We usually will use composites in very, very small fillings that don’t have a lot of attrition when you masticate. Optimally you will want to replace the amalgams with something that has been baked like porcelain.
Participant: Quick question over here. Can you recommend any dentist in the Atlanta, Georgia area that you know of? Any colleagues, friends that you know that’s truly a holistic dentist?
Daniel Vinograd: I don’t. I would be happy to look for you. If you want to email me, I will be happy to be in touch with you and try to find somebody for you.
Facilitator: Do you want to wait until you’re done to take some questions because it could be that some of the things that people are asking, you’re going to cover it …
Daniel Vinograd: Yeah. So if you have questions specifically about amalgams, about silver fillings, I will take them now.
Participant: Before you ask if there are questions, you’re ending with a comment that it was very important to find a holistic dentist who knew about your anatomy and physiology and things. You said that’s very important. Why is that important?
Daniel Vinograd: You’re a human being and everything is interrelated. Since industrial revolution, we actually learned to compartmentalize things. We have specialists in this, specialists in that and your body becomes a series of pieces that gets separated.
You have to think about the fact that everything that you eat goes through your mouth. All the bacteria in your mouth is really having some kind of relationship with the rest of your body and we’re going to go into that in a minute. But we cannot really separate the mouth from the rest of the body. It’s just one thing and we have to treat it like that.
Participant: Do they use amalgam in the crowns also? Because I know when I had crowns, if they weren’t completely porcelain, I had to choose a metal and depending on the metal is like the lowest base metal amalgam.
Daniel Vinograd: No. The amalgams are not used in the crown itself. Often when the dentist prepares a crown, if there’s an amalgam in there, in the structure of the tooth includes an amalgam, sometimes it will leave the amalgam in there just to maintain the integrity of the tooth rather than removing it and replacing it with something else, and then placing the crown.
So we find a lot of times that we take a crown off and we find amalgam silver fillings underneath. A very difficult thing to really assess because when you actually – we are very conservative with X-rays but when we do have to take an X-ray to see what’s going on, most of the metal crowns will not allow us to see inside to see whether there’s a silver filling or not.
So if you ever have a crown, you have to make sure that you ask your dentist to remove all the amalgam and hopefully do it in a safe manner.
As far as the crowns themselves, the metals on the crowns vary significantly. You have probably on the most biocompatible end of the spectrum, you have some pure titanium which is now being used more and more. Then you have non-precious metals which is mostly nickel, lead, a few other quite toxic metals that are used underneath and then they bake the porcelain on top most of the time. Does that answer your question? OK.
All right. So let’s talk a little bit about your question. Everything is connected. So what we learn is that you have a dentist. You have a doctor. You have a specialist in this. You have a specialist in that. We are beginning to get a lot of research back showing how much we really are interconnected and how much oral disease is affecting systemic disease.
So we have quite a number of studies on heart disease and even though the American Dental Association just came out and said that there is really no relationship between gum disease and heart disease, in my opinion – and I’m sure I’m going to get in trouble but it won’t be the first time in my life – I think this is a political position.
I think a lot of dentists [0:20:00] misdiagnose or do not diagnose periodontal disease and if they take the position that it is linked, then there’s liability involved for the dentist for not diagnosing periodontal disease.
So the other study that just came out probably three or four years ago is linking again periodontal disease, gum disease with pancreatic cancer. So the initial stages of gum disease looks like this. So if you begin to see some bleeding in your gums, you begin to see some pocketing in your gums and a little bit of redness, this is the beginning of periodontal disease and of course more advanced stages, you’re beginning to have a little bit of bone loss and more pocketing.
So if you see on the left side you have a situation that is normal. On the right side, you have actually already a periodontal pocket that has been formed and right on the bottom of that pocket you have bacteria that are having a great time. They’re throwing the party and they’re untouched.
Once you have two or three millimeters of pocket depth, you can get in there with the toothbrush or a Waterpik and clean those out. When you have four, five, six millimeters of pocket depth, you can no longer reach those bacteria and they’re basically home free.
Now what’s really interesting here is that they have found the same bacteria on the bottom of those pockets which are basically anaerobic bacteria which means bacteria that do not need oxygen versus the aerobic bacteria.