Problems after Amalgam Removed

[haha73]

1) Excessive Amalgams. I had at least 20 amalgam fillings. I saw the X-ray showing that 4 of my molars were almost completely drilled away.
2) Few natural teeth. 4 healthy teeth were removed as a tween for crowding even though they looked find, and 4 wisdom teeth were later removed even though 1 was healthy.
3) Amalgam replacement with white filling; broken tooth.  About 2 years ago, I had the silver amalgams removed and replaced with white filling (I think resin).  Within a year, 1 of the heavily-filled molars had 1/4 of the tooth break off.  
4) Heavy metal detox; broken tooth. I recently began treatment to remove heavy metal traces from the body.  I received DPMS injections, a few days later an IV that included glutathione and other, and then took a regimen of chlorella capsules and cilantro drops for the next 38 days.  Within a week after the DPMS, the 2nd of the heavily-filled molars cracked one side of my tooth in half and needed to be extracted (by another dentist since it was an emergency).
5) All my relatives have straight teeth, and have had all their teeth into their 70s even though they never went to a dentist, so there is no family history of dental issues.

I am only 40 years old and should not be losing my teeth.  I currently have 23 teeth in my mouth. I would like to know how to protect my other heavily-filled molars and my other teeth.  Should I get ceramic or glass fillings, or is it not worth it because it would cause more trauma and weakness by changing the filling?  What are the advantages and disadvantages of each kind of filling? Would sealants and flouride treatments help?  Would bonding strengthen or weaken my teeth? Should I take vitamin D, calcium, flouride supplements? Should I use prescription toothpaste or other products? Anything else?

Please don't tell me to "ask my dentist".  He has left the practice and other staff are not responsive.

[Jerome Tsang, DDS]

Replacing your composite (plastic) restorations with porcelain or baked composites provide a better fit generally as they are lab fabricated and can account for a better seal.  This is due to the fact that when curing a composite in the mouth, there is some shrinkage of the filling which can result in microleakage of the filling.  

With a baked composite or porcelain, the filling is made in a lab and the shrinkage can be better accounted for and since it can be heated, it is made stronger and can be cosmetically more appealing due to the time and ease of making a filling outside the mouth versus inside the mouth.  

My comment in regards to more risk is that these inlays and onlays tend to require more tooth structure to be removed at times.  Crowns as well to a further extent.  Because you are removing tooth structure, you are getting closer to the pulp and nerve of the tooth inside and puts you more at risk for problems that may require a root canal to fix.

[Jerome Tsang, DDS]

Well, if you don't want to ask your dentist, its important that you do find a new dentist that you trust because they can address your issues specifically whereas I can only answer them in a general way.

I would keep your amalgams if there are no problems with them at the present moment.  Some of your fillings may be extensively large which could make you more prone to fracturing of your teeth.  If that's the case, it may be advisable to replace it with a crown or lab fabricated inlays/onlays to better support your teeth.  Keep in mind that a crown or inlay/onlay replacement may put you at more risk for a root canal in the future when replacing your amalgams, especially if they are large. But the risk of keeping a large filling is possible fracture which can render the tooth non-restorable and needing extraction.

Removal of amalgams aren't really advised as there isn't any evidence to show that they leak mercury after placement.  It may actually be more dangerous to remove them as the heat generated from the drill during removal can actually vaporize the amalgam and release mercury so only remove the amalgams that are problematic and leave the others alone as possible.  Of course, this is all debateable as each doctor is trained differently but the current literature suggest no danger or problems with amalgams in terms of mercury release during placement or after placement.

Composites are plastics and function as well as amalgams. They are more technique sensitive and can fail more easily if placed in a moist environment so keeping the mouth dry is key.  Unfortunately there's tons of moisture in the mouth so its important to use a rubber dam to keep the area dry as possible.  Cosmetically they're superior to amalgams.

Sealants and fluoride would be beneficial in preventing caries.  

Bonding is a tough question.  Its basically the same thing as a composite and depending on whether tooth structureis removed, it probably would weaken rather than strengthen the tooth.

As for the prescription fluoride toothpaste, etc.  You should discuss that specifically with your doctor as he/she will have to write the prescription anyways and would know whether or not it would be of benefit for you.

Hope that helps.

[haha73]

Thank you for your response. (BTW, I had asked a dentist and he did not respond.)

All my amalgams have already been removed. Could you comment on the advantages and disadvantages of switching from fillings made of resin to a) ceramic and b) glass?

Could  you clarify the following statement? I didn't understand, given that there will be no futgure amalgam removals. Did you mean replacing resin with ceramic/glass?

"Keep in mind that a crown or inlay/onlay replacement may put you at more risk for a root canal in the future when replacing your amalgams, especially if they are large."

[haha73]

I wanted to clarify that the 20 + plus amalgams were almost entirely unnecessary.  They were due to a dentist who found 2-4 cavities on each visit, which is ridiculous.  On the last visit, he found 2 cavities, that when I went to another dentist, found to be nonexistent.  And no other dentist found as many cavities in the next 25 years as this one found in 1 year. So it's not as if I had a mouth full of decay or problems.