Source: Journal of the American Dental Association March 2001

The practice of replacing silver fillings with white, tooth-colored material for health reasons has been promoted by “biological” dentists who believe silver fillings are detrimental to your health. You may have heard these referred to as “silver”, “mercury”, or “amalgam.” These three terms are used to refer to the silver material which contains more mercury than silver, along with other metals.

If you’re confused about whether mercury fillings are safe or not, you’re not alone: even the FDA has seemingly changed their opinion. On June 4, 2008, the agency issued this statement on their website:

“Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses.” And: “When amalgam fillings are placed in teeth or removed from teeth, they release mercury vapor. Mercury vapor is also released during chewing.”

The FDA also agreed to release a new ruling in July 2009, and alert consumers about potential related hazards.

Instead, on July 28, 2009 the FDA issued the following statement, as reported by Reuter’s:

“While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients,’’ the FDA said, citing an agency review of roughly 200 scientific studies.

The American Dental Association stands behind mercury filling safety, stating:

“Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.”

For cosmetic reasons 90% of our patients prefer the white, tooth-colored material. If you’re among those of us who grew up when mercury fillings were the only option and you haven’t had these replaced, you can whiten and update your smile by replacing these with this new tooth-colored material.

I don’t see enough hard science confirming claims that mercury fillings are linked to such conditions as Chronic Fatigue Syndrome or Alzheimer’s. However, I’ve been using the white, tooth-colored non-metallic filling material since 1987, thereby eliminating the issue for my patients. That said, some people are allergic to this non-metal material.

A “biological dentist” would recommend you remove these fillings for health reasons, believing that the longer you leave these in your mouth, the longer you are exposing yourself to metal toxicity.

I recommend replacing decades-old mercury fillings for two reasons: one is cosmetic and the second is tooth preservation. You see, as a dentist, my primary role is to enable you to chew. Since mercury expands and contracts with temperature changes, over time the teeth underneath can crack, which has been the case with some patients. Sometimes, the tooth can crack so deeply it must be removed and replaced with an implant and crown.

Ok, let’s address some common questions.

1. Are white fillings weaker than amalgams?

Yes, however, if you take the total result—the filling plus the tooth—the composites are stronger

because they bond to the tooth, making the tooth more resistant to fracture.

2. Why don’t all dentists offer white fillings?

Many dentists don’t feel comfortable using white filling material on back teeth—it requires special

training to do so. The experience and training ensures the filling isn’t vulnerable to leakage and

new decay. The material has been around since the 70’s, but it wasn’t until the mid-80’s that technology was developed to bond it to your tooth.

For example if your tooth had a three surface cavity, many dentists would do a crown and build up. I might start with a three surface filling to see if that alleviates your problem. If the filling doesn’t hold up, you may need the crown in six months, but often times the less invasive — and less expensive –dental procedure will suffice.

The distance between your nose and chin is detemined by your back teeth. So your entire face, lips and smile is dependent on your back teeth.

The teeth in the back of your mouth serve a vital chewing function. If that function is compromised due to missing or broken down teeth that need to be capped or replaced, the entire chewing mechanism is compromised.

This sets the scene for more tooth loss in the future. Besides, it reduces the ability to chew up your food and puts the brunt of digestion on your stomach. This often results in gastointestinal problems.

So, replacing missing teeth or getting crowns in the back of your mouth is not a cosmetic decision — but a decision in favor of maintaining overall health.

This is not a recognized specialty in dentistry. Rather, it’s a term we use in our office to describe the Pagano Protocol – the sequence in which your teeth, gums and structure are treated which results in a dazzling smile that sits in a structurally sound foundation.

What do we mean by “orthopedic cosmetic dentistry?” Think of your teeth and gums as the inside of a house and your jaw and head bones as the structure and foundation. Once Doc ensures that the structure is balanced and stable – which often includes treatment that eliminates headaches,

teeth grinding and other unwanted conditions – then the restorative and cosmetic treatments on your teeth and gums can be performed on a stable foundation. This results in cosmetic treatment that lasts, a bite that feels natural, and eliminates redoing your work.

One patient with lifelong headaches experienced complete relief. Her treatment included straightening her teeth and getting a gorgeous smile.

You can read more about orthopedic dentistry in Doc’s free downloadable ebook: Lifetime Smile at www.stlouisdentistdrpete.com.

Correct the Problem and These Symptoms Go Away. That’s Done By Balancing Your Head, Neck and Jaw Before Doing Dental Work. That’s What Orthopedic Dentistry Is All About. It Also Ensures Your Cosmetic Enhancements Don’t Create An Imbalance.

In a perfectly constructed mouth, the teeth and jaw fit together to perform the function of chewing. The slightest adjustment to a tooth can throw this precise functioning off-balance. Even the replacement of a filling can make your bite feel different if it’s not balanced correctly and if not adjusted, can cause your jaw joints to move out of place.

If just a simple filling requires such precision, imagine the skill required in placing veneers or implants while ensuring they not only look great but are completely natural in their feel and fit.

Like a perfectly balanced bridge constructed to withstand the elements of weather and carry immense weight, your teeth and jaw are designed with a similar precision. The ability to work with the precision of an engineer and the talent of a master artisan ensures your dental outcome is both sound and beautiful.

Second, they mask the condition of your teeth underneath. So, if you’ve had mercury fillings in your molars for 30 years, you have no idea what condition that tooth is in underneath. Mercury expands and contracts with heat and cold and decades of that in your teeth exposes cracking underneath. In replacing these on patients, I’ve often removed the old fillings in time to restore the cracked tooth underneath. When it can’t be
restored, it’s more costly.

Third, old fillings can leak which simply means that over time it can start to let bacteria into the tooth. When this occurs, we say it is “leaking.” That’s when it is no longer protecting your tooth.

If you’ve passed the age of forty, you really should have a mid-life diagnosis to evaluate the overall state of your oral health AND to plan a proper course of treatment that will enable you to keep your teeth for the remainder of your lifetime.

Patients over forty have often shortchanged their dental health or just barely maintained their teeth and gums. With the expense of family taking precedence through the previous two decades, Boomer-aged patients coming to me for the first time are often prepared to play catch-up with their own dental health.

Today you can plan a course of treatment that will ensure you’ve got your own teeth to chew with well into your senior years. In addition, nothing is more youthful than a natural-looking white smile. Unlike your parents, if you take care now you can have both.

My dad, Dr. Sam Pagano, practiced dentistry in St Louis for over 50 years. Many of his techniques are lost today. Yet, his techniques resulted in quality dental work that lasts.

Case in point: My dad and I were having breakfast at Sunrise Café on 141 and Olive Blvd. A 91 year old woman by the name of Josephine came up to our table. She looked at my dad, waiting for him to recognize her. Turns out, he filled her teeth 40 years ago. She proudly announced that she still had those same fillings and that her current dentist wanted to know (and I quote): “Who did all of this beautiful work in your mouth?”

In another outing, my dad and I ran into a former patient of his who proudly displayed the dentures my dad had made for him – IN 1953! Over 50 years later, these dentures were still working for this patient.

In earlier times artisans and craftsmen spent years as apprentices in order to Master their skills. I was fortunate enough to get an apprenticeship fresh out of dental school, working with my dad for nearly ten years. I learned as much from him as I did in school, if not more. By mastering the fundamentals of dentistry and focusing on quality, I had a strong foundation on which to embrace the technological advancements that have been made in dentistry.

Despite my excitement at learning new procedures and acquiring the latest technology, I know that these aren’t substitutes for a firm grounding in the skills of providing quality dentistry that will last.