November 2007



	*Harry "Buzz" Waterston*

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For your drinking water

Environmentalists are becoming increasingly concerned about mercury in waste water. I haven’t placed silver-mercury fillings for 8 or 10 years, but the old fillings I remove break up and can potentially become sediment in the waste water. For that reason, I have installed a silver-mercury filtration system in my office to prevent this material from leaking into the water system we all share.

What is a “buildup (or, why do crowns fall off)?”

Let’s flash back in time. Bonding is not yet in widespread use. Teeth are routinely filled with non-bonded silver mercury amalgam fillings. When a corner of the remaining tooth structure fractures, the dentist reshapes the silver that remains in the tooth and places a crown to cover the tooth. Several years later the patient returns to the dentist with the crown in his or her hand. The silver is inside the crown, since it came out of the tooth when the crown loosened. There’s almost nothing left of the tooth.

How do I know this story? Been there, done that; won’t do it that way any more. For years, my practice has been to remove all the restorative material in a tooth before putting a crown on it. Why? Because you don’t know what’s under the material (we didn’t have decay-detecting dyes until relatively recently---about the last 12-15 years); decay may have been left in under the silver, or the silver wasn’t bonded to the tooth and can easily pull out once some of its retention is drilled away.

Once I’ve determined that a tooth needs a crown, I’ll remove all the old restorative material, use decay detecting dye (and remove any decay I may find), and bond an epoxy-like material to reinforce the tooth. Then I’ll reshape that material and place the crown over it, secure in the knowledge that that material is unlikely to dislodge and the crown is unlikely to ever fall off.

Why else might cause a crown to fall off?

? Insufficient mechanical retention. The remaining tooth structure is too short to hold a crown.

? The cement (glue) that held the crown in has dissolved. That’s right; until about 12 years ago, all crown cements on the market could slowly dissolve when exposed to saliva. That’s not a very good property for a crown cement to possess. Today’s cements actually bond the crown in place and are far superior. Some of the cements even time-release fluoride; another good property to have.

? Bite problems. If you bite on the crown in such a way as to torque the tooth back in forth, something has to give. Either the tooth will become loose, the jaw muscles will start to hurt, or the crown will be forced to come off the tooth because the cement or bonding agent gradually fatigues from excessive pressure.

What’s the right time to see an orthodontist?

Let’s flash back in our dental time machine again. I’m a kid with a horrible overbite. I’m embarrassed about my smile, and other kids make fun of my appearance. I have to wait until I’m 12 years old and all my adult teeth are in before I can see the orthodontist. I get four permanent teeth removed to alleviate the crowding, and my orthodontist closes up the spaces to straighten my teeth and reduce the overbite. All I have to do now is get over the trauma of looking lousy for years while I waited for the orthodontist to be ready for me.

In this area also, trends have changed. Orthodontists tend to intervene much earlier (sometimes as early as age 6 or 7, but more frequently at 9, 10, or 11) and phase their treatment over a longer time. Early treatment may involve the use of a “palatal expander” to alleviate crowding. Extractions are needed far less frequently nowadays.

What’s the right time for your child to see an orthodontist? It varies with every child, and we will recommend the best time for each child. It’s fine with me if the orthodontist says, “It’s a little too early; come back in 6 or 12 months.” What I never want is a call from the orthodontist who says, “I wish this person could have come in for an evaluation six months or a year ago; the treatment could have been so much easier.” Morale of the story? Get to the orthodontist soon after I make the recommendation.

What about orthodontics for adults? Maybe your family couldn’t afford braces for you when you were growing up. What about now?

In my practice I see more and more adults patients having orthodontic treatment. After all, if you’ve always put your kids first, there comes a day when it’s time to be good to YOU. I had four months of orthodontic treatment about 20 years ago to correct some problems that had developed since my original braces. Since then, I’ve had 20 years to enjoy the results of that improvement.

I know several excellent orthodontists, and would be happy to suggest someone convenient to you who could satisfy your needs and goals. Just tell me when you’re ready.

And remember, if you’re unsure what you want, it’s always best to collect some information first, then decide.

A true story

World War II produced many heroes. One of them was Lt. Commander Butch O’Hare. He was a fighter pilot on the aircraft carrier Lexington in the South Pacific.

One day his entire squadron was sent on a mission. After Butch was airborne, he looked at his fuel gauge and realized that someone had forgotten to top off his fuel tank. He would not have enough fuel to complete his mission and get back to the ship. His flight leader told him to return to the carrier. Reluctantly, Butch dropped out of formation and began his return.

As he approached the Lexington he saw a squadron of Japanese aircraft was speeding toward the American fleet. The American fighter planes were all out on a sortie and the fleet was all but defenseless. Butch couldn’t reach his squadron and bring them back in time to save the fleet, nor could he warn the fleet of the approaching danger. He needed to somehow divert the approaching squadron from the fleet. He dove into the formation of Japanese planes. Wing-mounted 50-calibre guns blazed as he attacked one surprised enemy pilot after another.

Butch wove in and out of the now-broken formation and fired at as many planes as possible until all his ammunition was spent. Then he dove at the planes, trying to clip a wing or tail in hopes of damaging as many enemy planes as possible and rendering them unfit to fly.

Finally, the exasperated Japanese pilots took off in another direction. Deeply relieved, Butch O’Hare took his tattered fighter and limped back to the Lexington. Upon his arrival, he reported in and related the events surrounding his return. The film from the gun-camera mounted on his plane told the tale. It showed the extent of Butch’s daring attempt to protect his fleet. He had destroyed five enemy aircraft.

This took place on February 20, 1942, and for that action Butch became the Navy’s first Ace of WW II, and the first Naval Aviator to win the Congressional Medal of Honor.

A year later, at the age of 29, Butch was killed in aerial combat. His home town would not allow the memory of this WW II hero to fade. O’Hare Airport in Chicago is named in tribute of this man’s courage.

If you find yourself at O’Hare sometime soon, you can check out Butch’s memorial between Terminals 1 and 2. His statue and Medal of Honor are there.

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