We often have patients asking about the mercury content of amalgam fillings, commonly called silver fillings.  Some media sources even call them "mercury fillings."  Obviously the general population has a right to be concerned because mercury is, by itself, toxic.  However, amalgam fillings are an alloy of different metals, which when combined make it's own unique chemical substance that is no longer toxic. Amalgam fillings are composed of mercury, silver, tin, copper, and other trace metals.  

"Another element, Chlorine (Cl), is also highly toxic.  Yet, when combined with the element Sodium (Na) you get a chemical that is common, safe and in reasonable doses, delicious.  Common table salt is a chemical compound called Sodium Chloride (NaCl) and is perfectly safe to eat in moderate amounts.  But no one in their right mind would go out of their way to ingest Sodium or Chlorine on their own.  The same goes for Mercury."  I borrowed this excellent example from Mead Family Dental in Michican, because it perfectly represents and explains the nature of chemistry.  A chemical compound is not the same as it's individual ingredients.

We offer both amalgam and composite (tooth-colored) fillings here at our office.  We also try to give you an estimated co-pay in advance of your restorative apointments so that you may choose an option that works best for you, both financially and aesthetically.  

There are a few advantages to choosing a composite filling over amalgam.  One is that, for very small cavities, the prep for the filling can be made more conservatively when placing a composite filling because it gets bonded to the tooth, whereas for the amalgam filling, the prep has to be made larger to mechanically retain the filling.  Any time a filling is done or redone, more of the tooth has to be removed to make a larger prep, so the more conservative we can keep a filling, the better it is for the longevity and strength of the tooth.  Another reason a composite filling may be preferable is that, if and when the tooth gets what we call recurrent decay, which means a cavity at the margin of an existing filling, we can simply remove the offending cavity and bond new filling to old filling.  When recurrent decay occurs around an amalgam filling, the entire filling must be removed, along with the decayed part of the tooth, to make a much larger filling.  

Have you found this post informative?  Have questions?  Let us know!  Be a fan on Facebook (Melanie Bach, DDS, PLLC) and tweet to us @MelanieBachDDS! As always, we are accepting new patients and hope to hear from you soon!

Plaque is a bacterial biofilm that attaches to the teeth.  Because the mouth is a perfect bacterial breeding ground (dark, moist, and well-fed), bacteria and other microbes multiply quickly there.  When teeth have prolonged exposure to bacterial plaque, the plaque begins to destroy the enamel, causing weak spots (demineralization) and caries (cavities).  Brushing for two full minutes a minimum of twice a day and flossing at least once a day will greatly decrease plaque buildup, but here are some foods that can help reduce plaque in between brushing and flossing.  FRESH fruits and vegetables act as natural toothbrushes and remove plaque as you chew.  Additionally, the tough, fibrous texture of natural foods mean they take longer to chew, so even more plaque can be removed.  

With increasing frequency, we are seeing more people who either have acid reflux, or don't know they have acid reflux but have acid wear on their teeth that says they do!

If you have acid reflux and are on medication for it, chances are that your teeth will have minimal damage.  However, if you think you might have acid reflux, typical symptoms might include a burning sensation in your chest, esophagus, throat, or back of the mouth, an acidic or bad taste, coughing, pain that increases lying down, regurgitation, bad breath, and belching.  Some things that can trigger an acid attack are stress, coffee, sodas, alcohol, fatty or spicy foods, overindulgence, citrus, tomatoes, onion, or laying down soon after eating.  

If you aren't sure if you have acid reflux, your dentist and hygienist are trained to recognize acid wear on your teeth.  We often see acid wear on the back sides of the upper front teeth, and in more severe cases, we also see pitting in the cusps of the lower molars.  In extreme cases, we occasionally see flattening of the teeth if the effects of the acid wear have been exaggerated by clenching and grinding.  A high acid level in the mouth also leads to a higher rate of tooth decay, as bacteria love acidic environments.  We can help you identify if there is a problem, and can direct you to have a visit with your physician for testing and/or antacid medication. We can make suggestions in the mean time to reduce your risk of further enamel damage. Our goal is to preserve your enamel as long as possible for strong, healthy teeth!

We hear all the time, "My wife/husband says my breath stinks!"  Bad breath can be embarrasing and can cause problems in your personal life and in your career, especially if you work with people!  Before we can find a solution to your problem, we need to isolate the cause.

Some potential causes of halitosis are:

Periodontitis (Gum Disease)

Plaque on the Tongue or Hairy Tongue

Tooth Decay

Gastro-Intestinal Problems 

Acid Reflux

Tobacco Use

Certain Foods

Sinus Infection

Respiratory Infections

Post-Nasal Drip

Chronic Dry Mouth (Xerostomia)

Diabetes

Yeast/Fungal Infections of the Mouth (usually associated with dentures)

Your hygienist and Dr. Bach will seek to find the cause of your bad breath, and depending on what we find, the treatments will vary.  If no dental condition can be pinpointed, we will be happy to give you a referral to your physician so that he or she may explore potential medical-related issues.  You will be surprised how your life can change by addressing this simple issue!

Again sparking controversy among patients and medical professionals, we would like to address the recent topic of thyroid cancer as brought to light by the Dr. Oz show.

 If you missed it, Dr. Oz recently blamed dental x-rays and mammograms for the rise in thyroid cancer in women, and is advocating the use of a thyroid guard during these procedures.  Incidentally, and going unrecognized on the show, thyroid cancer for men is also on the rise, both since about 1980, per Dr. Daniel Kopans, Professor of Radiology at Harvard Medical School who was featured on the show as a critic of the thyroid guard.

 Allow me to be casual here for a moment as it seems Dr. Oz points to one tiny cause for a very large effect.  Dental radiation and mammography are two very, VERY small sources of radiation.  He did not address the use of cell phones (coincidentally, also in use since the 1980’s), older televisions and microwaves, background radiation (we are all subject to), or even exposure to outdoor sunlight.  The things I just mentioned largely contribute the amount of radiation that a person is exposed to in a lifetime. This is similar to the fluoride critics who blame fluoride in water (at the rate of one part per million), which occurs naturally in water anyway, for fluoride toxicity, cancers, and whatever else people are coming up with these days.  But I digress; that is a topic for another day.

 Back to the issue at hand, I am not a mammographer and will leave that topic alone, just leaving you with the one quote on the show that really stuck out in my mind.  Dr. Kopans, an expert in mammography and professor at Harvard, stated that the amount of radiation that a woman gets from one mammogram a year, times 40 years, is still LESS than what the audience members were getting in background radiation during the hour they sat there; therefore, he said, if Dr. Oz were going to recommend thyroid guards during mammograms, then he should also be providing them for his audience.  

 Dental x-rays are aimed at the teeth and jaw, and the thyroid gland recieves little to no radiation from that exposure.  Your thyroid is located low, near your clavicle, as pictured in the diagram below.  

 Now, if dental x-ray radiation was really causing thyroid cancer, why the rise since 1980?  X-rays have been around for over 100 years and dental x-rays have certainly been the standard of care for the majority of the 20^th century.  Since the turn of the century, most dental practices have been making the move to digital x-rays, which use about a quarter of the radiation exposure than traditional film x-rays.  So, shouldn’t we be seeing a decrease in thyroid cancer, if in fact dental x-rays are to blame?

You’re still concerned?  That’s ok.  There’s already a thyroid guard attached to our lead apron. 

Are you looking for a Chester dentist, a Chesterfield dentist, or even a dentist in the Richmond VA /surrounding areas?  Our office is located at the intersection of Ironbridge and Centralia Roads, about a mile from the Chesterfield Courthouse.  We are a mile off of 288, reasonably close to Chippenham Parkway, and about 10 minutes from 95.  If you are near or far, we would love to treat you right.  We even have patients that live in Prince George, Colonial Heights, Hopewell, West End, Williamsburg, DC, JAPAN, and MALAYSIA!  If you can believe that these people are willing to drive (or fly!) the distance to come see us, we think you will enjoy coming here as well.

We are now offering referral credits.  If you are a patient here, and you refer other people to our business (family, friends, coworkers, baby mamas...), then we will post a $25 credit to your account per family, with NO LIMIT on how many people you refer.  You receive the credit after the person you are referring has been seen for their new patient exam.  You can use your credit toward anything you please - copays for fillings, fluoride treatments, whitening / bleaching, or any other service we offer.  We would say "you're welcome," but we really mean, "Thank YOU!"

We see it nearly every day in our office.  Someone comes in with a toothache, or a broken tooth, or whatever it is that lands them in the dental chair after X amount of years since the last time they saw a dentist.  Do you know that some of the most common answers are "I was too embarrassed to come in after letting my mouth get this way," or "my kids come first, and everything went downhill for me."  The first step is making the phone call - and the second, most importantly, is showing up.  We'll take it from there.  

FAQ from people who haven't been to the dentist in a while:

Q) I have a tooth that's loose.  Should I just pull it?

A) There are many cases that taking the tooth out IS the right answer.  If you are in that situation, we will discuss options for tooth replacement so that your other teeth don't shift, and you can still speak and eat.  It isn't always the case, however.  You may have periodontal (gum) disease and the tooth may be salvageable after a visit to the periodontist (gum disease specialist).  We will let you know what route to take.

Q) I have a MILLION cavities.  Where do I start, and how in the world am I going to afford to fix these teeth?

A) We will take x-rays and develop a treatment plan with you that suits your budget.  We will start with what's worst and work our way to the small stuff.  Our front desk personnel are very competent at figuring out what your co-pay will be for each appointment, depending on your insurance plan.  If you can only afford to do one filling at a time, we will do that for you.  If you have pressing issues that need to be treated sooner than later, we also participate with a company called Care Credit, that is like a credit card for medical/dental expenses.  Often times, they will allow up to 18 months of payment with no interest.  You can find out more at www.carecredit.com.

Q) I just want the front teeth fixed, since those are the ones people can see.  What's wrong with just pulling the back ones?

A)  The back teeth are your chewing teeth.  They are made for that purpose.  Molars are wide and have many cusps and valleys where the teeth come together to break down the foods you eat.  Without molars, your chewing shifts to the front of your mouth, to smaller teeth that aren't made to withstand all of the forces of chewing.  This can cause breakage and fracture of the front teeth, and can also cause major problems with your TMJ (your jaw joint).  We can replace back teeth with a removable partial, or implants or bridges, depending on the stability of the remaining teeth and the bone structure.  One thing to think about is that "sunken face" look that is typically associated with the elderly.  Removing the back teeth causes the cheeks to sink in.  If more teeth are removed, especially your canines or "eye-teeth," this causes additional sinking of the face and overclosure of the mouth.  Apply these thoughts to the picture below (it's also a cool optical illusion, but great for this demonstration!).

Please comment, find us on Twitter @MelanieBachDDS, or "like" us on Facebook (Melanie A. Bach, DDS, PLLC).

One of the biggest complaints our patients have about their teeth is that they are "sensitive."  Here is a briefing on what types of sensitivity can mean different things, and how to help combat the problem.

The most common is COLD sensitivity.  This can mean that your enamel is thin, or that you have recession (where the gum drops down from around the tooth exposing the root), or you may even have open margins in your existing restorations (meaning, that perhaps your existing fillings/crown need to be replaced due to a gap between the filling/crown and the tooth itself).  If your sensitivity to cold happens on almost every tooth, you can try using sensitivity toothpastes and extra fluoride to strengthen your enamel.  If your sensitivity can be pinpointed to one tooth in particular, speak with us about your concerns and we will be happy to try and help you find a remedy for the problem area.

If you have HOT sensitivity, see us immediately.  Hot sensitivity usually means one of two things: trauma, such as grinding your teeth, or an infected tooth (abscess).  We need to rule out that your hot sensitivity is not an abcess as soon as possible.  Abscesses can lead to infection in other parts of your body, so it is best to see us sooner than later.  If you are griding your teeth, we can preauthorize a comfortable, custom-fit night guard for you to wear.  It will relieve the pressures of grinding to make your sensitivity disappear.

If you have SWEET sensitivity, it's almost a sure bet you have a cavity, BUT, it can also be caused from recession.  Recession exposes the roots of the teeth which do not have enamel on them, and the sweet sensitivity will be right at the gumline.  We recommend extra fluoride applied directly to the recession.  In any other case, it is probably a cavity.  You will only feel the sweet sensitivity when the cavity is medium to large in size, so if you are experiencing this, please call us as soon as possible.  If you wait, there is a chance the tooth may become infected if the cavity becomes too large.

We recently were asked about a natural teeth whitening "recipe" that Dr. Oz had on his TV show.  It consists of mixing lemon juice with baking soda and putting it on your teeth daily before brushing. 

Sorry, Dr. Oz, but we disagree!  Lemon juice is a powerful acid, which will contribute to acid erosion of enamel.  For example, people who suck on lemons will develop acid wear patterns in their front teeth.  Certainly, you wouldn't purposefully wear down the prettiest enamel on your front teeth!  Additionally, baking soda is very abrasive.  Although it is marketed in many toothpastes, we don't recommend "whitening" toothpastes, or plain baking soda, due to the coarse texture.  As you brush your teeth, the coarse texture will wear down enamel as well.  If you have recession, exposing the root of the tooth that does not have enamel on it, that part of the tooth will wear down even faster.  We have attached a picture below to show you what acid erosion looks like.

Don't believe everything you see on TV.  Ask your hygienist or dentist for their opinion before beginning any whitening regimen.  We use a carbamide peroxide whitening agent, which is used short term (up to 4 weeks for the initial whitening).  The peroxide opens the pores of the teeth to whiten the inside part of the tooth, which causes the yellow outer color.  The pores will then close up after the whitening treatment and restrengthen the enamel.  Most of our patients will then "boost" their whitening by using the solution for a few days every 6 months to a year.

As your neighborhood Chester dentist, we offer our patients choices.  Tooth colored or amalgam fillings?  Bridges, partials, or implants?  Whitening or veneers?  None of the above?  Well, that's ok too, and we will discuss with you what the pros and cons are with every option.

Today, we're exploring the difference between amalgam (silver) and composite (tooth colored or "white") fillings.  As far as longevity is concerned, studies have shown that either filling material has about the same life expectancy, provided the patient practices at least fair-good oral hygiene habits.  In a patient who has poor oral hygiene, however, the life expectancy of a composite filling will decrease.  Often times in the pre-teen & teenage years when oral hygiene habits are at their worst, we will recommend amalgam fillings over composite fillings in hopes that it will last longer.  

In any case, there is a slight benefit to choosing the composite fillings over the amalgam.  Here's why: amalgam fillings are mechanically retained, meaning that when Dr. Bach or Dr. Gerber takes the cavity out, she will have to remove a little extra tooth structure, creating retention grooves in the tooth to make sure the filling stays in place.  On the other hand, composite fillings are chemically retained, meaning that a bonding agent is used to create a bond between the tooth and the filling, keeping it in place.  Let's get to the point now - the benefit to choosing the composite filling is that if you should ever get another cavity on the tooth or under the filling, Dr. Bach or Dr. Gerber can remove the decay and bond new filling to the old filling without having to remove more tooth structure.  If decay starts around an existing amalgam filling, the entire filling has to be removed, the decay removed, and new retention grooves put in the tooth, causing loss of tooth structure every time a filling needs to be replaced.