IN YOUR FACE
The best part of being a dentist is putting a tooth together that resembles the aftermath of Hiroshima. Going “by the book” involves crowning the tooth; placing an artificial cap over the entire tooth after first removing the decayed areas, then grinding off whatever healthy enamel remains. A rather aggressive approach.
When asked why I chose dentistry I would explain I really enjoy interacting with people and I like, no make that love, fixing things. The more fixing it needs the more it interests me. My philosophy is: the best thing in your mouth is what God and your mama gave you. Anything a dentist does is second-best. I think we humans are at our best when in the creative mode. We were designed by the Creator to create. I think it’s our highest calling. I believe it touches our inner Whomever. So, practically speaking, save as much natural tooth as possible and reinforce what’s left.
When I first started using adhesives in my practice more than 30 years ago, it was a bit scary. It violated everything I had learned up to that point. Dr. Ray Bertolotti, a dentist and my mentor, had a PhD in chemistry along with his DDS. Ray brought back some new technology from Japan. Japanese dentists were washing teeth with acid and then flowing superglue into the pores the acid created. With silver fillings, all the retention was mechanical. You had to make undercuts and gopher holes in the tooth to hold the metal plug, i.e. filling, in place. That means cutting away a lot more tooth, and considerably weakening it. With adhesives that’s not necessary. Repairing a tooth with a silver filling is essentially like putting a cork in a bottle. Not a very tight seal.
Adhesive fillings aren’t plugs. They actually fuse to the natural tooth creating a hermetic seal. So complete is this bonding process that bacteria cannot penetrate the seam. What does that mean? It’s rare to get decay under a bonded filling. Which also means, it’s rare to get an infected tooth under a bonded filling, since the bacteria are shut out.
Tooth is living tissue, which is why we give anesthetic before we cut into it. Recently, technology has surfaced that allows us to restore even a tooth deeply invaded by bacteria; a tooth that heretofore would have required root canal therapy. Silver diamine fluoride, SDF, is the new wonder drug in dentistry. As is commonly known, silver is antibacterial, antiviral, and antifungal. It kills lots of bugs. The phrase “born with a silver spoon in their mouth”, referred to people who were well off; those wealthy enough who could afford silver. Applied to decay, which is essentially softened, leathery tooth structure, SDF will freeze the decay dead in its tracks. No drill. Just scoop out the soft stuff with a tiny spoon and soak what’s left with the silver solution. The only negative is that silver leaves a dark stain on the tooth, but to a youngster visiting the Little Shop of Horrors:….”I can live with the stain. Put down the drill.”
To those with MacGyver-like tendencies it opens up untold possibilities. With the ability now to place a tooth almost anywhere in the patient’s mouth with an implant, or glue just about anything to anything else, or freeze decay dead in its tracks; life is good. Over the years, relying on dental superglues I’ve glued broken teeth together numerous times. Does it always work? No. There are always exceptions to always. Nothing in medicine, as well as life, is always. But it’s certainly successful enough that if the patient agrees, and the probability of success is mostly on our side, why not? Mostly is good.
The drill is being slowly being replaced by superglue, titanium, and chemicals. Teeth want to heal. Give them a bacteria free environment, protect them from incredible chewing pressures, and avoid periodically bathing them in battery acid, i.e. coke and its ilk, and most teeth will gloriously heal and survive. This is a great time for dentists but an even greater time for those of us gripping our dental chairs.
Stay well, Dr. Bill Ardito, D.D.S. – Sunshine Dentistry AZ 520-761-1600