Dr. Reichwage, every time I see my dentist, he keeps saying I have an old silver filling that’s got decay under it and has to be replaced with a cap, and that I have gum disease.

Here’s my question. My mouth doesn’t bother me. I hate to pay for something that I don’t think needs to be done because it doesn’t hurt at all. I’d rather wait until I’ve got some symptoms so I know something’s going on.

Eric M., New Haven 


Dear Eric;

What a great question!

First of all, your mouth consists of two types of tissue: hard and soft. In the “hard” tissue, your tooth, all nerve endings and blood supply are located in the very center.

When fracturing or when bacteria attack your tooth, you feel nothing until the very center of the tooth has been invaded; only then do you feel pain. But by this time, the tooth has been so badly affected that it’s beyond simple, conservative treatment.

Also, by this time, the bacteria have reached the tooth’s blood supply (and invaded your blood stream) and an abcess may now develop in the canals of the roots of your tooth. Your tooth has been badly compromised, your immune system has been invaded and, while your tooth is probably still salvageable, your investment to restore it will probably be about 8-fold.

Statistically, we generations now alive are going to be the longest-lived people in the history of the world. What an awesome thought! With that in mind, it’s worth looking at the importance of our oral health.


Each tooth is an individual organ in our body, with its own blood and nerve supply, and plays as important a role to our health and potential longevity as do our spleen, liver or kidneys, because our body functions as one integrated system. And within that system, the mouth works as a complex puzzle, Eric.

This puzzle incredibly intricate and subjected to constant stress and abuse from such things as grinding or clenching our teeth (about 90% of us do it now), to the radical temperature changes of hot/cold food, to seemingly simple acts like biting our fingernails or chewing gum, which place enormous pressure on teeth and jaw joints.

When one tooth is lost, the puzzle’s fit is destroyed, because teeth depend on one another for function and stability. It’s called a proprioceptive system, the interactive triad of: occlusion (how our teeth fit together), TMJ (including the functioning of the temporomandibular or jaw joints), and the facial muscles that control jaw and facial movement.

The teeth are also the guardians of your ability to properly absorb food for healthy cell functioning and energy production. When you loose teeth, you loose chewing ability and your body looses fuel because you’re absorbing less food/energy. I will not touch here on the obvious: the importance of your teeth to your appearance. Your teeth are also the guardians of your TMJ or jaw joints.

If any tooth is lost, other teeth move to fill in that vacant space, and often tip to one side, so the puzzle-like fit of your teeth is destroyed, resulting in destruction of your bite relationship and gradual impairment of your jaw joints, leading to a domino-like process of deterioration in your mouth and TMJ. Pain, sometimes radiating through the upper and even lower body, can result.

One of my recent columns covered vital new research on the connection between periodontal disease and heart/stroke risk. It explained that researchers now believe the primary cause of heart attacks and strokes is not high cholesterol, but is CHRONIC LOW-GRADE INFECTION, which researchers believe doubles our risk factors. Among others, causes include periodontal disease, obesity, smoking and high blood pressure. If we have a chronic low-grade infection AND high cholesterol, our risk factor increases 9-fold.

With contemporary dentistry, there are few reasons ever to loose a tooth, and we can now diagnose/treat periodontal disease in its earliest stages.

The focus of contemporary dentistry in my practice is to catch problems when they’re small in order to preserve the strength, integrity and appearance of your natural tooth and the health of your gum tissue, before damage is done to your systemic health, and at a point when the financial impact to you is least.