Our recent article on the most correct order for flossing and brushing did receive some mail. One gentleman said ‘I would rather go grocery shopping than floss my teeth’. Another woman said it was so ‘unsightly’ because it caused bleeding. A number of readers commented that they regularly did both, and it just reinforced how important it is. Make no mistake – flossing teeth is really an extension of the toothbrush within the teeth and inhabits the growth of cavities. It prevents recession of bone and gums, and contributes to fresh breath.
One reader wrote that her ‘very active’ flossing habit had cost her a gold filling, and she was wondering if perhaps she shouldn’t be flossing. Any filling material may reach the point where it begins to shred dental floss. Often it is a filling between the teeth. This was typically formed by not flossing there in the first place, and the original dentist removed the decayed tooth matter similar to how an auto body man removes rust from a car. Occasionally it erupts anew and attacks a new layer of teeth beneath the original filling which is recurrent decay.
Some early silver amalgam fillings appeared to last 20+ years, but deterioration underneath happened in half that time. Porcelain may last over 10 years, and some composite fillings need to be replaced in 7 years. Gold fillings may provide over 30 years of constant use, but they also cost approx. 10 times more than composite fillings. The reality is that people who invest in gold fillings generally have a heightened awareness of their dentition, and are Olympic brushers and flossers. As for cost – tell me when you spent $3,000 on a set of tires which lasted 3 years, or the same on a dental bridge which may last 20 years?
In North America, the average adult has 3 dental fillings, and 25% of the population have 11 or more fillings. The subject of replacing the silver/black fillings with composite is controversial. These older fillings did contain an alloy composed of silver, copper, tin, and mercury. The mouth is an often wet environment, and some of these alloys did break down and oxidize, sometimes turning black. In some cases the metal will stain the teeth and gums. In the case of further decay between a filling and the tooth material, the seal between the two may have broken down allowing decay causing bacteria plus food particles to invade that space. From an eye appeal standpoint, the silver fillings were and still are used by dentists primarily with rear teeth.
The white fillings were developed about 50 years ago, and have long been the sought after repair material for front teeth restoration. In addition, the composite construction reacts better to the expanding and contracting which occurs when teeth are exposed to temperature changes. Often, cavities that form next to or seemingly ‘on top’ of an existing filling are due to inadequate hygiene. It is human nature to blame something or someone for anything that goes wrong. But think back. Were some of those fillings done during elementary school? We occasionally hear patients who are unhappy about something breaking down, but it may be a dental repair half a century old! What did you get for $40 – 50 years ago? The 6 year molar is still the most damaged tooth in the entire mouth! We see 9 year olds with a rotted out 6 year molar which the parents brushed off because they thought it was a ‘baby tooth’!
As for our friend with the missing gold filling – it was and still is the premium product for strength and longevity. We may call it the ‘gold standard’ but there are options available in this day of digital dentistry that are just as good or even better. It didn’t cost her a filling -everything was cleaned up and re-cemented to possibly last another 30 years. When something falls out it can be simple or complex. Consult a professional, consider all options, and make your best decision possible. Once a tooth has been restored multiple times, many options may present. It may be a root canal and crown, an extraction and a bridge, or an implant with a reconstruction tooth built on top of it. Don’t blame the floss and shoot the messenger. It may be your best friend!
Dr. Michael Dolynchuk is a General Dentist practicing in Caroline and Red Deer. Forward inquiries to: DentalQuestions@shaw.ca