Question:
Your teeth do look great and we applaud the fact that you have worked at
improving them so nicely. My point was, "an esthetically-driven patient
would benefit from a nice composite, or porcelain inlay in the lower left
first molar, before the tooth becomes stained!"
Answer:
Did you check the pan x-ray
?
There viewers might see that that tooth which you have chosen, perhaps
in contrast to the next two, has a small filling which might be
good for changing.
It is also possible to see a crack in the tooth, in the colour photo,
isn't it. And that is what I would say to be an important problem of
amalgam. It swells a bit and cracks teeth. Though it tends to fill
the space and stop decay. Is it better in balance?
My dentist suggested about 7 years ago a crown on the next tooth.
A careful look at picture of the tooth you mention might show you a
somewhat
grey colour of it at the region near the next tooth. And in the photo you
gave us the http of a similar colour shows. Do you not think that it is
the
colour of the amalgam showing through transparent tooth material?
My tooth with the small filling that you point out has the filling quite
close to the facial edge of the tooth, therefore its shadow shows
through a bit. But the next teeth look whiter because light from the
fillings has further to travel through the teeth, though the fillings
are bigger.
All those fillings had been in something like 10 years I think, now
getting to 20.
There are some sort of brownish stains near the fillings on the biting
surfaces of some of my fillings. I don't think that is amalgam? To me it
looks like decay but the dentist prods at it for a while and says it is
OK.
A simple anaolgy I give my patients about amalgam splitting teeth:
How do you split firewood?
1) cut a hole in it
2) put a metal wedge in the hole
3) bang down on the metal wedge
How do you split a tooth?
1) drill a hole in it
2) put a metal filling in it (it deforms under repeated stress)
3) chew on the metal filling
How to prevent it? Splint the cusps together...preferably with a crown or
onlay....or with a bonded composite that "glues" the cusp together.
To all the amalgam users out there....thank you! I must do 25-30 crowns per
month just on teeth that had a large amalgam and fractured.
While I agree with your analogy for the most part, I feel there is one
factor that you are missing.
You mention "bang down on the metal wedge". I would place a lot of
emphasis on "BANG down". IOW's, most of these fractured teeth are in
the heads of clenchers. That's why many large amalgams last for 20-30
years.....those patients aren't clenching. Simply "chewing" on amalgam
won't split teeth........*clenching* on amalgams (BANGING down) leads to
a lot of destruction.
If all you are interested in is doing crowns, just sit back and wait for
all of the teeth to fracture. If you want to really help the patients,
identify the clenchers and get them to use an NTI. In your discussions,
you will find a lot of them already have jaw pain and head aches along
with their fractured teeth.
Amalgam does not stick to tooth structure (unless bonded). Amalgam does
not strengthen teeth. The converse is true--that is, smaller fillings last
longer. Their durability is related to the structural integrity of the
remaining tooth.
Teeth can be built up extensively with amalgam. Sometimes I will use
pins for the silver to set around to help retain it. But particularly with
back teeth that have to support heavy biting loads, they tend to break down
eventually.
