Fillings

FAQ: Dental Fillings

Dental amalgams are safe, right? Could one have an allergic reaction to amalgam? Have dental amalgams been banned in other countries? Is there one filling material that will match tooth color? If my tooth doesn't hurt and the filling is in place, why does it need to be replaced? See what the American Dental Association has to say.

FDA Consumer Update: Dental Amalgams

The safety of amalgams continues to be investigated by the Food and Drug Administration and other organizations of the U.S. Public Health Service (USPHS). To date, no valid scientific evidence has demonstrated that amalgams can cause harm to patients with dental restorations. The only exception is rare cases of allergic reactions.

ATSDR - Public Health Statements: Mercury

There is some scientific background from The Centers for Disease Control and Prevention about mercury (contained within silver-colored fillings), and whether the substance presents any health hazards. 

Analysis reveals significant drop in children's tooth decay

According to the Journal of the American Dental Association (JADA), today’s children have significantly less tooth decay in their primary (baby) and permanent teeth than they did in the early ‘70s. The percentage of decayed permanent teeth decreased by 57.2 percent over a 20-year period in children between the ages of six and 18 years of age. There was a drop of nearly 40 percent in diseased or decayed primary teeth in children between the ages of two and 10 years.

Alternative Materials

The current developments in today’s dental materials and techniques have introduced some surprising innovations that have resulted in more natural-looking smiles. Ceramic and plastic compounds are two of the latest introductions discovered by researchers. These esthetic materials closely mimic the appearance of natural teeth. This development provides dentists and patients with a variety of options when selecting materials for repairing missing, worn, damaged or decayed teeth.

That said, traditional restoration materials like gold, base metal alloys and dental amalgam are also used. When restored teeth have to stand up to great forces that result from chewing experienced in the back of the mouth, the strength and durability of these traditional dental materials make them useful for particular situations like this.

Cast gold restorations, porcelain, and composite resins are alternatives to amalgam, but they are more expensive. If you get gold and porcelain restorations, they will take longer to make and you may have to schedule two appointments. Although composite resins, or white fillings, are much more esthetically appealing, they do require a much longer time to place.

There are a number of alternatives to silver amalgam. Here is a look at some of the more common ones:

Composite fillings

These are a mixture of acrylic resin and finely ground glasslike particles the result is a tooth-colored restoration. In small-to-mid size restorations that have to withstand moderate chewing pressure, composite fillings are good durable and stand up well to fracture. The result is a smaller filling than you would have with an amalgam, because less of the tooth structure is removed in preparation. The dentist can also make a more conservative repair to the tooth because composites can be "bonded" or adhesively held in a cavity. The only drawbacks, in the case of high chewing loads, composite fillings are not as resistant to wear as silver amalgams. Composite fillings also take longer to place.

Ionomers

Made of a mixture of acrylic acids and fine glass, ionomers are powders for filling cavities. They are well suited to those on the root surfaces of teeth. Ionomers release a small amount of fluoride, which helps patients susceptible to a high risk of decay. They serve as small fillings in areas that are not subjected to heavy chewing pressure. Their low resistance to fracture, glass make them ideal for small non-load bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers consist of glass filler with acrylic acids and acrylic resin. These also are used for non-load bearing fillings (between the teeth) and contain a low to moderate resistance to fracture. Ionomers are not good for active chewing surfaces because they experience high wear. Although glass and resin ionomers imitate natural tooth color, they lack the natural translucency of enamel. Both are well tolerated by patients and occurrences of allergic reactions are rare.

Porcelain (ceramic) dental materials

Used as inlays, onlays, crowns and aesthetic veneers, all-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings. Veneers are very thin shells of porcelain used to replace or cover part of a tooth’s enamel. The color and translucency of all-porcelain (ceramic) restorations look like natural tooth enamel, making them more desirable. Restorations using all-porcelain generally require a minimum of two visits and might include more. These types of restorations are prone to fracture when placed under tension. The thickness of the porcelain will determine the strength and the ability for it to be bonded to the underlying tooth. Porcelain is resistant to wear but if the opposing porcelain surface of the teeth becomes rough it will wear more quickly.

Sealants

It’s proven that almost everyone will have a 95% chance of experiencing cavities in the pits and grooves of their teeth.

In the 1950s, sealants were developed. They didn’t become commercially available until the early 1970s. The American Dental Association Council on Dental Therapeutics accepted the first sealant in 1972. They work by filling in the crevasses on the chewing surfaces of teeth, preventing food particles that might get caught in the teeth from causing cavities. The application, which is fast and comfortable, can effectively protect teeth for years to come. Research has revealed that sealants actually stop cavities when placed on top of a slightly decayed tooth, sealing off the supply of nutrients to the bacteria, which causes a cavity.

Sealants will form a barrier that prevents bacteria and food from collecting and resting on the grooves and pits of teeth. Sealants are best suited for permanent first molars. These erupt at about the age of 6, and second molars, are introduced around the age of 12.

Sealants should be applied as soon as the tooth has fully come in. Children will derive the greatest benefit from sealants because of the new quality of their teeth. More than 65% of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth due to trapped food particles and bacteria.

Sealant Application

In sealant application, the tooth must first be cleaned and all traces of the cleaning agent rinsed from the surface. Then an etching solution or gel is applied to the enamel surface of the tooth, which also fills the pits and grooves. In 15 seconds, the solution is thoroughly rinsed away with water. Once the site has dried, the sealant material is applied and hardened with a special curing light.

Sealants can last up to five years. At the child's regular checkup, the sealants should be examined. It’s a known fact that sealants are very effective deterrent to decay in the chewing surfaces of the back teeth.

Insurance coverage for this procedure is increasing, but still remains minimal. Dentists feel that insurers will become more convinced that sealants will help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.