The Reality of Amalgam Fillings

Safe Amalgam Filling Removal

Nowadays, there is a lot of controversy about whether amalgam fillings should remain in the mouth due to their mercury content. Although scientists do agree on this fact, thousands of amalgam fillers are taken out of the mouth every day. Research has shown that a significant amount of mercury vapor is generated during the process of amalgam removal, and that it creates harm to the patient, the dentist and the personnel. Amalgam fillings should therefore be taken out according to the guidelines established by the IAOMT (International Academy of Oral Medicine & Toxicology).

However, this technique should be performed in a clinic that works respecting these rules and having the necessary equipment licensed by the IAOMT in order to insure the safety of the patient, dentist and personnel.

Dentway Dental Clinics have all the equipment and requirements specified by the IAOMT. In addition, to the SMART (Safe Mercury Amalgam Removal Technique) Certificate, which is essential for performing these procedures in a safe environment. Our aim is to perform these procedures without harming our patients, staff and ourselves.

When your amalgam filling gets broken or a new caries (tooth decay) occurs, and if your dentist recommends its replacement, you can get your amalgam filling taken out according to world standards in our clinics. After the filling and removal process are done, the appropriate treatment (Porcelain Filling, Composite Filling, Porcelain Crown, etc.) will be determined and performed by your dentist depending on the amount of substance loss in your tooth.

If you wish, you can safely seal your teeth with temporary restoration after your amalgam filling removal process has been performed and you can have your dentist do the necessary treatment.

What is Amalgam?

Amalgam filling is consist of ; a compound of mercury and single or multiple elements ( silver, copper, stannum etc.) and it is used for filling the missing part of tooth. Amalgam fillings are long lasting and durable for long years when applied on teeth. Generally they don’t leave teeth easily, when the tooth is fractured then they break away.

 

What are the Characteristics of Amalgam Filling?

Advantages;

Rapid application convenience; Amalgam filling can be composed swiftly by combining with other materials easily.

Moisture control is not necessary on the application field; Too much drying is not required when applied on the prepared tooth in other words tooth cleaned from caries.

Acid is not used in this procedure; Acid application is not necessary during application of amalgam and this decreases sensitivity.

Durability is good; It has a long term usage and very resistant to abrasion and fractures. Does not conduct intra -oral heat too much.

Disadvantages;

It’s color is bad; Silver colored amalgam has a structure not having color match with tissue. Creates a tattoo effect inside the tooth and deteriorates the color of tooth.

Biological discrepancy with tooth; They can not bind each other with the tooth and they work as a different good material.

Mercury vapour existing it’s application; During application existing mercury vapour may be inhaled by doctor- assistant personnel – patient.

Mercury accident risk during formation of amalgam; Liquid mercury and other materials should be mixed for obtaining amalgam particle. This procedure is manual most of the time, so mercury can fall on the floor. It may transmit from the standard latex gloves to skin. It is necessary to inform local health authority in case of this type of accidents.
Especially in America, it is mandatory to solve the situation with specific rules consisting the things that you should do when a mercury thermometer or fluorescent lamp is broken in your house.

Mercury release; After application of amalgam, especially during chewing or under pressure amalgam releases mercury vapour. The exposured mercury vapour is absorbed by respiration and oral mucosa.

Removal of amalgam requires special precautions; Special precautions should be taken when removing an amalgam filling. It causes a cost and time loss.

Amalgam chopping; Amalgam is not abraded but chopping even fracturing may occur, sometimes it may break the tooth. Because it does not bind with teeth chemically.

Marginal leakage may occur with amalgam fillings; Contraction occurs during amalgam material is getting hardened in other words during chemical reaction. Due to this contraction, discrepancy occurs with the tooth and gaps are formed on the margins. By the time, secondary caries can be formed from those gaps.

What is the Situation on Earth ?

In most of the countries in Europe, there is no limitation about the application of amalgam fillings. In two countries Norway and Sweden, application of amalgam fillings are ended and banned due to having less risky alternatives. The reason for this is declared as preventing possible harms to environmental and human health.

There is no ban in America yet. However doctors don’t want to make amalgam fillings. We can say that it is generally abandoned.

A Can I Have An Amalgam Filling ?

World Health Organization don’t have a definite ban about this issue. A significant toxicity is not reported in scientific researches. However, we are not recommending amalgam fillings due to having alternative materials and even superior materials.  In previous years, it’s usage was mandatory but now there is no need for it.

 

Consequently, we don’t recommend you to have it…
Should I Be Removed My Amalgam Filling?

We can recommend removal if you have multiple and very big Amalgam fillings. Especially amalgam fillings without polishing may release. But if you have a small, very shiny, well polished, marginally fitting well amalgam filling then it is not necessary to remove a filling like this.

In conclusion, it should be decided as a result of examination by a dentist. However generally, big and multiple amalgam fillings should be removed under special precautions.

Above mentioned information don’t consist definite judgement due to it takes time and not easy to reveal clearly the toxicity results of those type of materials scientifically.

LAMINATE VENEERS -LAMINATE

Laminate Veneers and Our Oral Health

Ceramic plates were first arise with the idea to cover anterior sides of teeth for aesthetical purposes and by the time, their contributions to oral health are also understood. Therefore, laminate veneers which are also known as ceramic plates are not only important in terms of aesthetic, they are also important in terms of health.    Because, when we search long term results of laminated teeth, the risk of having fracture, caries, color changes, bacterial plaque formations and position changes decreases to minimum levels.

Above mentioned health problems are also a reason in itself. However, laminate veneers are not applied on teeth not having any color and health problem, only for protection. We dentists don’t want to make those kind of foreign materials unless required even if they may have advantages. Therefore, making right indication is very important for laminate veneers and as for all other procedures.

The Relationship Between Laminate Veneers  and Age

It is possible to apply ceramic plates over the teeth not having any porcelain crown or not prepared previously. The important thing is, teeth and gingiva should have been completed their growth. Laminate should not be done to a person only 14-15 years old. If required, bonding procedure will be better. The ideal age for laminate porcelains is after 16-18 years old. It’s better of teeth and gingiva have their final shapes. In laminate veneers performed in early age, color discrepancies or gingiva discrepancies or even asymmetrical irregularities may occur. This situation creates dissatisfaction.

Laminate Veneers and Long Term Results

Usually, the first question of people is how a material having a thickness one third of a millimeter is not broken. We are getting comments like this very much ‘ I heard from my environment that these can remove or it is not possible to eat hard foods when we have these teeth.’ In terms of aesthetic success, fineness of ceramic is very very important. It is not possible to talk about aesthetic when laminate veneers are thick. However, limitation of functions like biting just because we prepared thin laminate veneers is not  proper. The important thing is to position those ceramics properly and then scientifically cement it over the teeth properly. There is no lifespan for Laminates. As the years goes by, laminate veneers don’t cause any problems. Usually they have to be changed when gingival recession occurs. You don’t have any chance to break laminate veneers while biting something. You should only know that; an impact that can fracture your natural tooth also can fracture laminate veneer.

Types of Laminate Veneers

Laminate Veneers can be produced by two different ways. These phases are performed in laboratory and their results reflected to the patient. The first method is press ceramic method and it is the simplest and easiest one. In this method, planned laminate veneers are studied on a wax up model and the design arises. Wax shaped laminates are pressed in special ovens with a ceramic that can be pressed from the designed model. Refinements that we call leveling are done on the pressed ceramics and finally it is painted with a color that both the patient and the doctor agree. So, laminates are prepared.

In the other method laminates are produced with accumulation technique. In this method, primarily a framework is produced for laminates. Later on, ceramics are added on this framework gradually according to the selected colors and laminate veneers are produced. This method is used to make more natural laminates. Because all the colors and tissues of teeth are produced layer by layer.

DO WE KNOW OUR CARDIAC HEALTH ENEMY ENOUGH ?

Cardiovascular diseases, is a general nomenclature for a group consist of blood vessel diseases which are called cardiac or artery and vein. Therefore, cardiovascular disease means any disease that effects circulatory system. Cardiovascular diseases include various cardiac and vessel related conditions like coronary heart disease, atherosclerosis, acute myocardial infections, stroke.

Cardiovascular diseases are the major causes of death globally. In recent twenty year, despite the decrease of mortality ratio related with cardiovascular diseases in high income countries, disease and mortality ratio has astonishingly fast increase in low and middle income countries.

In Turkey, according to the studies of  ‘Cardiac Diseases and Risk Factors in Turkish Adults’ (CDRFTA),which were started in 1990 and still continuing, 90 men of every one thousand men over the age of 20 and 71 of every one thousand women over the age of 20 has cardiovascular disease.  Recommendations of CDRFTA include advices about oral and dental health.

The incidance of gingiva diseases which we call periodontal diseases is high in Turkey as in the world. Periodontal loss increasing with the age is the major cause  of early tooth loss.

Periodontitis, is an infectious disease having a course characterized with bone loss created by inflammation caused by microorganisms in the supportive tissues of tooth. Primary cause of periodontitis is microorganisms. However, severity of the disease is determined by the response of body against those organisms.

Periodontitis , leads increase of systemic inflammation levels. Beside, bacteria and their products can be transferred with blood circulation or freely or inside circulating cells like monocytes or neutrophiles  to far areas like cardiac tissues.

In recent years, patogens related with periodontal diseases are shown to be associated with systemic conditions like cardiovascular disease, stroke, premature or low weighted babies, pulmonary infections, diabetes, osteoporosis, obesity, rheumatoid arthritis, renal diseases and even Alzheimer disease. The major cause of periodontal disease is poor oral hygiene. Extra oral risk factors include; smoking, diabetes, genetics, mental anxiety, depression, obesity and sedentary life style.  The risk factors of periodontitis and cardiovascular disease are common although they are inflammatory diseases separate from each other in a sensitive person. Serum C-reactive protein (CRP) level which is a laboratory finding that increases during inflammatory conditions in both periodontal disease and cardiovascular disease increases.

Periodontal disease and dental procedures may cause serious risks in patients having a known valvular heart disease. Because, during dental treatment, numerous microorganisms located inside gingival pocket can transfer to heart by blood and may lead a condition which is called bacterial endocarditis. Therefore, bacterial endocarditis is still a serious disease having significant morbidity and mortality.

A common report was published from American Cardiology Journal and Periodontology Journal in 2009 demonstrating the relationship between periodontitis and aterosclerotic cardiovascular disease. In this report, it is recommended that patients with moderate and severe periodontitis should be informed about the possible increased risk of cardiovascular disease and also patients having more than one risk should be evaluated medically.

The most effective method for preventing the risks like gingiva problems which are also known as gingivitis and periodontitis, odontogenic infections, dental caries is proper and regular oral care. During evaluation of our patients dental and gingival treatment plans, considering general health as a whole will provide us a healthier solution.

CANAN KABADAYI

Are We Aware Of Diabetes ?

‘Diabetes Disease’ which is also known as ‘sugar disease’ is very common in all over the world and have life long course. Nowadays, the number of people with diabetes is assumed as 250 million, in 2025 it is predicted that this number will increase to 380 million. Every year 7 million people are diagnosed as diabetes. Diabetes may lead severe organ damages and mortality in early period.

Every year, 3,8 million people lose their lives causes related with diabetes. 2 person in every 10 second are diagnosed as diabetes and 1 person loses his/her life related with diabetes, in the future, it is considered that this number will increase 25 %.  The most significant cause of mortality is cardiovascular diseases for patients with diabetes.

The risk of having a heart attack and stroke is double for diabetic patients then the non diabetic ones. The most important reason of renal failure cases and related big expenses is diabetes in developed countries.  10-20 % of all diabetics lose their lives from renal failure. Diabetic retinopahy (diabetes related eye damage) is the most common cause of vision loss in developed countries.   Approximately 2,5 million people are effected from diabetic retinopathy all over the world.  2 % have blindness, 10% have serious vision loss approximately 15 years later from diabetes diagnosis. Diabetes is responsible from 40-70 % of lower leg amputations (removal of foot). 1 diabetic person loses his/her foot in every 30 second in all over the world. .

What Are The Effects of Diabetes on Oral Health?

When we are talking about a healthy mouth, first we should consider healthy gums and teeth without caries. Similarly, also situations like proper alignment of teeth, non problematic intra- oral soft tissues, not having any bone loss, having restorations fitting with natural structure and functionability of mouth, not feeling bad breath, taste are also indicators of health.

Diabetes also have intra -oral effects because it is a systemic disease. Feeding of tissues becomes harder and diseases easily develop inside the mouth like the other organs. Immune system is poor in diabetes; treatment of intra oral problems takes too much time than before. Additionally, intra oral ulcers, dental abyses and gingiva diseases also cause increase of blood glucose level.

Are diabetic Individuals Under More Risk Than The Non Diabetic Ones?

Although there are many studies about this issue, there is no clear finding revealing that diabetes disease starts gingiva diseases or other intra -oral problems. However, it can be told that diabetes increases existing gingiva inflammation and worsen the course of disease definitely. Diabetes is not a negative factor for individuals with totally healthy gums. Diabetic patients are more prone to intra-oral candida infections due to their saliva content. Saliva is an important factor for physiological cleaning of mouth. Decrease of saliva and increase of saliva intensity makes physiological cleaning of mouth complicated in diabetes. Bacteria reproduce  rapidly and dental plaque formation becomes faster (dental dirt) on the food remnants that are not cleaned properly. Dental plaque, is the main reason of dental caries and gingiva diseases. In conclusion, high level blood glucose triggers intra- oral problems and intra- oral problems triggers increase of blood sugar level. This vicious circle increases the intra- oral damages which is caused by diabetes.

Diabetes, under control, having regular oral care, proper and complete application of all the mechanical cleaning agents which are used for oral hygene and regular dentist visits will solve most of the problems. .

The Things that Diabetic Patients Should Do During Their Dental

Diabetic patients absolutely should learn their fasting blood glucose level one day before their dentist visit and they should share this information with the dentist. Beside, the proper treatment hours are the morning sessions after breakfast.

DR.CANAN KABADAYI

Implant Treatment ? Or Bridge Treatment ?

Implant Treatment ? Or Bridge Treatment ?

The most recent and healthy prothetic treatment type for treatment of missing teeth is implant procedure. As an alternative to implant procedure, bridge prothesis were frequently used in previous years however, they are not preferred in nowadays unless there is no other option. Because minimum two healthy teeth should be prepared for a bridge prothesis. The teeth located in back and front sides of the missing tooth provide support and thus missing tooth area is treated functionally.

During preparation of teeth, dental enamel is completely removed and the tissue without natural protective layer reveals. This tissue is called dentin. Dentin, is a tissue consist of nerve extents , micro level canals and it gives the yellowish color of tooth. Although it is covered with bridge prothesis, it loses it’s first day adaptation by the time due to surrounding bone loss related with over loading  and gingival recession together with it.

Te patient feels this clinical situation as sensitivity and pain. Besides, gingival recession also triggers formation of dental caries. Interdental cleaning can not be done ideally because there is no gap between the teeth of bridge prothesis for dental floss.  Those mentioned disadvantages, may lead loss of the supportive teeth by the years. Additionally, food impaction becomes frequent by the time between the bridge pontic on the missing tooth are and the gum . Because the bone under the missing tooth area continues resorption by the time. Thus, ideal treatment of missing tooth is implant procedure. Because both bone resorption of the missing tooth area will stop and adjacent teeth will be protected without any operation..

Additionally people may clean inter dental area by using floss, because the teeth were prepared one by one. Except this, every tooth subjected to it’s own load thanks to implant. Therefore, the teeth located front and back side of the implant don’t have to bear over loads brought by bridge prothesis.  This situation provides for the patient to have his/her own teeth inside the mouth in a long term period. If we compare bridge and implant treatment economically, on the first stage the patient should have more budget for implant. However it should be kept in mind that implant stays in mouth for lifelong under proper care. But ideal bridge prothesis have maximum 15 lifespan.

At the end of this period, a cost will arise again. In fact, the second cost may be much more than the cost of implant. When we consider as a whole, it means a second payment for the same area. Whereareas, in implant procedure  only a single crown on the implant can be prepared again after years. There is no need to prepare minimum 3 porcelains like bridge prothesis. As a result, when we consider in a long term period, implant treatment is more economic than bridge prothesis.

Dt. Arca Baydar

Is General Anesthesia Safe for Dental Treatment of Children ?

Dental caries, are not only affecting oral and dental health of children, it also effects on general health, regular diet, regular sleep pattern and psychology of children. Therefore, if any, dental caries should be treated starting from the first moment they are diagnosed. However it is not always possible to make dental treatment on dental chair for children having dentist phobia and non -cooperated. Also there is injury risk especially for treatment of children in early ages, because they can move suddenly. In these situations, it is recommended to make treatment under general anesthesia.

Dental treatment under General anesthesia can be performed in every age starting from the first eruption of teeth in 1 year old. Duration of the treatment depends on the number of procedures. All of the planned dental treatment can be done in one session under general anesthesia and this situation provides a comfort for both the child and the parents.  Usually parents are concerning about receiving general anesthesia for their children. There are a large number of parents who think that there is no need for a procedure like this especially for treatment of deciduous teeth. But deciduous teeth starts to change at the age of 6-7.

The exchange of molar teeth is completed around 11-12 ages. Every deciduous tooth is a guide for the permanent tooth underneath. Advanced caries and infection of deciduous teeth will harm the permanent teeth underneath and loss of tooth material will prevent proper alignment of teeth. Children living with decayed teeth until this age period poses a serious risk in terms of both general health and oral and dental health.     Therefore, making treatments of children that can not be treated on dental chair under general anesthesia facilitates both children and their parents’ lives.

Full fledged hospitals should be preferred

Nowadays general anesthesia is performed extremely safe and comfortable with the help of new anesthesia techniques and medicines. The important thing here is to perform this procedure in a full fledged hospital and by specialist doctors. .

The experience of the dentist about this field who will make the treatments under general anesthesia is very important. As you know, dental treatments are long lasting treatments especially when more than one procedure will be done. Dentists specialist in their field can shorten this period as possible as they can and at the same time they can prevent recurrence of general anesthesia.

The Child Shouldn’t be Separated From His/Her Family!!!

The child should be examined by general anesthesiologist before deciding to make dental treatment under general anesthesia, in terms of checking if there is any harm or not. In situations that there is no harm for child to receive general anesthesia, he/she is taken to a special room with small surprises on the day of operation. Primarily relaxation of the child is provided by using oral or rectal sedative medications near his/her mother and father. Slightly sleepy child with the effect of the medicine, is taken to the operation room. With the help of this he/she don’t feel like leaving his/her family and don’t remember anything later on.The child is awaken by general anesthesiologist just after completion of all the caries and preventive treatments by a pedodontist. The child who is taken next to his/her mother and father again in a short period of time after the procedure, sees her/his mother and father when he/she opens his/her eyes. Therefore the child thinks he/she is always near his/her mother and father so he/she can easily adapts his/her normal life after sedation or general anesthesia.

One thing that should be done by mothers and fathers before the procedure is to start brushing their children’s teeth regularly and in an appropriate manner. Having healthy gingiva and not having bleeding related with not brushing will directly effect the duration of dental treatments under general anesthesia. The major problem during the treatment of  tooth decays is gingival bleeding related with not brushing regularly in a long period of time. Dental treatments are performed much more easily and in a shorter time period by means of preventing gingival bleeding with this way during fillings.

After the procedure children are referred to their home after resting in recreation room under supervision for 1-2 hours with their family. Children who are going to school may continue their school the day after the operation.The most important thing to be careful about is to continue brushing in a regular and proper manner. It should be kept in mind that parents should play an active role in tooth brushing of their children until the age of 7-8 years old.

Sedation in Dentistry

What is Sedation ?

The patient is relaxed by the help of some kind of combination of medicines including Sedative effect, Narcotic Analgesic and Hypnotiser and a short time Amnesia (forgetfullness)  is provided and dental treatments of patient can be done in a short period under Local Anesthesia. This procedure is not general anesthesia, it can be applied in dental clinics not in hospital or operation room conditions. The patient can fulfill the commands given by the dentist. The patient and the doctor may have a dialog. The patient may fulfill the commands easily including movements like opening his/her mouth, turning his/her head, answering questions.  During the operation the anesthesiologist monitorize the patient consistently and follow his/her pulse and blood pressure. With the help of medicines, the patient did not remember the intra- oral procedures, pain, irritating sounds, vibrations and thanks to this he/she does not have any psychological trauma.  A comfortable working field is provided during the treatment due to elimination of stress and preventing unwanted reflexes.

Recovery period of the patient is short and comfortable after sedation procedure. Those advantages facilitates dental visit for the patient for subsequent sessions. Conscious sedation can be used safely for both adult and child patients. It doesn’t have any known side effect. It can be applied intravenously for adult patients. Medicine doses are arranged according to weight. It can be applied orally (syrup), rectally (rectally), intranasally (from nose) for children. Dose arrangements can be done according to the duration of the procedure. It is possible to make multiple dental treatment in one session.

Anesthesia Examination Before The Operation

After planning of dental treatments for the patients by regarding doctors, then their examinations are performed for pre operative anesthesia procedures. During anesthesia examination, detailed history (previous operation or diseases, regularly used medications etc.) is learned from the patient and then physical examination is done. Operation appointment is arranged after completion of required analysis.   Patient Groups That Can Have Sedation;

  • Children smaller than 4 years,
  • Children or adults having growth retardation,
  • Adult patients having advanced level phobia (Fear)
  • Patients who don’t want to feel stress and effects that may occur under local anesthesia,
  • Patient groups having nausea reflex.

Oral Care During Orthodontic Treatment

During Orthodontic treatment, it is very important to provide oral hygene in terms of continuity of treatment and protecting general oral condition. Teeth and gingiva should be brushed carefully especially after breakfast and before going to bed minimum two times a day.

During Orthodontic treatment, surface areas increase so intra oral bacteria may attach and foods may accumulate therefore, cleaning all over the mouth like there is no food remnants and plaque will left, is very difficult. If your teeth and surroundings of your braces won’t be brushed well, white spots may occur on enamel surfaces and the risk of gingiva problems and bad breath will increase due to plaque accumulation around the orthodontic materials during the treatment,

If sufficient oral hygiene couldn’t be provided for patients having an ideal teeth alignment after the treatment, annoying problems may occur related with caries on teeth surfaces and gingiva problems. It will be inevitable to be treated in other dentistry departments when the enamel surface of the teeth are damaged irreversibly like formation of caries.

It is very important that the environment that tooth brushing is done should be bright. While tooth brushing, repeatedly looking teeth, between the braces and around the braces in front of the mirror will facilitate brushing for the patient. By looking carefully, it is possible to see food remnants and teeth can be cleaned detailed.

Oral hygiene can be provided in 4 stages for patients having orthodontic treatment.

First of all, all tooth surfaces should be cleaned with orthodontic tooth brush extensively as told by dentists,

At the second stage, residual remnants that tooth brush couldn’t reach should be removed with the help of interdental brush,
In the third stage, by using dental floss or preferably mouth shower, plaques remaining under gingiva should be cleaned,
In the Fourth stage, oral cleaning should be completed with mouth rinse containing fluor.

These four stages that should be performed, musn’t be considered as separately; every stage is completing each other.

Botulinum Toxin Procedures

 

With the opportunities provided by improvements in medical technology, we have arrived at an intersection of aesthetics and functionality. For people with severe teeth grinding, dentists recommend Botox treatment once every six months, in conjunction with night guard usage. Botox treatment consists of injections done to the chewing muscles (masseter muscle) located inside the patient’s cheeks. Thanks to these injections, the contraction strength of the chewing muscles decreases. Due to the decrease of this strength, forces on the teeth and temporomandibular joint also decreases. Botox injections are definitely not painful or disruptive. They result in no interruption to the person’s work, sport, or travel.

The most frequently asked question after receiving Botox treatment is concern  about the negative effect of chewing weakness in daily life. Botulinum Toxin treatment does not have any effect on the grinding strength of the chewing muscles during eating. The aim of Botulinum Toxin is to prevent the excessive force of tooth grinding that occurs after the chewing motion concludes. The force which is transferred to teeth during eating is almost one tenth of the force during grinding. Therefore, after Botulinum Toxin, patients can chew as before with the same comfort level.

Hi, my wisdom teeth are painful approximately for 5 years. I can’t have operation because of panic attack. I want to eliminate this problem in a safe clinic and with a sensible doctor. I will be glad if you can inform me about this issue..

Primarily, get well soon… As you told, your wisdom teeth problem can be solved by extraction. We can determine the exact position of the wisdom tooth inside the bone by using panoramic x-rays or three dimentional tomographies if required for those kind of operations and thanks to this, we complete the operation comfortably and without any stress both for the patient and for our doctors. By the help of experienced maxillofacial surgeons we solve the problems of our patients peacefully and without any pain in Dentway. Additionally, we want you to know that we can use sedation and general anesthesia for operations. Thus, you won’t feel anxiety.