Are white fillings OK in wisdom teeth?

Years ago, I let a dentist who obviously did not know what he was doing put white fillings in my teeth. Almost immediately I had to have several of them replaced, because my teeth became really sensitive and it was extremely uncomfortable to eat. At that same time, I let the same dentist put white fillings in my lower wisdom teeth, to “protect them against future cavities”. I had never heard of this practice, but did not know enough to argue.

The fillings have since worn completely away, and the teeth underneath where they used to be are not a pretty sight. I need to have fillings done again, but my regular dentist won’t do silver fillings. She said that many dentists won’t do silver fillings anymore, because of the mercury. Problem is that I don’t trust those white fillings to last, or to not cause me pain. What should I do?

Ron from Atlanta

Dear Ron,

The white fillings were not the problem–it was the technique used to place them. Placement of white fillings is still not taught in most schools of dentistry today, and it was certainly not part of the regular coursework “many years ago”. Placing white fillings, particularly in back teeth, is more challenging than placing amalgam fillings, because the area must be kept absolutely isolated from saliva or other fluids.

If your current dentist does not place amalgam fillings, then logic dictates that she is probably well trained and expert at placing white fillings. She would have a difficult time staying in business if she wasn’t! So I have to think you can trust her to do a good job with the white fillings to replace the ones that were in your wisdom teeth. Also, dentists as a group tend to be very ethical, so if she is recommending white fillings for your wisdom teeth, then she knows she can do a good job placing them for you.

The subject of the mercury in amalgam fillings in an ongoing controversy in the field of dentistry. The most current research cannot conclusively prove one way or the other whether or not the small amounts of mercury vapor released when you chew are harmful to the body. Many dentists (and patients) are choosing to err on the side of caution, and are just avoiding the amalgam fillings altogether.

Beyond the mercury issue, white fillings are much more cosmetically attractive than amalgam fillings. This may not be a top priority to you in the very back of your mouth, but an added selling point is that white fillings create a stronger structure after placement. The composite material actually bonds to your tooth, creating a stronger, more stable structure overall.

I hope you can trust your dentist to place those white fillings for you. The technology to place them has evolved a great deal, and hopefully you can trust your dentist’s skill and training.

Good luck.

Posted in Stained Teeth, White Fillings | Comments Off

Brown discoloration on front teeth.

I am in my early twenties, and I have always taken really good care of my teeth. Ever since my adult front teeth came in, they have been discolored and brown. I can’t remember who told me this, but I’ve always had the idea that this was because I was extremely ill when I was very young, and the discoloration was caused by the fever.

At the recommendation of my dentist, I’ve tried every whitening product on the shelf, but the situation just keeps getting worse. The areas around the spots are getting whiter, while the spots are getting darker. When I brought this to my dentist’s attention, he said he could try to grind away the material of my tooth until the discoloration is gone. I don’t claim to be a dentist, but this sounds like a terrible idea! He has no idea how much he might have to grind, and I have this horrible mental image of a mouth full of misshapen lumps where my teeth used to be.

Please help me figure out an alternative. Would professional teeth whitening help where the over-the-counter products have failed? I admit, I am pretty obsessed with getting this fixed. I hate my teeth. They create the wrong impression, and I feel like they are hurting my efforts to get a job. I just graduated from college (summa cum-laude) and my confidence is at an all-time low.

Please help.

Brianna from Charleston, SC

Dear Brianna,

You are wise to be uncomfortable with your dentist’s suggestion to grind away at your teeth. Not only will this probably still be ineffective at removing the spots, but he could do considerable irreversible damage to your teeth, too. I strongly suggest you seek the services of an accredited, experienced cosmetic dentist. You should not have to continue to be part of your dentist’s learning curve regarding stains and teeth whitening products.

If all those over-the-counter products did not work for you, it is extremely unlikely that a professional teeth whitening procedure will work. Both systems use the same whitening agents—the at-home systems just take more time. When your first attempts were not successful, your dentist should have been able to tell you that.

Depending on the kind and degree of severity of the spots, there is a chance that a procedure called “microabrasion” could help. If not, other treatment options open to you include dental bonding or porcelain veneers. Both procedures should absolutely only be done by an accredited, experienced cosmetic dentist.

Most general dentists are not at all qualified to do this kind of work, so it is very important that you locate the right dentist to help you.

Posted in Stained Teeth, Tooth Whitening | No Comments »

Bleaching natural teeth without damaging porcelain veneers

Are there any over-the-counter whitening products that are safe to use with porcelain veneers? I have six veneers that were placed several years ago. The veneers still look fantastic, but my other teeth have yellowed, and the difference is really noticeable.

Thanks for your advice,

Neil in Bethesda, MD

Dear Neil,

There are only a few teeth whiteningproducts that would be appropriate in this situation. Crest Whitestrips or other products that are similar are the only products I would consider both safe and effective. The active agent in the whitestrips is peroxide, which needs to be left on the teeth to penetrate and whiten them. The strips do a pretty good job, usually.

Whitening toothpastes, which are only on the teeth briefly, really don’t do anything at all. Some whitening products can actually make the problem worse over time. They contain acids that slightly etch the surface of your teeth, which allows the white pigment in the second step of the treatment to adhere to your teeth. Tests indicate that these products actually damage your teeth, and when the pigment wears away, the roughened enamel will pick up even more staining, making your teeth darker than they were before the treatment. If you are going to do this yourself, I would strongly suggest sticking with only the whitestrips type products.

There are, however, several reasons the whitestrips might not work for you. First, they are designed to work on the front six teeth, which are the teeth you have veneers on. You could try trimming them to fit, but you might wind up with strange gaps and uncovered areas. The whitestrips also take quite a while to really show dramatic results, as the peroxide solution that is legal to sell over the counter is so much weaker than  what is used in a dentist’s office. This could mean purchasing quite a few kits, and quite a lot of your time spent messing around with this.

It would almost certainly be worth it to get this procedure done in your dentist’s office. The bleach used in the office will not harm your veneers, and is simple enough that no special training is necessary, so your general dentist could take care of this.

Posted in Stained Teeth, Tooth Whitening | No Comments »

Fluorosis stains on my son’s teeth

I have a question about my 9 year old son’s teeth. He has severe fluorosis stains on his permanent teeth (the central and lateral incisors on both top and bottom), and our dentist doesn’t seem very concerned about this. My son is in braces already, even though his 12 year molars are not in, because he is so self-conscious about his teeth. The braces will straighten his teeth, but we need to figure out what to do about the blotches and stains. They look terrible, like the teeth of an 80 year old chronic smoker. What would be your recommendation?

Thanks,
Alice in Cedar Rapids

Dear Alice,

I think the first thing you must think about is seeking the advice of a different dentist. If you feel that your current dentist is not very concerned about the appearance of your child’s teeth, then he is not the one you want helping you deal with severe fluorosis stains. You need to seek the services of an expert cosmetic dentist.

The stains you describe do indeed sound like fluorosis stains, which indicates that your son consumed too much fluoride while his teeth were still forming. This could have been from the public water supply, or even from habitual swallowing of fluoridated toothpaste. If fluorosis is the source of the staining, then merely bleaching his teeth is not an alternative. The procedure is safe for children, but it will not remove the stains. Mild fluorosis stains can be addressed with direct bonding to cover the blotches and stains, but more severe stains will require porcelain veneers.

This problem is beyond your family dentist, especially if he seems indifferent to the self-esteem issues your son is experiencing with his teeth. You want the services of an experienced and talented cosmetic dentist, one who is sensitive to your son’s embarrassment about his teeth.

In terms of timing, the braces will have to come off first. When your son’s orthodontic treatment is complete, it could be possible that his front teeth may still not have fully erupted, so your cosmetic dentist may advise you to consider a direct bonding procedure as a temporary solution before placing porcelain veneers.

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