Sedation Dentistry for Anxiety & Phobia Toronto – Questions about Silver or White Fillings, Gum Health, Dental Anxiety

Q: What is the Difference Between Silver Fillings and White Fillings?

Dental amalgam (silver and mercury filling) has been used in dentistry for over 150 years. It consists of approximately 50% silver and 50% mercury with trace amounts of other metals such as copper and tin. These proportions slightly differ depending on the type of amalgam being used.

This restorative material has a number of important advantages. It is very durable and once placed may last 20-25 years. It's easy to work with, less expensive and offers good insulation for the nerves of the tooth.

Disadvantages primarily center around the fact that amalgam is not an esthetic looking material to many people. Another disadvantage and concern that has been expressed is that minute amounts of mercury vapor are released with chewing. Some of this mercury may be absorbed by the body. Following many years of experimentation, there is no scientific evidence that dental amalgam causes any illness. In fact, Health Canada considers it safe and effective for most people. Like many substances however, there are a small number of people who are sensitive or even allergic to dental amalgam. If this is a concern, it should be mentioned to your dentist.

Health Canada has issued two statements of interest. The first is "whenever possible, amalgam fillings should not be placed in or removed from the teeth of pregnant women". Mercury is vaporized as old amalgam fillings are removed. This mercury can subsequently be absorbed by the body. As well, mercury does cross the placenta. The second statement recommends that "non-mercury filling materials should be considered for restoring the primary teeth of childre when suitable".

To put all this into perspective, a study appeared in the Journal of the Canadian Dental Association in 1999. This paper suggested that a person would have to have 490 dental amalgam fillings for enough mercury to be released to meet the maximum exposure guidelines.

Finally, caution should be exercised if one decides to haphazardly remove sound amalgam restorations. Much more mercury vapor is released from the removal of these fillings than is released from chewing.

The most popular alternative to dental amalgam is composite resin also referred to as white fillings or bonding. Over the past 25 years, these materials have been constantly evolving such that today, they are stronger, easier to work with and more esthetic then they have ever been.

The most advantageous property of these materials is that they are tooth-coloured and as such are available in a wide range of shades to match different shades of teeth. They are thus extremely esthetic, usually completely invisible even when placed on a front tooth.

On the down side, they have only recently been strong enough (both in compressive strength and insulation ability) to be able to be used in back teeth. These are the teeth that bare the greatest stress from chewing. A composite resin in a back tooth may last 5-10 years. These materials are time consuming and difficult to work with. As well, they are more expensive for the dentist to purchase. For these reasons, the professional fee for a composite resin filling is higher than the fee for a dental amalgam filling. Finally, over time, composite resins are prone to secondary decay around its edges.

Other alternatives to fill cavities besides dental amalgam and composite resins are gold and porcelain. The situations for which these materials would be beneficial are more limited. They are very time consuming to place and thus more expensive. However they are extremely precise and offer the most superior durability

Q: Do I have healthy gums?

Take this test to find out if you have healthy gums.

Go to a well lit area where there is a mirror. Look at your gums where they meet your teeth and answer the following questions:

•What colour are your gums? If they are pink, they are healthy. If they are darker red or purple, they are not.
•What shape is the gum tissue between your teeth? Do they come to a point or are they flattened or crater
shaped? If they come to a point they are healthy. If they are flat or crater shaped, they are not.
•Do your gums look swollen and do they bleed? If they do, you likely have gum disease.
•Do you have chronic bad breath? If you do, one possible source is from bacteria that causes gum disease.
•Are any of your teeth loose? If they are, this is a sign of progressive gum disease.
•Have the gums receded from around your teeth and/or do your teeth appear to be longer than they used to?
If this is the case, you may have gum disease.
•Are your teeth drifting to different positions in your mouth? This may indicate that the anchorage (ie: bone)
is not as strong as it once was and this may indicate gum disease.

If any of your answers to these questions points towards the possibility of having gum disease, talk to us. This disease is easily corrected if treated in the early to moderate stages.

Q: I had some bad and painful experiences with dentists. I want healthy teeth, but I’m afraid of dentists.

In many people's eyes, dentistry has the reputation of being anything but pleasurable. This may not be unfounded.

A big contributor to this reputation is that years ago, pain control in medicine and dentistry was not nearly as profound as it is today. Many people in their fifties and older recall painful visits to the dentist.

Some people resent the loss of control that may occur while in the dental chair, not to mention that the mouth is a sensitive and intimate place for someone to be poking around.

A study done at the University of Toronto published in January of 1999 classified 16.4% of patient suffering from dental anxiety. Other studies have put as high as 21%.

It is interesting that those who are generally anxious have an increased risk of suffering from dental phobia and that people who are dental phobic, avoid dental treatment and therefore have a higher degree of dental disease.

Good dental health results in part from regular checkup and hygiene visits. The longer these visits are put off, the more plaque and tarter builds up on our teeth and this results in bacteria living around our teeth and gums. This leads to tooth decay (cavities) and gum disease ( gingivitis and/or periodontitis).

Our staff practices compassion and empathy while minimizing waiting, going slowly and explaining the unknown if an explanation is desired. Some anxious patients would rather not know the details of what is happening, and we understand that.

Some people have fears so deep that more is needed to allow them to even enter a dental office. This is where pharmacology comes in handy. Many dentists will prescribe an oral sedative to be taken half an hour before an appointment.

People who have a higher level of anxiety will require a deeper sedative technique to help them through their appointment.

When carried out by trained individuals, intravenous sedation is a very safe and effective means of anxiety relief during dental treatment.