By Paul Shenfine and Rumana Zahn
Holistic Dentistry involves an awareness of dental care as it relates to the entire person and most specifically how the teeth, mouth and jaws have a synergistic relationship that works best when there is balance and harmony between the different components of the system. I believe that recipients of dental care should be provided with appropriate information to make informed choices that will enhance personal health and wellness while feeling, accepted, listened to and understood. My personal educational is broad and includes, experiential knowledge and leading edge ideas; that I incorporate into my personal practice. I constantly strive to improve the quality of care I provide for my patients, by refining my skills and using the latest materials, and knowledge for their benefit.
Amalgam (Mercury) Fillings
The debate about the safety of amalgam has raged since 1833, when they were first introduced as a cheap alternative to gold fillings. Even then some dentists were outraged at the use of such a highly toxic metal in patients mouths. The controversy was quelled when proponents of amalgam insisted that the mercury was ‘safe’ because it was stabilized in the hardened amalgam compound of silver, copper, tin, and zinc. From then until recently amalgam has been the ‘default’ filling material for dental cavities.
Advantages of amalgam are it is durable, easy to use and inexpensive.
Physical disadvantages of amalgam include possible short-term sensitivity to hot or cold after the filling is placed. Amalgam’s silver color is not natural looking, and shows when the patient laughs or speaks. Also to prepare the tooth for an amalgam filling, the dentist needs to remove more healthy tooth than for other types of filling.
But the main disadvantage of amalgam is the fact it contains elemental Mercury – the second most toxic element after Plutonium. The World Health Organization believes that there is no safe level of Mercury, and the body’s predominant source of mercury exposure is from amalgam fillings. The average ‘amalgam filling’ contains 500,000 parts per million of mercury (enough mercury to contaminate a 5 acre lake and declare it unsuitable for drinking and fishing) as much as a typical mercury thermometer. A mercury thermometer is considered such a biohazard if broken, the government has recently banned them.
Mercury continues to be a used in restorative materials where significant amounts of mercury vapor are released especially when old amalgam fillings are removed and when new ones are placed. Mercury vapor, which is considered the deadliest form of mercury, is inhaled and passes via the lungs into the blood stream, which carries mercury to virtually all the body’s tissues and organs. It is noteworthy that as of October 1998, all over the counter products containing mercury had to be removed from the shelves because the manufacturers could not prove their safety. The scientific evidence for mercury toxicity from amalgam fillings is very compelling.
Despite this evidence major U.S. and international scientific and health bodies, (including World Health Organization and the British and American Dental Associations among others) still maintain that dental amalgam is a safe, reliable and an effective restorative material. This is despite studies showing toxic mercury vapor readings in the mouths of patients with amalgam fillings. Amalgam is not safe: Mercury is unquestionably a toxic substance, and it does escape from amalgam fillings, continuously vaporizing in amounts that are frequently in the hazardous range.
Proponents of amalgam argue that only a very small number of people are genuinely allergic to amalgam fillings. Citing that fewer than 100 cases where mercury has triggered an allergic response similar to a typical skin allergy. But these are overt allergic reactions, very little is known about the potential harm that the small doses of mercury released from amalgam can cause indirectly.
My opinion is why take the risk when other restorative materials are available that cause less sensitivity, look like teeth, last as long as amalgams and do not contain Mercury.
Other Restorative Materials
Several factors influence the performance, durability, longevity and cost of dental restorations. These factors include: the patient’s oral and general health, the components used in the filling material; where and how the filling is placed; the chewing load that the tooth will have to bear; and the length and number of visits needed to prepare and adjust the restored tooth.
The decision about what to use is best determined by the patient in consultation with the dentist. Before any treatment begins, I always discuss the options available.
In my practice the restorative materials I use are of two types: direct and indirect.
Direct restorations are fillings placed immediately into a prepared cavity in a single visit. They are predominately composite fillings but I also occasionally use glass ionomers in certain situations.
Indirect restorations generally require two or more visits. They include inlays, onlays, veneers, crowns and bridges (I do not use crowns or bridges that use base metal alloys for their substructure as there are better metal free alternatives available). During the first visit, I would prepare the tooth and make an impression of the area to be restored. The impression is sent to a dental laboratory, which creates the restoration. At the next appointment, I cement the restoration into the prepared cavity and adjust it as needed.
Composite fillings are a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when I prepare the tooth, and this often results in a smaller filling. Composites are also “bonded” or adhesively held in a cavity, reducing ‘leaking’ around the filling. Which can cause sensitivity and possible later decay and failure.
The cost is moderate and depends on the size of the filling. It generally takes longer to place a composite filling than what is required for an amalgam filling. Composite fillings require a cavity that can be kept clean and dry during filling and like all direct restorations they are subject to stain and discoloration over time.
Glass Ionomers are primarily used in areas not subject to heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth. Aesthetically they are not as natural looking as composites.
Indirect Restorative Dental Materials
Often the best dental treatment for a tooth (especially one that already has a large filling in it) is to use a restoration that is made in a laboratory from a mold. These custom-made restorations, which require two or more visits, can be a crown, an inlay or an onlay. A crown covers the entire chewing surface and sides of the tooth. An inlay is smaller and fits within the contours of the tooth. An onlay is similar to an inlay, but it is larger and covers some or all chewing surfaces of the tooth. The cost of indirect restorations is generally higher due to the number and length of visits required, and the additional cost of having the restoration made in a dental laboratory. The materials used to fabricate these restorations are porcelain (ceramic), or porcelain fused to a metal-free supporting structure (Cercon).
All-Porcelain (Ceramic) Dental Materials
All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel, they are chemically inert and do not stain, discolor or wear.
All-porcelain restorations require a minimum of two visits. Porcelain is a ‘glass’ and by itself is prone to fracture when placed under tension or on impact. Porcelain’s strength depends on adequate thickness and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can wear opposing teeth if the porcelain surface becomes rough.
Naturopathic Approach to Dentistry By Rumana Zahn, Naturopath
I often put together naturopathic programmes for patients undergoing dental work – before, during and after their treatment. How can this help?
Amalgams fillings consist of mercury and mercury is a highly toxic metal. Heavy metals can have significant detrimental effects on every organ in the body. Mercury has been known to be a potential neurodegenerator, harming the nervous nervous system.
Even if you do not have amalgams this does not necessarily mean you do not have any mercury in your body. Eating fish is a source of mercury contamination due to our polluted waters, as well as pesticide sprays and some vaccinations which use a mercury base preservative.
Getting rid of amalgams may mean more exposure to mercury initially therefore supporting the body to help eliminate this toxic substance as quickly as possible is important.
Regular heavy metal detoxification can help to keep our body organs and systems well. Herbs and certain supplements are very good at this and these are prescribed according to the different stages of dental treatment.
Here are the steps I take my patients through in their naturopathic programme:
- Nutritional programme to strengthen the body
- Prepare the body for detoxification
- Strengthen the immune system
- Natural chelating agents to help eliminate mercury
- Support for liver detoxification
- Support for the gut
- Support of the immune system
- Clearing the effects of the anaesthetic
- Continued support for the liver
- Blood detoxification
- Guidance on natural based products for dental care
By Rumana Zahn