OT: Question for a dentist

[Row80]

I've gone to a small practice in Omaha for a year. A second dentist has come in and appears to be taking over. My question is if his plan is legitimate or just striving to raise money for his boat/house/college payments?

I am 58 years old. I have 6 or 7 silver fillings and he wants to be proactive and start replacing them with newer fillings. His explanation is that they look pretty old, he sees a gap between one and the tooth, sees some small cracks in the teeth, says that these old silver fillings are aren't bonded to the teeth, thus decay can develop beneath them, wants to prevent future problems, i.e. part of tooth breaking off. I did have part of one molar break off a few years ago.

While what he says makes sense, I am leaning toward the feeling that this is a money making avenue for him rather than something necessarily good for me. I do have decent dental insurance but don't know yet the cost. He suggested replacing two soon.

I lean toward the if it ain't broke (causing problems), don't fix it approach. When part of one of the molars broke off, I didn't have any pain, they fixed it with a crown and I went on. My thought is if I get a cavity under one of the 'silvers', then they fix it and replace the 'silver' then.

 

[schuele]

If the old dentist is still around, why not get his (or her) opinion?

Even if you've only been a patient there for one year, it's worth asking why these procedures weren't recommended on your first couple of visits. What's changed?

 

[TheBeav815]

So you're asking a bunch of dudes who are not dentists and also cannot see your teeth? Go see another dentist for an additional opinion.

Or don't, I'm sure there are great dentures now.

 

[Row80]

So you're asking a bunch of dude who are not dentists and also cannot see your teeth? Go see another dentist for an additional opinion.

Or don't, I'm sure there are great dentures now.

The title of my post is "Question for a dentist". The odds are very good that there are dentists who read this board. The purpose of that title was

So you're asking a bunch of dudes who are not dentists and also cannot see your teeth? Go see another dentist for an additional opinion.

Or don't, I'm sure there are great dentures now.

I didn't ask "a bunch of dudes". The title of my post is "Question for a dentist". The odds are good that there are dentists that read this forum.

 

[huskerfan1414]

I've gone to a small practice in Omaha for a year. A second dentist has come in and appears to be taking over. My question is if his plan is legitimate or just striving to raise money for his boat/house/college payments?

I am 58 years old. I have 6 or 7 silver fillings and he wants to be proactive and start replacing them with newer fillings. His explanation is that they look pretty old, he sees a gap between one and the tooth, sees some small cracks in the teeth, says that these old silver fillings are aren't bonded to the teeth, thus decay can develop beneath them, wants to prevent future problems, i.e. part of tooth breaking off. I did have part of one molar break off a few years ago.

While what he says makes sense, I am leaning toward the feeling that this is a money making avenue for him rather than something necessarily good for me. I do have decent dental insurance but don't know yet the cost. He suggested replacing two soon.

I lean toward the if it ain't broke (causing problems), don't fix it approach. When part of one of the molars broke off, I didn't have any pain, they fixed it with a crown and I went on. My thought is if I get a cavity under one of the 'silvers', then they fix it and replace the 'silver' then.

Get another opinion.
He doesnt need you to make money. Hes going to be seeing patients all day every day.
While I dont buy into the money grubbing hypothesis it still doesnt mean this procedure is necessary. It may be overkill and not worth the cost.
Or it might be worth it. You gotta sit in the chair to get the right 2nd opinion.

 

[mgbreis]

In my 20's and 30's I had three different dentists that wanted to pull my wisdom teeth. One almost insisted. The teeth were fully in and caused me zero issues, but they said they were hard to clean and could be prone to cavities. I refused. Now I'm 44 and have a dentist (my age and who by all appearances loves to make money) who says there's absolutely no reason to pull them.

 

[rrthusker]

Get a second opinion. I`ve experienced a few dentists here in SoCal that to say the least, perform unnecessary procedures.

 

[Redondo]

The title of my post is "Question for a dentist". The odds are very good that there are dentists who read this board. The purpose of that title was



I didn't ask "a bunch of dudes". The title of my post is "Question for a dentist". The odds are good that there are dentists that read this forum.

I hate to reveal personal info on a discussion forum, but I am an Air Force residency trained dentist, am board certified, and used to be on a dental school faculty.

Obviously I can't examine your dentition, but I have always stayed conservative in treatment. I don't believe in crowning every tooth because nothing is kinder to the periodontium (gums and bone around the teeth) than natural tooth structure, and defects in bone are the major cause of tooth loss.

Older silver amalgam restorations which have been placed in the last 35 years, or so, have a relatively high copper content of about 13-17 % and are VERY stable and strong. If there is a space between the restoration and tooth structure, it may be because a bit of enamel or a thin area of the restoration has flaked off. That doesn't AUTOMATICALLY mean the restoration needs to be replaced. Ask the dentist if he can try polishing out that area. If the explorer (probing instrument) "sticks" into the tooth margin between the restoration and the tooth, then it is likely the restoration should be repaired or replaced as the gap is large enough for decay to recur in the tooth, but that doesn't mean it automatically needs a crown and may just need a new restoration.

Enamel that "looks cracked" may only be crazed with tiny defects similar to your safety plate glass on your windshield. Those don't usually go through to the underlying structure of the dentin of which would have sensitivity to it because of its communications with the pulp or nerve of the tooth. Enamel itself doesn't have that communication with the pulp and has no sensitivity in and of itself.

I tell my patients not to chew ice, popcorn kernels, jaw breakers, corn nuts, or hard rock candy, etc. That could cause the enamel to crack completely through to the dentin and chip your teeth.

The key is sensitivity. If there is hot and/or cold or biting (or percussion/ tapping) sensitivity , then there is some communication with the pulp and more extensive treatment may be needed.

But, crazed enamel in and of itself, should not be treated just for treatment's sake.

Older restorations, likewise, should not be treated just for treatment's sake.

Let me say this about older silver amalgam restorations. I have had some of my own that are decades old. What might that tell you? When restorations are replaced, they ALWAYS get larger, and anything that gets bigger or more extensive always affects the pulp in some way, either reversibly or irreversibly.

There is actually somewhat of a seal or "bond" of oxidized metal between the silver amalgam and tooth structure, which seals the restoration.

Bonded composite (white) restorations are basically plastic with glass fillers. There is a "bond" of unfilled resin (plastic) placed to supposedly seal them, but unless they are placed very particularly, that bond is not always very durable.

I am not going to say anyone told you misinformation or about the purpose of anything said to you because I wasn't there to hear it. I am simplifying this information to summarize it for your questions.

Again, I haven't examined you, obviously, and am only commenting to your comments and questions, but by word of mouth from your friends as to whom may be a conservative dentist, you may seek a second opinion. I am of the same philosophy of "if it isn't broken, why fix it?"

Hope this might help. And yes, there is over treatment going on in this country, especially in the last several years as education has become so costly.

Good luck.

 

[Row80]

I hate to reveal personal info on a discussion forum, bit I am an Air Force residency trained dentist, am board certified, and used to be on a dental school faculty.

Obviously I can't examine your dentition, but I have always stayed conservative in treatment. I don't believe in crowning every tooth because nothing is kinder to the periodontium (gums and bone around the teeth) than natural tooth structure, and defects in bone are the major cause of tooth loss.

Older silver amalgam restorations which have been placed in the last 35 years, or so, have a relatively high copper content of about 13-17 % and are VERY stable and strong. If there is a space between the restoration and tooth structure, it may be because a bit of enamel or a thin area of the restoration has flaked off. That doesn't AUTOMATICALLY mean the restoration needs to e replaced. Ask the dentist if he can try polishing out that area. If the explorer (probing instrument) "sticks" into the tooth margin between the restoration and the tooth, then it is likely the restoration should be repaired or replaced as the gap is large enough for decay to recur in the tooth, but that doesn't mean it automatically needs a crown and may just need a new restoration.

Enamel that "looks cracked" may only be crazed with tiny defects similar to your safety plate glass on your windshield. Those don't usually go through to the underlying structure of the dentin of which would have sensitivity to it because of its communications with the pulp or nerve of the tooth. Enamel itself doesn't have that communication with the pulp and has no sensitivity in and of itself.

I tell my patients not to chew ice, popcorn kernels, jaw breakers, corn nuts, or hard rock candy, etc. That could cause the enamel to crack completely through to the dentin and chip your teeth.

The key is sensitivity. If there is hot and/or cold or biting (or percussion/ tapping) sensitivity , then there is some communication with the pulp and more extensive treatment may be needed.

But, crazed enamel in and of itself, should not be treated just for treatment's sake.

Older restorations, likewise, should not be treated just for treatment's sake.

Let me say this about older silver amalgam restorations. I have had some of my own that are decades old. What might that tell you? When restorations are replaced, they ALWAYS get larger, and anything that gets bigger or more extensive always affects the pulp in some way, either reversibly or irreversibly.

There is actually somewhat of a seal or "bond" of oxidized metal between the silver amalgam and tooth structure, which seals the restoration.

Bonded composite (white) restorations are basically plastic with glass fillers. There is a "bond" of unfilled resin (plastic) placed to supposedly seal them, but unless they are placed very particularly, that bond is not always very durable.

I am not going to say anyone told you misinformation or about the purpose of anything said to you because I wasn't there to hear it. I am simplifying this information to summarize it for your questions.

Again, I haven't examined you, obviously, and am only commenting to your comments and questions, but by word of mouth from your friends as to whom may be a conservative dentist, you may seek a second opinion. I am of the same philosophy of "if it isn't broken, why fix it?"

Hope this might help. And yes, there is over treatment going on in this country, especially in the last several years as education has become so costly.

Good luck.

Thanks for the reply. I will get a second opinion. I left my long-time dentist because they stopped handling secondary insurance. I do trust him so maybe I'll go there for the second opinion, and if I get lucky I'll find that they have gone back to handling secondary insurance.

Thanks

 

[Redondo]

Thanks for the reply. I will get a second opinion. I left my long-time dentist because they stopped handling secondary insurance. I do trust him so maybe I'll go there for the second opinion, and if I get lucky I'll find that they have gone back to handling secondary insurance.

Thanks

BTW, I am a University of Nebraska, College of Dentistry graduate and am still proud of it.

GO BIG RED

 

[mthskrdoc]

I too have over 40 years of providing dental care. I’m a UNL dental grad.
Everything that was posted above is correct. Good job soldier.
I would hope a dentist that is removing silver filling (amalgam) is doing it because of disease or failure and not to place a composite because of esthetic or $$$. I too am seeing overtreatment by too many young dentists
WWSFD. What would S Frost Do

 

[redwine65]

strevey dental in Omaha, nice chap, he's not cheap but his work lasts. he worked on neal diamond teeth when he had problems and was in Omaha for a concert.

 

[tro80]

I'm not a dentist, but will play one on the internet so I can give you my 2cents. I have a fillings in a few of my molars going back from my younger days (70s). I have had my current dentist replace two of them in the past five years. In each case, I started to feel sensitivity in the tooth to cold and/or when I bit down on food, particularly something more sweet or salty. It was not painful, but just uncomfortable. In each case, the Dentists found a crack in the filling. Replacement was easy and it has 100% taken care of the sensation I was having. My other two fillings are no problem. So, my point being, if they aren't bothering you, don't mess with them. Also, I would check your insurance first, because my dentist also said its only covered if it is "necessary" - i.e., the old filling actually failed. Of course, that was my insurance and yours might be different.

 

[Row80]

I too have over 40 years of providing dental care. I’m a UNL dental grad.
Everything that was posted above is correct. Good job soldier.
I would hope a dentist that is removing silver filling (amalgam) is doing it because of disease or failure and not to place a composite because of esthetic or $$$. I too am seeing overtreatment by too many young dentists
WWSFD. What would S Frost Do

Thanks.

I'm trying to figure out 'mthskrdoc'. I'm going with 'Mountain Husker Doc", tho I did consider "Moth Sker Doc"!

 

[Row80]

I'm not a dentist, but will play one on the internet so I can give you my 2cents. I have a fillings in a few of my molars going back from my younger days (70s). I have had my current dentist replace two of them in the past five years. In each case, I started to feel sensitivity in the tooth to cold and/or when I bit down on food, particularly something more sweet or salty. It was not painful, but just uncomfortable. In each case, the Dentists found a crack in the filling. Replacement was easy and it has 100% taken care of the sensation I was having. My other two fillings are no problem. So, my point being, if they aren't bothering you, don't mess with them. Also, I would check your insurance first, because my dentist also said its only covered if it is "necessary" - i.e., the old filling actually failed. Of course, that was my insurance and yours might be different.

Thanks.

Sounds like the "if it ain't broke, don't fix it" mind-set is prevailing. My attitude is that when I have a problem, then is a good time to replace things.

 

[michael p moriarty]

Well I am a dentist and teeth can break regardless of silver fillings or tooth colored fillings. The question you need to ask this new dentist is if there is decay or not? Also ask him if tooth colored fillings last as long as silver fillings! If he says that tooth colored fillings last as long or longer go somewhere else for second opinion on treatment that is proposed! Fact is yes the tooth color fillings don’t last as long and their bond breaks down leading to marginal decay! Just a short heads up! I’ve been a dentist for 28 !

 

[PeliniTheCrutch]

I’m an Anti-Dentite.

 

[mthskrdoc]

Thanks.

I'm trying to figure out 'mthskrdoc'. I'm going with 'Mountain Husker Doc", tho I did consider "Moth Sker Doc"!

Montana

 

[little a]

I hate to reveal personal info on a discussion forum, bit I am an Air Force residency trained dentist, am board certified, and used to be on a dental school faculty.

Obviously I can't examine your dentition, but I have always stayed conservative in treatment. I don't believe in crowning every tooth because nothing is kinder to the periodontium (gums and bone around the teeth) than natural tooth structure, and defects in bone are the major cause of tooth loss.

Older silver amalgam restorations which have been placed in the last 35 years, or so, have a relatively high copper content of about 13-17 % and are VERY stable and strong. If there is a space between the restoration and tooth structure, it may be because a bit of enamel or a thin area of the restoration has flaked off. That doesn't AUTOMATICALLY mean the restoration needs to e replaced. Ask the dentist if he can try polishing out that area. If the explorer (probing instrument) "sticks" into the tooth margin between the restoration and the tooth, then it is likely the restoration should be repaired or replaced as the gap is large enough for decay to recur in the tooth, but that doesn't mean it automatically needs a crown and may just need a new restoration.

Enamel that "looks cracked" may only be crazed with tiny defects similar to your safety plate glass on your windshield. Those don't usually go through to the underlying structure of the dentin of which would have sensitivity to it because of its communications with the pulp or nerve of the tooth. Enamel itself doesn't have that communication with the pulp and has no sensitivity in and of itself.

I tell my patients not to chew ice, popcorn kernels, jaw breakers, corn nuts, or hard rock candy, etc. That could cause the enamel to crack completely through to the dentin and chip your teeth.

The key is sensitivity. If there is hot and/or cold or biting (or percussion/ tapping) sensitivity , then there is some communication with the pulp and more extensive treatment may be needed.

But, crazed enamel in and of itself, should not be treated just for treatment's sake.

Older restorations, likewise, should not be treated just for treatment's sake.

Let me say this about older silver amalgam restorations. I have had some of my own that are decades old. What might that tell you? When restorations are replaced, they ALWAYS get larger, and anything that gets bigger or more extensive always affects the pulp in some way, either reversibly or irreversibly.

There is actually somewhat of a seal or "bond" of oxidized metal between the silver amalgam and tooth structure, which seals the restoration.

Bonded composite (white) restorations are basically plastic with glass fillers. There is a "bond" of unfilled resin (plastic) placed to supposedly seal them, but unless they are placed very particularly, that bond is not always very durable.

I am not going to say anyone told you misinformation or about the purpose of anything said to you because I wasn't there to hear it. I am simplifying this information to summarize it for your questions.

Again, I haven't examined you, obviously, and am only commenting to your comments and questions, but by word of mouth from your friends as to whom may be a conservative dentist, you may seek a second opinion. I am of the same philosophy of "if it isn't broken, why fix it?"

Hope this might help. And yes, there is over treatment going on in this country, especially in the last several years as education has become so costly.

Good luck.

And more corporations owning dental, chiropractic, and medical facilities.... money is the bottom line with them

 

[Redondo]

And more corporations owning dental, chiropractic, and medical facilities.... money is the bottom line with them

I have noticed a good deal of evidence of this. When state legislators have, in some states, allowed non dentists to own dental practices, I strongly believe it has been greatly detrimental for patients AND dentists.

 

[ThereIsNoPlace]

I’m an Anti-Dentite.

Not that there's anything wrong with that.

 

[little a]

I have noticed a good deal of evidence of this. When state legislators have, in some states, allowed non dentists to own dental practices, I strongly believe it has been greatly detrimental for patients AND dentists.

Yep- and with tort reform young doctors that work for these “shops” have no vested interest in the community. You truly get what you pay for.....

 

[CameronMcGrath]

That's a huge problem nowadays, and the authorities are doing nothing to solve it by legislative changes. There even was a case recently that a kid got paralyzed because of a bad dentist who did something wrong, and now he can't walk. This is why when I have some kind of pain, I use https://www.jacksonavedental.com/post/how-to-kill-tooth-pain-nerve-in-3-seconds-permanently better, than going to a dentist. It helps me with the pain and this way I can avoid going to the doctor, when I can treat the problem by myself.

 

[salsa red]

Dentists as a whole a lot of times do more harm than good imo. If you have a tooth issue denstists are great, but for healthy teeth they can cause issues. Mercury fillings, root canals and unnecessary procedures can be more harmful than leaving it alone or pulling the tooth. Also flouride has been shown to harm the brain and decrease iq in children. Even "regular" toothpastes have flouride, glycerin and other harmful ingredients.

Get a quality electric toothbrush, remineralizing toothpaste, oil pull and watch your diet and you should be good.

 

[Laner2]

In my 20's and 30's I had three different dentists that wanted to pull my wisdom teeth. One almost insisted. The teeth were fully in and caused me zero issues, but they said they were hard to clean and could be prone to cavities. I refused. Now I'm 44 and have a dentist (my age and who by all appearances loves to make money) who says there's absolutely no reason to pull them.

I'm in my 60s with all four wisdom teeth (no wisdom yet, the bastards) and no dentist recommended they be yanked.

 

[Laner2]

I’m an Anti-Dentite.

Bite me.

 

[bigboxes]

The new guy is looking for ways to increase his business. My dentist did this too. Usually, it's unnecessary. Do you need to have your "silver" fillings redone? Not if you're not having any issues. The white just looks nicer. But the white fillings don't last as long as the silver ones.

 

[itseasyas1-2-3]

Dentists as a whole a lot of times do more harm than good imo. If you have a tooth issue denstists are great, but for healthy teeth they can cause issues. Mercury fillings, root canals and unnecessary procedures can be more harmful than leaving it alone or pulling the tooth. Also flouride has been showing harm the brain and decrease iq in children. Even "regular" toothpastes have flouride, glycerin and other harmful ingredients.

Get a quality electric toothbrush, remineralizing toothpaste, oil pull and watch your diet and you should be good.

No one in my family uses Fluoride toothpaste, and no cavities. I always wondered why it was necessary and when the tube says if you swallow the toothpaste contact the Poison Control Center.

 

[bigboxes]

No one in my family uses Fluoride toothpaste, and no cavities. I always wondered why it was necessary and when the tube says if you swallow the toothpaste contact the Poison Control Center.

It's called science. Use of fluoride in your toothpaste and in your public water supply greatly reduces tooth decay. Fluoride toothpaste is safe to use but not to eat. That would be your little kid thinking it tastes like candy. Plus your diet and brushing habits also contribute to your lack of cavities. I suppose some genetic as well.

 

[itseasyas1-2-3]

It's called science. Use of fluoride in your toothpaste and in your public water supply greatly reduces tooth decay. Fluoride toothpaste is safe to use but not to eat. That would be your little kid thinking it tastes like candy. Plus your diet and brushing habits also contribute to your lack of cavities. I suppose some genetic as well.

I think that's a bunch of science bullshit.

Fluoride is a waste product of aluminum.

The fluoride in the water systems isn't even health grade. It's a scam.

 

[bigboxes]

I think that's a bunch of science bullshit.

Fluoride is a waste product of aluminum.

The fluoride in the water systems isn't even health grade. It's a scam.

But yet it's not.