Alternatives to Mercury Dental Fillings

Additional Info

• Segment Number: 3
• Audio File: healthy_talk/1525ht3c.mp3
• Featured Speaker: Robert H. Gregg II, DDS
• Organization: LANAP
• Guest Bio: Dr. Robert Gregg is a former faculty member at UCLA School of Dentistry, Section of Hospital Dentistry.
  
  He has been using lasers clinically since August 1990, including CO2, free-running pulsed (FRP) Nd:YAG, both single- and variable-pulsed; FRP Ho:YAG, surgical Argon, CW Diodes, and Er:YAG. He has given lectures nationally and internationally on the subject of clinical laser applications.
  
  Dr. Gregg is a co-developer of the FDA-cleared PerioLase® MVP-7™ pulsed Nd:YAG laser, and is a co-developer and patent holder of the LANAP® laser periodontitis treatment. He maintains a group private practice where he sees patients.
• Transcription: RadioMD Presents: Healthy Talk | Original Air Date: June 17, 2015
  Host: Mike Smith, MD
  
  Anti-aging and disease prevention radio is right here on RadioMD. Here's author, blogger, lecturer, and national medical media personality, Dr. Michael Smith MD, with Healthy Talk.
  
  DR. MIKE: So, I'm back with Dr. Robert Gregg. He is the President and Chairman of the Board for Millennium Dental Technologies. He's worked with the School of Dentistry over at UCLA. He's worked with lasers most of his career; he's even the co-developer of a specific laser that we'll talk about a little bit later in the show.
  
  Dr. Gregg, welcome to Healthy Talk.
  
  DR. GREGG: Thanks, Mike. Good to be here with you again.
  
  DR. MIKE: We just talked a lot about the issues with mercury fillings, and you mentioned a few alternatives to mercury and what's available out there. So, I want to talk a little bit more about that with you. But before we do that, let's say a patient comes into your office, Dr. Gregg, and they have mercury fillings. How do you actually remove that? It would seem to me that that might even be an issue, just removing the mercury. What kind of process do you go through?
  
  DR. GREGG: There's a very specific process for removing silver amalgams. It's interesting that OSHA doesn't allow us to dispense any of our residue amalgams into anywhere but a secure container covered in water. So, if their concerned about it, what are those concerns for the patient? [laughing]
  
  DR. MIKE: [laughing] Right.
  
  DR. GREGG: We have to handle it like a hazardous waste in our office. I don't use it anymore, but in the days back in the 80's when I did, we had to handle it like it was a hazardous waste. What you do is you put a rubber mask over the tube that surrounds the tooth and you use high volume evacuation. In some cases, you have an additional vapor remover that looks kind of like an elephant's trunk that can suction any additional vapor out of the room. But you do it underwater, and most of the time it is just the safety process. As long as you're submerging amalgam underwater, it's fairly safe but you don't want to be touching the skin and the tissues.
  
  DR. MIKE: This is interesting. Even OSHA recognizes the toxicity of mercury.
  
  DR. GREGG: Oh, my gosh, yes.
  
  DR. MIKE: Yet we're putting this in people's bodies and stuff, so that right there tells you something.
  
  DR. GREGG: It's quite ironic. That's why I stopped using those amalgams in the 80's.
  
  DR. MIKE: Can any dentist remove it? Is this extra training people go through?
  
  DR. GREGG: No.
  
  DR. MIKE: If I have mercury fillings, can I go in just a general dental office and get it removed?
  
  DR. GREGG: Yes. I think the difference lies in those that take the additional steps of safety precautions—isolating the tooth with a rubber band is what it's called – but more and more dentists are going back to our dental school training which is what we did. We put rubber bands over the teeth we were working on, a rubber mask.
  
  DR. MIKE: Let's talk about some of those alternatives that you had mentioned before. You mentioned that these can be costly, so why don't we start with maybe some of the alternatives; let's move it from least costly to most expensive as you discuss this.
  
  DR. GREGG: It's fascinating and I'm sure you probably see some irony in your medical literatures, that the dental literature looks at the success of a filling, whatever it is, by how long the filling lasts, not how much damage happens to the tooth. Why aren't we grading our restoration by how well they service the tooth?
  
  There's a very inexpensive, white filling material, it's called Ketac, and you do not have to create the wedge shape prep in the tooth (where you actually undermine the supporting walls of the tooth), you can bond that in, it releases fluoride to the tooth, it's not supposed to be a permanent restoration, but I've had patients slip way and out of my practice for 10 and 20 years and when I finally get them back in to re-care and I take that Ketac out, there's absolutely no damage, no fractures, no residue, no metal sulfites that have been leeched because there are no metals in the Ketac at all. If you were to go to peer review and represent that as a permanent restoration, they'd scold you and slap your wrist and I don't know what else. But it doesn't damage the tooth. That's the point. And they do last, even if they wear. So, we start to grade our restorations by how successful they are in longevity, regardless of all the damage it's doing to the teeth.
  
  DR. MIKE: Dr. Gregg, but where did the standard come from then, that we're going to look at the actual filling itself and how long that lasts versus tooth damage? Where did that start? Why are they measuring that?
  
  DR. GREGG: American Dental Association.
  
  DR. MIKE: That's just the standard they came up with? Because I sense some frustration even in you when you talk about this. [laughing]
  
  DR. GREGG: I am. I am very frustrated. There's a reason why the Academy of General Dentistry formed. It was some disaffected general dentists with the ADA. And it's the same thing with the AMA. My dad was a physician. They often don't represent the interest of frontline general practitioner.
  
  DR. MIKE: So, that's one alternative. Let's go into the different alternatives, because I'm going to make sure we get through all this, Dr. Gregg.
  
  DR. GREGG: Sure.
  
  DR. MIKE: So, that's one. Now how expensive is that that you just described?
  
  DR. GREGG: You're talking comparable with silver filling. It's right in there.
  
  DR. MIKE: But long term less tooth damage, so probably a better option. What's another option that people can use if they want to spend a little bit more money?
  
  DR. GREGG: A little bit more money might be some of the new packable composites, that's really what they're referred to, because they're a composition of resin and glass. Some people call them porcelain fillings. That's kind of a misnomer. They're really composites. Those are probably two and a half times maybe a silver filling per surface, so they do start to go up and more technique sensitive. The Ketac is not as technique sensitive; it's pretty simple. You put it in just like you do an amalgam. Just a little bit different, but no technique sensitivity.
  
  Then you go up from there, and you start to get into some of the fifth and six generation ceramics that are cast just like gold is cast, and you bond them to the tooth. And they actually are restorative versus the filling. So, you can take a tooth that's been hollowed out from a previous amalgam and insert these in and unless some extreme force like a car accident, these don't break. I used the first generation stuff and it was more brittle. This stuff nowadays is called E-max, to a lesser degree zirconia, E-max especially, it just doesn't fracture under duress of the mouth, and chewing on things and biting on inappropriate things like corn nuts and things like that on Super Bowl Sunday.
  
  DR. MIKE: [laughing] So, Dr. Gregg, if one of my listeners is interested in learning about some of these alternatives that you're speaking of, is there a website or source – your own website – that they can learn about this stuff?
  
  DR. GREGG: Not on our website. There are a number of websites. The American Academy of Cosmetic Dentistry probably is a good one. You might find some information on the ADA's website, but it would be kind of limited. Of course, the restoration of last resort is a full coverage crown. That can be all porcelain, all gold, it could even be stainless steel that might be filled with color.
  
  DR. MIKE: Let's do this, Dr. Gregg. I'm going to put you on the spot here because we only have about a minute left. I have two questions that I'm going to put together in one. And these questions came from the last time that you were on. I have a listener from Houston named Amy, and a listener from St. Louis named Kevin. I'm going to kind of put their questions together. What is a deep pocket exactly and how do the lasers help with deep pockets?
  
  DR. GREGG: Deep pocket is where the gum tissue meets the tooth. You measure that with a probe that has millimeter markings on it. So, normal is one to three, and anything three and above--so four, five, six, and up--is a deep pocket.
  
  DR. MIKE: What's the downside to the deep pocket? What's in there and what does the laser do? You've got about ten seconds. [laughing]
  
  DR. GREGG: It's an inflammatory process. It's destructive to the attachment of the tooth to the bone, and the laser is designed to kill the infection and kill the inflammatory process.
  
  DR. MIKE: Okay, perfect timing, Dr. Gregg. We're going to have to leave it there. Thanks for coming on. This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.
• Length (mins): 10
• Waiver Received: Yes
• Host: Mike Smith, MD