Dentiste Wigger Tasman

Dental hypnosis: The royal road to freedom from fear of the dentist.

Our practice offers care in all areas of dentistry, excluding orthodontics:

• Dental hygiene and prophylaxis
• Dental care for children
• Conservative care and cosmetic treatments
• Periodontal care
• Surgery
• Implants
• Fixed and removable dentures
• Dental hypnosis

 

Should amalgam fillings be replaced?

While the noise surrounding the controversy has died down considerably, a few years back there were some very lively, high-profile discussions about the supposed evils of dental amalgam. The subject is complex, and it's difficult even for professionals to form a balanced opinion. This is not helped by the fact that, on both sides, certain opinions sometimes take on an almost ideological air. The conclusion to be drawn from this is that a universally accepted unity of doctrine does not yet exist.

The alternative material to amalgam is composite resin (known as " composite "). This material, which is tooth-colored, does not have the same biological and biomechanical properties, and therefore also does not have the same advantages and disadvantages as amalgam.

The main points to bear in mind here are

The main points of comparison between amalgam and composite are as follows :

Amalalgam                                            Composite

1) unsightly                                                        1) aesthetic

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2) better wear resistance                                2) lower wear resistance

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3) contains potentially toxic mercury            3) does not contain mercury

4) may cause electric currents in the mouth       4) does not cause phenomena

                                                                            electrical

5) does not adhere to tooth                                            5) adheres to tooth

6) inhibits bacterial growth                          6) does not inhibit bacterial growth

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7) expands over time                                           7) contracts when the material is taken

8) associated with lichen planus (a mucosal disease)      8) not associated with mucosal diseases

9) would cause allergies in some cases ( ?)                9) potentially causes allergies

10) simpler in-mouth handling                           10) more delicate in-mouth handling

A health hazard ?

A large percentage of the population has been wearing dental amalgam in their mouths for many years, and without experiencing the slightest problem. We can therefore consider that - biologically speaking - this material has provided proof that it is well tolerated by a majority of people. With this in mind, the US Food and Drug Administration (FDA) considers that, to date, there is insufficient scientific evidence to advise against the use of amalgam in general. It maintains this opinion even for pregnant women and children. (www.fda.gov/cdrh/consumer/amalgams.html - in English)

Although they are largely in the minority, there are nevertheless cases where amalgam is the cause of health problems. This has prompted health authorities in Norway to ask dentists to stop recommending amalgam to their patients. In Sweden, amalgam has even been banned for children and teenagers.

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There are clearly two contradictory attitudes here, which refer each person to his or her own appreciation. In the case of lichen planus (a disease of the mucosa) in contact with dental amalgam, removal of this material is recommended.

As for lichen planus (a disease of the mucosa) in contact with dental amalgam, removal of this material is recommended.

In the case of lichen planus, removal of the material is recommended.

As for mercury poisoning, all possible symptoms are aspecific, and could also have other causes. So we don't know in advance whether amalgam is the culprit in the story. It's only after the amalgams have been removed that we can assess whether any improvement has been achieved.

A wide variety of health problems have been associated with mercury poisoning from dental amalgams, starting with chronic fatigue and mood alterations, through to sleep disorders, various neurological, immunological and cardiovascular disorders, as well as gastrointestinal and respiratory ailments (asthma). In children, hyperactivity, neuropsychological delays and even autism have been cited. It's worth pointing out here that these assumptions are not unanimously supported by the scientific community. If health problems of the types described could not be explained otherwise, the elimination of amalgam fillings may be worth discussing.

Crunching on a rock

Aside from its lack of aesthetics, which hardly requires comment, dental amalgam has another major disadvantage in practice, which is less often heard of.

Amalgam doesn't stick to the tooth surface at all. If it holds, it's only because it's been given a crooked shape. So when you bite down on an amalgam filling, it's a bit like biting down on a pebble, which separates the two halves of the tooth without holding them back. This explains why small or large cracks can be detected in the majority of teeth from which old amalgam fillings are removed. And it is indeed relatively common for a tooth refilled with amalgam to break after some time.

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In contrast to amalgam, composite adheres strongly to the tooth. This means that it simultaneously solidifies the different parts of the tooth by bonding them together. It is much rarer for a tooth repaired with composite to break than with amalgam. And even in these rare cases, the fracture is usually far less dramatic. These findings regularly lead us to suggest replacing amalgam fillings with composite, to prevent dental fractures.

The wear resistance of composite resins has improved significantly in recent years. As a result, composite is now tending to supplant dental amalgam. However, in certain special cases - which are becoming increasingly rare - amalgam can still find an application.

In our practice, we do not offer the systematic removal of all old amalgam fillings. In this respect, we would also point out that exposure to mercury is much greater when an amalgam is removed than when it is worn in the mouth. However, when an amalgam filling has to be changed anyway, composite resin is generally the preferred replacement. We sometimes suggest replacing an amalgam filling with a composite to prevent tooth fracture. In certain cases of health problems - much rarer - the systematic removal of all amalgams may be discussed.

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Sensitive teeth : advice in a nutshell

- Consult a dentist to rule out cavities or other problems requiring treatment

- Adopt a proper brushing technique, and use a soft toothbrush

- In case of enamel wear, any teeth grinding should be treated

- In case of acid reflux from the stomach, consult your family doctor

- Avoid consuming acidic food and drinks repeatedly

- Don't brush your teeth immediately after consuming acids ; rinse with water, or better, milk ; brush only after about 30 minutes

- In the case of very pronounced sensitivity, apply a slightly acidic fluoride gel (Elmex® gelée) to the tooth concerned before consuming acids

- Use a soft toothbrush and special toothpaste, and possibly a mouthwash for sensitive teeth

Why can teeth be sensitive ?

Teeth sensitivity to hot and cold, when sucking in air, or to sweetness, is a relatively common phenomenon. It can originate from decay, receding gums, worn enamel, or hypersensitivity of the tooth's nerve for other reasons.

It is also advisable to consult a dentist in the event of dental sensitivities, if only to rule out the presence of a cavity or other lesion that would require treatment.

The part of the tooth that is normally visible in the mouth, the crown, is covered by a layer of enamel. Beneath the enamel is another hard tissue, called the dentine. In the center of the dentin is the pulp of the tooth. Among other things, the pulp contains nerve fibers and blood vessels. Dentin also forms the bulk of the root, by which the tooth is fixed in the jaw.

While tooth enamel is relatively watertight, dentin is porous. In fact, there are tiny microscopic canals (the " tubuli dentin ") running through dentin from the inside to its outer surface. Nerve cells in the pulp inside the tooth have extensions that enter these canals. If the dentin becomes denuded, the nerve can therefore have direct communication with the tooth surface, which explains the tooth's eventual sensitivity.

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Remember, however, that even in the case of one of these lesions, teeth by far do not always present sensitivities. The absence of pain or sensitivities is therefore no guarantee of healthy teeth.

Remember, however, that even in the case of one of these lesions, teeth are by no means always sensitive.

Finding and treating the origin

If a tooth presents troublesome sensitivity, it's most often because the dentin is exposed. Once the presence of decay has been ruled out, it is first necessary to stop the process that is causing this denudation of dentin.

Gum removal

As the years go by, gums tend to recede. However, this process can be greatly accelerated by inadequate tooth brushing technique. In particular, avoid using a hard toothbrush, and avoid brushing back and forth across the gums. Once the gums have receded, they will never return to their original level. Ask your dentist or hygienist to show you a correct brushing technique.

Enamel wear

If sensitivity is caused by enamel wear, the origin may be erosion by acidity in the mouth, teeth grinding, or a combination of both.

The erosion of teeth is caused by acids that come from food and drink, or from the stomach in the case of acid reflux or frequent vomiting. To prevent this phenomenon, follow the advice specified on the following page.

People who grind their teeth are generally unaware of it. It's an activity we perform unconsciously, and most often during sleep. When we grind our teeth, we can apply forces that far exceed the maximum forces of chewing, which can cause muscle and joint problems, as well as fractures and tooth wear.

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To avoid teeth grinding, there are two possible strategies :

- Making a mouthpiece to wear at night, which prevents the upper and lower teeth from touching

- In some cases, good results can be achieved with hypnosis

 

Avoiding sensitivity

Teeth sensitivity is often variable over time. This is due to the fact that dentin porosities on the tooth surface may be more or less open or blocked. To reduce sensitivity, demineralization (= opening of porosities) must be avoided, and remineralization (= closing of porosities) encouraged.

The tooth is demineralized by acids. These acids come from food and drink, or from the stomach in cases of gastric reflux or frequent vomiting. If the acidity comes from the stomach, contact your family doctor so that appropriate treatment can be offered.

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At the dietary level, it is recommended to reduce especially the frequency of acid consumption. These acids are typically found in vinegar, fruit and fruit juices. The consumption of certain fruits and their juices (especially grapefruit) requires particular vigilance, as their residues remain acidic in the mouth for a very long time. Avoid repeated consumption of these foods.

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After consuming food or drinks with lots of acids, it's advisable to brush your teeth right away. Acids actually weaken the tooth surface, and brushing at this point can cause erosion and increased sensitivity. Instead, it's recommended to rinse the mouth with water, or even better with milk, and brush the teeth only after about 30 minutes.

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The most effective way to avoid sensitivities is to use a paradoxically slightly acidic fluoride gel, such as Elmex® gelée. Apply this gel with your finger to the teeth concerned just before consuming acids. Thanks to its slight acidity, this gel binds with saliva, forming a protective layer that sticks to the tooth like a blanket. This prevents the acids in the food from reaching the sensitive areas. Since this method is relatively inconvenient, it is generally reserved for cases of very pronounced sensitivity.

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In general, but even more so in cases of tooth sensitivity, it's best to use a soft toothbrush. The brush can also be placed for one or two minutes in warm water just before brushing, to soften the bristles even more. It's best to use a toothpaste that's not too abrasive. Toothpastes specially designed for sensitive teeth are available from a number of brands. Various mouthwashes for sensitive teeth can also be beneficial.

Remedy sensitivity

If good preventive measures are observed, tooth sensitivity often diminishes spontaneously after some time.

There are a variety of products that the dentist or hygienist can apply to tooth surfaces to reduce sensitivity. In our experience, most of these products give variable, and more or less conclusive, results. In general, we apply a fluoride lacquer, which is very often effective. Sometimes, a laser can also be used to reduce the sensitivity of dental surfaces.

If the sensitive surface also shows a loss of substance due to erosion, a filling of this defect with a composite resin can be considered. This resin covers the tooth tightly, and can thus remedy the sensitivity.

In some cases, a gum graft may also be used to cover a sensitive root surface. This treatment is more likely to be chosen if removal of the gum also poses an aesthetic problem. Often, coverage of the exposed surface remains more or less incomplete if this method is applied.

In very rare cases, and particularly after periodontal treatment, it may be necessary to decide to devitalize a tooth because of its sensitivity. This option will only be considered if all other attempts to remedy the problem have failed.

 

Why is it necessary to treat baby teeth ?

 " Why treat baby teeth, if they're going to fall out anyway? " That's a question we're often asked.

There are several reasons why it's important for baby teeth to stay in place and in good condition until the time comes for them to give way naturally :

-  maintain the space so that the permanent teeth can fit into the right place

-  avoid damage to permanent teeth

- avoid pain and infectious risks

-  maintain masticatory function and enable language learning

Maintain space for permanent teeth to come in properly

In general, teeth always tend to move forward if there's nothing in their way. If a baby tooth has to be extracted prematurely from the side - which would normally only fall out at the age of 10 to 11 - the first permanent molar, which has already grown in by the age of 6, moves forward into this empty space. This prevents the tooth that should replace the extracted tooth from emerging properly. To remedy this situation, complicated, time-consuming and costly orthodontic corrections will be indispensable.

Avoiding damage to permanent teeth

The germs of permanent teeth lie very close to the roots of baby teeth. If a decayed baby tooth develops into an infection, it can irreparably damage the permanent tooth.

Preventing damage to permanent teeth

The germs of permanent teeth are located very close to the roots of baby teeth.

Avoid pain and risk of infection

If decay in baby teeth is left to develop untreated, it can at some point reach the nerve of the tooth. This doesn't always cause complaints, but the child may also suffer violent pain. The treatment of the tooth itself is at this stage more complex, and it is obvious that it can be difficult, if not impossible, to carry out properly in a child who is in pain, and who is moreover often exhausted by the pain.

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If the decay reaches the nerve of the tooth, the child is often not in pain at all. A tooth in this condition, however, becomes infected. It can cause an abscess in the mouth, which can sometimes be dangerous. In all cases, the tooth is a gateway for bacteria to enter the body. This can cause health problems even in an entirely different part of the body.

Maintaining masticatory function and enabling language learning

Our teeth are used for chewing. Chewing doesn't just grind up food, it also mixes it with saliva. This is an important first step in digestion. Saliva contains substances (enzymes) that already begin to break down the chemical structure of food in the mouth, enabling the body to absorb it properly later on. If we can't chew properly, we'll tend to swallow food " all round ", which is detrimental to the body.

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In little ones, the presence of milk teeth is also important for language development.