- The Washington Times - Thursday, October 31, 2002

It's easy to think of dentistry as simple-minded stuff: Drill a hole in a tooth and plug it up with something. It's a little more complicated, and there is actually a lot of science behind it. I know this because I'm visiting Ralph Gitomer, a friend who is a dentist.
He talks at length about new developments in dentistry, such as better adhesives for gluing crowns to teeth, lasers, experimental this and that. He says, though, that in his experience, people most need to understand technical basics.
For example, why do dentists use gold for crowns? Because they own stock in gold mines? Because it's pretty?
No. The issue is "biocompatibility." Gold is not chemically very reactive, so the body doesn't try to reject it. Other materials can cause an immune response. Steel, for example.
"The body can't get rid of it. The gums react, get inflamed, and try to move away from it. It's not uncommon to see red inflammation around one tooth and no others, and it's almost always a crown. I tell the patient to replace it.
"Crowns made from steel or other metal alloys, if you put them under the gum, will always cause a reaction. My rule was simple: always use gold."
Porcelain?
"All-porcelain crowns, if made of the right material, are highly biocompatible and look good. The problem is that they aren't as strong as gold. The big issue is thermal expansion. You want a material that expands as much or as little as the tooth itself. Today, the permanent crown materials are all good, but plastic white filling materials expand and contract and often break the seal. Bacteria get in and you get decay."
Dr. Gitomer has a low opinion of white fillings for back teeth.
"Basically, they're plastic. They wear out and you have to replace them. They just don't hold up. The only advantage is that they're pretty."
Whiteners?
"If you want to whiten your teeth, you have two choices: Bleach them or abrade them. Neither is a particularly good idea for your teeth.
"When you use abrasive whitening toothpaste, you in theory are just scraping away the stain. In practice, you can't do that. You always scrape away enamel, too. It doesn't grow back.
"You can apply peroxide strips to your teeth. It just generates hydrogen peroxide slowly and bleaches the enamel. Not too harmful."
A high-tech approach to making crowns comes from Sirona Dental Systems. An optical device like a camera takes pictures of the tooth to be crowned. Software then turns the picture into three-dimensional instructions to a small milling machine that, in a few minutes, machines a very precise crown.
If you read the technical magazines of dentistry for example, the Journal of the American Dental Association you find common themes. One is doing a good job, and the other is making money. Dentistry, after all, is a business. If you can make good crowns fast without having to pay a lot of lab technicians, the patient gets a good tooth and the dentist sees more patients, making more money. The Sirona approach helps with both.
Dr. Gitomer says the machines are accurate to within one ten-thousandth of an inch. This matters because you don't want space for bacteria to leak under a crown.
Fillings? Most dentists, he says, prefer to have gold fillings in their own mouths instead of the silver amalgam that most of us have. Why?
Gold fillings are a hard sell because they cost more. People don't want to pay. But they're better, stronger, last longer, fit better, and you get a better-shaped tooth that chews more efficiently and stays cleaner.
If dentists do it, maybe it's a good idea, sez me.


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