What are the advantages and disadvantages of dental filling materials? What are indirect fillings? Are silver amalgams safe? Can you be allergic to amalgam fillings? These and other popular questions are answered.
What are dental fillings?
Dental fillings are single or combinations of metals, plastics, glass or other materials used to repair or restore teeth. One of the most popular uses of fillings is to “fill” an area of tooth that your dentist has removed due to decay – “a cavity.” Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding).
What materials are dental fillings made from?
Dental filling materials include:
- Silver amalgam (contains mercury mixed with silver, tin, zinc, and copper).
- Tooth-colored, plastic and glass materials called composite resin fillings.
The location and extent of the decay, cost of filling material, your insurance coverage and your dentist’s recommendation help determine the type of filling that will best address your needs.
Are there advantages and disadvantages to various filling materials?
Yes. Advantages and disadvantages of the various dental filling materials are as follows:
- Gold: Lasts at least 10 to 15 years, some say gold presents a pleasing appearance.
- Silver fillings (amalgams): Lasts at least 10 to 15 years, less expensive than composite fillings.
- Tooth-colored composite fillings: Shade can be closely matched to color of existing teeth, bonds to existing tooth providing additional support, commonly used for repairs other than cavity filling, sometimes less tooth needs to be removed compared with amalgams.
- Ceramics/porcelain: Lasts more than 15 years, more resistant to staining than composite resin material.
- Glass ionomer (acrylic and a specific type of glass material): Mostly used for fillings below the gum line, releases fluoride that can help protect from further tooth decay.
- Gold: More expensive than other materials, may require more than one office visit to place.
- Silver: May require more tooth to be removed to make space large enough to hold filling, creates grayish hue to the surrounding tooth structure, may have higher risk of tooth cracks and fractures due to wider degree of expansion and contraction, allergic potential in some people.
- Tooth-colored composite fillings: Lasts at least five years (less than the 10 to 15 years of other materials), may chip off tooth depending on location, can cost up to twice as much as amalgams, can take more time to place and/or additional visits.
- Ceramics: Can cost as much as gold.
- Glass ionomer: Is weaker than composite resin, more likely to wear and prone to fracture, lasts five years or less, costs comparable to composite fillings.
What are indirect fillings?Indirect fillings are similar to composite or tooth-colored fillings except that they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when you don’t have enough tooth structure remains to support a filling, but your tooth is not so severely damaged that it needs a crown. During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental laboratory that makes the indirect filling. A temporary filling (described below) is placed to protect the tooth while your restoration is being made. During the second visit, the temporary filling is removed, and the dentist checks the fit of the indirect restoration. If the fit is acceptable, it will be permanently cemented into place. There are two types of indirect fillings – inlays and onlays.
- Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
- Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.
What’s a temporary filling and why would I need one?You might need a temporary fillings:
- If more than one appointment is needed for your filling. For example, before placement of gold fillings and for indirect fillings that use composite materials.
- Following a root canal.
- To allow your tooth’s nerve to “settle down” if the pulp became irritated.
- If emergency dental treatment is needed (such as to address a toothache).
What steps are involved in filling a tooth?First, your dentist will numb the area around the tooth to be worked on with a local anesthetic. Next, a drill, air abrasion instrument or laser will be used to remove the decayed area. The choice of instrument depends on your dentist’s comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay. Next, your dentist will probe or test the area during the decay removal process to determine if all the decay has been removed. Once the decay has been removed, your dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it. Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that “cures” or hardens each layer is applied. When the multilayering process is completed, your dentist will shape the composite material to the desired result, trim off any excess material and polish the final restoration.
Are silver amalgam fillings safe?The American Dental Association (ADA), the FDA and numerous public health agencies say that silver (mercury based) amalgam fillings are safe. However, the FDA recently issued updated recommendations about the use of amalgam fillings in certain individuals. They state that the following individuals may be at greater risk for potential harmful health effects of mercury vapors and should avoid getting these fillings whenever possible.
- People at greater risk include:
- Pregnant women and their developing fetuses.
- Women who are planning to become pregnant.
- Nursing women and their newborns.
- Children, especially those younger than six years of age.
- People with pre-existing neurological diseases including Alzheimer’s disease, multiple sclerosis or Parkinson’s disease.
- People with impaired kidney function.
- People with sensitivity or allergy to mercury or other components of dental amalgam.
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