AT the turn of the last century, Dr. George Black, a pioneer dentist, laid down his principle of preparing a cavity in a tooth before filling material is placed in it. This forms the basis for not extracting an offending tooth but rather, saving it. Although empirical and untested in the field, these principles undoubtedly catalysed the significant growth in restorative dentistry that has occurred. Today, thanks to the work of Dr. Black, amalgam (silver) fillings remain the most commonly performed restorative procedure, although more inert and aesthetically pleasing alternatives are replacing them.

Part of his contribution involved the tendency for dentists to restore teeth with small carious lesions and even to remove parts of teeth and restore them as a preventive measure in the absence of caries.

It is known that diseases involving the teeth and gums have afflicted mankind since the beginning of recorded history. As society has developed with advancing scientific knowledge, the prevalence of tooth decay (caries) and periodontal disease has increased in most parts of the world. One can easily recognise that the consumption of more foods containing refined sugars, as is the case in so-called developed countries, is a major cause of the decline in oral health over the years. Another important reason is that people generally are too passive when it comes to adopting the principles of prevention. Apart from that, the great majority of people who have received some form of dental restoration or appliance are unaware of the inherent limitations.

The prevailing belief is that after failing to preserve healthy teeth, one can rarely rely on modern dental procedures to reverse the effects of neglect. However, it is indeed a fatal mistake to expect that oral rehabilitation, however sophisticated, can effectively solve one’s dental problems and that caries can be treated solely with fillings, thereby assuming that such treatment automatically results in oral health.

Before and after executing a procedure on a patient, many dentists are guilty of not explaining the potential disadvantages involved. Filling material itself is imperfect. For example, in a normal, healthy adult, the force directed at certain parts of a tooth during the process of chewing can exceed 40,000 pounds per square inch. No dental cement or resin is capable of withstanding more than fifteen percent of that. In addition, when a tooth has been filled, its chances of further decay become ten times as great as the one whose enamel is intact.

In other words, teeth with fillings need ten times more brushing and flossing than teeth without fillings or caries. This is because the material-tissue interface (where bacteria may penetrate) immensely increases the tooth’s vulnerability to decay.

Root canal therapy always involves the removal of the tooth’s nerves and blood vessels, effectively killing that tooth. In the same manner that infection by Mycobacterium leprae destroys the nerves in the fingers and toes of a Hansen’s disease (leprosy) victim, causing them to disfigure and deteriorate, extirpation of the pulp ultimately results in the absorption of the dead root.

Patients must fully acknowledge the numerous constraints associated with dental treatment. Although technology and clinical skills progressively provide a compromise, in the final analysis, the cure for dental ailments lies in changing lifestyles. Initially, there must be enough motivation to lead to the development of a preventative attitude, rather than relying on the dentist to substitute for your God-given attributes with man-made implements.

If, however, there are limitations in your individual circumstances due to various, filled, or missing teeth, then make a special effort to prevent that from happening to the young and innocent with whom you associate or have control.