FAQs Continued..

Composite vs. Silver Amalgam
Many dentists no longer offer silver fillings; however, white (composite) fillings end up costing more money because the insurance only covers the amount of silver filling. What are the benefits of using composite fillings?

Many people think that insurance companies always do what is in their best interest. In actuality, the insurance companies are bound to only pay what the patient's employer allows them to cover. Insurance companies will usually pay an allowance towards a treatment that exceeds the cost of their "accepted treatment." 

The decision as to what is best for the patient should always be a decision between the dentist and the patient. The following are several advantages to composite fillings that have prompted many dentists to switch away from amalgam. 

  • Composites bond to the tooth structure. So when a composite is placed, it actually forms a union with the tooth, thereby reinforcing the entire structure that has been damaged by decay or fracture. Unless special bonding agents are used, amalgam just fills in the hole in the tooth and does not reinforce the structure.
  • Composites are smoother than unpolished amalgam. Thus, they are easier to clean.
  • Composites are a resin material, and when bonded correctly, they are less sensitive to cold than metallic amalgam. This eliminates the need for weaker insulating base materials.
  • Composites look better and do not cause a gray shadowing through remaining tooth structure.
  • Modern composites have wear characteristics that are very similar to amalgam.
  • If a filled tooth needs a crown, an existing composite filling will usually provide a more secure substructure for that crown.


It is true that composites cost more than amalgams, but that doesn't necessarily mean they are more profitable for the dentist. It takes about three times longer to place a composite than an amalgam, and the materials are quite expensive. In my office, I find that composites are less profitable than amalgams; therefore, profitability is not a factor in my treatment recommendations.

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Dental Care For The Elderly
An 88-year-old woman is presently having dental problems with 5 existing loose teeth (bottom), and has a dental plate on top. There is not a lot of pain involved but it's becoming difficult for her to chew. Could you suggest how she should go about seeking out treatment in a rural area and other considerations regarding her treatment?

There are many considerations in treating the elderly. Most dentists can treat the elderly the same as their regular patients; however, the medical history must be carefully reviewed. Treatment and postoperative care must be modified to suit the health needs of the patient. In this scenario, since the teeth are loose, extractions would not likely be difficult. Single rooted front teeth are much easier to remove than multi-rooted back teeth. Many elderly people are on blood thinners and some take antibiotic premedication due to heart valve abnormalities and/or joint replacements. Other medical considerations include angina, irregular heart beat, and obstructive pulmonary disease. Local anesthetics used for most dental procedures are extremely safe and effective in treating minor surgical cases. Other precautions can be outlined at the initial consultation visit, based on the findings of the dentist. 

You mentioned that chewing was becoming difficult. This may lead to digestive problems since the food has not been thoroughly masticated before swallowing. So it does sound like treatment would be beneficial. When only five loose teeth remain, most often an immediate denture, or implant retained denture will be recommended. That means that all the steps leading up to the denture will be done prior to the extractions so that the denture can be delivered the same day of the extractions. This denture will then be modified several weeks later to adjust for the changes that occur during healing. It is usually better to make a new upper and lower denture at the same time, especially if an existing denture had been made to fit against an opposing arch of irregularly positioned remaining teeth. 

Dentists are not always evenly distributed throughout the state, but a qualified dentist can usually be found within a comfortable driving distance from home. I always suggest that patients ask others in their area for a referral to a dentist they are happy with, check with the Michigan Dental Association's website at smilemichigan.com for a list of dentists, or call a local dental laboratory for a referral to a reputable dentist in the area. Some dentists will handle all phases of treatment and others may refer to a specialist, such as an Oral Surgeon or a Prosthodontist, for parts of the treatment. I have found that many elderly are reluctant to spend money on their dental treatment, saying they are too old to spend that much money. I usually respond to them by saying that they are too old to spend each day of their life uncomfortable or displeased with the way their teeth look. Seniors deserve a happy healthy smile just like everyone else! 

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Dry Socket
What is a dry socket?

When a tooth is extracted, the space left in the bone has to begin healing. The first stage of that healing is the formation of a blood clot. The formation of a blood clot can be disturbed by smoking, or in the first 24 hours, sucking through a straw, rinsing too vigorously, or spitting. Premature breakdown, or loss of the normal blood clot, leaves the bone in the socket exposed causing pain and odor usually 4-5 days after the extraction. The treatment for a dry socket includes placement of a medication and/or inducing bleeding to form a new clot. Local anesthetic is usually used during the treatment, and treatments may have to be repeated more than once. 

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Extractions
The decision to remove a tooth that has the ability to be saved shouldn't be taken lightly, even if you have others to chew with. There are several consequences to the premature tooth loss of permanent teeth, and these are listed below: 

1. The removal of a tooth will cause the bone to begin shrinking, since the stimulation of the bone by the root of the tooth is what prevents the bone from shrinking. The shrinkage of the bone that previously surrounded a tooth, can change the way the face and cheeks are supported from underneath. 
2. Other teeth will shift into empty spaces. This can cause changes in the bite and make the remaining teeth more difficult to clean. 
3. When one tooth is lost, the remaining teeth have to take on the work of that missing tooth. This causes extra stress on the remaining teeth. 
4. Upper and lower teeth work together as biting partners. If one of them is lost, the other may move either up or down into the empty space. This can throw off the bite. 

Sometimes there is no choice but to have a tooth extracted. When there is no alternative, replacing the tooth with a dental implant is the best choice for preventing these complications. 

Q1: "I had to have a back tooth extracted. My dentist tells me I should replace it. Why does it need to be replaced?"

A1: Although you may not require replacement for cosmetic reasons, there are functional reasons to replace missing teeth. Your teeth work together as a team, and if you lose one team member, it can affect the remaining teeth in a negative manner. Specifically, the teeth in front of the space and behind the space can move or 'drift' into that space over a period of months or years. This can negatively change your bite pattern. Also, the tooth opposing the extracted one can drift into the space created by the extraction. Remember, most people that end up with dentures did not lose all of their teeth at once, but lost them occasionally, and then failed to replace them at the time of each extraction. 

Q2: "My dentist has recommended I replace an extracted tooth with a bridge or a partial denture. What are those?"

A2: A bridge is a replacement tooth that is attached to the teeth on either side of the space of the extracted tooth. It is fixed into place, meaning it is not removable. It can be attached in many different ways, but most frequently some type of crown is placed on the adjacent teeth, and the replacement is attached to that. A partial denture is a replacement tooth (or teeth) that has flexible hooks, or clasps, on the other teeth. It is removable, which means you can take it in and out. 

Q3: "My wisdom teeth are in part-way and have been that way for over a year. They don't bother me, but my dentist says that they should come out. Do I get them removed?"

A3: The answer to this question is rather simple. If the wisdom teeth cannot be cleaned by normal means, then they are better off being removed. A partially erupted wisdom tooth (3rd molar) cannot be cleaned because the flap of gum tissue partially covers the surface of the tooth. However, the bacteria in plaque can easily access the tooth that is hiding under the flap of tissue. This will cause decay, inflammation of the gums, and will often cause a puss-producing infection. The most important thing to realize is that what is happening in one part of the mouth DOES affect the health of teeth elsewhere in the mouth, especially the 2nd molars directly in front of the 3rd molars. Breath odor, and a bad taste in the mouth, can also be caused by partially erupted 3rd molars. So, unless there are risks to removal that exceed the risks of keeping the teeth, then you are probably better off without them. 

Q4: "My daughter is beginning to get her permanent teeth and there seems to be so much crowding. Shouldn't she have her baby teeth taken out to make room for the permanent teeth?"

A4: Sometimes yes, sometimes no. Many years ago, it used to be more common to remove baby teeth to alleviate crowding. Ongoing clinical research later showed that this may not be the best thing to do. When the teeth are crowded, there are forces exerted on the bone around the teeth. These "pushing and crowding forces" may help to stimulate additional bone growth. If this extra bone growth did not occur, there may not be enough room to accommodate all of the permanent teeth. So, dental crowding is not actually a bad thing during a child's growth and development. Taking out baby teeth too early may limit the normal growth of the jaw. 



There are other times when a child is supposed to be losing a baby tooth, and it just won't come out. This usually occurs because the permanent tooth is not coming in right under the baby tooth and therefore the baby tooth root does not dissolve. In these cases, it is a good idea to take out the baby tooth so that the permanent tooth has a better chance of coming in more where it was supposed to. If the child is the right age to be losing a baby tooth and that tooth is not loosening, then dental intervention should be considered. In some cases, a permanent tooth may have never developed and the baby tooth may be retained for an indefinite amount of time. Dental x-rays should be taken prior to extracting a baby tooth unless the dentist is absolutely positive there is a permanent tooth waiting to take its place. 

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Fluoride
I have well water, and I'm not sure my children are getting the right amount of fluoride. Does it really make a big difference?

You bet it does! Fluoridation of city water supplies has decreased the incidence of decay in children by over 50%. It is important to have exposure to fluoride while the baby teeth and permanent teeth are developing, which begins long before the teeth come in. The city-fluoridated water is maintained at or near 1 part per million or 1 mg/litre. The following guidelines are helpful when trying to obtain the proper amount of fluoride. 

  • Get your well water tested because some wells naturally contain fluoride. The Michigan Department of Environmental Quality, in Lansing, will provide water testing bottles and testing for a nominal fee. They can be contacted at 517-335-8184 or www.michigan.gov/deq. You may also contact your local county health department. In order for supplements to be prescribed, the base level of fluoride exposure must be known. The sample should be taken from where you would obtain your drinking water.
  • Check with your bottled water supplier to see what the concentration of fluoride is in their water.
  • Reverse Osmosis systems and central water softeners will often remove the fluoride from the water. Water from these sources should also be tested.
  • Bottled water containing fluoride can now be purchased.
  • Nursing formula bottles should be mixed with water containing optimal fluoride levels, or with prescription fluoride drops if needed.
  • Too much fluoride is harmful. So, do not use another person's fluoride prescription.

We can help you make sure that your children are receiving the correct amount of fluoride and are given the best chances for a cavity free childhood. Please notify us when children are about to become part of your life. 

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Heart Disease and Gum Disease
I have heard that gum disease can cause heart problems. Is this true?

There is increasing evidence of a link between oral infections such as periodontal (gum) disease and other general health problems including heart (cardiovascular) disease, stroke, diabetic control, pneumonia, and more recently ulcers. Since a high percentage of adults have gum disease, this is a potentially serious health issue. The unhealthy gum tissue is actually ulcerated. This is just like having an open sore on the outside of your body, and it allows bacteria to enter into the blood stream. The detrimental effects listed above can be due to these bacteria and the body's immune reaction against them. 

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I Can't Afford Dental Work
I need a lot of dental work that has to be done. I need to know where I can go to get dental work (crowns, root canals, bridges) done at a low or discounted cost. I do not have dental insurance, nor can I afford the cost of such work, especially since dentists want part upfront before work and the rest at the time it's completed. I can't put this off much longer. What should I do?

I can make a couple of suggestions that may help you follow the path toward improved dental health. Some of the things I will mention may not apply to your situation, and some of the suggestions will perhaps challenge you to think about your oral health differently. Either way, my goal is to put you in control of your health, and many people have more control than they realize. 

  • Preventative dental care costs about 80 cents/day. This would include a regular cleaning, examination, and x-rays. This will help ensure that healthy teeth stay healthy. This is within reach to nearly everyone with or without insurance.
  • Closely follow the home care and diet recommendations of your dentist. These recommendations are designed to reduce your dental care needs.
  • Look carefully at spending priorities and consider what you can temporarily go without so that those funds may be directed toward your health. For example, cable TV, cell phone, smoking, and eating out, are all tapping into what may be a limited budget. By reallocating resources, you can begin working to address your health needs.
  • Consider financing your dental treatment using a home equity loan, or other short term loan. Most people consider having a car as a necessity. If having your teeth is a necessity, then obtaining a loan as when buying a car, would not be unreasonable. Many dentists also offer a 3-12 month no-interest financing plan through third party lenders.
  • Consider having your dental work completed by a dental student at the U of M (Ann Arbor) or the University of Detroit/Mercy (Detroit). Your treatment will take longer to complete, but will cost less.
  • You can apply for Donated Dental Services by calling (800) 850-5913. There is limited enrollment to this program with strict eligibility requirements.
  • Build a long term relationship with a dentist so that when a true hardship arises you are more likely to get some charitable help. As a dentist, there is nothing more frustrating than someone looking to be financially bailed out of dental trouble after they have totally neglected their dental health for many years. However, most dentists will help out those patients that have a true need and have made an effort by keeping up with prevention (item #1 above), scheduled appointments, and have followed preventative care and diet recommendations.

The cost of providing dental care to patients correlates to the patient's cost of receiving that care. Quality care cannot be provided at a discount unless the care is being provided charitably. Unfortunately, there are so many people that express hardships; dentists have a very difficult time weighing each individual situation as to whether it is a true hardship, or an uninformed patient making poor priority choices. Hopefully, the suggestions above will help point you in the right direction. 

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Is Bleaching Safe and Does It Work?
I think my teeth are yellowing. Does bleaching work, and is it safe?

There are various types of bleaching systems available to patients. Tooth whitening will lighten just about everyone's teeth to a certain extent. The degree of whitening depends on what kind of stain is present, how dark the teeth started out, and the origin of the stain. Some bleaching agents are available over -the-counter, and some are available through dental offices. Bleaching is safe and effective but it is advised that only clinically tested and proven materials are used. These materials are only regulated as cosmetics, even though they are placed inside the mouth and can cause long term changes in appearance. It is also important to understand that only the natural tooth structure will bleach. Any fillings or crowns on teeth will not bleach. This can cause crowns and fillings to appear much darker after bleaching, since the surrounding natural teeth are now whiter. Until these materials are better regulated, it is always best to ask your dentist about bleaching, even if you are considering over-the-counter bleach.

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Medical Expense Accounts For Dentistry
Many people are not fortunate enough to have the help of dental insurance, but there may be another option available to you that can save you as much as 35% on your dental expenses. More and more employers are offering Medical Expense Spending Account (MESA) options to their employees. There are a few different versions of these accounts, but basically they allow employees to have a portion of their income withheld before taxes. The MESA can then be used to pay health care costs not covered by insurance. The benefit to the employee is that they are now using pre-tax dollars to pay for these expenses, and by doing so, they are saving as much as 35% of the treatment cost, depending on their tax bracket. Planning is important with some of these plans because if you don't use what you have withheld from your pay, it will be sacrificed come year end. In a dental office, out of pocket expenses can be closely estimated for patients, short of unforeseen dental problems. If you are unable to itemize your medical expenses on your taxes, then this type of plan can be just what the doctor ordered! 

A MESA is a great benefit that employers can offer their employees with surprisingly little cost. So, if you think you might benefit from a MESA, talk to you accountant and your employer to see how a MESA can benefit you. 

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Nursing Bottle Decay
Pre-natal care and parent education has reduced the incidence of Nursing Bottle Decay in children, but this devastating form of rapid tooth decay still appears in dental offices far too often. When children are allowed to go to bed with a bottle containing milk, formula, breast milk, or juice, the teeth are continuously bathed in these fluids for prolonged periods of time. This also occurs when a child is allowed to suckle the breast for prolonged periods of time throughout the night. The bacteria normally present in the mouth easily break down these fluids to form acid. This acid rapidly begins to destroy the enamel on the baby teeth. Within a few months, visible changes are present on the enamel, and many times, the teeth will literally decay down to the gumline. 

When Nursing Bottle Decay occurs on a 2-year-old child, treatment is very challenging for the dentist, child, and parents. Parents are often made aware of the problem after some of the damage has already occurred and, therefore, may be embarrassed to seek treatment. However, if the damage is not repaired early on, the decay will continue to progress as it has already penetrated through the enamel. Children with nursing bottle decay are often too young to rationalize the need for dental treatment and most often, sedation is required to accomplish the type of treatment needed. In early cases, minor restorative treatment can sometimes be performed without sedation. 

If you know of a child that may have Nursing Bottle Decay, a simple examination by a dentist should be sought out early. Don't let one mistake lead to another by not seeking care. Water does not always initially satisfy a child at bedtime but it will eventually, if no other option is offered. Only water is recommended after cleansing the teeth before bedtime. There is nothing more precious than a child's smile. Preserve it for a lifetime! 

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