What advice do you have for people with amalgam fillings, many of whom have had them for years? Should they get them replaced? If so, with what?

Although I don’t place many amalgam fillings in my patients mouths, I agree with the American Dental Association’s position that “dental amalgam is a safe and effective treatment option for the general population” It is my belief that amalgams pose no real health risk to my patients since they only release minute quantities of mercury. When they need to be replaced I tend to use either composite restorations for small to medium sized fillings or recommend crowns for teeth missing a larger percentage of tooth structure.

What do you think are the biggest misconceptions about dental health?

Most people like to believe that if there mouth doesn’t bother them, it must be OK. Many wait until something is hurting or they recognize a symptom that should be addressed. This is not the best way to maintain dental health. The best strategy is to maintain a regular schedule of recare appointments with your dentist. Although most dentists recommend twice yearly visits, this schedule could also be annual or quarterly depending on a patient’s need and budget. If you can’t afford to go twice a year, than an annual visit is better than going when something hurts. Having your mouth cleaned and examined, removes tarter and plaque from your teeth and tends to improve the health of your mouth and gums. Also small problems addressed early are less likely to lead to big ones later.

What teeth, mouth, gum, and other dental symptoms or warning signs should never be ignored?

Of course most of us go to the dentist when we have a tooth ache, but many of us wait until the symptoms are severe. Often it’s best to visit your dentist at the first sign of trouble. Swelling, Intermittent pain, sudden increase in sensitivities to cold or hot or bleeding gums are all symptoms that should not be ignored.
Swelling of the gums can be an indication of an infection and should never be ignored. Often the sooner an infection is discovered and treated, the better the outcome. Intermittent pain on chewing can be an indication of cracked tooth syndrome and cracks in teeth should be addressed before they are allowed to propagate and cause worse problems for a patient. A sudden increase in sensitivity to cold or hot liquids should not be ignored since this can be a evidence of an underlying tooth problem that may need to be treated. Bleeding gums also can be a cause for concern since they often signify that a gingivitis or periodontal inflammation or infection is present.

We’ve all heard that it’s important to brush and floss. What other important things should you do every day to take care of your oral health?

Smoking and alcohol can be extremely detrimental to a person’s oral health. Both habits put a person at much higher risk for developing cancer of the mouth or throat. In addition, I have found that my patients who smoke have a much higher incidence of periodontal disease and periodontal bone loss than those who do not.

Diet is another factor that plays a role in oral health. Carbonated soda consumption or an acidic diet can lead to the breakdown and erosion of teeth and make caries more likely. Frequent consumption of sugary foods or a high carbohydrate diet also can have this effect.

Of course we should be able to enjoy all sorts of foods and beverages, but when considering their potential for producing harmful effects, what matters most is the amount of time these foods remain in the mouth. If you consume them once or twice a day they are much less likely to cause a problem than if they are consumed throughout the day.

What's the connection between oral and dental health and conditions such as heart disease and diabetes?

This question was submitted by Everydayhealth.com as part of an interview they requested of me. I thought they asked some excellent questions, so I have decided to post one question and answer each day for the next 5 days. Here is my first answer: There is plenty of evidence that having your teeth cleaned and a mouth free of periodontal disease is good for you’re over all general health. This is not an entirely new idea. In 1933 Charles Mayo, one of the founders of the Mayo Clinic, was quoted as saying “The presence dental health is important. Dentistry is a distinctive health service and can extend human life ten years.”

Many studies(Slade et al is one), show a correlation between periodontal disease and cardiac disease. Also there is at least one study indicating that treatment of periodontal disease improves endothelial (vascular) function. In addition evidence indicates that periodontal disease may cause a worsening of a diabetic’s glycemic control. The exact mechanism is still being debated and studied, but the scientific literature makes a strong case for the connection of vascular disease, diabetes control and periodontal disease.

Can chipped bonding be repaired?

Using bonded composite can be a durable way to restore a tooth, however if the bonding is placed near the incisal edge of a tooth it can chip or crack. This chipping can mar the esthetics of a restoration and at that point a dentist has the option of replacing the entire restoration or just repairing the chipped portion.

When the pre-existing filling is in good shape, but is marred by the missing portion, a repair often is the most affordable and easy solution. Although additions to pre-existing composites may not have the same bond strength as an initial placement, they can provide a durable solution when properly performed.

As is true for all bonding procedures, cleanliness and good moisture control a extremely important to the long term success of composite restoration. Also care should be taken by a dentist to check for anterior excursions that the patient may make. The repair should not be unduly stressed during the mouths lateral and protrusive excursions. Often the reason the initial composite chipped was due to a stress placed on it during these excursions. If the subsequent repair is to be successful often a slight bite adjustment is recommended.

What are the alternatives to apicoectomy surgery?

Apicoectomies are performed on teeth that have had a prior root canal procedure that has failed. This procedure is a 'reverse' root canal in which the tooth's apex is cleaned, shaped and sealed through a surgically made window near the end of the root. Although apical surgery is a viable way of addressing a failed root canal, patients do have two other treatment options.

If the tooth is amenable, than a conventional endodontic retreatment probably has a greater chance of success. This is a good option if the tooth has not been restored with a post and core or if an endodontist feels that a post maybe safely removed in order to retreat the root canal conventionally.

Another option that has become increasingly popular is to skip an apical procedure and instead extract the tooth in question and place an implant instead. Proponents of this treatment usually maintain that it is better to place an implant while there is sufficient bone at the site. (Usually performing apical surgery involves removing some additional bone at the apex in order for the surgeon to have better access to the end of the root.)Further more they often point out that apical surgeries have a lower rate of success than implants do.

Personally I believe that each case should be considered on an individual basis with a patient's individual circumstance carefully evaluated, before a decision is made on which course of treatment is best.

Is it normal to have pain and swelling after a dental implant?

Although it is not unusual for patient to have minimal symptoms after implant placement, sometimes they do experience pain and some swelling afterwards. It doesn't necessarily mean that the implant placement will not be successful. Often implant surgeons have to make a vertical flap incision while placing an implant and also can perform bone grafting at the time of placement. These two procedures can cause some swelling of the face afterwards and patients can experience post treatment discomfort. Some patients can also experience bruising of the face due to tissue manipulation of the cheek during surgery.

If you are having any unexpected symptoms after implant surgery it is a good idea to call you dentist and discuss your symptoms since it is possible for bone grafts or implants to develop infections after their placement. It is advisable to inform your dentist of any unanticipated symptoms,especially if they do not resolve after a week post surgery.