Repair of teeth

Individuals vary in tooth shade and shape, and teeth yellow with age. Teeth are damaged by caries, wear, failed restorations, trauma, and congenital and developmental defects. Patients usually demand treatment for pain, when appearance is compromised, or when there are occlusal problems (see previous article).

Restorations

Most older adults have had restorations (fillings), but, with the benefits of health education and fluoride, many younger people have unrestored teeth.

Most restorations are placed to treat caries. The decay is removed mechanically, the cavity shaped to retain the filling, and material is packed into the cavity and then sets hard. Even high quality restorations have a finite life span. If the pulp is diseased, root canal treatment is necessary, which involves removing the pulp and cleansing and filling the chamber.

Amalgam

Amalgam contains silver, copper, tin, and zinc mixed with mercury, and sets within a few minutes. Exposure to mercury vapour is hazardous. Mercury is neurotoxic, and even in people with low level chronic exposure, subtle preclinical effects on symptoms, mood, motor function, and cognition have been identified. Pregnant dental staff have special concerns related to any daily occupational exposure to mercury (or nitrous oxide).

However, any risk to patients from dental amalgams is less clear. Twenty two million amalgams are placed annually in the United Kingdom, with no reliable evidence of associations with systemic disease, …