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All materials used in the dental setting have been approved by the Australian TGA (therapeutic goods administration)
Resin composites are commonly used routinely as a tooth-coloured filling material. There is concern from members of the public that they contain bisphenol A (BPA) which is thought to have oestrogenic effects on cells. The evidence comes from studies showing that BPA binds to oestrogen receptors in vitro. However, the oestrogenic effect of BPA is 1000-fold less potent than the native oestrogen hormone.
All current resin composites consist of methacrylate monomers (such as Bis-GMA) and DO NOT contain BPA. However, BPA is a synthetic chemical starting point from which all methacrylates are derived – in dentistry as well as many other plastics.
No evidence exists that dental composites have estrogenic effects in vitro or invivo.
Dental ceramics are very chemically inert materials and remain stable over very long periods of time. They therefore have excellent biocompatibility.
They furthermore exhibit excellent flexure strength, fracture toughness, wear resistance and colour stability. The ceramics can also be formed into precise shape to replace missing parts of a tooth.
They are an excellent material where a substantial part of a tooth is missing or for crowns.
However, in order to be held onto the tooth, the ceramic restoration has to be bonded to the tooth surface with a cement. The cement in some cases has to be a resin cement in order to provide the best adhesion. Resin cements have chemical similarities to resin composites which have been described above.
Reference: Phillips’ Science of Dental Materials, Kenneth J. Anusavice 2007.
When the aim is the detection of decay and assessment of gum health, radiographs are not necessary at every check-up appointment.
The recommendations are:
For decay assessment:
If it is your first visit at the dentist and you have had a lot of fillings in the past or decay is detected in your teeth, radiographs are recommended. These would consist of 2 radiographs called bitewings to check the posterior teeth on each side of the mouth. If there are more severe or extensive issues, other kinds of radiographs might be necessary in order to obtain as much information as possible to help get a proper diagnosis.
If it is a recall visit and you have had decay in the past and considered high risk of recurring decay, radiographs are recommended at 6-18 months interval for adults and 6-12 months interval for children of up to 11 years of age.
If it is a recall visit and you have not had fillings and is considered at low risk of decay, radiographs are recommended at 24- 36 months interval for adults and 12-24 months interval for children.
For gum disease monitoring:
When gum disease is present, specific radiographs might be required to assess its severity. These might be necessary at different intervals depending on the case to determine whether there is progression or stabilisation of the disease. The frequency is decided by the dentist based on clinical judgement.
For post-treatment monitoring:
In cases where a patient has received more complex treatment like implants, root canal treatment or crown and bridge work, radiographs might be necessary to ensure the restoration or treatment site is being maintained in good health. Again, frequency is determined by clinical judgement.
Reference: Dental radiographic examinations: recommendations for patient selection and limiting radiation exposure. American Dental Association. Council on Scientific Affairs. 2012
They are necessary for a variety of reasons:
For decay detection
During an examination, decay in a tooth can be seen if it is in an area that is visible in the mouth. Often, however, decay and other pathology can be situated in between teeth or in areas where it cannot be easily visualised with the naked eye and hence remain undetected. This is where radiographs are necessary. The earlier a problem is detected, the simpler the treatment required. There are different types of radiographs taken for different purposes and they are recommended as appropriate.
For root canal treatment
During root canal treatment, radiographs are an absolute necessity as the dentist is operating inside the tooth within the root system. This is not visible as the roots of the teeth are beneath the gum line and enclosed within the jaw bone. Radiographs are needed to give an image of the roots structure, length and shape so they can be cleaned and filled.
For pre-assessement before major dental treatment:
Prior to starting orthodontic treatment, radiographs are required, firstly, to ensure there is no decay in the teeth, and secondly, to visualise the position of the teeth in the jaws.
Prior to placing an implant in the jaw, a radiograph of the area is necessary to ensure that there is enough bone thickness. The proximity of anatomical structures, like the sinus in the upper jaw or the inferior alveolar nerve in the lower jaw, need to be determined so the implant is placed in such a way as not to impinge on these structures.
Crown and bridge work
Prior to placing a crown or bridge, the teeth being crowned need to be assessed to make sure they are healthy and strong enough.
Prior to extraction of teeth
Radiographs show the hidden root structure of a tooth and also its position relative to other teeth and other anatomical structures. This is helpful to plan the extraction to minimise trauma during the procedure and is especially important when wisdom teeth are being extracted
For general diagnosis of pathology and gum disease
Pain in the oro-facial region is often dentally related. Radiographs can be helpful in confirming the diagnosis. Simple visual examination might not provide enough information to allow the dentist to reach a definite diagnosis.
Radiographs also allow assessment of gum disease severity.
We often have patients reporting that their gums bleed during brushing or eating or even spontaneously, and this is often a cause of anxiety.
The most common cause of bleeding gums is gum disease. Gum disease means that the gum tissues are inflamed. This inflammation is most often caused by a deposit of plaque and calculus (soft and hard debris) , which act as an irritant, around the gum lines. Inflamed gums usually look red, swollen and bleed easily. The more severe the inflammation, the more severe the bleeding.
In the early stages of gum inflammation, this is known as gingivitis. Gingivitis is reversible. When the irritant is removed, the gums are able to recover and stop bleeding.
However, continuous inflammation over a long period of time can lead to irreversible changes where the gums recede. This more advanced state of disease is known as periodontitis. Periodontitis can lead to teeth becoming loose and eventually falling out. Periodontitis requires immediate professional treatment to stop its progression.
Inflamed gums that bleed easily can make other dental treatment more challenging. It is important that prior to more complex dental treatment such as cosmetic dentistry, orthodontics, implant placement, and even filllings, that the gums are as healthy as possible.
The best way to prevent gum disease is with good oral hygiene both by adequate tooth brushing and flossing as well as professional cleans on a regular basis.
While bleeding of the gums from gum disease is not life-threatening, it is indicative of chronic inflammation of the gums and we recommend that you seek advice from your dentist as soon as possible.