Until recently anyone who needed to repair cavities in his or her teeth ended up with a mouth full of “silver” fillings. Dental amalgam, which has a silver appearance, was the tooth restoration material of choice. Amalgam, a combination of metals including silver, mercury, and other metals, is still used — but today there are other options that mimic the original teeth they are restoring.

You may have read about some people's concerns about the mercury used in dental amalgam. According to the American Dental Association (ADA), scientific studies have found no ill effects arising from using dental amalgam in fillings for adults or children: “While questions have arisen about the safety of dental amalgam relating to its mercury content, the major US and international scientific and health bodies, including the National Institutes of Health, the US Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.” Dental amalgam is still used for molars (back teeth) that must withstand heavy pressure from chewing.

For teeth that are more visible, materials that look and perform more like the original teeth — and are thus more pleasing in appearance — are now available. Dentistry is now taking a “biomimetic approach” (from words meaning “life mimicking”). The new materials — composite resins and porcelains — look like teeth because in many ways their structure imitates the biologic structure of teeth.

Composite resins are made of a plastic material (methacrylate) combined with fillers made of silica, a form of glass. They are able to bond to natural tooth structure and resemble the dentin, the inner layer of the tooth, which has a porous structure similar to bone.

Dental porcelains are a form of ceramic. They are non-metallic materials formed by the action of heat, like the ceramics used in porcelain cups and bowls. They come in a powder form that is mixed with water, shaped, and then placed in an oven until they reach the proper hardness. The end product is translucent and very hard, resembling the densely packed crystals of calcium that make up a tooth's normal outer layer, the enamel.

The old amalgam fillings required removal of tooth material to prepare a site in which they could be placed. Composite resins and porcelains can be used to treat teeth that have small or large amounts of damage to their natural substance because the materials bond directly to the remaining dentin and enamel. Thus they end up stabilizing and strengthening the restored tooth, as well as providing a natural-looking appearance.

Contact us today to schedule an appointment to discuss your questions about tooth colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

If you are dissatisfied with the way your smile looks, and your dentist is unhappy with the way your teeth fit together — but you don't like the idea of wearing braces — clear aligners may be your best solution. How much do you know about this teeth-straightening alternative? Below are some FAQs on the subject.

What do we mean by clear aligners? Clear aligners are a system for straightening teeth that uses clear plastic removable “trays” that fit over your teeth. As the teeth move to fit the trays, new trays are substituted that are designed to continue to move your teeth into the desired position. This system is an alternative to the traditional system of brackets and wires known as braces.

How can teeth be moved to new positions? The connection that holds a tooth in place in your jaws — the periodontal ligament — is not immobile. It constantly changes its position based on the normal forces of your bite. As the ligament is pushed on one side and pulled on the other, the living cells of your mouth respond by depositing bone and cementum (the protective covering of the tooth's root) on one side and dissolving it on the other. Normally this happens in a balance, maintaining your teeth in their position. We can manage these slight changes by applying constant light forces to move teeth in a predictable way.

How long does it take to move teeth to their optimum position using clear aligners? As with braces, the process is gradual. Total treatment time can range from six months to two years.

Do the trays have to be worn all the time? As you move through the sequence of trays, each is worn for 20 hours per day for two weeks. They may occasionally be removed for important social occasions.

How does an orthodontist design the sequential trays that are used? The trays are designed using a computer, based on an assessment and images of your mouth, teeth and jaws.

What kinds of problems can clear aligners correct? This method works well to correct mild to moderate crowding or spacing. If your back teeth already fit together as they should, the system may be ideal. If you have an extreme overbite or underbite, braces might work better.

Are clear aligners an alternative for everyone? Clear aligners are recommended for adults and recently, teenagers. They are not usually recommended for young children.

Why is it important to have your teeth straightened? Besides the obvious benefit of feeling better about yourself and your appearance, straight and well-aligned teeth work better. You will experience a better-functioning bite and can improve your oral health.

Contact us today to schedule an appointment to discuss your questions about orthodontics and clear aligners. You can also learn more by reading the Dear Doctor magazine articles “Clear Orthodontic Aligners” and “Moving Teeth With Orthodontics.”

It is always good to be prepared before you have any dental or medical procedure. Make sure that you are informed and know what to expect to make you as comfortable as possible. We recommend that you have a list of questions with you to ask us during your consultation. If we inform you that you need a crown, consider asking any or all of the following questions:

• Am I a good candidate for a crown?
• Can you do a computer-generated mock-up of my new smile with crowns? (This question is only applicable if the crown is for a front or visible tooth.)
• Is there a way that I can “test-drive” my new smile and crown(s) before making them permanent?
• How long will the entire process take from my first appointment through completion?
• What are the risks, benefits and alternatives associated with the type of crown(s) you are recommending?
• Is there any discomfort associated with crown procedures?
• Will I need or receive any type of sedation when you prepare (drill) the tooth or teeth for a crown?
• Is what you are recommending commonly done?
• Can you show me some before and after photos of cases that you have done?
• How much will my crown(s) cost?
• Will my insurance cover all or a portion of the cost?
• How long can I expect my crown(s) to last?
• Will there be any maintenance required with my crown(s)?

To learn more about crowns, read the Dear Doctor article, “Porcelain Crowns & Veneers.” Or you can contact us today to discuss your situation and schedule a consultation.

When it comes to patient comfort, one of the most important developments of the 21st century has been sedation dentistry, which enables you to relax in both mind and body allowing you to focus on feeling peaceful rather than anxious. And the prescription medications we use are some of the safest on the “therapeutic index” (the scale pharmacists and health professionals use to measure the safety of medications.) However, it is critical that we are aware of any medications you are already taking and your medical health and history, so let us know all about you so that we can avoid adverse (negative) reactions. Please note that we will take a full history to gain this information prior to any treatment or sedation — our utmost concern is your safety. During this time, it is vital that you are honest and feel comfortable sharing your responses to our questions. It's also our way of getting to know you and the first stage in relieving your anxiety. We will need to know all about:

• All medical conditions for which you are currently being treated.
• All prescription medications you are taking.
• Over-the-counter (OTC) medications, remedies, or vitamins and/or supplements you are taking. This even includes aspirin, St. John's Wort, and Kava Kava. (Why? If taken daily for good heart health, aspirin thins your blood and thus may interfere with blood coagulation. And St. John's Wort and Kava Kava may be beneficial in helping relieve depression, but they can negatively impact how oral sedation medications work.)
• Foods and drinks you consume, such as alcohol and even grapefruit (juice or the fruit), can negatively impact how your body responds to both your treatment and sedation medications.
• And lastly, we need to know if you are a tobacco user — especially if you are a smoker. In addition to increasing your risks for oral and other cancers, tobacco can negatively influence the effectiveness of sedation medications.

To learn more about this topic, read the article “Oral Sedation Dentistry.” Or you can contact us today to discuss your questions or to schedule an appointment.

If an adult has lost his or her teeth (a condition called “edentulism”), full removable dentures (false teeth) can restore the person's appearance and ability to bite, chew, and talk properly. Even with our current extensive knowledge about tooth care and restoration, over 25 percent of Americans have lost all their teeth by the time they are 65.

How much do you know about dentures? Test yourself below.

How does tooth loss affect your bones?
Bone is a living substance that is constantly changing and rebuilding itself, depending on signals it receives from surrounding tissues. The bone that surrounds your teeth is called alveolar bone (from “alveolus,” meaning sac-like). To keep healthy, alveolar bone needs stimulation or function such as chewing and your teeth touching your opposing teeth. If you lose your teeth, bone begins to melt away (resorb).

How can we minimize bone loss during tooth extraction?
We can maintain bone volume by using bone grafting techniques. While this sounds scary, it is a relatively easy procedure. The principle of bone grafting is to build a sort of scaffolding on which your body begins to build and maintain its own bone. Bone loss can be prevented by the placement of a few dental implants.

How are dentures designed and created?
The dentures that look best and work best for you are based on your original teeth. We often utilize photographs of how you looked with your natural teeth, along with your input about possible changes you would like to see. First we take detailed impressions (molds) of the residual ridges in which your teeth once rested. From these we make denture bases of a light cured plastic resin. We attach horseshoe-shaped rims made of wax to the bases, to simulate the position of the teeth as we work out their design and spacing, based on both appearance and function. The prosthetic teeth are then tried out in your mouth, adjustments are made, and the dentures are processed in a dental laboratory. The final product substitutes a pink colored plastic (methyl methacrylate) to represent the gums and white plastic material as the teeth, created to make them look as natural as possible.

What is your part in the denture fitting process?
As a patient with new dentures, you must learn to use your jaw joints, ligaments, nerves, and muscles in new ways to help stabilize your dentures and to relearn to speak, bite, chew, smile, and laugh with these new structures. It takes a little practice, but with your removable dentures you can once again enjoy a complete and normal life.

Contact us today to schedule an appointment to discuss your questions about full removable dentures. You can also learn more by reading the Dear Doctor magazine article “Removable Full Dentures.”