Q: I try to read your column on a regular basis. I cannot recall exactly but I believe your overall thinking has been to not casually replace metal fillings with white ones. I have discussed that with my local family dentist and we are in agreement on that subject. We now choose white fillings only where looks are very important.

My question is this: my 22-year-old daughter moved to California about eight months ago. When she left the area, she had her teeth checked by our local dentist. All was normal. In California she sought out the treatment of a highly recommended dentist who after a short exam, told her that she should replace all of her silver fillings with tooth-colored ones. She is skeptical and asked me what should she do. I think from past readings you would disagree with this treatment. Can you tell me and my daughter once again what your thoughts are?

By the way, I am a local physician and believe strongly in your recommendations.

R.P. M.D.

A: I very much appreciate your kind words. The link to all of my old columns if you desire some reference is https://bit.ly/2DRAZCv. You of course can, if you choose, take a peek at past articles to review my thoughts.

Currently you are asking about your daughter and whether she should go along with replacement of silver fillings. The answer is simply a question. WHY? If there is decay around the silver filling or decay can be detected under the filling (with the use of radiographs) or if there is a crack in the filling that is going through and through to the base touching internal tooth structure, then I would say the answer is yes. But the reasons I just discussed happen very infrequently. The silver ion particles in the amalgam material being used has, in and of itself, some anti-bacterial activity. This is not found in any tooth colored material.

This anti-bacterial characteristic plus the fact that metal fillings hold up very well under biting pressure for many years - sometimes under very adverse oral conditions - means that it is rare to need to replace a metal filling to better your oral health. Nowadays, the general public, for some uninformed reasons, feel that all dental fillings should be white even to the point of taking out perfectly good ones. They even more strongly want fillings that need to be replaced because of fracture or decay, to be replaced with white fillings. The general public is absolutely wrong in trying to push their dentists to use tooth-colored materials. 

I am sure that if you ask your dentist, they will tell you that metallic restorations in all areas will be easier for he/she to do, will be far less expensive to you and will last much longer than white ones. With all of that to consider, I believe that the prudent now-educated patient should choose the metallic where there is no cosmetic concern or if you just do not care. Metals are better and silver amalgam is quite adequate. You may also consider the use of gold as it is even better as a restorative material if finances permit.

Since you as a medical professional have embraced many of my prior columns and comments, I would say again to your daughter and to anyone whose dentist desires to replace a silver filling for a white filling or to use a white filling material as the restorative material of choice to stop, step back and carefully discuss the pros and cons of all that he or she is proposing. 

Replacing a filling that is fine and doing its job just because you do not like the color is a most foolish decision. In my mind - and should be in yours - drilling on a tooth that is a living member of your body is a surgical procedure that can easily be damaging. If the tooth is heated up or cooled off dramatically, this can affect the health of the nerve and blood vessels in the tooth (the pulp). If this pulp is damaged, that nerve and blood vessels may cease to function and you now have a "dead tooth." When the tooth dies, it is very prone to infection with or without swelling and pain. All of these symptoms require more treatment and more money to be paid for that treatment.

The sum total of my remarks, the BEST DENTISTRY IS NO DENTISTRY as it refers to surgical treatment.  Any preventive treatment always has the potential to be beneficial.

In summation, I would caution your daughter to ask good questions as to why the treatment is needed, realize that those answers should be similar to what I said and if not, please call your old dentist who is familiar with her case to give her some more input or even talk to the California dentist about when and why they propose the treatment she first talked about.

All of this will help make a decision with the best health interests as an outcome.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.