Tuesday, July 25, 2006

No guarantees

"I never promise any medical cures because you can't," he said. Instead, he presents both sides of the issue on his Web site and provides patient referrals. "If people come in asking about amalgams, I'll tell them," he said.

"If they're there for basic dentistry, I don't say anything." Linda Brocato of Prospect Heights went to several dentists before she made the difficult decision to have her 16 silver fillings removed. Her problems began in 1980, when she looked in the mirror one morning and noticed her right eye was drooping. Seven years and dozens of health issues later, the former social worker was crippled, diagnosed with multiple sclerosis.

It wasn't until Brocato heard about the Minneapolis-based group Dental Amalgam Mercury Syndrome (DAMS), however, that she began to believe she had mercury poisoning. Two weeks after she had her last amalgams replaced, Brocato said her slurred speech began to disappear and her strength and balance improved. She knows the symptoms of MS come and go, which could explain her improved health, but she is convinced that removing the silver fillings made a big difference. "I have five pages of improvements," said Brocato, 56, who is still in a wheelchair but no longer takes medication for MS.

She is now one of the Illinois coordinators for DAMS. "I don't know how people can say there isn't evidence." Mercury-free options for teeth A major debate surrounding silver (mercury) amalgam fillings is whether they cause the teeth to crack, creating the need for root canals and other major surgery. Lincoln Park dentist Gerilyn Alfe believes they do, just one reason she has embraced mercury-free alternatives to amalgams for the last decade. "I don't think ripping metal fillings out of everyone's mouth is a good practice," said Alfe of Chicago Smile Spa. "But if they're starting to deteriorate or fracture, I will replace them with bonded, tooth-colored aesthetic fillings."

The use of silver fillings has dropped nearly 40 percent since 1979, thanks in part to better oral care that decreased the overall frequency and size of cavities. Better diagnostics allow dentists to find cavities earlier, when they are much smaller and easier to restore with alternative materials, including porcelain inlays or onlays, and tooth-colored fillings, or composites. Porcelain inlays or onlays are ceramic or glasslike fillings and crowns. They are popular because "they are bonded to the tooth structure, extremely strong and many people can expect 15 to 20 years service with it," said Peter Dawson Boulder of Aesthetic Dentistry of Atlanta. The American Dental Association, which says it doesn't promote the use of one restorative material over another, says porcelain is highly resistant to wear but can rapidly wear opposing teeth if its surface becomes rough.

They may fracture under "heavy biting loads." And it's important to find a dentist with good technique because the strength depends greatly on the quality of the bond to the underlying tooth structure. Tooth-colored fillings, another common option, are made from durable plastics called composite resins. First introduced in the 1960s, they've undergone continual improvements in durability, color stability and esthetics. Tooth-colored fillings are actually bonded to teeth; silver/amalgam fillings are not bonded to teeth. "The technique behind bonding actually strengthens a tooth because the bonding locks in so tightly to the inside walls of the tooth through tiny micro pores," said Chris Kammer of the Center for Cosmetic Dentistry in Middleton,

Wis., a mercury-free practice. But composites aren't for every tooth. They work best in small restorations and low-stress areas and might not be effective with a large cavity or for the chewing surface of a back tooth. They also cost more because they take longer to place. Unsightly amalgams are still considered the most durable and the best choice for large restorations. But amalgam is metal and X-rays cannot penetrate through it, said Dr. Parviz Azar-Mehr, a Prosthodonist and Professor of Clinical Dentistry at the University of Southern California.

That means X-rays might not pick up decay under the amalgam filling, and "it can lead to even worse problems than the original cavity the amalgam was meant to treat," said Azar-Mehr, who recommends that silver fillings more than 15 years old be replaced with crowns or tooth-colored fillings.

By Julie Deardorff

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