You may have retired but your teeth haven’t!!!!!!!!

Inspiration to write this article in the newsletter has surprisingly come from one of my patients who recently had the most unpleasant of experiences while travelling on a cruise ship in Southern Europe between Hamburg and Copenhagen.

Jim (name changed) has been a patient of the practice for the last 35 years and I have been personally in charge of his dental visits for the last 5 years. Jim hated coming to the dentist and only saw me when he needed a quick check up or was in some pain. On previous check up’s (short ones) I had recommended to Jim to come in for a full mouth comprehensive examination to assess the condition of his large cracked silver fillings and discolouring teeth from bacteria leaking around multiple patch up fillings .However Jim like most people firmly believed that “no pain is no problem” and we decided to simply tread along and see what happens.

During his vacation, when he was on the cruise, Jim fractured one of his heavily filled back molars which had large silver filling in it as well and was in excruciating pain. Unfortunately the nerve had got exposed and he needed to see a dentist straightaway which was impossible on the cruise ship. It was 2 days of painkillers and sleepless painful nights before he eventually saw a dentist in Copenhagen for emergency relief.

When I saw him back in the treatment rooms some 2 weeks later 2 other teeth had cracked at the same time and we had to undertake complex root treatment and eventually restore the teeth with porcelain crowns, both of which were complicated and very expensive.

Jim’s story is not unique or unusual and it happens to a lot of my patients mainly because amalgam restorations which were done 25-30 years ago come to a use – by date and eventually start to fail. These restorations are sometimes 50-60% or more of tooth structure and instead of the tooth supporting it; they are actually supporting the teeth. Minute cracks develop in these teeth with forces of the bite day in and out and eventually one of the cracks propagates and causes a large fracture of the tooth.

Because there is no pain we often don’t accept the underlying problems and consequences and allow bacteria to leak underneath these fillings which then eats away tooth structure and teeth crack and split the tooth into halves.

Such fractures in restored teeth are a vexing and relatively common problem to dentists and their patients. Some studies have concluded that teeth with amalgam restorations are more likely to be associated with cusp fractures than are teeth with resin-based composite/porcelain restorations. Some academics addressing the likelihood of fractured cusps in teeth with amalgam restorations, called such restorations “time bombs” that “may threaten not only specific teeth, but possibly an entire dentition.

The magic mantra is Brush, floss, rinse and sees your dentist every 6 months for periodic reviews and updated photographs and X-rays to monitor your condition. Get in EARLY and save the AGONY!!!

References

  • Bulk fracture of amalgam restorations—a 5-year controlled clinical trial
    *Journal of Oral Rehabilitation Volume 15 Issue 6, Pages 521 – 529
  • Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite
    http://www.adajournal.com/cgi/reprint/135/8/1127
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