Comprehensive Care is More Conservative! (Part 2)

And is much cheaper in the long run!

Dental disease fits in one of three categories:

  • Bacterial infections in the gum tissue
  • Bacterial infections in the teeth
  • Dysfunction in the structure and bite

Each of them can be treated by standard or traditional dental care and treated completely incorrectly.  On the other hand, in a dental office with the right training, the comprehensive plan can be completed relatively quickly and with long-lasting benefits!  The key is to invest in the treatment options that get you to your goals quickest and will have the most predictable longevity afterward.

In this blog, we will outline tooth health and the best ways to keep your teeth for a lifetime!


Indiana Jones yelled that about ancient artifacts, but it’s also true of metal fillings!!  In the late 1800s they were an exceptional alternative to gold crowns or extracting teeth; the only two options of the day.  For the last 20 years, there simply has been no reason to select mercury-silver fillings for quality conscious patients.  The doctors of Aesthetic Dentistry of Georgetown focused their training from the beginning on mastering high-quality adhesive solutions because that’s what they would want in their mouth, and they wouldn’t want to put anything in their patient’s mouth that they wouldn’t want in their own!  One of the most frustrating things we deal with in dentistry today is that our patients do an incredible job of maintaining their teeth and gums, but their old dentistry is what is failing them!

Cavities are bacterial infections

We’ve been told that sugar causes cavities and fluoride strengthens teeth for years, and while that’s sort of true, there’s more to the story.  The real culprit in tooth decay is bacteria.  There are a few bugs that, given the right conditions, cause the decay and cavities in teeth.  That’s one of the reasons that excellent daily home care is so critical to keeping your teeth for life!  The food for these bugs is sugar, so the more you feed them, the more damage they can cause.  What happens is sugar feeds the bugs and their waste is acidic.  Yes, it’s the bug’s poop that is causing the cavities!  Fluoride helps because it strengthens the enamel of your teeth, but if we limit the bug’s activity and remove the waste, that’s a difference maker! More good news is that we have another amazing tool to limit the damage the bugs cause (more on that in the Xylitol blog coming up soon!).

Metal fillings leak and crack teeth

Solutions for dental problems in the mid-1800s were to crown a tooth or extract it.  A slug of whiskey and a tight grip on the barber’s chair and they just yank that tooth out for you.  Fortunately, science in the late 1800s developed amalgam, a mix that was about 50% mercury and 50% a mix of silver and other metals.  Silver was well known for it’s healing properties; unfortunately, at that time mercury wasn’t yet recognized as a neurotoxin. Quicksilver or mercury was used in a lot of fields in the 1800s and is quite literally why we have the expression ‘mad as a hatter’ when we see someone crazy.  The people who built hats used quicksilver too, and it actually made them crazy!  It is no longer used in most applications like thermometers and is actually banned in most modern countries for use in humans including dental fillings.

While the science isn’t focused on the neurotoxin aspect of mercury in fillings, what it clearly shows is that, like any metal, these fillings expand and contract in the tooth with hot and cold and the brittle tooth around it cracks and fractures.  Before the development of bonded plastic fillings, the typical sequence of events was to get a small filling when you were a kid and replace it with a bigger one every 6-8 years until the tooth breaks and needs a crown or root canal.  Or worse.

The other issue with mercury-silver fillings is that they leak around them until they corrode and seal the gap between the tooth and filling.  They are typically annoying and uncomfortable for a while until this corrosion layer or rust forms around them and seals that gap.  Then they work for an average of about 6-8 years.  Interestingly, there is a mercury dissolution curve that has shown that at the 5-year mark, a significant amount of the mercury has disappeared from the filling, presumably evaporated into the mouth as mercury isn’t solid at body temperature.  While this hasn’t been clearly demonstrated to be causing problems, the rust around the filling is a function of the metal and as the metal changes, the corrosion changes too…  Not long after that 5-year mark, these kinds of fillings begin to fail.  It seems that given today’s alternatives, they should be considered a long-term temporary filling at best!

Adhesive dentistry is amazing!

Early in our transition from metal-based dentistry to adhesively placed dentistry, an interesting thing happened.  With the focus on the health of the gums and bone that holds teeth in place a central focus of the practice, it was actually gum tissue that reinforced the need to eliminate non-adhesive dentistry wherever possible!  There are two major problems that eventually occur around mercury-silver fillings and cemented metal-based crowns.

One is the very high incidence of metal sensitivity; either the nickel or the palladium inherent in these metals will irritate the gum tissue until it recedes from the restoration.  This process is much like how the body responds to a splinter as a protective reaction to eliminate the foreign body.  Unfortunately that foreign body is your tooth!

The other constant concern is the micro-gap that is a necessary evil.  With soft gold, it can be exceedingly small, but in traditional fillings and cemented crowns, that gap is filled with corrosion or water-soluble cement and is a repository for bacteria.

With the introduction of adhesive materials, it is possible to have a seamless transition from the tooth to the plastic filling or porcelain onlay or crown.  This not only eliminated the gap at the margin but also is accomplished with materials that the body can treat as healthy tooth.  It was the hygienist who first noticed the stable healthy gum tissues were found around adhesive dentistry and almost never around metal fillings and metal-porcelain crowns!

The other major advantage of bonded materials is that they support and strengthen the tooth from within.  Rather than expanding and contracting with hot and cold like metal, bonded plastic and porcelain responds to temperature changes like a tooth.  In addition, the flexibility of the materials is much closer to the natural tooth, and the resulting impact is that these solutions don’t create cracks in the tooth structure left.

Even better than that, when bonded in place, it acts to support the tooth and the studies have shown that a properly placed adhesive restoration returns the tooth to 95-100% of the original strength before it even had decay!  It is one of the very few areas in the body where we can virtually wipe the slate clean and eliminate the impact of the disease and broken tissue!

Science has clearly shown there are better options

It is widely recognized that dental solutions are almost never permanent.  The oral environment is a combination of stress and load and chemicals that can easily destroy nearly any material.  Back in the late 1800s when mercury-silver fillings were invented, they allowed an option other than gold to rebuild the tooth so that it wouldn’t need to be removed.  Unfortunately, that material has limitations and after over 100 years of development and improvement, the best we can do is an average life-span of 6-8 years.  Of course, this is better than removing the tooth, but it’s really just a long-term temporary.  The tooth is a wear and tear part, like tires on a car, and will be subject to incredible stresses during function.  A major issue with the metal fillings is they create fractures in the tooth structure left around them, and ultimately a big chunk of the tooth breaks off.  If there weren’t a better option, then obviously this would be better than losing the tooth, but today there is an option that is clearly better!

One of the best ways to determine something is what’s called a meta-analysis.  Rather than simply looking at one or two studies to decide how valid a finding is, in a meta-analysis you can look at the combined information from lots of studies.  This means that with the huge increase in sample size, the results found from the meta-analysis is much more powerful than any single study.  We are now seeing meta-analysis longevity studies showing the 10-year survival of materials and are seeing them as being at least as good as mercury-silver fillings and in many ways better.  Obviously, for it to have survived for 10 years, not only was it placed more than 10 years ago, but also it was with materials that don’t have all the benefits of the last 10 years of improvements!

After 100+ years of improving mercury-silver fillings, the average lifespan is still only about 6-8 years and while we don’t know if it is a health risk, we do know the mercury escapes from the fillings into the mouth.  We also know the rate of mercury loss is increased by acids (like tomato sauce and orange juice) and temperature change (like hot coffee or cocoa or ice cream) and functional stresses (like chewing) and at the 5-year mark, a significant amount of the mercury has disappeared.  This may contribute to the outright failure a year or two later.  On the other hand, we also know that at the 10-year mark, relatively older materials bonded with relatively older bonding agents are still performing like new.  Plastic fillings or porcelain onlays or crowns, when placed well, are the clear choice in dental materials today!

“Lowest-cost alternative” is probably illegal

Today there are still a lot of places where the first option is a mercury-silver filling or traditional cemented crown.  That isn’t an option at Aesthetic Dentistry of Georgetown simply because it isn’t what we would ever allow in our mouths and we can’t, in good conscience, provide it to patients.  But, it is still the most common option today.  Sadly.  It isn’t to say metal fillings are not a viable solution, but rather there are significantly better options available and that is what we would want in our mouths so that’s what we provide for our patients.  It does require more time, training, and attention to detail, but quality always does.  The unfortunate reality is that dental insurance standards are set to a thing called the “lowest cost alternative” and this is a tactic the insurance companies use to dictate and deny modern appropriate care and save themselves a few dollars.

There are places in the world that the “lowest cost alternative” set of new dentures is to try out used dentures from a bucket until one is found that fits ok and looks ok.  This is unthinkable in the United States, but it is dental care in other areas of the world.  In much the same way, there are other countries that have banned the use of mercury-silver fillings in favor of the vastly superior and safer bonded plastic fillings.  This hasn’t happened in the U.S. yet, but perhaps someday.  The good news is that delay gives the dentists time to figure out how to properly place bonded plastic fillings.  A well-placed plastic filling will be more conservative and healthier and longer lasting solution than any metal filling ever could be.

With the advances in dental care over the last 20 years, it is shocking that mercury-silver fillings are still the most commonly placed restorations today.  A large part of that reason is that they are the “lowest cost alternative” and what insurance companies offer a rebate for.  They are also potentially harmful to the patient, a significant risk to the dental team, considered a biohazard and can only be disposed of by a biohazard waste management company, don’t last as long as alternatives, require healthy tooth to be removed, will fracture tooth structure, leak for their first two weeks and after 5 years, expand and contract within in the tooth, and are contraindicated in pregnant or nursing women and in mouths with other metal already in them.  And they’re ugly.  That’s a mouthful of reasons why they simply don’t make sense as a dental solution today!

We’re here to help!

We see ourselves as a resource for you.  In this story, you are the hero and we are simply the guides.  It’s our job to know the latest information in dentistry and to offer you the best options available.  If you wanted to know dentistry at that level, you would have been a dentist!  While some of our patients are dentists, most really don’t care about it that much and we get it!  We will always offer you the best options available and always support whatever plan you decide is right for you.  Quite often that won’t line up with the goals of dental insurance companies as their goals aren’t health care, but rather keeping your monthly premiums.  In fact, Insurance companies have developed lots of ways to deny and delay your payment and not help with your care!  We will always work to maximize whatever help you can get from them.

Together with you, we develop a plan for your mouth to achieve your long-term goals. These plans will generally fit into some insurance code and we will fight with you to be sure you get whatever rebate is due to you according to the particular plan you have purchased or have through work.  Proper care is sometimes a little bigger investment on the front end, but it saves you a lot more over the long term…  it saves you not only money but in the long run, it saves your teeth!

Your Aesthetic Dentistry of Georgetown Team!

At Aesthetic Dentistry of Georgetown, your entire team is an incredible blend of care and compassion with the latest clinical training and systems.  Each of them is committed to ensuring a simple and comfortable experience whether it is a routine exam and cleaning, incredible professional whitening, chronic pain help, solutions to snoring and sleep apnea issues, or restorative care that spans the range of a single metal-free filling all the way to full mouth reconstructions supported with dental implants, and everything in between.  Quite simply, we are a full-service practice that focuses on high-quality options across the complete range of dental care.

With years of experience, world-class training, and team approach to being a resource for you ensures that whatever your needs are, one of our team is always ready to help you to regain or protect the health of your mouth!  Teeth were meant to last a lifetime, and with the unique education and experience of your dental family, you can expect us to help you to make that a reality!

If you are new to the practice, the best step to long-term health is a New Patient Experience where all aspects of the health of your mouth will be evaluated and a customized care plan will be developed with you to achieve your goals.  If you aren’t new to the practice, you already know how amazing your team is and know they are in your corner for optimal oral health!

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