Amalgam (Silver) Fillings and Composite (White) Fillings

The tooth to the left has a composite filling and the tooth to the right has an amalgam filling. What is the best restoration for you?




Amalgam restorations are time tested, durable and safe restorations. The American Dental Association, the WHO, and the FDA all have recently released statements and supporting clinical research on the safety of dental amalgam for all non-allergic patients and healthcare workers.

Composites are a newer class of restorations that offer patients esthetics and bonding. This often allows for more conservative tooth reduction during filling placement than for amalgam.


Amalgam fillings are better suited for:


* Teeth that take a heavier chewing burden - i.e. premolars and molars;
* Teeth that have the need for a large restoration;
* Areas in the mouth where moisture control, during the filling process, is hard to achieve. Amalgam is a more forgiving material is areas where the cavity is below the gumline, or near salivary glands; and
* Areas in the mouth where esthetics are not critical.


Composite fillings are better suited for:

* Teeth that do not carry a heavy chewing burden - i.e. anterior teeth and first bicuspid teeth;
* Teeth that will have small to medium restorations;
* Areas in the mouth where it is easy to have good moisture control during the filling process; and
* Areas in the mouth where esthetics are critical.

Reasons to Consider Porcelain Veneer

Celebrities and others in the public eye have been improving their appearance for years with porcelain veneers, but it may also be a great option for your smile.

What can porcelain veneers do for you?

* Cosmetically close gaps between your teeth;

* Change the color of your teeth, or cover up discolored teeth;

* Change the shape of your teeth;

* Create the illusion of better tooth alignment;

* Strengthen tooth surfaces that have been weakened by prior cavities and fillings;

* Replace missing tooth enamel that has been damaged or is defective; and

* In some circumstances, repair broken porcelain on existing crown or bridgework.

Impacted wisdom teeth

Via email Wensday.February, 24, 2010. Anonymous.

Q: A friend of mine has recently been examined regarding some pain in his jaw that one dentist already misdiagnosed as cavity pain. It turns out that after being examined by specialists at a very good university research hospital that in fact he has some very seriously disoriented wisdom teeth – teeth that are growing horizontally inside the gum and the roots are tangled up with nerves that control feeling in the tongue. They say that operating will very likely cause a loss all feeling in his tongue..for life. That sounds pretty horrible and there seems to be no alternate solution. What advice can you give in a case like this? Is a good surgeon really likely to damage the nerves in this area or are they just ‘speaking cautiously’? Are there any alternative options?


A: Thank you for the question. First off, I am glad that he has got a second opinion from a specialist, I am assuming the specialist he saw was an oral surgeon. Wisdom teeth unfortunately can form and be impacted (under the jaw either interfering with other teeth or imbedded in the jawbone itself). It sounds like in your friend's case his are horizontally impacted which would then mean they would be moving towards his teeth in front of the wisdom teeth and in near the inferior alveolar nerve. In many cases where the wisdom teeth are impacted in this way they interfere or are intertwined near this nerve, this is when the decision whether to take the wisdom teeth out or leave them in comes to play. It sounds like he is having discomfort with the wisdom teeth and the teeth they are impeding on, in this case the decision to extract them needs to be weighed with the possible side effect of developing paraesthsia (numbness) due to damage to the nerve during the extraction. In some cases this cannot be avoided as the nerve is directly around the wisdom tooth.

I would suggest your friend think about the decision to extract after a thorough discussion with the oral surgeon he is being examined by.

A wisdom tooth protrudes outwards from the gumline at the back of the lower teeth.

10 Things To Ask Your Dentist

What I find happens during most dental appointments is the dentist asks most of the questions. Patients reply to their dentist's specific queries, and we go on to begin active treatment. It might be a time crunch on everyone's part that silences further dialog, but here are 10 things I wish my patients would ask me to clarify for them:

1. Tell me what you believe is the best brush/toothpaste/floss/rinse I can use to keep my mouth clean and healthy.
ANSWER: Slight variations in dental products can help you get the best results. The same regimen will not work for everyone.

2. Tell me what you believe are the foods I should minimize in my diet in order to keep tooth decay/gum problems at bay;
ANSWER: All patients know to avoid table sugar and candy. Did you know that many other foods such as dried fruit, granola, popcorn and sugar-free diet soda can harm your teeth and gums as well?

3. Tell me what you believe are some of the most staining foods, and is there a way to reduce their staining effects?
ANSWER: Coffee, tea, darkly colored sodas, darkly colored candy, darkly colored juices, and red wine are very staining. Adding milk to coffee and tea reduces stain, drinking a glass of water shortly after consuming the staining food helps wash it off the teeth to reduce stain, and, of course, brushing shortly after consuming the staining food reduces its staining effect.

4. Tell me what constitutes excessive tooth whitening product use, and what damage I may be doing to my teeth and gums if I do not cut back;
ANSWER: This answer will be different based on the age of the patient, the condition of the patient's teeth and gums, the type of whitening product the patient is using, the concentration of the whitening product being used, the length of time the product is placed on the teeth, and many other factors, so please ask your dentist to provide you with the answer that applies to you. If you are indeed using the products excessively, your teeth may become more sensitive, your tooth enamel may become damaged, and your gums may become irritated.

5. How can tobacco potentially harm my mouth?
ANSWER: Tobacco can come in the form of chewing tobacco, cigars, pipes and cigarettes. All of these products increase your chances of getting oral cancer. Other conditions that can arise may not cancerous, but the gums may have become chronically irritated or inflamed. Both of these conditions may require surgery to correct.

6. How can unprotected sex potentially harm my mouth?
ANSWER: HPV (human papilloma virus) is a sexually transmitted infection that can infect the mouth during unprotected oral sex. HPV is a known risk factor in oral cancer, and oral cancer is on the rise. There are tests available to determine if you are at risk. They are quick, easy, inexpensive and pain free.

7. What are all the available dental materials available to place in my mouth, and is any one better than another?
ANSWER: If we are talking about fillings, the choices are gold alloy, silver amalgam, tooth colored composite filling material and porcelain. Each has potential advantages and disadvantages, and which one is best for you would be determined based on the condition of the tooth being filled.

8. How long can I expect my dental restorations (fillings, crowns, etc.) to last?
ANSWER: Once again, the answer would depend on the size of the restoration, how the patient bites on the tooth, and the oral hygiene habits of the patient. The answer would be different for each patient based on these factors.

9. At what age should my dentist begin regular dental checkups for my child, and how do I care for my child's mouth?
ANSWER: Children should have their first dental visit at the age of one year. Parents need to keep their baby's/toddler's mouth clean until the child can start brushing on his or her own with supervision, and lastly without supervision. Parents need to limit sugar and carbohydrate intake, and maintain adequate fluoride exposure, in order to prevent tooth decay in both the primary (baby) teeth and permanent (adult) teeth of their child.

10. Is is all genetics or is it mostly what I do on my own that will help me keep my teeth into old age?
ANSWER: While you may inherit the shape and size of your teeth and jaws from your parents, and that may have an effect on brushing and flossing, for the most part, it is what you do in your oral hygiene routine (at home and at the dentist's office) that will determine the health of your mouth.

Why Are Dental X-Rays Important?

Almost on a daily basis a patient makes the statement, "I do not need x-rays. I'm fine."

I secretly find the statement amusing because, even I, their dentist, cannot make the statement that they are fine, with any certainty, without the diagnostic aid of dental x-rays. Why? I do not have x-ray vision!

Here are just some things a dentist cannot see without the eyes of the dental x-ray:

• Tooth decay ("cavities") on surfaces that are not visible to the naked eye. These surfaces include root areas and inbetween the teeth areas. That is more than half of your total tooth structure!
• The level of bone supporting the tooth roots. This is a measure of gum health.
• Impacted wisdom teeth and/or other impacted teeth.
• Tooth infections or abscesses.
• Cysts or cancers.
• Integrity of existing dental work - fillings, crowns, posts, root canals.

So, as you can see, much of your oral health indicators are hidden from plain sight. Dental x-rays are the ONLY way to obtain this information.

Dental x- rays are a necessary part of your check-up oral evaluations. Please opt to have them taken at appropriate intervals.

Keeping Your Pearly Whites White

Patients want to know how to keep their teeth whiter than white.

Don't Smoke. It is BAD for your health, and the color of your teeth!

Limit consumption of drinks and foods that stain the teeth - red wine, coffee, tea, colas, dark colored candy, including gum and chocolate, blueberries, cherries, beets, and other items that are rich in color.

If you do drink coffee and tea, add milk or creme to the mix.

If you can, brush or rinse with water, after you consume products that stain.

Brush your teeth twice daily, floss daily and rinse with antibacterial and/or anti-cavity rinses twice daily.

Get your teeth professionally cleaned at least twice a year, so stains on the teeth can be removed before there is heavy buildup.

Professionally whiten your teeth, under a dentist's supervision, with either in-office or at-home teeth whitening products. Over the counter whitening products work well for touch-ups.

Consider straightening your teeth so brushing is most effective in reaching all tooth surfaces equally. Crooked teeth may harbor areas that are difficult to clean, and easily hold on to stain.

DO NOT use peroxide out of the brown bottle or brush with baking soda. Both methods are too harsh to the teeth and gums, and you can damage your teeth and gums.

Is There a Difference Between Plaque and Tartar? Absolutely!

Patients often confuse plaque and tartar buildup in their mouths. What is the difference?

Plaque is:
Soft;
Sticky;
Made up of bacteria and their byproducts;
Made up of Food Debris;
Harmful to the Teeth and Gums; and
Easily Removed with Brushing, Flossing and Rinsing.

Tartar is:
Hard;
Non - sticky;
Porous (bacteria attach to the rough surface easily);
Made up of mineral deposits from saliva;
Harmful to the teeth and gums because of the bacteria it harbors; and
Can only be removed professionally during your checkup and cleaning visits with the dentist.

The good news is that patients can exert a great deal of control on the plaque in their mouths through good home oral hygiene techniques. On the other hand, since tartar is a hard deposit it will continue to build until removed by a dentist or dental hygienist. So, stick with your biannual checkups and cleanings, and you will keep your mouth clean and healthy!

"Just Take It Out, Doc" - Better Yet, Not So Fast!

Yes, some teeth cannot be saved, no matter what heroic measures are taken to try and save them.

Other teeth can be saved, but the patient wants them removed because of the immediate tooth pain, or perceived financial pain to save them. In the long run, pulling a tooth that can be fixed is a mistake. Period.

Here are some of the things that can happen when one or more teeth are pulled:

• Adjacent teeth or opposing teeth (the ones the extracted tooth once chewed with) will shift;
• The bone that once supported the tooth's root will resorb (melt away) reducing the strength of your jaw;
• As teeth shift, the remaining teeth will meet at odd angles, increasing the wear to those teeth, and increasing the risk of fracture;
• Also, as teeth shift, gaps may appear in areas where the teeth once touched. This allows for more food to be caught between the teeth, and causes the gums be become irritated and inflamed;
• If many teeth are lost, and consequently much jaw bone is lost, there is a potential increase of jaw fractures;
• If not many teeth remain, the stability and retention of removable dentures decrease;
• As teeth are lost, and if they are not replaced, diet and nutrition suffer, as the diet becomes one of soft foods; and
• The way your face looks will change - sagging of the skin, skin folds around the mouth and wrinkles increase.

Lost teeth can be replaced with many different restorative options. A patient can have a flipper, a Maryland bridge, a traditional bridge, an implant or a denture depending on the number of teeth that are missing, the overall dental and medical health of the patient, the time available for treatment, and the cost of the treatment.

Keep Your Child's Teeth Healthy By Keeping Your Own Teeth Healthy

Childhood dental caries, or "cavities", is an infectious disease. Read that again, and let it sink in. Childhood caries is an infectious disease.

Infections are caused by the transfer of bacteria or viruses from one person to the next . In the case of early childhood caries, the bacteria is passed from the child's caregiver, usually the mother, to the child via sharing of utensils, or kissing on the lips.

The window of infectivity is the first two years of life. If the bacteria is passed from caregiver to child in the first two years of the child's life, the child's chances of getting cavities are dramatically increased.

How does this process happen? The bacteria in the mouth break down food, and in the process, produce acids. These acids break down tooth enamel and the caries process begins. The more sweet foods the child eats, the greater the chance of caries formation. Keep in mind that the frequency of sugar consumption is more harmful than the quantity of sugar consumption.

What can be done?

• If you are a child's caregiver, keep your teeth clean and healthy. Fill any existing cavities in your own mouth;
• Limit the frequency of sugar consumption for both you and your child;
• Take your child to see the dentist between the ages of 6 months to 1 year;
• Help your child brush their teeth;
• Have the dentist give your child a fluoride treatment every 3-6 months depending on the caries state of your child;
• Examine your child's teeth for caries. You will see white spots or brown spots in areas of active tooth decay; and
• Use tap water as often as possible in order to increase the fluoride exposure to the teeth.

What Causes Bad Breath?

Patients ask me this question all the time: " What Causes Bad Breath?"

The possibilities are:

1. Tooth decay ("cavities") or tooth infections ("abscessed tooth");
2. Gum disease - gingivitis or periodontitis;
3. A diet of spicy foods;
4. Post nasal drip;
5. Acid reflux;
6. Retention of bacteria on the tongue;
6. Retention of bacteria on the tonsils; and/or
7. Certain medications or vitamins - prescription or over the counter.

As you can see, bad breath can have many causes. It may be due to only one factor listed above, or a combination of factors.

Remember a good start is a dental exam and cleaning (or "deep cleaning" depending on your needs).
During this visit, your teeth and gums can be evaluated to find the possible solution for your bad breath concerns.

Bad breath can usually be improved once the possible cause is determined.

In the meantime, keep brushing, flossing and rinsing!

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