Dental materials for Class V filling without fluoride

[otterslide]

My dentist wants to use Riva Light cure Ionomer for the Class V fillings I need, but I am concerned that GI's are made of fluoride and release fluoride.
Found a study at pubMed that fluoride kills pump stem cells.
https://www.ncbi.nlm.nih.gov/pubmed/22420549
Cytotoxic effects of glass ionomer cements on human dental pulp stem cells correlate with fluoride release.

What are my alternatives, if anybody is familiar with this? I did some digging and it seems 3M Filtek 250 or 250XT would be suitable and has pretty good results according to studies. There is also P90 .. but 250 without XT seems to stand out. I don't know much about materials, are there different etchers/bonders that are used along with the 250, that may not come from 3M?.. I think 3M is a pretty good brand, as I have existing 3M Supreme fillings for 15 years or more, and they're still good.

This dentist has not helped me prevent this, he allowed a small cavity to go untreated for 20 years which recently spread to the gumline of the tooth. Once the gumline turned black, again he did not warn me or said to do anything, and now the 2 teeth adjacent got a cavity at the gum line..
It took about 2 years to happen and I should've got another opinion, but now it's too late.. He is doing the work for a good price compared to other dentists. He said the small cavity wasn't worth fixing because it would be a big hole for such a tiny cavity that might not expand.. and it did not expand, but it spread!.. and still he did not mention to fix the small cavity, which is on the side of a filled molar and black in color.

Any help is appreciated.

 

[Sonia Salamuri]

Hi,
I hope you can have a good treatment for your tooth. I've read the article, but I also found another that explain the benefit in the fluoride release as an prevention of secondary decay. But if you're not certain it's better to get a second opinion. Even if you have a less expensive treatment, consider the benefit of seeking a second opinion, since you don't trust the clinician that is treating you at the moment.

Modifications in Glass Ionomer Cements: Nano-Sized Fillers and Bioactive Nanoceramics - PubMed

Glass ionomer cements (GICs) are being used for a wide range of applications in dentistry. In order to overcome the poor mechanical properties of glass ionomers, several modifications have been introduced to the conventional GICs. Nanotechnology involves the use of systems, modifications or...

www.ncbi.nlm.nih.gov

 

[MattKW]

This is the downside of the internet; anyone can find nearly anything out there. But you also have to understand how to interpret these random findings, e.g. was it a good study, what do the results mean in real-life, and what are the alternatives? I could easily find you studies that show composites are carcinogenic. And 3M also make GICs ("Ketac"), so maybe they're not all that good?
The use of GIC for decay at gumline level has a better result than an amalgam, which has a better result than a composite.

 

[otterslide]

This is the downside of the internet; anyone can find nearly anything out there. But you also have to understand how to interpret these random findings, e.g. was it a good study, what do the results mean in real-life, and what are the alternatives? I could easily find you studies that show composites are carcinogenic. And 3M also make GICs ("Ketac"), so maybe they're not all that good?
The use of GIC for decay at gumline level has a better result than an amalgam, which has a better result than a composite.

I also found another study that some GIC's release a lot more fluoride than others.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075459/
So maybe the one he would use is not too bad.

Can you explain more about GICs compared to composite? What is the benefit of GIC over composite at the gumline? I'm just trying to pick something that won't cause issues in the long term.

Seems I have issues with some materials, and one is composite, unless it was just not placed right. I have one composite that bothers me for years and yet there seems to be no problem in that spot... the pain comes and goes, its the number 12 tooth. The hygenist who did the cleaning at this same doctor's office scratched the tooth on the back which turned into a cavity about 10 years later..

I got biocompatibility testing done for most other fillings, except for one that by luck is causing no problems. Dentist used what he thought was close to something on the compatibility list I had but an upgraded version.

I am also skeptical about the compatibility stuff, but given how I had silver amalgams and all my teeth hurt that had the amalgam in them and my health went completely downhill by the time I was 21 years old.. I am trying to be more careful what goes in.. I'm 38 now and in better health than when I was 21!.. I don't think it's a coincidence, and it's no fun when most of your molars have a dull pain.

This same dentist put in 6 amalgams .. that I had taken out.. and I was grinding my teeth at night, which they say can release the vapors out of the amalgam. I no longer have teeth grinding.

Either way, I understand the dilemma for the dentist and that we can never know 100% for sure if those testing machines are hocus pocus or not.. but also as patient this is more important than almost anything... to keep my teeth and have no pain.. So I have to at least try my best.

Thanks for your help!

 

[MattKW]

1. GICs will bond better to dentine, and release some fluoride to slow decay.
2. Amalgam can be put slightly under the gum even if a bit moist. But can be hard to place properly.
3. Composites under the gum will fail. The bonding will fail and leak.

That's why I put them in that order. You really only have a choice between GIC and amalgam, and the guidance of your dentist.

 

[otterslide]

1. GICs will bond better to dentine, and release some fluoride to slow decay.
2. Amalgam can be put slightly under the gum even if a bit moist. But can be hard to place properly.
3. Composites under the gum will fail. The bonding will fail and leak.

That's why I put them in that order. You really only have a choice between GIC and amalgam, and the guidance of your dentist.

Hi Matt,
Are there better GICs than others, in terms of long lasting?
My dentist gave me two options for composite where it's needed, Sonicfill and TPH Spectra , for GIC only Riva Light cure.

Do you know anything about these, If I can't do much else, at least make sure he's using good things I can do... he's giving me a good price, so I just hope he's not using something not so good to cut on the price. I don't even know, are there significantly more expensive materials than others?

Thanks again!

 

[Sonia Salamuri]

You are right Dr Matt, I've shouldn't go along with the tendency to reply about something I wasn't sure about. I will be more carefull next time

 

[otterslide]

I was finally able to get the x-rays from them as well.. He said there is a cavity on tooth number 20 he can see in the x-rays. I can hardly see anything from these... Is it really noticeable?.. Although if there was I wouldn't be surprised because it's next to the tooth with gum problems and decay at gumline, although no hole was created by the decay, it just turned dark.
Any help appreciated of course. I'm still hoping I can trust this dentist.. even though he hasn't ever guided me towards preventing future problems at all.