Wednesday, April 23, 2014

Health and Wellness: Dental Adornments, Gold Teeth or Gold Dental Restoration

Nothing has been more of an eye opener than today’s post under the Health and Wellness theme; teeth jewellery. Intriguing, albeit, a subject I have viewed from a distance for many years. My father tells me that in the 60s/ 70s there was a trend at the time where  people were extracting one of their front teeth so as to leave a gap. He says this was the style back then, thankfully, he never fell for it. I have always been critical of people who adorn their teeth with jewellery and ornaments but nothing could’ve prepared me for the bit of information I received from a representative of the South African Dental Association regarding this subject. If you thought gold teeth were merely decorative then you thought wrong. They could also be gold restorations placed to restore a tooth that has been damaged by trauma or decay.
Before I delve deeper into the matter let me introduce Professor Joy Shackleton from Wits University, who fielded all my questions regarding this subject.

Hello Professor Shackleton and thank you very much for talking to us!
What is the proper term for gold teeth, grills, slits, etc?
No single term covers all of these. Gold fillings that are used to repair teeth are called inlays. Gold slits refers to gold fillings that are placed for aesthetic reasons (i.e. to improve the appearance or the smile, according to the patient’s wishes), rather than replacing tooth structure that has been destroyed by tooth decay, fracture or trauma in the anterior (front) teeth. There are also flat gold patterns (such as a star) or flat jewels that can be bonded to the outside surface of the tooth (the enamel), which are called tooth jewellery. Grills refer to a tooth decoration which is made to fit over the upper front teeth when the person wants to wear them e.g. for a concert or a photo shoot, but the grill can be removed at any time by the wearer. A grill is a bit like the plastic teeth that you wear at Halloween to make you look like a vampire.
Do they serve any dental health benefit or are they purely decorative?
Unless a gold filling is placed to restore a decayed or fractured tooth, it has no benefits for the patient’s oral health. Many patients still request gold slits for decoration, even though their teeth are healthy.

Some people frown upon them. Are there any that are acceptable in professional circles?
No oral health professional should place a gold slit for decorative purposes alone. The reason is that in order to make the slit retentive (stay in place without moving at all) on the tooth and not have sharp edges that irritate the tongue, healthy tooth enamel and dentine must be cut away to make space for the gold.

Tell us about the history of this practice.
Gold has been used to repair teeth for centuries and is still regarded as an ideal material for posterior (back) teeth (like molars) because of its accurate fit, and perfect properties as a grinding surface for food. When front teeth were first repaired after becoming decayed or broken, gold was the only material that could be used, as it could be cast or moulded into the correct shape. So at that time there was a health benefit, because decay was removed and the tooth structure and bite was restored.
Until about 50 or 60 years ago a rotten front tooth could only be repaired with gold, filling or crowns, which were both very expensive. If a patient could not afford the filling or crown, the tooth would be extracted and placed onto a denture (false teeth) or not replaced, leaving a gap.
In the mid-20th century tooth-coloured fillings were developed which were less expensive and made the filling look like natural tooth substance. These filling materials are now so advanced that they will last a long time, and have different shades and reflectiveness, that simulate the different shade of the person’s natural teeth.
However, in many places in the world gold fillings were a status symbol because they were expensive, displayed one’s wealth, and became “fashionable”. This belief persists in some countries and cultures, including parts of South Africa. Even today, people still ask for gold “slits” to be placed in their false teeth to make them look “natural.”

Do the gold inserts have any value? I heard a story recently of someone who was mugged and his tooth was pulled out.
It depends whether the insert is real gold or fake gold.  Real gold is very expensive and pure, and most dental labs and practices no longer use it because of the expense. Real gold can be removed from an extracted tooth and reused to make other gold things like jewellery. Many “gold” inserts are made of gold-coloured metal, which is non-precious and not worth much. They cannot be melted down and reused in the way that gold can.

What are some of the reasons that people offer for wanting them?
The majority of patients want gold slits for their decorative value. Patients, who have had gold fillings in their natural front teeth, may request that the gold is replaced even when dentures are made, so that people can’t see that they now have false teeth.

Are there any medical reasons why a dental health professional would recommend them?

What does the process of inserting gold teeth entail?
The tooth enamel and dentine must be drilled away in a special shape to allow space for the gold to be retained (or cemented) in the tooth. The gold has to be at least 1mm thick (if it is real/pure gold) as it is very soft and can be worn through or distort. So quite a lot of healthy tooth is removed and whenever this happens the tooth nerve can be damaged (sometimes temporary sensitivity; other times permanent damage). In contrast white fillings require only the removal of decayed tooth matter and are chemically bonded into the cavity left behind so that minimal healthy tooth is destroyed.
After that the dentist should take a mould of the tooth which is made into a model in the lab, where the gold is shaped to fit the cavity that has been drilled. While this is done the dentist should use a temporary filling to cover the exposed tooth surface and prevent sensitivity and nerve damage.
At the next appointment the dentist will remove the temporary filling, and ensure that the gold fits correctly. If it does, a thin layer of dental cement is used to bond or glue the gold in place. Once that is set the dentist checks that the gold does not interfere with the way the patient bites and that all the edges are smooth.

Can the process be reversed flawlessly? When some people have opted to take them out the tooth is left with a greyish shade. Is that the original tooth that was there or is it false?
The process cannot be reversed because tooth material has been lost. The tooth left behind discolours because there is seepage between the “gold,” the cement and the tooth which allows discolouration of the dentine. Discolouration may come from non-precious metal alloys in the filling, or be as a result of the ageing of the dentine which gets yellower as you get older. Greyish shades may indicate that the tooth nerve has been damaged or become infected.

Is there permanent damage to the teeth?
Yes, if the tooth is prepared and enamel and dentine is removed, the tooth is damaged permanently. If the gold slit is removed, the exposed tooth surfaces need to be covered with some kind of restorative material; otherwise the tooth will be sensitive to cold, hot and sweet things. This is because there are small channels in the dentine that connect to the dental nerve and blood vessels which are in the centre of the tooth. If the dental nerve is exposed, it can become infected and that is when you get a tooth abscess.
The exposed tooth surfaces are also much more likely to become decayed and to contribute to gum disease because plaque bacteria stick to it.
If the gold slit is very tightly wedged in the front tooth or teeth, it becomes impossible for the patient to floss between them and remove the plaque. This may allow further decay to start where there is a margin between the tooth, the “gold” and the cement that retains it.
Tooth jewellery where a flat gold shape is bonded to the tooth causes less damage because enamel and dentine is not removed. However, when the jewellery is replaced or removed there is a chance that the enamel can be damaged.
The use of a grill does not entail cutting away tooth tissue or bonding to the enamel. The dentist takes an Impression of the teeth, which is used to make a model of the teeth. The metal is made to the patient’s request e.g. 6 gold front teeth (or gold-like) in the lab. The dentist will fit the grill to the patient’s teeth, and make sure that it clips on and comes out without causing damage to the teeth. And the person can still brush and floss and keep his or her teeth healthy. (Refer to Dr Smile on Facebook – he was quoted in the Sunday Times last month).

Professor, is there anything else that you would like to add?
A healthy smile is a beautiful smile. Healthy teeth can never be restored, re-grown or replaced and be as good as new.

Professor Shackleton, thank you very much for talking to us.
Professor Joy Shackleton is the head of Department of the Wits University School of Paediatric and Restorative Dentistry. This department comprises the disciplines of paedodontics, restorative dentistry, and endodontics.
                                                  PG: Man to man, generation to generation.


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Very interesting and helpful. Thank you for sharing such an amazing post here. Keep 'em posting. Waiting for more such concerns.

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