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Many of you know about the criticisms of Amalgam (Silver/Mercury/Tin) restorations from various publications and perhaps even your dentist. I shall not attempt to tout the virtues of this restorative material , since that is fairly counterproductive here. Instead, I would like to inform you about some of the problems with the 'replacement' material, composites.
Composites, or 'tooth-colored' restorations are beautiful, reasonably long-lasting, and biologically compatible when placed properly. An excellent modern-day composite restoration is wear-resistant, which prevents 'bite-collapse' or loss of facial vertical dimension (facial height) and esthetically superior to metallic restorations of any type including cast gold or 'semi-precious' fillings (there is no such thing as 'semi-precious', but the term evolved during the gold price increases of the early 1980's and is often used).
There are two distinct problems with composites which you must be made aware of:
1. The restoration is technique-sensitive. Exquisitely so. If errors of any type are made during the placement of a composite, the filling will FAIL. Immediately. Moisture and bacteria will percolate into the tooth and degradation will begin immediately. If the tooth is isolated, kept perfectly dry during the placement, etching of the enamel and dentin is executed properly, thoroughly rinsed and re-dried, placement of the unfilled resin covers every micron of the surface, and filled resin placement does not stress or flex the tooth in an untoward fashion leading to chronic pain, then you've performed a terrific service for the patient. Any variation is a FAILURE. By professional definition. Remember that word: FAILURE.
By contrast, if a dentist were to place a silver restoration WITH HIS OR HER THUMB rather than to carefully condense it into the tooth preparation, likely the restoration would only last for 15 years rather than 25. When silver amalgam has a void or deficiency, it corrodes slightly - like a patina - and actually fills the microspace. Composite WILL NOT DO THAT. Period. It will decay catastrophically. That is why people can not go to the dentist for 20 years and most of their teeth, if not their gums and bone, are in pretty good shape in Fluoridated environments.
2. The other problem with composites is that if the etching of the enamel and dentin is not performed properly, OR EVEN IF IT IS AND THE DENTAL PULP (NERVE) IS TOO PROXIMAL TO THE ETCHANT, the tooth may be permanently exquisitely sensitive to temperature changes...permanent until the root canal and crown are performed to quell the sensitivity. In my practice lifetime we have gone from 60 second etch not on dentin EVER, to 10 second etch of enamel and dentin. If the etchant is not thoroughly rinsed away, it will be sealed into the tooth and the pH may eventually cause sensitivity/devitalization of the dental pulp, and thus pain.
So we may conclude from this that the dentist must perform this work virtually perfectly for each tooth, all the while considering the nature of non-compliant patients who cause problems for themselves during the procedure (insistence upon rinsing and spitting, etc), time issues, and other exigencies of dental practice. We call this Clint Eastwood Dentistry: "Do you feel LUCKY?" Because luck has a lot to do with success or failure of the procedures. Here in Philadelphia, we will soon be discouraged from placing amalgam restorations - City Council has passed a resolution which will require dentists to fully 'inform' their patients about the 'dangers' of these restorations and hand them a pamphlet to that effect and to obtain written permission following this 'patient education'. I do not want to get into the 'junk science' issues here, but it is a sad day for the patient population and believe me, if I were going into the profession today as a new practitioner, I would become a root canal specialist and just await my gold mine.
If you decide to have posterior composites performed, please be advised that you need ot address these issues with your dentist. I will tell you that most dentists attempt to perform a great service for their patients and will try very hard to do it correctly and within the standard of care. The problem is that the material itself is less forgiving and consequences of applying this to the public as a whole will be altering the morbidity and mortality not only of the teeth and the dentition as a whole, but of the patient population as well. We know that less effective medical treatment of any type leads to greater morbidity and mortality and it is a cascading effect...loss of teeth or breakdown of the dental unit as we call it leads to periodontal disease and we now know that the bacteria involved are implicated in cardiovascular disease including blockages of coronary arteries, which, to say the least, is not a particularly good outcome of dental neglect or treatment complications.
I state these things because our political, ecological, and health care pendulum is swinging and we must needs be careful what we modify or eliminate from our treatment plans and armementaria.
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