Expert: Zev Kaufman, D.D.S. - 2/6/2009

Question
QUESTION: Dear Dr. Kaufman,
  Would you please share with me any information you might be aware of regarding new technology in regrowing teeth or enamel?  How would one go about participating in trials for such new techniques, or whom might one contact? I am interested because I recently had an unfortunate experience in which my 6 upper anterior teeth were drilled down to dentin--even up under the gums.  I'd believed I was getting veneers with no prep and no enamel removal, as my sole purpose was to build my teeth bigger and more convex.  But, due to this "accident" by a dentist who is known for such "accidents," I now am in severe pain. I've never even had a cavity and am having a very hard time coping with suddenly having ruined teeth and root canals.  I have to be further cut down to crowns to fix this mess, and worry that crowns and luting cements may cause me to have systemic ill-health in future years.  Is there hope for regeneration of "natural" teeth--within the foreseeable future?  I'd so much appreciate any information you might have.  Thanks very much,
Jessica

ANSWER: Dear Jessica:
I am so sorry to hear about your situation, and unfortunately, I have to disappoint you.  We are still very far away from growing enamel back onto teeth.  It has to do with the very slow rate of growth of the cells that create dentin and enamel.
At this time, the only way for you to restore your teeth to proper form and function, is with properly fabricated prosthodontics (dental restoratives).
I do have a piece of advice for you...
Since you have already had a "not so good" dental experience, maybe it is time to go and see a specialist in restorative/cosmetic dentistry?  As you have personally experienced, you see that all dentists are not alike.  Since you are not in position to evaluate an individual dentist's knowledge, training, skill, or judgment, the American Dental Association did the evaluation for you.  They designated Prosthodontics as the specialty in restorative, cosmetic, and implant dentistry.  Prosthodontists are carefully selected top dental students, who go on for another 2-3 years after their Doctor of Dental Surgery degree from Dental School and train to perform restorative, cosmetic, and implant dentistry at the highest level.
Of course, there are some excellent general/family/cosmetic dentists out there, but as you see, as a patient, you, unfortunately cannot tell who can deliver, and who cannot.  By going to a Prosthodontist you are guarantee yourself a higher level of expertise and competence.  www.prosthodontics.org will have a link to a Prosthodontist near you, or just call me at the office, and I'll gladly refer you to a colleague in your area.
You have been burned before, don't take any chances again.
I wish you well and good luck with restoring your teeth.
Dr. Zev Kaufman

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Kaufman, thank you so much for your expert information and kind reply.  Would you have time for another question?  I definitely will have a prosthodontist fix this mess, but I still worry about future health problems from the restorative materials, e.g. some of the chemicals from the luting cement getting into my system through the dentinal tubules, etc.  Although I have no specific allergies, I seem to be more sensitive to plastics and such than most people, and I have autoimmune problems that I don't want to be worsened by reacting to the chemicals in restorations.  Could you suggest which cements are least "toxic?"  Do the glass ionomers have aluminum in them?  Isn't aluminum related to Alzheimer's?  Thanks so very much,
Jessica

Answer
Dear Jessica:
I am glad that I was able to give you some guidance, and will continue to do so, as you require.  I would like to settle your very valid concerns.
1.  Most dental cements do not penetrate appreciably into the dentinal tubules, as a matter of fact, the particle size of the cements is too small.  Some of the bonding agents do penetrate the dentinal tubules, but again, not appreciably (I wish they penetrated more...it would make my job much easier).
2.  Any aluminum that is used in cements is in such tiny concentrations that there is no effect on the human body.  The reports that you might read about people getting Alzheimer's or any other diseases from dental work are unsubstantiated and are just stories.  The profession itself, through the American Dental Association and other reputable organizations will not allow products that harm our patients on the market.  It is OUR livelihood that relays on patient's trust.
I have personally have not heard of anyone who was adversely affected by cements, but I have come across patients who could not tolerate the Eugenol oil used in some.
The best thing to do is to focus on restoring your mouth to proper form and function, express your concerns to your Prosthodontist, and do not focus on hear/say anecdotal stories which are unsubstantiated.
I treat people with problems similar to yours on a regular basis.  The dentistry is easy for me, it is what I was trained to do... the most difficult part is actually addressing the psychological issues that come with the need of such work.  Don't despair.  Once the proper dentistry is done, and beautiful teeth are in place, all concerns for the minutia disappear.
I wish you luck with your treatment and please update me from time to time.  I'd love to hear that everything worked out in your favor.
Best wishes,
Dr. Zev Kaufman