Biocompatibility should be a core consideration in every restorative dental decision, holistic dentist Dr. Jessica Shireman says, because the materials dentists place in the mouth can affect the oral microbiome, salivary systems, and systemic health, not just mechanical durability.
- The oral cavity is a biological ecosystem where restorative materials can alter the microbiome and create inflammation if not properly placed or selected.
- Material quality matters systemically. Poor-quality crowns with nickel, incompletely cured composites, and mercury fillings may release chemicals that affect overall health.
- Dentists should expand clinical decision-making beyond mechanical stress to include biocompatibility and long-term effects on patient health.
- Understanding how restorations participate in the patient's biological environment is essential to fulfilling dentistry's mission of improving patient health.
As a profession, dentists have overcome the obstacle of placing inorganic materials in the human body and watching how they perform under the stresses of the oral cavity. In the 9,000 years that dentistry has existed, material science has improved dramatically, and the restorations we place now last for decades.
In our quest to improve patients’ health, one question should come to the forefront: “How does a long-term restorative product participate in the patient’s biological environment?” This question is not meant to be accusatory toward general practitioners or to assume that synthetic materials are harmful. It is meant to expand clinical decision-making beyond mechanical stress alone.
The mouth is a biological ecosystem
Dr. Jessica Shireman.
The mouth serves many functions in human health, and we need to understand that before we can assess the role of restorative products. Teeth are essential for smiling and chewing, and they shape facial aesthetics. Restoring missing teeth preserves biological function, which makes this career rewarding.
Understanding the oral cavity at the microscopic level matters because the materials we use to restore patients’ smiles can affect systems such as the oral microbiome and the salivary buffering system.
How placement changes the environment
The way we place restorations can alter the oral environment. A smooth, polished composite resin works well in the patient’s mechanical environment. A rough composite can trap plaque and create a focus of localized inflammation. That inflammation causes a bacterial shift that makes the oral microbiome less healthy in that area.
Beyond mechanical properties
Dental materials can also have systemic effects. Consider a poor-quality porcelain-fused-to-metal crown placed in a patient with a nickel allergy. The crown would cause localized inflammation that challenges the patient’s immune system indefinitely, and we have little understanding of how much this affects the patient’s overall health.
Or say you’re busy, running from room to room, and don’t have time to verify that a composite was fully cured. Incomplete polymerization releases small amounts of chemicals over time, and we have little understanding of how those chemicals affect patients’ health.
It is also questionable that we use mercury fillings in a biological system so close to the brain when we have little understanding of how the trace amounts of mercury they release affect patients’ health. We have discounted our role in patients’ health, and we are not questioning the materials we use.
Where we go from here
In a profession where we create voids in the human body and fill them with foreign materials, it’s time for all of us to consider the impact those materials have on systemic health and inflammation. We should commit to understanding how we can make our patients healthier.
Looking beyond mechanical properties to biocompatibility would help us understand our effect on the oral cavity and the body.
Dr. Jessica Shireman practices general dentistry in beautiful Wilmington, N.C. Her interest in dentistry started in her early childhood and has continued through 18 years in practice. She has completed many research projects, including a fellowship through Howard Hughes Medical institute, holds numerous patents and publications and is a member of various professional organizations.
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