I recently had my first visit to a new dentist after moving. The new
dentist said I had three fillings that needed to be replaced. Since
I've had no problems with the teeth in question, I'm a little
concerned as to the necessity of having the fillings replaced.

When asked, the dentist told me that he could fit the tip of his probe
between the top of the filling and the tooth and that decay of the
tooth was already occurring. I've never had a filling replaced (I'm 37
years old) and most of my fillings were done when I was a child.

How do I now whether I need to have these fillings replaced. I'm
afraid that the dentist is too concerned with generating income than
my dental health. My wife had one of her fillings replace three weeks
before my appointment by the same dentist. She also hadn't any
problems with that tooth, but after three weeks of pain, she went in
again and the dentist removed the composite filling and put in some
type of temporary medicinal filling. I would like to avoid the pain
and cost of replacing my fillings if at all possible.

Is there any type of consensus about when an amalgam filling should be
replace? Do these type of fillings have a limited lifetime?

Any information would be gratefully received.

You sized this dentist up correctly. Go to another one. Check his
reputation beforehand, not afterwards after the damage is done.
Forget about amalgam, it is a biohazardous material. With your age it
is possible that a filling has to be replaced for many reasons. Get
rid of the amalgam for any good reason and live a healthy life
without mercury poisoning. It works slow but sure like any other
homeopathic drug. Check around on the INTERNET on this subject.

: How do I now whether I need to have these fillings replaced. I'm
: afraid that the dentist is too concerned with generating income than
: my dental health. My wife had one of her fillings replace three weeks
: before my appointment by the same dentist. She also hadn't any
: problems with that tooth, but after three weeks of pain, she went in
: again and the dentist removed the composite filling and put in some
: type of temporary medicinal filling. I would like to avoid the pain
: and cost of replacing my fillings if at all possible.

: Is there any type of consensus about when an amalgam filling should be
: replace? Do these type of fillings have a limited lifetime?

Most researchers seem to suggest that the average life expectancy of an
amalgam filling to be around 11 - 15 years.  This will depend on your
chewing habits and the kind of cooking.net">food you eat.  Parafunctional activities
can greatly reduce the life of a filling.  Fillings breaking down around
the edges will eventually lead to new decay.  Decay usually is painless
until it causes pulpal damage... then, it's usually root c{*filter*}city,
usually followed by a crown because by then, the tooth will have been
extensively ravaged by the decay.

As far as composites go, they are great because they are actually adhere
to the tooth, unlike the conventional amalgams, which are mechanically
retained by undercuts in the preparation.  The adherence of the composite
to the tooth can actually strengthen a weakened tooth.  The downside is
that they are more technique sensitive to place than amalgams.
Sensitivity might be related to technique, or it could be related to some
other problem which may have been coincidental to the placement of the
filling.

I hope this info. helps you out.

Dr. M

says...

W.L. DDS  

Dr. Dave

Well Mr. David, I hope the info provided by the others has given you some
sort of direction.  Let me offer my 2 cents.

First, Amalgams should never be placed.  There are cases where people with
amalgams in their mouth having some sort of, shall we say "mental
problems".  After removing those amalgams and replacing them with another
material, supposedly has helped them in the "mental department".  You see,
since amalgam, dentistry has progressed further.  Now patients have
several options to have filling with: Composites, gold inlays/onlays and
now what is becoming popular is InCeram inlays/onlays (this is a
combination of composites and gold.  It is the approximate of gold
inlays/onlays and is tooth colored like composites).

Next, according to research, amalgams are supposed to last what 10-15
years.  Well, what you do not know, amalgam is not really a solid
substance, like gold.  What I mean is that amalgam keeps changing their
sturcture especially under pressure, and assuming you chew, well guess how
much pressure that amalgam is under.

Finally, in regards to replacing your filling, germs such as bacteria and
saliva are so small that they get into the smallest crevices.  And with
the 'space' between your filling and tooth, well the tooth is a time bomb
ready to blow.  Bacteria is a silent killer, it gets into the tooth,
starts rotting the tooth away and then when it hits the pulp (the nerve of
the tooth), BOOM.. you scream at night, cursing and complaning about the
incompetent dentists.  

Well, I hope I have been of help.  If there is anything that needs
clarification, please post and I will get back with you.

Your friendly neighbourhood dentist....

RK

Watch and wait or a second opinion are often ways to go.

Regards

M. (dentist, germany)

--

As a former amalgam victim, I believe that all amalgams
should be replaced at the first sign of mercury poisoning.

Punch up "amalgam" into the search engines for an educating
ride.
    earl

Since the the change young{*filter*} has been more aggressive. I picture
seminars on "How To Grow Your Business". I go once a year and after
periods of 2 to 3  consecutive years between fillings, I had 2
"catches" as he calls them, the first year. I had 2 more "catches"
the 2nd year. This time I had 5 more. But I couldn't get an appointment
for 8 months. At this rate it'll be years before I address the catches
I already have and I'll have 10 new ones besides.

I'm 48 and my fillings are old, tho none of them hurt. I can see the
argument for going along with this, however I think one issue hasn't
been addressed in this discussion. When to drill is a judgement call.
How do I know that he isn't being too aggressive? I remember dentists
saying, "we'll keep an eye on it." And besides the pain and expense
doesn't removing a filling, drilling more and replacing it, put
a lot of stress on the tooth? I recently had a tooth break in half
and I have to believe this replacing fillings weakens the tooth.

How faast does the decay work? Can't "catches" be monitored by exams
and x-rays? I've read that sometimes minerals actually refill cavities.
Is a cavity simply a hole or is there disease, rotting, etc with it?
If a cavity or catch is a superficial hole that will be cleaned by the
brush, might it NOT grow, or maybe even fill in? My fillings are
HUGE - was that really necessary?

Ron

PS

I picked on William Lee...but I invite anyone and everyone to post
or Email me. I hate buying a service with so little information.
Would anyone buy a car the way we buy health care?

There definitely is a case for observing initial catches. Many times the
catches are inadvertently created by dentists using the methods of
cavity detection we were taught in school.
On the other hand I can't count the number of times that something that
appeared to be a small cavity mushrooms out when the tooth is prepared.
Cavities in their initial stage can be remineralized through the use of
fluoride rinses or gels. However once the enamel is penetrated by the
decay the process usually proceeds very rapidly. Observing initial decay
is rational thinking in a person with good {*filter*}hygiene.
With respect to teeth being weakened the ultimate in weakened teeth are
those that have been allowed to linger having the decay process
undermine the filling and thus causing the filling to dislodge or the
tooth to break.
The older amalgam fillings can actually cause teeth to break because
they continue to expand with time acting like a wedge on the tooth
structure.
Always ask why the dentist wants to replace the fillings, is there
decay,or isthe margin of the filling breaking down creating a cooking.net">food trap?

K.Papadopoulos D.D.S.

  The problem with your tooth is independent of the filling material used.
If the same tooth had been refilled with amalgam rather than composite, for
instance, then your wife almost certainly would have suffered the same
amount of pain for three weeks.  Since I am not a dental professional, I
am unable to make any concrete recommendations on how to solve that part
of your problem.

  Noone is going to deny that amalgam is durable.  The question of whether
or not amalgam is more durable than alternatives is impossible to answer in
one way because there are SO MANY alternatives:  the material which I have
is called CONQUEST.  It is white in color, and after eight years it has
given me no problems whatsoever (except for settling in one posterior tooth,
but that was easy to fix).  This must not be considered an endor{*filter*}t,
however, because the concept of biocompatibility (allergy) testing is
important.  Allergy to a new dental material could make your life very
miserable, since removing all traces of the new material (or amalgam) is
usually very difficult.  (If your dentist has never heard of biocompatibility
testing and does make use of such a testing service, then you're visiting
the wrong dentist).

  Allergy to amalgam exists, too (something that the ADA has itself been
forced to admit;  vide J.H. Berry, Manager of Media Services [ADA], SPECIAL
NEWS RELEASE, 1983).  But the U.S. will never have amalgam banned just
because some people are allergic to it -- just like the U.S. will never ban
strawberries just because some people are allergic to them.  The real concern
over amalgam is that it is 50 percent mercury, and mercury is a potent
protoplasmic *poison*.  This is something that I found out the hard way:  
in 1982, I swallowed a large (not small) amalgam filling and suffered all
the effects of acute mercury poisoning:  unusual timidity, decline of
intellect, subnormal body temperature.  It then took me a couple of years
just to learn that dentists daily load unsuspecting peoples' mouths with
grams of poisonous mercury.  Despite the fact that some readers of this ng
laughed when I posted here my fully descriptive letter to CONSUMER REPORTS,
FDA, etc., I know that some unlucky person out there will someday verify
my full description of what it feels like (for instance, your heart will
pound wildly and with deep strokes moments after swallowing amalgam).  Fur-
thermore, the list of disturbing periodical articles in Dr. Huggins'
strangely written book IT'S ALL IN YOUR HEAD prove that this has happened to
other unlucky people, too.  And it will continue to happen -- apparently
because the idea that poison does not belong in a person's mouth is still
too advanced for most of the dental profession to understand.

  Does my POST answer your question?

                                                                -- MF

Replace amalgams as soon as possible. If you have no signs of mercury
poisoning now, they will show-up in time. Maybe too late. I made
it..(in time) from the wheelchair to the bicylcle. Mercury is a
pretty hazardous STUFF. Granted, ir may affect different people
different ways. It is cooking.net">food for thought, however.
Bill

Perhaps someone should consider advising patients to have their amalgam
fillings polished regularly. I do not have any scientific evidence (and any
that you know of would be appreciated), but I feel that this has many
obvious advantages viz.
- less surface roughness and thus less plaque buildup and less chance of
secondary decay.
-regular polishing can prevent "ditching" of the margins and thus maintain
the marginal integrity of the filling
-possibly the removal of corrosion on the surface of the restoration will
also reduce any alledged mercury    leaching from the filling ( it is this
proposal that I am most interested to confirm with any studies you know of)
-once polished, the marginal integrity and the presence of decay can be
re-evaluated

Surely you would only replace an amalgam filling, or any filling for that
matter, when it is no longer functionig correctly ie. leaking, worn,
discoloured etc. (this applies to Composite, Ceramic and cast restorations
also), or if you want to improve aeasthetics.

I personally feel that well executed and polished amalgam restorations are
of the best fillings that you can have and would not advocate their
indiscriminate or routine removal.

My mentors at dental school always advised us (jokingly) that you NEVER
extract a tooth untill you have filled it, refilled it, root treated it,
and crowned it! Why throw away all that turnover?

I have found it very amusing that patients who tell you they are very
concerned about mercury in their mouths, suddenly forget their mercury
phobia when they receive the quote to replace their amalgams with
alternative materials.

Yours in quality Dentistry
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