to laboratory processed materials.  Also, if the bonding material replaces a large biting area of a back tooth where the opposing tooth contacts only the material and not much surrounding biting tooth surface, it can wear away from chewing forces causing a bite to change through the opposing tooth’s erupting into the void created by the wear. One feature of mercury amalgam fillings is that they wear similarly to that of tooth structure.  I’ve seen them replaced with bonding materials and although the mercury was now absent, the materials that replaced it presented other types of problems such as teeth sensitivity, bite shifting, etc. A tooth with large and/or multiple fillings will eventually need a protective restoration of some type, and this adds more trauma to the pulp.  Here is where the philosophy of the dental practice enters, which can vary considerably from dentist to dentist.  The type of protective restoration most frequently placed is a porcelain crown.  Yet, the most frequently root canalled teeth are those with porcelain crowns.  This is because, along with the accumulated traumas earlier described, a porcelain crown requires that 35 – 40% additional healthy tooth structure be removed circumferentially as well from top down to make room for the porcelain and  underlying metal or zirconium materials fabricated within it that give it strength.  This causes a lot of pulp/nerve trauma, as the surface of the tooth at its neck area just above the gum needs to be cut into deep enough around its base to provide strength of material.  This area - 360 degrees around the base of the tooth - is especially close to its nerve.

02Jun

Mercury part 2

Protocol for a patient desiring to have their mercury amalgam fillings removed/replace:
    
Alternate oxygen breathing system for Dr., assistant and patient


More information about mercury fillings is in the book "The Poison in Your Teeth"
which can be obtained from Dr. Tom McGuire’s website.

Protocol for a patient desiring to have their mercury amalgam fillings removed/replaced:

  • New patient examination including an initial interview with the doctor.
  • Many new patients are working with a health care provider and have a mercury detoxification program in place already.  For those who don’t and would wish to develop one, I recommend Dr. Tom McGuire’s book, “Mercury Detoxification” http://dentalwellness4u.com/index.html for adjunctive procedures such as blood testing, Melisa test, supplements, activated charcoal, vitamin C infusions etc. 

Filling removal procedures:

  • Rubber dam is placed to keep filling debris from being swallowed.
  • Fillings are kept cool with copious amounts of cold water during filling removal to minimize mercury vapor release.
  • Fillings are "chunked" out, rather than being drilled away completely which results in very minute particles causing more vapor.
  • High-volume evacuation is used to capture amalgam particles and mercury vapor.
  •  Oxygen masks for Dr, assistant and nasal hood for patient during their removal.
  • Clean up immediately after their removal - we remove and dispose of our gloves and rubber dam, and thoroughly rinse and vacuum the entire mouth for at least 10 seconds.
  • Treatment room air is filtered to capture residual mercury vapor and other contaminants.