Safe Practices in Dentistry: Out with the Old in with the New

Having recently published a post regarding the dangers of amalgam fillings, I was eager to further explore the web for related topics in dental medicine. In particular, I decided to search the blogosphere for topics that focus on the alternative and more efficient techniques that professionals are using to ensure quality care and safety for their patients. As a dentist in the making, it is critical to gain a comprehensive understanding of the current trends in all areas of dentistry so that I am able to effectively employ them with my own patients in the future.

The first post I came across was within The Endo Blog entitled Research Update: Direct Pulp Capping with MTA. The blog was created by Dr. Edward Carlson D.D.S and Dr. Jason Hales D.D.S., M.S., two endodontists with training from West Virginia University. Apparently, endodontists are now using a Mineral Trioxide Aggregate as a direct pulp capping agent (see picture to above), which appears to be a safer and more successful material. It was refreshing to see that the experts in the specialty fields of dentistry are not the only ones starting to engage in new and improved technological advances; general dentists are also getting involved. The other post that interested me was within Glen Ellyn’s blog, Smile. Dr. Ellyn, pictured below, is a high tech dentist with more than 27 years of experience in cosmetic, sedation, and implant dentistry. On a more general level, his post entitled Dentists Using Dangerous Dental Labs, appropriately warns consumers to inquire about the origin of their fillings, dentures, and veneers due to a recent discovery of dangerous levels of lead found in porcelain dental crowns. I have offered a few comments to both posts, and have also placed them below for your convenience.Comment: (Research Update: Direct Pulp Capping with MTA)

Although I am naïve to the field of endodontics, I found your post intriguing because, on the other hand, I am very aware of the issue involving the health hazards of certain materials used in dental work. It was only recently brought to my attention that harmful substances are found not only in fillings, but in dentures, veneers, and in capping agents as well. From my understanding, MTA is a type of cement that is easy to use, more predictable than traditional materials used for capping, and more importantly, safe for the patient. As I am sure you are aware, many practitioners are unfortunately reluctant to incorporate the use of newer and safer material in their practices, so the inclusion of the data that supports the use of MTA as a direct pulp capping agent is appropriate and necessary in your post. You state that, “Over a 9 year period of observation, the authors found that 49 of 53 teeth had a favorable outcome on the basis of radiographic appearance, subjective symptoms & cold testing,” which seems remarkable. Since practitioners are trained to rely solely on evidence based dentistry and medicine, it might be beneficial to include additional cases similar to the study in your post to sell other dentists on this new product. Regrettably, the fact that it can do wonders for the patient, by inducing cell proliferation, cytokine release, and hard tissue formation, is still not enough to convince all professionals to use MTA. As you have mentioned, it can also potentially be used by a wide variety of specialists and general dentists, which should also add to the benefits of MTA and encourage its use. My question to you is, how can other specialists besides endodontists employ this material? I am curious to know because, although I do not expect to enter the field of endodontia, I want to integrate the best and safest materials in my own practice in the future. By informing dentists of all types about the applications of MTA, perhaps more MTA will be put to use, making the dentist’s job easier, which could ultimately yield more successful and safer outcomes.

Comment: (Dentists Using Dangerous Dental Labs)

First, I want to say that I think it is excellent that you are making the public aware of the potential harmful consequences resulting from toxins that may be found in their dental repair components. Your brief post regarding this topic was the only one I encountered in my exploration throughout the blogosphere. It is unfortunate that other professionals are not showing as much concern for their patients’ safety. This issue was brought to my attention after recently publishing my own post regarding the health hazards of amalgam fillings. Reading the research on the subject of the consequences of mercury within these restorations and how some dentists are reluctant to discontinue their use was disturbing. It was even more appalling to read in your piece that this is not only an issue with fillings, but that there are also dangerous materials within caps, crowns, dentures and veneers. The fact that millions of dental prostheses are actually made in labs in China, India, the Philippines, Mexico, Eastern Europe, and Costa Rica is also new to me. There is no question that the United States is one of, if not the most, technologically advanced countries in medicine and research. Do you agree that dental products and supplies could be made safer if manufactured under the eye of the prestigious professionals within our nation, or even under the scrutiny of the FDA? The inclusion of more stories in future posts, similar to the account of the woman being sickened by lead-tainted dental work from China, may sway more experts and dentists into adopting some method of policing the dental components utilized in this country. I certainly concur with you when you state, “It is unfortunate that many dentists who have felt the pressures of managed care and rising costs are reducing the standard of care by using dental laboratories that may not meet the standard of professional care that patients deserve.” I enjoyed reading your post, and hope you find a moment to respond to my comments. Thanks for your time.

Amalgam Fillings: Danger to those in the Dentist Chair and Behind it

Despite the fact that the World Health Organization declared that a safe level of mercury exposure has never been established, dentists are still giving patients mercury-containing amalgam fillings. Although amalgam fillings are durable and strong, the potential harmful side effects that can result from the mercury within these dental restorations should be a sufficient reason to band these fillings from all dental practices.

Several government and medical studies have concluded that amalgam fillings (see picture to below), which contain 50% Mercury, are the number one source of human exposure to this toxic substance. Mercury has been proven to damage DNA, impair kidney function, and induce autoimmune and neurological diseases, like Multiple Sclerosis and Parkinson’s disease. Dr. Kourosh Maddahi, a Beverly Hills biological dentist claims that, “A wide range of problems have been associated with mercury poisoning such as chronic tiredness, digestive problems, muscle and joint aches, and stiffness and sinus troubles,” Other signs and symptoms associated with mercury poisoning include tension and migraine headaches, hair loss, asthma, allergies, and eczema. There are several stories posted on the web that cover patients’ experiences with overcoming these side effects. Daniel Lewis, a former varsity athlete in Portland Oregon, said that two weeks after the removal of his amalgam restorations, his nose bleeds, neurological moods swings, and paranoid thoughts immediately ceased. Chuck Balzer of Lincroft, New Jersey, was misdiagnosed with fibromyalgia because he suffered complaints of lower leg pain, exacerbating arthritis, and fatigue. Once he took the advice of the right general practitioner who recommended he remove his amalgam fillings, he noticed that his overall health dramatically improved.

It is quite disturbing that these types of fillings are still in use, especially after the publishing of over 100 scientific papers linking mercury poisoning with amalgam fillings. What is even more appalling is the fact that the well-known and respected American Dental Association recently published an article that labels any dentist who removes amalgam restorations unethical. The European Union scientific committee recently stated in a similar bulletin that, "No risks of adverse systemic effects exist and the current use of dental amalgam does not pose a risk of systemic disease.” Unfortunately, comments from certain “trustworthy” organizations appear to be persuading practitioners that these fillings are safe.

If the risk to the patient’s safety is not enough to completely dissuade dentists from amalgam fillings, perhaps the consequences mercury can have on the practitioner’s health will be sufficient. Scientific data has revealed that dentists who use these restorations have double the number of brain tumors and perform less well with respect to neurological function tests than dentists who do not use fillings containing mercury. It would be beneficial for dentists to take advantage of the several technological advancements in dental medicine, and become more adamant about promoting the use of alternative methods and materials, for both their own safety and the patient’s. Some new techniques are not only safer, but more efficient and less painful. Using a dental laser instead of a drill to fill cavities is a less invasive technique. Gold fillings, although not aesthetically pleasing, are very durable like amalgam, but less dangerous. White fillings, otherwise known as composite fillings, are smaller than amalgam fillings and require less tooth preparation. They also make the tooth stronger, and less sensitive to temperature changes in the mouth. Resin ionomers is another option. They offer a more natural appearance and contain fluoride, which protects the tooth from future decay. According to Dr. Maddahi, “It is impossible for dentists to say who or who will not manifest overt symptoms of chronic mercury poisoning,” similar to how physicians cannot always determine which patients may react defectively with certain medications. This should further encourage dentists to use these other types of fillings that are guaranteed to fix dental caries and simultaneously maintain the wellbeing of the patients. .

Regrettably, the extensive evidence on the dangers of amalgam fillings and the emergence of new technology is still not enough to completely discontinue their use. Furthermore, since there is also a lack of regulation from the government and other health organizations, it seems as though the only other source that could possibly provide a solution to this recurring issue may be the patient. While some are more prone to cavities than others, like smokers, chemotherapy patients, sufferers of Sjogren Syndrome, and those who have dysfunctional salivary glands, there are still ways to prevent the development of caries (see picture to right). Simply by avoiding sugary foods, and brushing and flossing three times a day, individuals can maintain good oral hygiene, which may save a trip to the dentist, a few hundred dollars, and allow an individual to steer clear of receiving fillings altogether. Nevertheless, it is still unfortunate that patients may need to guard their safety solely by themselves, instead of being able to entirely rely on their practitioner.

The harmful side effects of amalgam fillings, which have been recognized for several years, should make their use unacceptable. More dentists and organizations need to take a stance like the American Academy of Head, Neck and Facial Pain, who feels that, “The evidence is too overwhelming to continue to practice in ignorance and avoidance of the facts.” Though some dentists have taken the appropriate actions and attitude towards these mercury-containing restorations, some is not enough.