I’ve been talking a lot lately about gum disease as it is so foundational for the health of your mouth and your body. I am going talk about gum surgery today and when it should be used. First of all, surgery should not be the first option, but when it is necessary, it can and often does save teeth. That is because gum or periodontal surgery has come a long way over the years.

There are techniques including bone grafting techniques that have evolved over the years. The types of things that can be done and the results possible are quite impressive. It of course depends on the knowledge and skill of the practitioner and the healing capacity of the body.  The main difference is that instead of cutting gums back to where the bone is, often times bone can be added to support and strengthen the teeth.

Lasers can also play a role in gum surgery at the periodontal office. Instead of using a knife the periodontist can sometimes use a laser to cut tissue and coagulate the blood. The main advantage of this technique is that often there is recovery and healing that leaves the tissue and bone levels better than before. In other words there is more  bone and gum attachment after the healing is complete.

While it is not faster than traditional surgery, the results can be as good or sometimes better. Although not applicable in every situation, laser surgery definitely has its place. Most periodontists in San Diego charge around $1,000 per quadrant and there are four quadrants in the mouth. Unfortunately, the treatment needs to be completed within a 2-3 week period, so it is not something that can be done over time.

I have found that most patients first want to try the conservative and non-surgical approaches first. I have had good luck in my office with patients who will do the necessary home care required to reverse gum disease.

If you have been told you have periodontal disease or gum disease, you’re not alone. An estimated 80 percent of American adults currently have some form of the disease. Periodontal disease ranges from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. At the end of the day, if the process goes unchecked and untreated, you can even loose your teeth.

The problem is that dentistry offers very few easy and simple ways to handle and reverse gum disease. There are differing opinions and treatments that are offered depending on the doctor you choose. I’ve actually had cases where one dentist does not recommend any treatment beyond simple cleanings, a second dentist recommends an involved appointment and treatment protocol including root planing, and a third dentist recommend referal to a periodontist who is a specialist who does gum surgeries to eliminate the pocketing and diseased tissue. Keep in mind all three recommendations were for the same patient.

How can there be such a difference of opinion and recommended treatment you might ask? Well, the simple answer is that people, including doctors, are a product of their education and experience. If they were taught to refer involved cases out, they will do so. If they were taught that root planing is the right treatment for any gum pocketing, that is what they are going to recommend.

In the end the patient is left with little good news. They have to choose between treatment recommendations that are involved, expensive and painful, when all they want is a cleaning. Many patients will just not pursue the treatment, besides, “I’ve gone this long without doing all this fancy and expensive gum work. Why should I do it now?”

 On the other hand not addressing the problem doesn’t work either, as it will continue to worsen until you reach a point of no return and face either gum surgery or losing teeth. So there is a real motivation to treat the problem as early as possible and not to wait. If a dentist says that you have gum disease and/or pocketing, my recommendation is that you don’t ignore it. You have a condition that needs treatment to reverse and hopefully cure. Based on the above some of you may be thinking, “Is there any good news doc, or are you just trying to depress me?” Well, there actually is some good news I can share that might help.

Over my 25 years of practicing dentistry, I have seen every kind of situation and treatment protocol out there. Based on the questions I have been asked over the years, it seems that the overiding interests people have are, “What treatment will work and what is the minimum that I can do to take care of this situation?” As a holistic dentist in San Diego, my patients gravitate toward conservative approaches using natural products and treatment whenever possible. This approach dovetails well with my personal and professional philosophy. As it turns out, I have found the conservative approach can often be very effective in treating gum disease.

I will explain in detail what I mean by this in tomorrow’s post. I will use real life examples from my practice of cases that I have treated and the actual products and sequences that worked. As always if you are looking for a San Diego holistic dentist you may call us to discuss your case. Often times a second opinion when it comes to gum disease is time and money well spent.

A study just came out concluding that 1 in 4 children under the age of 11 have never seen a child dentist. This is in California where dental education is higher than many other areas in this country and worldwide. In addition, many of these children were covered under insurance or Medicaid, so lack of insurance and cost should not have been a deterrent.

Researchers from UCLA and from the California HealthCare Foundation found that underprivilaged kids were less likely to have visited a childrens dentist in the previous six months – or even in their entire lifetime. Also, Latino and African American kids saw a pediatric dentist less, even when they had the same insurance. One solution was to raise re-imbursement to Medicaid dentists and increase the network of dentists.                                                 

According to the study, 54% of the kids who had insurance, 27% of the publicly insured kids and only 12% of the kids without insurance saw the kid dentist within the last 6 months. These numbers are not good. According to Dr. Pourat from UCLA, “Having insurance isn’t always enough, we need to address the other barriers that keep children from getting the help they need.”

As a holistic dentist this is of special concern to me because I know good habits are hard to come by. If our children get used to going to a pediatric dental office, especially a pediatric dentist they like and learn to trust, they are so much better off than waiting till something bad happens or they are in pain and have to go under stressful conditions. In addition their dental health will be better and their home care habits will be instilled early and correctly. 

Basically, good habits once instilled never seem to leave you and good health is best supported through taking consistent action throughout life, not just when the need arises or worse yet an emergency. 

Please, start taking your kids to the children friendly dental office as early as possible. Usually the best time to start is when they are 4-5 depending on the child. If there is something that needs addressing before, by all means bring them. We view pediatric dentistry as truly important for children to accept and get used to.

If you are looking for a San Diego kid friendly dentist who focuses on biocompatible materials for their teeth feel free to call our office. We have a kid area with puzzles, things to draw with and toys. Kids seem to love coming to our practice and we really enjoy them as well. By starting early, your kids will benefit their entire lifetimes.

This is kind of exciting. A lot of people have asked me about root canals. Are they healthy or not? Well a lot depends on the individual situation. However, there are some real questions. I ran across an article discussing a future alternative to having to do a root canal to save a tooth.  Keep in mind that this is experimental at this time and is not as of yet available to the public.

“Scientists are reporting an advance toward the next big treatment revolution in dentistry – the era in which root canal therapy brings diseased teeth back to life, rather than leaving a “non-vital” or dead tooth in the mouth. In a report in the monthly journal ACS Nano, they describe a first-of-its-kind, nano-sized dental film that shows early promise for achieving this long-sought goal.

Nadia Benkirane-Jessel and colleagues note that root canal procedures help prevent tooth loss in millions of people each year. During the procedure, a dentist removes the painful, inflamed pulp, the soft tissue inside the diseased or injured tooth that contains nerves and blood vessels. Regenerative endodontics, the development and delivery of tissues to replace diseased or damaged dental pulp, has the potential to provide a revolutionary alternative to pulp removal.

The scientists are reporting development of a multilayered, nano-sized film – only 1/50,000th the thickness of a human hair – containing a substance that could help regenerate dental pulp. Previous studies show that the substance, called alpha melanocyte stimulating hormone, or alpha-MSH, has anti-inflammatory properties. The scientists showed in laboratory tests alpha-MSH combined with a widely-used polymer produced a material that fights inflammation in dental pulp fibroblasts. Fibroblasts are the main type of cell found in dental pulp. Nano-films containing alpha-MSH also increased the number of these cells. This could help revitalize damaged teeth and reduce the need for a root canal procedure, the scientists suggest.”

 I will continue to research this potential game changer in dentistry and no doubt will be writing more about it. So stay tuned

What happens when you are exposed to mercury long term.  Nobody knows for sure, but there are certain researchers who have raised concerns and red flags over the years. I will write more on this on later posts.

For now I wanted to pass along the warning from one of the major amalgam manufacturers that they are required to put out to dentists informing them of properties, characteristics, and possible risks of the products they are selling. This report is called the MSDS or Material Safety Data Sheet.

Below Caulk is talking about Dispersalloy which comes in capsules where the metal powder and liquid mercury is mixed before it is placed in your mouth.  They are warning about what could happen if someone breathes in very small amounts of mercury over time.  I copied this section directly from their website:

“Inhalation: Chronic: Inhalation of mercury vapor over a long period may cause mercurialism which is characterized by fine tremors and erethism. Tremors may affect the hands first, but may also become evident in the face, arms, and legs. Erethism may be manifested by abnormal shyness, blushing, self-consciousness, depression or despondency resentment of criticism, irritability or excitability, headache, fatigue, and insomnia. In severe cases, hallucinations, loss of memory, and mental deterioration may occur.”

There is more to the statement which I will post tomorrow, but suffice it to say this is a bold statement given the fact that the American Dental Association insists that the small amount of mercury released from amalgams pose no real health threat.

Caulk is one of the main suppliers of the metals that go into silver amalgam fillings.  It comes in a powder form that contains silver, copper, tin, and zinc. It also comes with about a half gram of mercury per filling.  According to the EPA one gram of mercury is enough to pollute a large body of water.

This is some of the stuff on Caulk’s website on mercury:

1. After placement or removal of dental amalgam restorations increased mercury concentration in blood and urine has been observed.
2. Ingestion of mercury may cause neurotoxic or nephrotoxic effects.
3. In individual cases, hypersensitivity reactions have been observed
4. Do not place amalgam in direct proximity of other metallic restorations in order to avoid all risk of corrosion.
5. Avoid placing and removing amalgam during pregnancy and lactation.

If this is what the manufacturer says about amalgams, how come the FDA  can’t follow suit and at least protect children and pregnant women?

It has been a year since the FDA was forced by a court settlement to put a warning about amalgam fillings on their website.  That is until July 28th, 2009. Remember this date because it is the date that the FDA basically reversed its position and was able to go back to its old ways.  I read the transcript of the lawsuit and in my opinion it was not one of the FDA’s finer moments.

This was to be the opportunity for the FDA to step up and help protect children and the unborn from mercury poisoning.  It did not happen.  In fact the only people with clout who seem to care are consumer groups and a spattering of politicians like Congresswoman Diane Watson (D-CA) and Congressman Dan Burton (R-IN) who co-authored a letter to FDA, signed by 19 Members of Congress, calling for a rule to protect children and young women from amalgam.

The FDA has essentially passed the buck and is providing little leadership.  It took a lawsuit and pressure from the judge to get them to settle in the first place.  The FDA of course fought the lawsuit and tried to wiggle out of it, but the judge wouldn’t let them.  When it comes down to it, it looks like they just don’t want to deal with this issue.

No one expected them to be as progressive as Sweden or Norway and ban amalgam fillings all together.  However, it was expected that they would stand behind their previous warning and not recommend amalgams for children and women who are pregnant.   Models of this appoach are Canada and Britain who have banned amalgam use for these two groups. This is our government not willing to make the tough decisions necessary to protect the public.

Source: Consumers for Dental Choice

In a disappointing move, the Food and Drug Administration (FDA) did an about face in issuing a final regulation classifying dental amalgam without calling for stringent precautions for pregnant women and children. Last June, a court settlement filed by the Consumers for Dental Choice required the FDA to withdraw claims of mercury amalgam’s safety from its Web site and issue an advisory indicating: “Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses.”

“FDA broke its contract and broke its word that it would put warnings for children and unborn children for neurological damage,” said Charles G. Brown, National Counsel for Consumers for Dental Choice, who brought the lawsuit compelling today’s action. “Bowing to the dental products industry, FDA for the first time in its history pulled a warning about neurological harm to children. This contemptuous attitude toward children and the unborn will not go unanswered. We will see FDA in court.”

Most consumers, and most dentists, have already switched to the main alternative, resin composite. The FDA rule destroys a dental myth that the mercury becomes inert in the mouth; FDA says the vapors from dental mercury go into the human body. Due to mercury waste, amalgam is also increasingly targeted by environmentalists.

Intense interest in the rule exists on Capitol Hill. Congresswoman Diane Watson (D-CA) and Congressman Dan Burton (R-IN) co-authored a letter to FDA in May, signed by 19 Members of Congress, calling for a rule to protect children and young women from amalgam. In July, they introduced a resolution on the issue with 29 co-sponsors (H.Res. 648).

Amalgam has also become controversial because the middle-class has largely moved to non-toxic alternatives while the poor, minorities, and institutional recipients, such as soldiers and prisoners, still get amalgam.

“FDA remains alone in the world in failing to protect children and pregnant women from mercury fillings. Since 1996, Canadian dentists have been told not to put mercury amalgam in children or pregnant women. Since 1998, British dentists have been told the same for pregnant women. Norway and Sweden have banned amalgam altogether. Regrettably, this rule should have meant the end of two-tiered dentistry: mercury for the poor and choice for the rest. Instead the FDA has failed to carry out its mission of protecting the public health,” concluded Brown.

Here are the highlights of the FDA’s position:

“While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients.”

My Response:  This is basically the American Dental Association’s position on amalgam fillings. The FDA says that they looked at 200 studies to come up with that conclusion.

“Specifically, the FDA recommended that the product labeling include:
* A warning against the use of dental amalgam in patients with mercury allergy;
* A warning that dental professionals use adequate ventilation when handling dental amalgam;
* A statement discussing the scientific evidence on the benefits and risk of dental amalgam, including the risks of inhaled mercury vapor. The statement will help dentists and patients make informed decisions about the use of dental amalgam.”

My Response:  This seems to indicate that there is risk of mercury inhalation due to vapors being released during handling. Of course’ handing’ could also include removal of old amalgam fillings. Just think of the release of mercury when your old fillings are removed with a bur under heat.

This is why I recommend a special protocol when removing old amalgam fillings to prevent exposing yourself to mercury as it is released. This includes having a nosepiece placed over your nose so you can be breathing clean air. There are other protections possible. See our website to learn more.