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Replacement of silver amalgam dental fillings (sometimes called mercury fillings)

Q. I have some old silver fillings that are beginning to look bad, and I have concerns with the mercury that is in them. What can be done to improve them?

A. Silver amalgam dental fillings, which are composed of at least 50% mercury and the remaining material is silver alloy, eventually need to be replaced. It may surprise you to know that the average lifespan of a silver filling is only five years.

If your concern is strictly cosmetic, there are many new methods available to replace the dental fillings with beautiful, functional, long-lasting restorations.

Several different mercury-free materials are available. White fillings called composites or resins are available and can be used if sufficient tooth structure remains to support the filling. If there is minimal tooth structure remaining, an impression of the remaining tooth is taken, and a porcelain crown can be fabricated.

If your concern is about the mercury content, you might want to consider several options. The holistic community believes in removing silver dental fillings with a dental dam, high-speed suction and oxygen delivered nasally. This prevents the mercury vapors from entering your body. During the course of this process, there are holistic practitioners who can offer you various herbal remedies to help the body detox from the mercury. We can offer these services to you upon request.

Teeth whitening

Q. I would like to have my teeth whitened. There are so many products and ads for whiteners that it is hard to decide which is best. What do you recommend?

A. There are several products and techniques available that I recommend. The various over-the-counter products give the least predictable results and may cause permanent tooth damage – therefore, DON’T use them.

The two products we offer are as follows: BriteSmile® gets really great results in just over an hour in our office. You choose a CD from our vast music selection and relax for about an hour. A special gel is placed on your teeth and a soft halogen light is placed near your mouth. When the procedure is done, your teeth are six to ten shades lighter! This process costs about $500, and (for a nominal additional cost) comes with a set of custom trays so that you can maintain the whiteness of your teeth indefinitely. We recommend, once your teeth have been whitened with BriteSmile, that you use the custom trays once a month to maintain their whiteness. If not, the BriteSmile results can last for two years, depending on your diet, tobacco and coffee habits.

Or if you prefer to whiten your teeth at home, we will take an impression of your teeth, fabricate a custom tray and give you several applications of a whitening gel, which you will wear in your custom tray each day for 7 to 14 days. There are various strengths of this gel – one requires 45 minutes per day of wear, and the other you leave in at night while you sleep. This product costs $330. Once the results are rendered, it requires touch-ups, monthly to once per quarter, depending on your diet, tobacco and coffee habits.

Missing teeth, dental implants, bridges, dentures

Q. I am missing several teeth. What are my options?

A. Dental implants are a wonderful way to replace missing teeth when certain conditions exist. Such things as your overall general health and the length of time you have been missing your teeth must be considered. The replacement of missing teeth using dental implants frequently requires a team approach.

After a thorough examination and treatment plan, the surgical phase of treatment takes place, in which the implants are placed into the jaw. When healing is complete, usually after four to six months, the tooth or bridge segment can be placed on top of the healed implants.

B. Bridges. When you are missing teeth and you have healthy teeth on either side of the missing teeth, we are often able to fabricate a permanent bridge. A bridge is simply a series on crowns (caps), that are precision-made to fit the strong teeth on either side of the gap and have “fake” crowns in the middle. It is permanently seated on the real teeth and appears to the eye as individual, natural teeth.

C. Dentures… are removable. They usually replace numerous teeth and could replace all the teeth in one arch. If some natural teeth remain, dentures can be made to “grab onto” healthy teeth in order to gain some support and retention. The downside of dentures is that they must come out for at least four to six hours a day. Most people find the ideal time to be when they are asleep. The upside of dentures is that they are financially more reasonable then crowns.

Toothbrushes

Q. There are so many different toothbrushes on the market today. How do I know which one is the right one for me?

A. The brand of the toothbrush is not nearly as critical as the type of bristle and how frequently you replace your brush.

We recommend only a soft-bristled brush. The soft bristles are most important for the health of your gums. Brushing at least twice a day and replacing your brush at least every three months, or sooner if the bristles start to bend, is crucial. My employees and I all brush, on average, five times a day. We brush first thing in the morning, after each meal and at the end of the day.

The Sonicare is an electric toothbrush that uses sonic vibrations to “shake” the tartar off your teeth. I have recommended this brush as the absolutely best way of caring for your dental health for over five years.

Wisdom teeth

Q. I have my wisdom teeth, but how do I know if they should stay or be extracted?

A. Having regular dental checkups with X-rays allows you to learn about potential problems and have them corrected before they begin to bother you. There are a number of reasons for recommending removal of unerupted or impacted teeth. If these teeth could cause problems for the adjacent teeth if left in place, it may be reason to extract them, especially while they are asymptomatic (problem-free). There is also the possibility that you could develop such things as a cyst or abscess if they are left in place. We have a special X-ray machine that takes a picture outside your mouth and shows you the layout of all your teeth, in particular the location and angulation of your wisdom teeth.

Caps (crowns)

Q. What’s the difference? What are they made of?

A. The word “cap” as used in dentistry refers to a crown, made by a dental laboratory, that covers the outside of your tooth. Crowns come in a variety of forms. They are made out of a metal, usually gold, or porcelain, or a combination of gold fused to porcelain. They can cover the tooth completely or partially. Once prepared, an impression is made, the tooth is covered with a “temporary” material for approximately two weeks, and then you return for the “permanent” crown, which was fabricated in the lab, to be seated.

Discolored teeth in children

Q. Why do some children’s teeth have a brownish or greenish hue? What causes this and what can be done about it?

A. Children’s permanent teeth often are surrounded by a soft tissue membrane called Nasmyth’s membrane (named after Alexander Nasmyth, a Scottish dental surgeon in London who died in 1847). As the teeth erupt, remnants of this membrane remain on the surface of the enamel. The fibrous nature of the membrane readily picks up coloration from food.

In most cases, normal chewing and brushing will remove the remnants with time. If they don’t come off, they can be removed by having a professional dental cleaning.

Other causes for staining of teeth include high fevers during infancy, too much fluoride in drinking water and certain medications, especially the antibiotic tetracycline, if taken while the teeth are still forming.

Depending on the child’s age, there are options – call us so we can discuss it personally.

Drill noise, scared about shots

Q. I cannot stand the sound of the drill. I think I have a new cavity but am reluctant to call a dentist. What can I do? I don’t want a toothache and certainly don’t want to lose my tooth.

A. Dental technology has come a long way in recent years. If you have a new cavity that requires a filling, there are numerous ways to remove decay. It is quick, and sometimes you do not need a shot of anesthetic. If you do need to get numb and are anxious about the shot, we may offer nitrous oxide (laughing gas) to make you more comfortable. Under certain conditions, we can offer general anesthesia so that you are fully relaxed and asleep for the entire procedure. We have a board-certified anesthesiologist on staff to provide this service for you.

We have an extensive list of CDs to choose from with private headphones in each operatory. Our patients say that they feel more relaxed listening to their favorite music and like the fact that they don’t hear the drill!

Tongue piercing

Q. My boyfriend thinks it would be neat if I got my tongue pierced. What can you tell me about this? I am a little concerned about whether it would be safe. I do have pierced ears and have not had any trouble with that.

A. In four words, PLEASE DON”T DO IT! I have seen numerous cases in our dental office, which have resulted in all sorts of problems.

To begin with, the tongue is an extremely vascular organ, which means that it has an extensive blood system. A tremendous amount of swelling is expected when the tongue is pierced and a large oversized “barbell” is initially placed to accommodate the expected swelling. Often there is infection in the tongue after the piercing and uncontrollable bleeding.

The piercing can cause difficulty in breathing and swallowing, eating, drinking and speaking. The large barbell flops around and has caused fractures of teeth when accidentally bitten.

The barbell can come unscrewed and be swallowed or possibly be aspirated (sucked into a lung). Either of these could require surgery.

I repeat, PLEASE DON’T DO IT!

If you’re looking for a dental specialist who can protect and empower your smile, come to family dentistry Dr. Jay S. Grossman & Associates and let us inspire you to achieve a beautiful, healthy smile. Give us a call at 310.820.0123 or use our online Appointment Request form to schedule your consultation time. In addition to English, we speak Russian, Spanish and Farsi. Patients come to us from the cities of Westwood, West Los Angeles, Brentwood, Culver City and Santa Monica.