conservative dentistry

Modern dentistry ranges from the provision of single restorations to complex full mouth rehabilitation, where a broken or worn dentition can be completely rebuilt.

It is recognised and known that, while metals are extremely durable materials-and gold, in particular, can be used in thin sections, thereby conserving tooth structure-there are some patients who would rather not have materials placed in their mouths that some consider could upset the energy balance in their bodies. Some holistic dentists use simple kinesiology to test for sensitivities and overload. Laboratory tests are also used. A Kelmer challenge, lymphocyte sensitivity and stool tests for heavy metal assessment are lab tests that can indicate the level of and sensitivity to mercury and other toxins. These are important tests to have carried out when considering amalgam replacement.

Many different restoratives are available, including porcelain and gold; these materials are considered to be the most durable, and form the basis of most of the complex restorations provided by dentists.

Resin-bonded quartz composites (white fillings) are a relatively new invention dating from the mid-1960s. Early composites were intended primarily for use in the front teeth. However, although they were aesthetically good when initially placed, they had poor wear characteristics. But, by the mid-1980s, sufficient developments in this field had allowed their routine use for selected restorations in back teeth as well. Furthermore, these composite fillings have the ability to bond chemically with dentine and enamel, allowing for smaller restorations which can be sealed into the tooth. Fissure sealants were developed as part of this technology so that the small pits and cracks in molar and premolar teeth could be sealed soon after their eruption, before they developed cavities.

Glass ionomer cements can also bond to tooth substance but, in their present form, they are not durable enough for permanent restorations in adult teeth. For direct amalgam replacement, composite materials can be used, provided that the area of tooth involved is not too large and that the bite is not too heavy. From an holistic viewpoint, the least toxic replacement composite should be one with no aluminium or resin bisphenol-A (an oestrogen-like substance which can `mimic' hormone effects), and no fluoride.. Where there is no suitable alternative and metals must be used, either because of the complexity of the restoration or a heavy bite, they should have the highest gold content possible. For front crowns where, for aesthetic reasons, gold is bonded to porcelain, this can be as high as 99 per cent. A similar bonded crown on a back tooth would have a gold content of 88 per cent. Composite crowns are being developed but, at present, they do not appear to have acceptable wear characteristics.

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