Tuesday, September 17, 2013

Controversy Over Amalgam Filling

In dentistry, amalgam is an alloy (combination of metals) of mercury with various metals used for dental fillings. It commonly consists of mercury, silver, tin, copper and other trace metals.
In the 1800s, amalgam became the dental restorative material of choice due to its low cost, ease of application, strength and longitivity.
The dental amalgam controversy refers to the conflicting views over the use of amalgam as a filling material because it contains the element mercury. Scientists agree that dental amalgam fillings leach mercury into the mouth, but studies vary widely in the amount and whether such amount presents significant health risks. The effects of that amount of exposure are also disputed,. The use of mercury in dental fillings is approved in most countries. Norway, Denmark, and Sweden have banned the use of mercury in dental amalgams over environmental concerns, and in Sweden's case also from concerns over its effect on human health.

Health effects
A 2003 monograph on mercury toxicity from the World Health Organization concluded that:

  • Studies on humans and animals have demonstrated that dental amalgam contributes significantly to mercury body burden in humans with amalgam fillings.
  • Dental amalgam is the most common form of exposure to elemental mercury in the general population,
    constituting a potentially significant source of exposure to elemental mercury, with estimates of daily intake from amalgam restorations ranging from 1 to 12.5 µg/day, the majority of dental amalgam holders being exposed to less than 5 µg mercury/day.
  • Intestinal absorption varies greatly among the various forms of mercury, with elemental mercury (as found in amalgam) being the least absorbed form (<0.01%)
  • Absorption also varies according to individual factors such as gum chewing and bruxism (tooth grinding).
  • The number of restorations - amalgam or otherwise - is declining, largely due to improved dental hygiene, in all industrialised countries examined declining by 38% since the 1970s in the USA and over 65% in the ten years from 1986 in the UK
  • Although several studies have demonstrated that some mercury from amalgam fillings is absorbed, no relationship was observed between the mercury release from amalgam fillings and the mercury concentration in basal brain.
  • However, in the same report it was concluded that "...even at very low mercury levels, subtle changes in visual system function can be measured."
  • In multiple sclerosis patients with amalgam fillings, red blood cells, haemoglobin, hematocrit, thyroxine (T4), T-lymphocytes and T-8 (CD8) suppressors cells levels are significantly lower, while blood urea nitrogen and hair mercury levels are significantly higher.
  • The report also notes that regarding elemental mercury exposure, the main form of exposure from dental amalgam," most studies rely on assessment of exposure at the time of study, which may not be fully informative, as mercury has a long half-life in the body and thus accumulates in continuous exposure ", making the evaluation of effects on health uncertain.

Health effects for dentists :

In 1991, Geir Bjørklund published a toxicological risk analysis of occupational diseases in dentistry that are related to chronic exposure to inorganic mercury, especially metallic mercury vapour. He found studies indicated that dental work involving mercury may be an occupational hazard with respect to reproductive processes, glioblastoma (brain cancer), renal function changes, allergies and immunotoxicological effects.

Are there alternatives to amalgam?
There is now a dental amalgam that contains indium as well as mercury. The indium helps retain the mercury
so that less is released into the environment. There are also high-copper amalgams. They contain less mercury and more copper. Dentists use other materials for filling teeth. These include Glass Ionomer Cement, Miracle mix, composite resin, porcelain and gold. Amalgam is stronger than composite resin. This is a tooth-colored material.

Monday, March 4, 2013

Options For Missing Teeth

Missing teeth are not socially acceptable. So, people with missing teeth can feel self-conscious about their appearance or speaking in public. The options to choose to replace a missing tooth depends on a number of different factors. The factors to consider include cost, time, longevity, comfort, esthetics, convenience, and the effects of the treatment on the adjacent teeth and the rest of the mouth. The four basic options given below can be done to replace missing teeth.
  • Removable partial denture
  • Fixed bridge
  • Dental implant

The Removable Partial Denture
The most inexpensive tooth replacement option is the acrylic removable partial denture. Removal dentures have some advantages and disadvantages. 

  • Cheaper in the short term
  • If broken or damaged, partial dentures are easier to repair compared with bridges, complete and overdentures
  • The denture is not fixed.
  • Chewing function is restricted.
  • Precautions should be taken to while eating. Eating hard food is avoided.
  • The poor fit of the denture can lead to painful pressure points.
  • Because of the lack of bone stimulation, this can shrink and further worsen denture fit.
  • Speech can be impaired by poorly fitting dentures.
  • The sense of taste can be impaired.
  • Self-confidence and quality of life can be impaired.

For those people who have no teeth, full dentures are used to provide a functioning set of teeth. With this solution, the new teeth are borne by a gum-colored acrylic base.The oldest useful complete denture appeared in Japan, and has been traced to the ganjyoji temple in Kii Province, Japan. It was a wooden denture made of Buxus microphylla, and used by Nakaoka Tei (20 April 1538). This wooden denture had almost the same shape as modern dentures retained by suction. It also shaped to cover each condition of teeth loss. Wooden dentures were used in Japan up until the Meiji period.

The Fixed Bridge
The fixed bridge or prosthesis is the next tooth replacement option we can have. A fixed bridge requires prepartion of tooth structure, that is cutting down, the teeth on either side of the missing tooth. Tooth preparation of the adjacent teeth is irreversible and involves the removal of quite a bit of tooth structure.  A well made fixed bridge can look natural, function well, and potentially last a lifetime. There are different materials used for preparation of crowns are stainless, metal ceramic, full ceramic, Zirconia. 

The Dental Implant
The dental implant can be the best method for replacing a missing tooth in most cases.  It involves surgically placing a titanium artificial root (the implant) into the bone that the root of the lost tooth occupied.  A crown is then connected to the implant. One benefit of this tooth replacement method is that the adjacent teeth are left unaltered.  The dental implant and its crown are a free-standing self-supporting total tooth replacement.
They offer longevity. Implants are very durable and designed to last many years and also improves speech and appearance. They support good oral health. But they are the most expensive dental surgery available. They involve a very time-consuming procedure if many implants are placed.

Tooth loss due to tooth decay and gum disease may be prevented by practicing good oral hygiene, and regular check-ups once in six months at the dentist's office.

Tuesday, February 26, 2013

Bleeding Gums Prevention

Gums play a major role not only in your dental health, but in your overall well-being. Swollen and bleeding gums are first signs of gum disease. Bleeding gums are mainly due to inadequate plaque removal from the teeth at the gum line. This will lead to a condition called gingivitis, or inflamed gums. An important aspect of gingivitis to remember is that it is reversible. Gingivitis is usually painless, although the gums may be red, swollen, and bleed easily with brushing. There can also be a bad taste in the mouth or persistent bad breath

If gingivitis is left untreated, it can progress into an advanced form of gum disease known as periodontitis, which damages the gum tissue and underlying bone. Tooth loss and other damage caused by periodontitis cannot be reversed. However, your dentist can limit further damage by stopping the progression of periodontitis by treatment

Other causes of bleeding gums include:

  • Any bleeding disorder
  • Brushing too hard
  • Hormonal changes during pregnancy
  • Idiopathic thrombocytopenic purpura
  • Ill-fitting dentures
  • Improper flossing
  • Infection
  • Leukemia
  • Scurvy
  • Use of blood thinners
  • Vitamin K deficiency
  • Stress
  • Orthodontic Treatment

Tips To Prevent Bleeding Gums :
  • Visit the dentist at least once every 6 months for plaque removal. Follow your dentist's home care instructions.
  • Brush your teeth gently with a soft-bristle toothbrush after every meal.  Rinsing with salt water or hydrogen peroxide and water will be helpful. Avoid using commercial, alcohol-containing mouthwashes, which aggravate the problem.
  • Flossing teeth twice a day can prevent plaque from building up. Avoiding snacking between meals and reducing carbohydrates can also help.
  • Use an antibacterial mouthwash
  • Eat balanced diet, including plenty of vitamin C and calcium, may minimize the likelihood of experiencing gum problems.
  • Drinking water, especially after eating, can help wash food off your teeth and make it less likely that bacteria will form gum-damaging plaque.
  • Avoid the use of tobacco chewing and smoking, which aggravates bleeding gums.
  • Control gum bleeding by applying pressure directly on the gums with a gauze pad soaked in ice water.
  • If you have been diagnosed with a vitamin deficiency, take recommended vitamin supplements.
  • Avoid aspirin unless your health care provider has recommended that you take it.
  • If side effects of medication are irritating, ask your doctor to recommend another medication. Never change your medication without consulting your doctor.

Consult your Dentist if :

  • The bleeding is severe or long term (chronic)
  • Your gums continue to bleed even after treatment
  • You have other unexplained symptoms with the bleeding

Tuesday, February 12, 2013

Some Useful Tips for Those With Sensitive Teeth

Tooth sensitivity is common problem that causes discomfort or pain to one or more teeth or associated areas that are triggered by hot or cold food or even by breathing cold air.

There are two types of tooth sensitivity:

  • Dentinal sensitivity
  • Pulpal sensitivity
Dentinal sensitivity occurs when the dentin of a tooth is exposed. Normally, the dentin is covered by enamel above the gumline and by cementum below the gumline. Dentin contains tiny openings called tubules which contains nerves. When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches. Some causes of dentin exposure include:
  • Brushing your teeth too hard. This can wear away the enamel layer also called tooth abrasion.
  • Poor oral hygiene. This may allow tartar to build up at the gum line.
  • Long-term tooth wear
  • Untreated cavities
  • An old filling with a crack or leak
  • Receding gums that expose the tooth's roots. Receding gums often are caused by periodontal diseases or by brushing too hard also called as gum recesion.
  • Gum surgery that exposes a tooth's roots
  • Tooth whitening in people who have tooth roots that already are exposed
  • Frequently eating acidic foods or drinking acidic liquids also called tooth erosion
Pulpal sensitivity is a reaction of the tooth's pulp. The pulp is a mass of blood vessels and nerves in the center of each tooth. Pulpal sensitivity tends to affect only a single tooth. Some causes of the pulpal sensitivity include:
  • Decay or infection
  • A recent filling
  • Excessive pressure from clenching or grinding
  • A cracked or broken tooth
How to prevent sensitive teeth?
  • A sensitivity toothpaste, is the simplest way to fight a tooth sensitivity problem. Sensitivity toothpastes contain special ingredients as strontium or potassium which are de-sensitising agents. Strontium chloride works by blocking the dentin microtubules that enable cold and heat sensations to reach the tooth's nerve. Potassium citrate and Potassium nitrate work in a different way by blocking the mechanism of pain transmission between nerve cells.
  • Fluoride varnishes may be applied on sensitive teeth by your dentist in more severe cases of teeth sensitivity. 
  • Brush your teeth twice a day for two minutes with fluoride toothpaste. Use small circular movements with a soft-to medium-bristled brush. Try to avoid brushing your teeth from side to side.
  • Change your toothbrush every two to three months or sooner if it becomes worn.
  • If you grind your teeth, talk to your dentist about the possibility of having a mouthguard made to wear at night.
  • Regular visit to Dentist will avoid dental sentivity problem atleast once in a year.

Friday, February 8, 2013

Do Pets Need Dental Care?

We humans brush our teeth at least twice a day in order to keep our teeth healthy.  Dogs and cats have teeth just like we do, and the same conditions that lead to our tooth and gum problems also occur in our pets mouths. Oral hygiene has perhaps been the most neglected aspect of pet health care. Lets now look at some facts about pets dental structure :

Types of teeth
Mammalian carnivores have teeth that line the upper and lower jaws. There are four types of teeth with different functions:
  • Incisors: cutting and nibbling food
  • Canine teeth: holding and tearing food
  • Premolars: cutting, holding, and shearing food
  • Molars: grinding food
Numbers of teeth
Many mammals, including dogs, cats, and ferrets are "diphyodont" meaning they have two sets of teeth, one set (called "deciduous") being shed and replaced by a permanent set. Although the exact number can vary, puppies have 28 deciduous (temporary or "baby") teeth, and adult dogs have 42 permanent teeth. Feline kittens have 26 deciduous teeth, and adult cats have 30 permanent teeth. Ferret kits have 30 deciduous teeth, with adults having 34.

Tooth eruption
In kittens and puppies, the deciduous teeth begin to erupt at about 3-4 weeks of age and the permanent teeth begin to emerge at about 3-4 months of age. By 24 weeks of age, usually all of the permanent teeth have emerged.

Pets Dental Problem
  • Pets mouths are biologically similar to humans. Their teeth can form plaque and tartar build-up and bacterial infections. 
  • A significant bacterial infection growing under the gums can damage the gums and bone. This is called periodontal disease, and the pet should receive the appropriate treatment from a veterinarian.
  • If a tooth has been cracked or chipped, bacteria may migrate deeper into the surrounding tissues and cause inflammation or an abscess. In some cases, abscessed teeth require extraction
  • Periodontal (gum) disease is the number one diagnosed problem in dogs and cats. By the age of just two, 80% of dogs and 70% of cats have some form of periodontal disease. In addition, 10% of dogs have a broken tooth with pulp (nerve or root canal) exposure. This is extremely painful until the nerve dies, at which point the tooth becomes infected! Infectious oral diseases affecting the gums and root canals create systemic bacteremia (bacteria in the blood stream, which can infect other parts of the body). 
  • Periodontal inflammation and infection have been linked to numerous problems including heart attacks, strokes, kidney disease, emphysema, liver disease, osteoporosis, pregnancy problems and diabetes. Therefore, oral infectious diseases are known as “the silent killer.” 
  • In addition to systemic effects, oral disease can also cause inflammation to the eye, resulting in blindness. Furthermore, jaw bone loss from chronic infection can lead to a jaw fracture known as a pathologic fracture, and these have a very hard time healing. Finally, infectious oral disease can result in osteomyelitis (an area of dead, infected bone), nasal infections and an increased risk of oral cancer.
  • In cats, a very common problem is feline tooth resorption lesions, which are caused by normal cells called odontoclasts eating away at the cat’s own teeth. Approximately half of cats over 6 years of age have at least one. They are similar to cavities in that once they are advanced, they are very painful and can become infected. They are first seen as small red areas along the gumline. 
  • Other oral problems include bacterial cavities, painful orthodontic problems, dead teeth (which are commonly discolored), and worn teeth. Almost every pet has some form of painful or infectious oral disease that needs treatment.

Prevention is Better than Cure
Annual or semi-annual visits to your veterinarian should be utilized to establish a prevention/treatment plan for dental health care year round. Owners noticing changes in their pet’s behavior, eating habits, and/or teeth are encouraged to seek professional advice from their veterinarian.

Thursday, February 7, 2013

What Causes Dental Plaque and Why Is It Harmful?

Dental plaque is a sticky, colorless film that continually forms in between and on the surface of the teeth. Dental plaque is a biofilm that is made up of microorganisms such as streptococcus mutans and other bacteria.

Plaque consists of microorganisms and extracellular matrix. The microorganisms that form the biofilm are mainly Streptococcus mutans and anaerobes, with the composition varying by location in the mouth. Examples of such anaerobes include fusobacterium and actinobacteria. The microorganisms present in dental plaque are all naturally present in the oral cavity, and are normally harmless. However, failure to remove plaque by regular tooth brushing means that they are allowed to build up in a thick layer. Those microorganisms nearest the tooth surface ferment dietary sucrose; it is in this state that they start to produce acids. Acids released from dental plaque lead to demineralization of the adjacent tooth surface, and consequently to dental caries. Saliva is also unable to penetrate the build-up of plaque and thus cannot act to neutralize the acid produced by the bacteria and remineralize the tooth surface. They also cause irritation of the gums around the teeth that could lead to gingivitis, periodontal disease and tooth loss. Plaque build up can also become mineralized and form calculus (tartar)
Continued plaque accumulation can contribute to structural damage to your teeth and the bone supporting the teeth and gums, as well as other health complications.
How Can Plaque Formation Be Prevented?

  • To prevent plaque buildup, brush your teeth at least twice a day with a soft, rounded-tip bristled toothbrush.  Using a fluoride-containing toothpaste also helps in removing dental plaque.
  • Floss between teeth at least once a day to remove food particles and bacteria.
  • See your dentist or oral hygienist every 6 months for a check-up and teeth cleaning.
  • Application of dental sealants are a thin, plastic coating that are painted on the chewing surfaces of teeth to protect them from cavities and decay.
  • Eat a balanced diet and limit the number of between-meal snacks. Eat nutritious foods such as plain yogurt, cheese, fruit, or raw vegetables. Vegetables, such as celery, help remove food and help saliva neutralize plaque-causing acids.
  • Use of an antibacterial mouth rinse can reduce bacteria that cause plaque and gum disease, according to the American Dental Association. 
  • If you notice that your gums are red and inflamed, or that they bleed after you brush your teeth, it is important that you see your dentist.
  • Gingivitis and early periodontitis can be controlled by routine professional teeth cleanings and more diligent brushing and flossing at home.

To prevent excessive plaque buildup in between visits to your dentist :

  • Avoid sugary and starchy snacks.
  • Eat a balanced diet.
  • Stop using tobacco products.
  • Brush your teeth twice daily using a fluoride-based toothpaste.
  • Floss your teeth daily, or use an interdental cleaner.

Sunday, February 3, 2013

Toothpaste History

Toothpaste is a paste or gel dentifrice used with a toothbrush as a medium to clean and maintain the  health of teeth. It serves as an abrasive that aids in removing the dental plaque and food from the teeth, reduces halitosis, and delivers active ingredients mainly fluoride to help prevent tooth caries and gum disease. Most of the teeth cleaning is achieved by the mechanical action of the toothbrush, and not by the toothpaste. Salt and sodium bicarbonate (baking soda) are among materials that can be substituted for commercial toothpaste.

Content of toothpaste
In addition to 20-40% water, toothpastes are derived from a variety of components, including three main ones: abrasives, fluoride, and detergents. 

Abrasives constitute at least 50% of a typical toothpaste.
They helps in removing plaque and tartar.
The removal of plaque and calculus helps minimize cavities and gum diseases.
Commonly used abrasives are aluminum hydroxide, calcium carbonate, various calcium hydrogen phosphates, various silicas and zeolites, and hydroxyapatite.

Fluoride is the most popular active ingredient in toothpaste to prevent cavities.
Sodium fluoride is the most common source of fluoride, but stannous fluoride, olaflur (an organic salt of fluoride), and sodium monofluorophosphate are also used. Stannous fluoride has been shown to be more effective than sodium fluoride in reducing the incidence of dental caries and controlling gum diseases.

Toothpastes contain sodium lauryl sulfate which enables uniform distribution of toothpaste, improving its cleansing power.

Antibacterial agents:
Triclosan, an antibacterial agent, is also a common toothpaste ingredient.

Toothpaste comes in a variety of colors, and flavors intended to encourage use of the product. Three most common flavorants are peppermint, spearmint, and wintergreen. Toothpaste flavored with peppermint-anise oil is popular in the Mediterranean region. 
More exotic flavors include anise, apricot, bubblegum, cinnamon, fennel, lavender, neem, ginger, vanilla, lemon, orange, and pine.

Other components:
Strontium chloride or potassium nitrate is included in some toothpastes to reduce sensitivity
Sodium polyphosphate is added to minimize the formation of tartar.

Other types of toothpaste:
Whitening toothpastes
Some of the toothpastes contain peroxide, the same ingredient found in tooth bleaching gels. The abrasive in these toothpaste remove the stains, not the peroxide. Whitening toothpaste cannot alter the natural color of teeth or reverse discoloration by penetrating surface stains or decay. To remove surface stains, whitening toothpaste may include abrasives to gently polish the teeth, and/or additives such as sodium tripolyphosphate to break down or dissolve stains. When used twice a day, whitening toothpaste typically takes two to four weeks to make teeth appear more white. Whitening toothpaste is generally safe for daily use, but excessive use might damage tooth enamel.

Herbal and "natural" toothpaste:
The ingredients found in natural toothpastes vary widely but often include baking soda, aloe, eucalyptus oil, myrrh, plant extract (strawberry extract), and essential oils.

History of toothpaste
The Greeks, and then the Romans, improved the recipes for toothpaste by adding abrasives such as crushed bones and oyster shells. In the 9th century, the Persian musician and fashion designer Ziryab invented a type of toothpaste, which he popularized throughout Islamic Spain. Toothpastes or powders came into general use in the 19th century. Tooth powders for use with toothbrushes came into general use in the 19th century in Britain. Most were homemade, with chalk, pulverized brick, or salt as ingredients. Arm & Hammer marketed a baking soda-based toothpowder in the United States until approximately 2000, and Colgate currently markets toothpowder in India and other countries. Fluoride was first added to toothpastes in the 1890s. "Tanagra", containing calcium fluoride as the active ingredient, was sold by Karl F. Toellner Company, of Bremen, Germany. Striped toothpaste was invented by a New Yorker named Leonard Lawrence Marraffino in 1955.

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