A guest post by Eva Twardokens (the famous “Eva T.”): two-time Olympian, coach, and Registered Dental Hygienist 

In Part 1 of this series, we talked about basic concepts in oral health. In Part 2, I covered periodontal disease, and homecare tools and medicaments to make your life easier.

Today, in Part 3 of this three-part series, I’ll talk about the materials that a dentist uses, giving you guidance to choose the healthiest options. And if you have to have a root canal (and I hope you don’t…), I’ll discuss why it needs to be done right the first time, and how to ensure that happens. Finally, I’ll discuss my thoughts on dental insurance, including when and when not to take advantage of it.

Dental Materials

Amalgam. Everyone is freaked out about amalgam, those “silver fillings with mercury.” Man, amalgam was awesome! If you still have some in your mouth it is okay, unless you have a metal allergy or severe mercury toxicity. I’ve had mine for 20 years!

Leakage? Almost all of the amalgam leakage escapes as a vapor upon installation. So, unless your tooth is leaking because of a fracture in the filling or the tooth, you can leave it alone. Remember: “ The best drilling is none.”

So why don’t they use amalgam now? Simply because there are better materials, like composite. Composite holds the tooth structure together by drawing it in, because it adheres to the tooth and the dentist can match the color accurately.

Crowns. I am a big proponent of gold crowns. People hate it because of the color, but if you are a grinder or a clencher, it will protect the opposing tooth because gold has a wear rate similar to a natural tooth. Wearing down teeth puts them at risk for pulp damage, gum recession, and the possible need for a root canal. Ask any dentist what type of crown they would put on themselves, the vote would be gold.

Gold crowns are thin, so you need to remove less tooth when drilling the preparation to fit the crown. Porcelain crowns are okay, but they are very hard and wear down the opposing tooth, which makes them my least favorite.

There are several types of composite crowns, and some are pretty good if you must have white. However, the potential for high turnover (cracking) with composite crowns is high.

Whitening

The dental staff has a joke about whitening, because folks come in with all kinds of problems and decide they will go without treatment and “see what happens”—but these same folks at will ask at the end of the appointment, “Hey what about whitening?” I’m thinking, “Great, let’s whiten those teeth so they look super good in your cigar box when they fall out.”

The priority with whitening should come after health is established. Then, whitening is appropriate, kinda. Zoom whitening is for instant-gratification folks with money to burn. If you are going to whiten your teeth, first just buy some Crest White Strips (around $40) and see how you like the result. If they work, you’re done. If not, you may invest in professional trays and bleach (around $400). The chemicals in these products are mostly the same, and the Zoom (not so magical) light simply adds the factor of heat, which we all know quickens chemical reactions.

There are really not many long term studies on what bleach does to your teeth, and the industry assumes it is pretty safe. Just know that if you are in the process of whitening your teeth, stay away from chromogenic foods like blueberries, red wine, and coffee. You can really embed that stain into your teeth if you do it along with a series of whitening.

Finally, don’t become a whitening addict. The rule about whitening that your teeth should match the whites of your eyes, if you want them to look natural.

Root Canals

Root canals are a treatment where the dentist cleans the infected pulp out of the tooth and replaces it with a soothing substance called gutta percha. The tooth is technically dead, but the periodontium still lives and the tooth still functions for chewing.

Root canal treatment is needed when the pulp of the tooth gets contaminated and therefore infected. The infected pulp accumulates pus, and pressure builds from the inside of the tooth. The infection (pus or exudate) finds the path of least resistance and continues to develop somewhere outside the tooth, usually at the apex of the root in the form of an abscess. It can also travel to the outside of your gums, forming a pimple-looking mass called a fistula. (This will drain on its own, but it is pretty gross.)

Generally these infections destroy the supporting bone of your tooth. In order eradicate the infection you have two options: extraction or a root canal. Losing teeth is bad, so a root canal will save the tooth, but root canals are not without controversy. Root canals can leak small amounts of bacteria through the micro tubules of the tooth into your system, causing an inflammatory response. However, tissue and bone do not heal in the presence of bacteria, so if your bone and tissue recover, then the root canal has done its job and your worries about leakage are unfouded.

Root canals are necessary for several reasons, but the following are the most common:

• Undetected decay that has reached the pulp. If you declined X-rays it was impossible to diagnose the decay and it spread.
• You clenched your teeth and caused a fracture that leaked.
• You got hit in the face, traumatizing your tooth and the pulp died. This is usually fixable by the procedure with the “bad reputation”- a root canal!

Get your root canals done by an Endodonist with a microscope. These specialists work quickly and effectively. Unless you get all of the bacteria out of the tooth (hence the microscope) you are likely to end up with a “re-treat.” Your general dentist might offer to do the treatment, but unless he uses a microscope, request a referral to an Endodontist.

Wisdom Teeth

Let’s just start by saying that wisdom teeth are not smart. Unless you have had your other teeth removed because of braces, get them out! Wisdom teeth are usually a nest for bacteria and are often involved in periodontal disease. This increased inflammation and bacterial load in your mouth will start affecting other (good) teeth.

I know wisdom teeth are very “Paleo,” but in this instance, the Neolithic solution of extraction is almost always the right one. If your wisdom teeth are in perfect (I mean perfect) health, you can consider leaving them in your head. Just know that the older you are, the higher the risk of complications for extraction. You don’t want to end up with infected wisdom teeth when you are too “high risk” to have them extracted.

Extraction

It is not a good thing to lose teeth. Except for the above scenerio, you generally want to hang on to your teeth. If you lose one and don’t replace it, your body will sense this and try to fill the gap by compensating through shifting teeth in new positions. This causes spaces, imbalances, and opposing teeth to self-extract because teeth need another tooth to bite against, or they will move in the direction of self-extraction.

Implants and Bridges

Solutions for missing teeth are implants and bridges. Implants are expensive and the process is long, but they are still the best way to go, and worth the wait. It is like having a brand new tooth!

Bridges are okay, but you have to drill down the teeth to either side of the tooth you are replacing, and the missing tooth is only suspended (a bridge) between the two crowns to each side. If you need to replace a tooth, your dentist should explain the options and help you decide what the best treatment is for you. Just try not to lose the teeth in the first place, okay?

Insurance

Insurance is only worth it if your workplace is paying for it. Buying your own insurance in most cases can be a real waste. You’ll probably end up spending about $100-$150 a month, and then when you need a crown the company will offer to pay only 50-80%.

Typically over the course of a year, you have spent $1,200 or more on insurance, and in exchange, received only two cleanings, one set of checkup x-rays, and one exam, which totals around $350 if you were to pay out of pocket. It doesn’t add up in your favor if you have a healthy mouth and are treatment-free.

I suggest that unless you find a killer deal on dental insurance that you create your own “dental savings account.” Put $100 away monthly, just for dental care.

In Closing

Since I was a kid, I’ve had an interest in health with a particular focus on the teeth. This led to a career in Dental Hygiene. Years later, when my interest in optimizing health through strength, conditioning, and functional medicine developed, I realized that the link between oral health and total health is significant. Oral disease contributes to systemic inflammation and its myriad of pathological consequences.

With this in mind, I hope you have enjoyed this three-part guide to Dental Hygiene, and hope to continue to bring you information on keeping your mouth and teeth healthy.

I am honored to be posting on the Whole9 blog, and hope this information will guide you to a healthy mouth that will in turn help you be strong, healthy and happy. If you have questions about dentistry, feel free to contact me via my blog, http://evatsc.com.

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Eva Twardokens (also known as “Eva T.”) is a two-time Olympian and six-time National Champion in Alpine Skiing. In 2012, she was inducted into the U.S. Ski and Snowboard Hall of Fame. She graduated from Cabrillo College Dental Hygiene School in 2001 and has been practicing in a general dentistry setting for 12 years. She teaches her patients how to aquire oral health, and how good oral hygiene practices contributes to overall health and quality of life.

She is also the founder of Eva T. Strength and Conditioning, a consulting site encouraging  strength, health, and happiness through the integration of  lifestyle choices, exercise, and