> I hope that this is an appropriate place to start this discussion, if
> not, please let me know where would be appropriate.

> OK, backstory - I'm 34 years old, had a family dentist as a kid, and
> went every year for regular cleanings etc.  Also had braces in junior
> high/early high school but they didn't work out so well (more on that
> later.)  Family dentist only gave me one filling and that was my
> freshman or sophomore year in college.  After I graduated college, I
> did not have dental insurance so since I had no problems with my teeth
> I just didn't go to a dentist.  Finally got a job with insurance in
> 2000 but was laid off six months later.  Went to a dentist - just
> picked a name off the list of dentists that participated in my
> insurance program - quickly before my insurance ran out.  Was shocked
> to hear that I needed to have six (!?!?!?!) teeth filled but went
> ahead and did it because I didn't know when I would have insurance
> again.  All of the fillings done were amalgam, except for the one done
> by my old family dentist, not sure what that one was.  I did not have
> a good feeling about this dentist because a) I suspected that he was
> filling everything that might possibly look like a hole to get the
> most from my insurance and b) this was in Detroit, not the most
> affluent area, everything seemed to be done quick and cheap.  I didn't
> have time to find the "rich people's dentist" though.

> Fast forward to today.  I got a better job about three years ago, but
> still wasn't having problems with my teeth so put off going to the
> dentist until I could get a recommendation with a GOOD one.  Was
> recommended a dentist by my PCP and when I checked him out online
> found that he was highly recommended by all his patients.  Went in for
> the usual irradiating, scraping, and buffing, and was told several
> things:

> 1) I apparently have very large, strong roots on all my teeth save for
> my lower front teeth.  Was told that this was possibly due to
> orthodontic work in the past, that moving teeth too quickly can cause
> roots to not develop fully or even become reabsorbed.  This makes
> sense, because I quit wearing my retainers in college because while I
> was told that I only needed to wear them at night, if I did so my
> teeth would actually shift enough during the day that I'd have to jam
> the retainers in, and I remember having several mildly loose and
> sensitive teeth.  I decided that I was not vain enough to put up with
> this for the rest of my natural life and just let my teeth go where
> they would.  I have two noticeably crooked teeth but other than that
> no issues.

> 2) I was told that amalgam fillings were "old tech" and that that
> office hadn't used them at all since the mid-90's.  In fact, the
> dentist flat out told me that in his opinion amalgam fillings, if left
> in the teeth for 10+ years, eventually would cause the teeth to crack,
> requiring that they all be capped (at of course great expense.)  He
> only found evidence of decay on one of the filled teeth and
> recommended that that one be replaced at my next visit, but suggested
> that I should plan on having ALL of the fillings replaced before too
> long to prevent issues down the road.  My concern is that this will
> probably cost me over $300 per tooth and I don't know that this will
> be reimbursed by my insurance (Aetna)  He also found a spot on one
> tooth where the pick would catch on the edge of the filling but said
> that there was no decay evident, seems to me that that is a sloppy
> filling and reflects badly on the last dentist.

> So...  what do I do about these old amalgam fillings?  I certainly
> don't want to end up like my dad with multiple caps on his teeth...
> does this new dentist sound on the up and up?  I'm a little
> disappointed but honestly based on my impression of the previous
> dentist am not totally surprised.  Should my insurance coverage cover
> replacement of old amalgam fillings if the teeth are not decaying/
> fillings are not loose/etc. or are we getting into morally
> questionable territory?

> thanks for any advice,

> nate

>> I hope that this is an appropriate place to start this discussion, if
>> not, please let me know where would be appropriate.

>> OK, backstory - I'm 34 years old, had a family dentist as a kid, and
>> went every year for regular cleanings etc.  Also had braces in junior
>> high/early high school but they didn't work out so well (more on that
>> later.)  Family dentist only gave me one filling and that was my
>> freshman or sophomore year in college.  After I graduated college, I
>> did not have dental insurance so since I had no problems with my teeth
>> I just didn't go to a dentist.  Finally got a job with insurance in
>> 2000 but was laid off six months later.  Went to a dentist - just
>> picked a name off the list of dentists that participated in my
>> insurance program - quickly before my insurance ran out.  Was shocked
>> to hear that I needed to have six (!?!?!?!) teeth filled but went
>> ahead and did it because I didn't know when I would have insurance
>> again.  All of the fillings done were amalgam, except for the one done
>> by my old family dentist, not sure what that one was.  I did not have
>> a good feeling about this dentist because a) I suspected that he was
>> filling everything that might possibly look like a hole to get the
>> most from my insurance and b) this was in Detroit, not the most
>> affluent area, everything seemed to be done quick and cheap.  I didn't
>> have time to find the "rich people's dentist" though.

>> Fast forward to today.  I got a better job about three years ago, but
>> still wasn't having problems with my teeth so put off going to the
>> dentist until I could get a recommendation with a GOOD one.  Was
>> recommended a dentist by my PCP and when I checked him out online
>> found that he was highly recommended by all his patients.  Went in for
>> the usual irradiating, scraping, and buffing, and was told several
>> things:

>> 1) I apparently have very large, strong roots on all my teeth save for
>> my lower front teeth.  Was told that this was possibly due to
>> orthodontic work in the past, that moving teeth too quickly can cause
>> roots to not develop fully or even become reabsorbed.  This makes
>> sense, because I quit wearing my retainers in college because while I
>> was told that I only needed to wear them at night, if I did so my
>> teeth would actually shift enough during the day that I'd have to jam
>> the retainers in, and I remember having several mildly loose and
>> sensitive teeth.  I decided that I was not vain enough to put up with
>> this for the rest of my natural life and just let my teeth go where
>> they would.  I have two noticeably crooked teeth but other than that
>> no issues.

>> 2) I was told that amalgam fillings were "old tech" and that that
>> office hadn't used them at all since the mid-90's.  In fact, the
>> dentist flat out told me that in his opinion amalgam fillings, if left
>> in the teeth for 10+ years, eventually would cause the teeth to crack,
>> requiring that they all be capped (at of course great expense.)  He
>> only found evidence of decay on one of the filled teeth and
>> recommended that that one be replaced at my next visit, but suggested
>> that I should plan on having ALL of the fillings replaced before too
>> long to prevent issues down the road.  My concern is that this will
>> probably cost me over $300 per tooth and I don't know that this will
>> be reimbursed by my insurance (Aetna)  He also found a spot on one
>> tooth where the pick would catch on the edge of the filling but said
>> that there was no decay evident, seems to me that that is a sloppy
>> filling and reflects badly on the last dentist.

>> So...  what do I do about these old amalgam fillings?  I certainly
>> don't want to end up like my dad with multiple caps on his teeth...
>> does this new dentist sound on the up and up?  I'm a little
>> disappointed but honestly based on my impression of the previous
>> dentist am not totally surprised.  Should my insurance coverage cover
>> replacement of old amalgam fillings if the teeth are not decaying/
>> fillings are not loose/etc. or are we getting into morally
>> questionable territory?

>> thanks for any advice,

>> nate

>     You should not replace "old tech" fillings because they are "old
> tech".  They should be replaced if they are failing.
>     No filling material is without its problems.  Amalgam does expand
> slightly.  For that matter composite resin contracts (not so slightly).
>  The key to a successful filling is correct design of the cavity
> preparation and correct placement and handling technique of the filling
> material.
>     Replacing fillings because they pose a theoretical chance of a
> problem in the future is IMO (and using your words) "getting into
> morally questionable territory.
>     Get another opinion.

> Steve

> I did some googling after I posted that enquiry and found that it seems
> that amalgam actually on average lasts *longer* than composite resin,
> which is what I ASSume he's going to want to use...  but neither one it
> sounds like often lasts more than 10-15 years or so.  I don't
> particularly look forward to having fillings redone every decade or two,
> and particularly so when I assume that every time a tooth is drilled it
> is farther weakened making it that much more likely that it'll fail at
> some point...

> What's your opinion on gold fillings?  How long do those last, should I
> even consider going down that road?  I really would prefer a "permanent"
> solution if there is one, and my teeth have always been strong and
> trouble free even given, frankly, indifferent care by Yours Truly at
> times.  I do brush... flossing, not so much.  Tartar buildup...  awful.
>  (not much I can do about that... I do search out "firm" toothbrushes,
> which are hard to find, and use tartar control or baking soda
> toothpastes... still grows like weeds.)

> thanks again for any thoughts.

> Nate

> Steve

> > I did some googling after I posted that enquiry and found that it seems
> > that amalgam actually on average lasts *longer* than composite resin,
> > which is what I ASSume he's going to want to use... ?but neither one it
> > sounds like often lasts more than 10-15 years or so. ?I don't
> > particularly look forward to having fillings redone every decade or two,
> > and particularly so when I assume that every time a tooth is drilled it
> > is farther weakened making it that much more likely that it'll fail at
> > some point...

> > What's your opinion on gold fillings? ?How long do those last, should I
> > even consider going down that road? ?I really would prefer a "permanent"
> > solution if there is one, and my teeth have always been strong and
> > trouble free even given, frankly, indifferent care by Yours Truly at
> > times. ?I do brush... flossing, not so much. ?Tartar buildup... ?awful.
> > ?(not much I can do about that... I do search out "firm" toothbrushes,
> > which are hard to find, and use tartar control or baking soda
> > toothpastes... still grows like weeds.)

> > thanks again for any thoughts.

> > Nate

> ? ? ? ? Gold is a wonderful material. ?Direct gold is almost never used
> anymore--most commonly as a filling material in licensure exams. ?The
> theory seems to be that it is so labor-intensive to place that if you
> can do a good gold foil filling you can do anything.
> ? ? ? ? Cast gold is also terrific. ?In this age of radioactive-white teeth,
> patients don't much go for the look of gold anymore. ?But gold works
> very well. ?The only crown in my mouth is a lower molar crown made of
> cast gold.
> ? ? ? ? Old amalgam fillings can fail. ?In general, the larger the filling, the
> greater the chance of failure. ?Really large cavities should onlay the
> cusps--regardless of the material used. ?Crowns may be advisable, but
> sacrifice greater amounts of tooth structure.
> ? ? ? ? No restoration should be represented as lasting forever. ?None will
> guarantee permanence, esp. if your {*filter*}hygiene is subpar. ?You may
> never get another cavity, and then lose your teeth to periodontal disease.
> ? ? ? ? Get a good trustworthy dentist who will not overtreat. ?Oh, and learn
> to love flossing. ;-)

>>> I did some googling after I posted that enquiry and found that it seems
>>> that amalgam actually on average lasts *longer* than composite resin,
>>> which is what I ASSume he's going to want to use...  but neither one it
>>> sounds like often lasts more than 10-15 years or so.  I don't
>>> particularly look forward to having fillings redone every decade or two,
>>> and particularly so when I assume that every time a tooth is drilled it
>>> is farther weakened making it that much more likely that it'll fail at
>>> some point...
>>> What's your opinion on gold fillings?  How long do those last, should I
>>> even consider going down that road?  I really would prefer a "permanent"
>>> solution if there is one, and my teeth have always been strong and
>>> trouble free even given, frankly, indifferent care by Yours Truly at
>>> times.  I do brush... flossing, not so much.  Tartar buildup...  awful.
>>>  (not much I can do about that... I do search out "firm" toothbrushes,
>>> which are hard to find, and use tartar control or baking soda
>>> toothpastes... still grows like weeds.)
>>> thanks again for any thoughts.
>>> Nate
>>         Gold is a wonderful material.  Direct gold is almost never used
>> anymore--most commonly as a filling material in licensure exams.  The
>> theory seems to be that it is so labor-intensive to place that if you
>> can do a good gold foil filling you can do anything.
>>         Cast gold is also terrific.  In this age of radioactive-white teeth,
>> patients don't much go for the look of gold anymore.  But gold works
>> very well.  The only crown in my mouth is a lower molar crown made of
>> cast gold.
>>         Old amalgam fillings can fail.  In general, the larger the filling, the
>> greater the chance of failure.  Really large cavities should onlay the
>> cusps--regardless of the material used.  Crowns may be advisable, but
>> sacrifice greater amounts of tooth structure.
>>         No restoration should be represented as lasting forever.  None will
>> guarantee permanence, esp. if your {*filter*}hygiene is subpar.  You may
>> never get another cavity, and then lose your teeth to periodontal disease.
>>         Get a good trustworthy dentist who will not overtreat.  Oh, and learn
>> to love flossing. ;-)

> So if I'm understanding you correctly the cost premium of a gold
> filling is FAR more than that of just the added cost of the
> material... yes?

> sounds like I should probably just schedule the one filling to be
> replaced (I'm assuming dentist wants to use composite) and worry about
> the others if/when I have to?  or is there actually a valid case for
> proactively replacing what appear to be perfectly functional and non-
> problematic amalgam fillings?

> nate

>>>> I did some googling after I posted that enquiry and found that it seems
>>>> that amalgam actually on average lasts *longer* than composite resin,
>>>> which is what I ASSume he's going to want to use...  but neither one it
>>>> sounds like often lasts more than 10-15 years or so.  I don't
>>>> particularly look forward to having fillings redone every decade or
>>>> two,
>>>> and particularly so when I assume that every time a tooth is drilled it
>>>> is farther weakened making it that much more likely that it'll fail at
>>>> some point...
>>>> What's your opinion on gold fillings?  How long do those last, should I
>>>> even consider going down that road?  I really would prefer a
>>>> "permanent"
>>>> solution if there is one, and my teeth have always been strong and
>>>> trouble free even given, frankly, indifferent care by Yours Truly at
>>>> times.  I do brush... flossing, not so much.  Tartar buildup...  awful.
>>>>  (not much I can do about that... I do search out "firm" toothbrushes,
>>>> which are hard to find, and use tartar control or baking soda
>>>> toothpastes... still grows like weeds.)
>>>> thanks again for any thoughts.
>>>> Nate
>>>         Gold is a wonderful material.  Direct gold is almost never used
>>> anymore--most commonly as a filling material in licensure exams.  The
>>> theory seems to be that it is so labor-intensive to place that if you
>>> can do a good gold foil filling you can do anything.
>>>         Cast gold is also terrific.  In this age of radioactive-white
>>> teeth,
>>> patients don't much go for the look of gold anymore.  But gold works
>>> very well.  The only crown in my mouth is a lower molar crown made of
>>> cast gold.
>>>         Old amalgam fillings can fail.  In general, the larger the
>>> filling, the
>>> greater the chance of failure.  Really large cavities should onlay the
>>> cusps--regardless of the material used.  Crowns may be advisable, but
>>> sacrifice greater amounts of tooth structure.
>>>         No restoration should be represented as lasting forever.  
>>> None will
>>> guarantee permanence, esp. if your {*filter*}hygiene is subpar.  You may
>>> never get another cavity, and then lose your teeth to periodontal
>>> disease.
>>>         Get a good trustworthy dentist who will not overtreat.  Oh,
>>> and learn
>>> to love flossing. ;-)

>> So if I'm understanding you correctly the cost premium of a gold
>> filling is FAR more than that of just the added cost of the
>> material... yes?

>> sounds like I should probably just schedule the one filling to be
>> replaced (I'm assuming dentist wants to use composite) and worry about
>> the others if/when I have to?  or is there actually a valid case for
>> proactively replacing what appear to be perfectly functional and non-
>> problematic amalgam fillings?

>> nate

>     I think both Dartos and I were pretty clear that the only benefit of
> being "pro-active" in this case is likely to be to the dentist's finances.
>     In the case of the one filling, if there is decay it should be
> replaced with an appropriate material.  Yes, the cost differential of
> either direct gold or cast gold will be greater than the differential in
> the cost of gold--because of the increased time of placement in the
> first place, and the use of a dental lab in the second.
>     However, if this is a big filling, you will be getting a superior
> restoration with cast gold.  If it's a small filling, it hardly matters
> what you use.

> Steve