Are there gentler alternatives to needles and drills?

You bet! For teeth requiring only a single filling, Dr Jones may be able to prepare a cavity for filling using air abrasion instead of a high-speed drill. This can reduce or eliminate a need for anesthetic. Air abrasion is a fine, narrow, highly controlled stream of abrasive powder propelled by compressed air delivered from a hand piece (below). The stream produces no heat or vibration. In dental applications, it eliminates the unpleasant “whine” associated with drills while the fine abrasive selectively and precisely removes decay.

Air abrasion was introduced in the 1950s, originally used for extremely delicate shaping in the aerospace industry and for cleaning priceless artifacts and prehistoric fossils. Thanks to recent advances in dental bonding materials, it’s now possible to fill small dental cavities prepared using air abrasion with strong restorative material and eliminate the unpleasant effects of high-speed drills.

• Air abrasion frequently means that no anesthetic (read, needles) is required.
• Its gentle abrasive stream can also remove stain and debris in those “nooks and crannies” of your teeth and enhance detection of any hidden decay.
• Air abrasion dentistry is especially effective for children, whose teeth often have natural fissures smaller than a single toothbrush bristle. These can be cleaned with air abrasion, then sealed to keep decay-causing bacteria from lurking where even the best brushing can’t reach.
• Air abrasion cleans and slightly etches (roughens) tooth surfaces in preparation for bonded (glued on) restorations such as crowns and porcelain veneers, resulting in a stronger, longer lasting bond.

Air abrasion is not always dental magic, however. In some cases, only high-speed drills or special cutters can perform the tasks necessary for restoration. Dr Jones does use air abrasion for its comfort benefits to her patients, and she will always suggest it when appropriate.

Finally, there is a moral to this story. (What else did you expect?) Good oral hygiene and regular dentist visits help reduce cavities and detect them early on when they can be filled quickly, often without needles and drills.

ARE DENTAL VENEERS RIGHT FOR ME?

Veneers are coverings placed on healthy front teeth that have become worn, chipped, or are discolored or poorly shaped. Veneers are a popular treatment for patients who don’t like their smile. Two types are available:

Porcelain veneers are thin shells of a very durable and stain resistant material fabricated to the patient’s desired shape and shade. A single porcelain veneer can match surrounding teeth. However, multiple veneers can be a means of brightening a patient’s smile. Dr Jones removes a small amount of enamel to make room for the veneers, makes casts, and then orders custom made veneers from a dental lab. At the next visit, she checks the veneers for proper fit and shade, adjusts them as necessary to the patient’s approval, then bonds them onto the prepared teeth.

Porcelain veneers are very natural in appearance and more resistant to staining than composite resin. In addition, porcelain veneers are a larger investment because they involve custom impressions in our office and fabrication by a dental laboratory technician. If a porcelain veneer fractures, another may be needed to replace it.

The backside of a porcelain veneer, made to fit over the prepared tooth and then be cemented in place.  Note that it widens, lengthens and reshapes the tooth		The front side, the veneerer as it appears in the patient’s mouth.

Composite Resin veneers are generally done at one visit and little or no removal of tooth structure is required. Dr Jones carefully bonds and sculpts properly colored composite material to create the desired result. The composite resin is hardened with a special light for one to five minutes and finished to look like a natural tooth.

Composite veneers are a smaller investment than porcelain since they usually require only a single office visit and no lab work. They are not as wear resistant as porcelain, but are more easily repaired and can be made to appear quite natural.

Little or no anesthesia may be needed for either process. Dr Jones can help each patient choose the best material for him or her. Prior to veneers, teeth must be healthy, free of decay and active periodontal disease. Dr Jones can treat these conditions prior to making veneers. Veneers are not recommended for patients who grind or clench their teeth because the veneers may chip or break. In this case, Dr Jones may suggest a plastic dental nightguard to be worn while sleeping. Just like teeth, over time, veneers can wear and need repair or replacement.

ARE MERCURY AMALGAM FILLINGS HARMFUL TO CHILDREN?

Two government funded clinical studies published in the April 19, 2006 issue of the Journal of the American Medical Association (jama.ama-assn.org) addressed this question. Based on results from both study groups of over 500 children each, the answer is, “No.”

Neither study found clinically significant evidence that brain, nerve or eye, nor kidney functions are affected, compared to same sized and age groups. Study groups received amalgam fillings while control groups mostly composite resin. Dr Timothy DeRouen, a University of Washington professor of biostatistics and dental public health lead a study of 507 children ages 8 to 10 in Portugal to determine if amalgam fillings containing mercury had any neurological effects. “We didn’t see any indications of harm to these kids, and we tested them repeatedly over seven years,” he said. In response to accusations from an advocacy group pushing to end the use of mercury in dental fillings that these studies were unethical, DeRouen said, “We weren’t doing anything experimental. We were giving standard dental treatment.”

Another study of 534 New England children ages 6 to 10 looked at amalgam fillings’ effect on intelligence, memory and other mental functions, and kidney function. Again, No effects were found. Lead researcher Dr Sonja McKinlay of the New England Research Institutes said she is confident that such fillings are safe for children in this age group, primarily because the youngsters were given far more amalgam than the average child gets.

Autism and neurological disorders weren’t studied, since autism wouldn’t be expected among the number of children studied and subjects with either condition would have been eliminated from the study. The National Institute of Dental and Craniofacial Research funded the studies. The Institute’s deputy director said, “From a scientific point of view, they give us confidence that these findings are not equivocal and their similarity suggests that the results are real.” The American Dental Association’s Dr Frederick Eichmiller stated ”This will give patients the reassurance they are making a safe and good choice.”

Amalgam fillings have been used successfully for 150-odd years. As a competent and conscientious dental practitioner, Dr Jones knows and informs patients that no dental treatment is entirely risk free. However, the risks of no treatment or of using untested or inappropriate materials are vastly greater.

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