Montrose Star interviews trusted dental authority Dr Randy Mitchmore from his Montrose practice called LifeSmiles.
M.S. It seems that there is always the disease of the decade. I can remember when I was a kid hearing about polio and the March of Dimes, The Salk vaccine, measles and small pox, whopping cough, TB, and malaria. More recently smoking and cancer, heart disease, HIV and flesh eating bacteria.
What trends have you seen in dentistry?
Dr M When I was a young dentist cavities were like a wildfire going through a hot California desert. I would take x-rays and the cavities made teeth look like Swiss Cheese.
M.S. That has changed?
Dr M Yes! Fluoride supplements in water, toothpaste and some vitamins are the single most successful and most cost effective public health measure in this country. The amount of time I spend fixing brand new cavities has been dramatically reduced. Most of the cavities I see now are when people have old fillings or crowns that are worn out and cavities set in again on those.
M.S. What a minute, I thought metal fillings and crowns lasted a lifetime!
Dr M That is an extremely common misconception. The expected lifespan of a typical silver/mercury amalgam filling is plus or minus fifteen years. Silver corrodes! Metal expands when it corrodes! When that happens at around the fifteen year mark, there is no longer a good seal between the metal and the tooth. Cavities grow where the seal is broken. The metal expansion causes teeth to crack and break.
M.S. How do I know when that is happening?
Dr M Probably the most common phone call I get on Monday morning – “My tooth broke over the weekend and I was eating something very soft!” Typically the tooth had a very old silver filling and there were cracks in the tooth. The filling stays in and a large chunk of tooth fractures off. Another symptom is the teeth start getting sensitive to sweets, acids, or temperature changes. The best way is for a detail minded dentist visually inspect the status of your old fillings and crowns.
M.S. How do you do that?
Dr M: Technology is my friend. I look geeky, but when I examine a mouth I use microscopes attached to my glasses with a very bright LED light. I supplement that with macro photography both with video and SLR cameras. You have to inspect what you expect if you want healthy teeth. I can see micro cracks in the teeth. I look for tell tale signs of the tooth turning grey around the perimeter of the filling.
If the filling or crown is replaced when the cavities are first detected, it can save a lot of pain, suffering, and dollars!
M.S. Tell me about the new Cancer in Dentistry, Teeth that look Old.
Dr M Most everybody knows what a cavity looks like – a dark brown or black spot on a tooth. The bigger issue that I spend a great deal of my time explaining and fixing is teeth that are wearing away prematurely.
M.S. What is going on and what does it look like?
Dr M Teeth start looking shorter and the lower front teeth start looking thicker. On the lower front teeth you can see a darker color in the center with a lighter ring around it. Each tooth is covered with a shell of very hard but very brittle enamel. Enamel is whiter in color than the inner core of the tooth called dentin. If you wear through the enamel the inner dentin core of the tooth is exposed. The dentin is seven times softer than tooth enamel. So once it is exposed, it wears faster and the enamel literally chips away because it is unsupported. Picture this. If you cut down a tree and look down at the stump you see a ring of bark on the outside and a different color inside. If the top layer of enamel is worn on the tip of the tooth and you look down on it, you will see a ring of white enamel and a darker color inside that ring. If it is really bad you can see a third color that is more like a dot. That is the nerve inside the core.
Front teeth are thicker at the gumline and get thinner as you go up to the edge or tip. So if you cut off or wear away the tip, the biting edge of the tooth looks thicker than when the tooth was not damaged. The nice original scalloping lines between the individual teeth is lost and the teeth look very flat or straight across.
As premature wear goes on, teeth that look short, thick and very flat on the edge look old. Another sign is a dark notch right at the gumline of the tooth.
M.S. Those are a lot of four letter words in my book! What do you mean by “premature”?
Dr M. Sometimes you can guess the age of a horse by looking at how worn away the teeth are. Not true with humans! I have patients in the 30’s that you would swear by looking at only their teeth they were 90. I have patients in the 90’s that you would swear their teeth are in their 30’s!
M.S. How can you prevent it and what do you do to fix it?
Dr. M The most common cause is a bad bite. Much like the tires on your car being out of alignment. The tires will roll down the road alright, but they wear out way too soon. The best solution to prevent the problem is to fix the bite first. One of the very best ways to do that is with Invisalign to put the teeth in the proper alignment. Guess what? They actually look better as a result of that. We have all heard the true phrase, form follows function.
The next step is to re-attach the worn off tips. That is some really cool technology for another conversation later.
Dr Mitchmore is active in the community. He was appointed by the Texas Legislature and serves as Vice-Chairman of the Montrose Management District. His passion is Dentistry. He has also been a City Councilman and Chairman of the American Academy of Cosmetic Dentistry’s Charitable Foundation, Give Back A Smile. The foundation helps survivors of intimate partner abuse regain their smile.