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Articles
of Interest
Amalgam vs. Composite Restorations
 For over 100 years, teeth have been restored with amalgam restorations. Amalgam is a metallic colored mixture of silver, tin, and various trace metals that is bound tightly with mercury. Once the amalgam hardens, it is virtually impossible to release any free mercury from the restoration. Many billions of teeth have been restored successfully with this time tested and durable material.
Since the 1960’s various white, tooth colored restorative materials have been developed. Some of the early alternatives were either not strong enough to withstand the forces of chewing or dissolved slowly in the mouth over time. In more recent decades, composites were developed. Composites are silica quartz filled polymers that come in various white shades to match nearly any tooth color. Composites adhere to teeth by chemically bonding to tooth structure – both enamel and the underlying dentin. This adhesiveness along with their tooth color has been their primary advantage. They have proven to be nearly as strong and durable as amalgam.
Placement of tooth colored composite restorations is technically more demanding than placement of amalgam restorations. Composites require various additional steps and equipment to successfully bond to tooth structure. They are also very sensitive to salivary contamination during placement. Composite restorations are more costly since they require more time and skill on the part of the dentist, and the material itself is more expensive than amalgam.
Many parents choose composite restorations simply because they are tooth colored. There are, however, certain clinical situations where composites are preferable. For example, if a tooth has a very large cavity where the remaining sides of the tooth are thin, composite is a better restoration because its adhesive properties actually helps keep this tooth intact after restoration. If amalgam is used in this type of situation, it is not uncommon for the thin remaining tooth structure to fracture away from the amalgam restoration.
Another example where composite is preferred is when decay is found in a corner of a tooth instead of in the center. Since amalgam attaches to the tooth mechanically rather than chemically, the base of an amalgam restoration must always be wider that the surface. To make the base wider in the corner of a tooth requires removing an unnecessarily large amount of healthy tooth structure simply to hold the amalgam in place. Composite, on the other hand, actually bonds to the tooth structure and this adhesiveness requires removal of very little tooth structure beyond the decay itself.
Whether composite is used for its cosmetic benefit or its adhesive qualities, insurance companies generally prefer to pay only for the less expensive alternative - amalgam. Insurance companies all ‘allow’ use of composite, however, but hold the parent responsible for the difference in cost between that insurance company’s amalgam fee and the cost of the composite.
We, at Dentistry for Children, offer both materials since they both have their advantages and disadvantages. If a particular tooth requires a composite restoration, we discuss that with the parent. If the choice is purely a cosmetic one, we leave it up to the parent to make his/her own decision.
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Preventing Sports Injuries
With sports season in full swing, parents should be aware that dental injuries are the most common type of injuries to the face, and 60% of facial injuries occur during sports. An athlete is 60 times more likely to suffer damage to the teeth when not wearing a mouth guard.
A mouth guard is a flexible piece of plastic that fits around the upper teeth and protects them from injury. In addition to protecting against direct damage to the teeth by cushioning the lips and cheeks from the teeth or orthodontic appliances, a mouth guard helps prevent laceration and bruising. A mouth guard can also prevent serious injuries caused when the lower jaw is jammed into the upper jaw, including concussion, cerebral hemorrhage, jaw fractures and neck injuries.
There are several types of mouth guards. When choosing one, remember that a mouth guard should be flexible, comfortable, durable, odorless, tasteless, and easy to clean. A mouth guard should fit properly so that it protects your child's mouth, but does not interfere with breathing or speaking.
The least expensive mouth guard is a stock one sold in sporting goods stores. They come in small, medium, and large and are held in place by biting down. The disadvantage of these mouth guards is that the fit is not adjustable and may not protect your child's teeth as well as a more fitted model would. Holding these guards in place requires that your child bite down, so they can interfere with speech and breathing.
The most commonly used type of mouth guard is also sold in sporting goods stores. They're called "boil and bite mouth guards," because they're softened in boiling water and then formed to fit your child's mouth. This type of mouth guard costs a little more than the stock types, but because it is formed around your child's teeth, it fits and protects your child's mouth better. However, it still may not cover all the teeth properly.
The best mouth guard for preventing injury is one that is custom made for your child by our office. This type is a bit more expensive, but it is the most effective at protecting your child's mouth, face and head. Because it is custom fit to your child's teeth, it's also the most comfortable to wear. When you consider that the cost of fixing one broken tooth is many times more expensive than having a mouth guard custom made, the value is obvious.
Whatever type of mouth guard you choose, your child should wear it for any activity in which there is a chance of contact with other participants or hard surfaces. Mouth guards aren't just for football and hockey. If your child rides a bicycle, participates in gymnastics, volleyball, skateboarding, baseball, basketball or any sport or activity in which a facial or dental injury might occur, a mouth guard is a necessity. Half of all dental injuries can be prevented, and a mouth guard is an important aid in protecting your child's teeth, face and mouth.
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