Posted by mattdds on October 29, 2003, at 12:50:32
In reply to Re: Have you ever had strep throat? » mattdds, posted by tealady on October 28, 2003, at 4:27:03
Hi Jan,
I try to clearly delineate my problem with "holistic" dentistry, since it seems to be what you are advocating:
IT LEAVES US WITH NO TREATMENT OPTIONS EXCEPT EXTRACTION OF THE TOOTH.
There. Sorry, didn't mean to yell, it's just that people go to the dentist thinking that we are secretly hiding perfect, no-risk restorative materials, while meanwhile, willfully and deceptively, putting deadly toxins in the mouth by using all the bad materials.
I will be the first to acknowledge that some of the materials in dentistry, perhaps most, are toxic *at certain doses*, but toxicity is *dose dependent*. It frustrates me that people don't catch this concept - they just use a straw man argument by saying "mercury is toxic", or "fluoride is toxic". Yes, true. But they are leaving out the most clinically relevant point, THE DOSE!
>>I think cerec is a good idea, although the machine/computer software setup costs about $15,000AUD..presumably about US$10,000. The porcelain is not too wearing against other teeth as it is not coated (from what I've heard). My son had one of these done above his root canal.
Indeed, Cerec fabricated porcelain inlays / onlays are a decent treatment modality in certain cases. However I will point out some rather large drawbacks.
1. Marginal integrity is very poor and the likelihood of recurrent decay is high. On the other hand, amalgam expands, and the corrosion produducts actually *fill* the margins of the restoration, and recurrent decay is much less likely. The mercury and silver salts (which are not toxic - they're salts) also act as antimicrobials in the margins of the restoration.
2. In posterior teeth, I feel they should be contraindicated - mainly because of the poor resistance of porcelain to shearing forces (during mastication) - i.e. they fracture a lot.
3. They *do* cause a great deal of wear to the opposing dentition, this is undisputed by dentists. The gold standard for posterior occlusion is still metal - in terms of function.
>>The dentist I went to today reckons he won't use calcium hydroxide as it stops the bonding material (Optibond Solo) from working as well
He is right. There are better pulp capping agents available, and you can't bond to CaOH. Actually, the new thinking on pulp-capping is that CaOH is *not* unique in it's ability to induce reparative dentin formation. The formation of reparative (tertiary) dentin, is solely dependent on the establishment of a seal around the affected dentin, not a raising of the pH or an antimicrobial effect of CaOH as was currently thought.
The current standard of care for pulp capping is to actually leave a small amount of affected, demineralized dentin (using special burs) and coat it with a layer of resin-modified glass ionomer (RMGI) cement, such as Fuji. RMGI's actually *expand*, rather than contract, so it also helps to use this material as a cavity liner to help attain a better seal and marginal integrity. The study you cited does not show the whole picture, because RMGI's *do not need* to be acid-etched, which was the cause of irritation and subsequent failure of the pulp cap. If you do a pulp cap with only resin, it necessitates acid etching with phosphoric acid to open the dentin tubules for adhesion. This is not the case with RMGI's.
Using resins in posterior teeth and doing away with amalgam is going to make dentists rich! Why? We'll have to routinely replace them because they will get recurrent decay and / or fracture! I am telling you, even the best packable posterior composite will not average more than 5 years. A well placed, high-copper content amalgam will last up to 30. Resin *SHRINKS*, which opens up the margins and creates avenues for the re-entry of bacteria into the lesion. Amalgam adapts to the cavity margin, and continues to improve over the years - reducing recurrent decay.
>>I did have a naturopath atached to one dentist I visited do a http://www.holistic.co.nz/art4.html electroacupuncture
Please, get a second opinion, this has absolutely no scientific basis as a dental treatment, and in my opinion is malpractice.
>>Yep, I'm anti-amalgam AND anti gutta-percha
Again, I think you are severely limiting your treatment options, in some cases to extraction. Remember toxicity is *dose-related*, and the doses that dental amalgam introduces are insignificant clinically. 100+ years of experience makes it the most well studied treatment out there. Gutta percha is an inert material, biologically.
And BTW. Larry mentioned obturating (filling) root canals with MTA or Calcium hydroxide.
Hmm, good idea in theory, but let's think about this. When teeth are endodontically treated, they typically need a post, core and a crown, either because the tooth is extensively decayed to begin with or because of the endodontic access that is necessary for the procedure.
The problem with using MTA or any other "hard" material for canal obturation, *is_that_you_cant_drill_it_out* of the canals when it comes time to make your post and core. So why bother doing the root canal in the first place? You have performed a great seal on a tooth you can no longer restore! Worthless.
Gutta percha can be reamed out with instruments, MTA (or Ca hydroxide) cannot - so it is a nice idea, but makes no sense in the overall treatment plan.
>>wrap the nerves
I have no idea what this means.
>Oldest son had one fissure sealant done.. think probably the whole just kept growing underneath.
This is an unfortunate anomaly. But overall, sealants are near miraculous in their ability to prevent occlusal caries. Again, this is not in dispute between any credible groups of scientists.
>>My son had a root canal done with this (I think)
I seriously doubt it. He probably had a *pulp cap*, which is entirely different as the pulp is not exposed or minimally exposed, and is performed on *vital* teeth.
I hope you see that the story is a bit more complicated than you may have thought. We don't have any perfect restorative materials. We do have better alternatives to tooth loss, in the opinion of most. But if you choose to be anti-whatever, you can make that informed choice yourself. I just hope you listen to science, and not to scaremongers.
Dentistry is like any other branch of medicine, the treatments carry (usually small, sometimes insignificant) risks, and good prognosis for improvement. People, it seems, tend to expect much more out of dentists than physicians (especially psychiatrists!). They want nothing less than perfect, completely non-toxic materials, to be out of pain instantly, with no treatment risks. Whereas a patient will have no fault with the physician for inducing tardive dyskinesia for using antipsychotics (and at least this is an undisputed, specific adverse event, not some vague, psuedoscientific "syndrome" caused by amalgam or fluoride in people that sometimes tend to self-diagnose because they have unexplained symptoms).
With all the "anti-s" you have, you are really leaving no other alternative than extraction, in many cases.
If this is the case, I suggest you take *tremendous* care of your teeth. This really is more important than fluoride, sealants and such. Mechanical removal of plaque with a toothbrush and floss are irreplaceable, and the most important part of prevention.
Happy smiling :)
Matt
poster:mattdds
thread:272970
URL: http://www.dr-bob.org/babble/alter/20031023/msgs/274650.html