When I was a kid and had a cavity (far more often than I care to admit!), my dentist would always ask me what type of filling I wanted -- vanilla, chocolate or strawberry. I always chose strawberry, and for a while there, actually believed the dentist had different flavors. My suspicions grew when I realized no matter what "flavor" I chose, the filling was always silver in color, and tasted metallic.
Of course, now I know that ice cream flavors are complete fiction -- what I was receiving was a standard Mercury Amalgam filling. Still, it was nice that the dentist kidded with me about my "choices."
But today you often DO have a choice when it comes to fillings. Many dentists out there work with several different types of fillings and allow their patients to choose. I'll go over the standard choices here, and offer you a few thoughts on each.
To start, let's just quickly establish what a filling is: when you have a cavity, part of your tooth is drilled into/removed, the decay removed and then the tooth area that was drilled/removed is "filled" with a substance. We're discussing that substance in this post.
Here are the "big four" in terms of fillings:
Mercury Amalgam
This is the one you all remember growing up -- those "silver" fillings. These were the popular choice for years and years because they served the purpose well enough and were low in cost. Truthfully, there wasn't much choice years ago -- most dentists offered these and little else. Mercury Amalgam fillings typically run $200 or so, making them (in general) one of the lowest cost fillings available.
Today, given what else is available, I'm not a huge fan of Mercury Amalgam fillings. The "upside" to Mercury Amalgam is the cost, and that's about it. The downsides are numerous. First of all, they are ugly. They can also discolor your teeth over the long run and can fracture teeth because they are more prone to expansion and contraction. You also may need "more" of this stuff to make a decent filling than other materials, meaning a Mercury Amalgam filling will always be larger than if other materials were used.
But the biggest downside? Your health. If you read here often, you know I'm not a fear-monger, but I also view any substance that needs reassurance with a skeptical eye. There have been scattered reports linking Mercury Amalgam fillings to several afflictions (the reports are scattered enough that I'm not going to name any). But, in my opinion, putting mercury in your mouth is not the smartest thing in the world to do.
Composite Resin Fillings
Composite resin fillings are my top choice for smaller fillings. They are durable, solid, non-toxic, easy to work with (although there is a longer "chair time" as they need more time to set). And yes, they look great. Often you can't even tell that the tooth was filled.
The downsides to composites are cost and durability. They are not as "strong" as Mercury Amalgams in larger quantities, which is why I say they are ideal for smaller fillings. Also, they are not as durable long-term. But since no filling is really a long-term/lifetime solution, that matters less than you may think. Costs are higher than Mercury Amalgams, coming in at about $400 per filling.
Many dentists today will only use composite for cavities, and if the cavity is too big, go straight to Porcelain, or even a crown.
Porcelain
I like these the best in terms of "what's the optimal solution for your mouth." Porcelain is strong, durable, god looking, long lasting, and more resistant to staining than almost anything else. Newer types of Porcelain, such as IPS E.max (lithium disilicate) are some of the strongest ever developed.
Of course, your downside here is cost. These are pricey, coming in at around $1,500 (you're getting into crown territory here). But in my opinion, you cannot get a better filling than porcelain.
Gold
Some people like gold fillings. If you find yourself thinking "a gold smile might be nice"(and you have the checkbook for it) gold can be a viable choice. I personally don't like colored fillings all that much, but my opinion on aesthetics matters little -- it's about what you, the patient, likes.
In terms of durability, gold is a solid choice -- your gold fillings will last as long as porcelain, and perhaps even longer. The cost is a drawback, however, as gold fillings will easily run $1500-plus, and require multiple visits. There's also some risk of a painful interaction if it's placed next to an existing amalgam filling (called a galvanic shock).
So there you have it -- the four main types of fillings. Granted, it's not as much fun as "vanilla, chocolate, or strawberry", and depending on what your dentist prefers to work with, you may not have much choice, but it's at least nice to know of the options available to you.
Until next time, keep smiling.
Follow Thomas P. Connelly, D.D.S. on Twitter: www.twitter.com/dr_connelly
Fillings fracture teeth usually due to biting and chewing forces. More likely the area around the filling, the margins, is more likely to open and get decay because expansion and contraction is not identical to enamel.
Mercury Amalgam
Metal fillings like amalgam and gold contract expand more like enamel than any other filling, so they resist the marginal decay better.
The size of the filling depends on the amount of decay More decay then the bigger the hole to fill. Bigger holes are best filled by amalgam and if they are too large then a crown is needed.
Composite Resin Fillings
Composite fillings, plastic resin and binding material, cost less to make than Amalgam metal fillings? So ask the cost for a metal filling and then ask for the composite to cost the same.
Composite white fillings wear out faster and need replacing on the average about two to five times more frequently than metal ones.
The other reason is the margins get decay as composites do not expand and contract like enamel.
Porcelain
I suspect you can get these made for around $500 from a lot of dentists,
Gold
We all know that feeling when we bit on aluminum foil when aluminum foil touches the metal filling. This Galvanic shock is not really an issue. Gold is an inert metal and rarely has this painful interaction.
Joseph Cannon D.D.S.
Dentist/Orthodontist
Los Angeles, Ca.
Take a break from all this and go treat your family and yourself to a FANTASTIC MOVIE!! I just saw
SOUL SURFER and it was WONDERFUL!!! It's in limited release... so look for it... SO GOOD!!!
My response is, when something crumble I will do something.
Right now, nothing is moving, I have no sensitivity, what is the point,
I'm not a singer, who care how much metal is in my mouth?
Let me tell you about the OLD DAYS of the 1970's. Our dentist charged $10.00 for a filling, and even less if you really needed to have a tooth pulled.
I'll always remember Dr. Laub in Pottsville, PA ... I was 17 years old and going by myself to the dentist. I had my $10.00 for a filling. He looked in my mouth and said "...you have 3 very small cavities, I can do them all this visit..." Afterwards I went to the receptionist to give her my $10.00 and tell her I'd pay the rest as soon as possible. She smiled at me and said "...that will be $10.00 total..." ???? But the dentist did THREE fillings! Then I heard Dr. Laub call out DON'T WORRY ABOUT IT - IT'S A BACK TO SCHOOL SPECIAL!!! God Bless Him. Those were the good old days.
We can't exaggerate about 1970 pricing -- there are too many young 'n's on line that need the facts, maam, just the facts...
- The amount of mercury, if any, decreases over time, so the fillings will not issue as much mercury after 30 years any more, as in the beginning. Drilling those fillings out may actually trigger more release.
- No filling is non-toxic, not even the composite mentioned in this article. There are self-etching primers used in the process, phosphoric acid, dimethacrylates, urethane dimethacrylate, phenylpropanedione, etc. which are beleived to be sustainable, but may not be beneficial for the body either.
- Porcelain fillings can contain PBA. They are essentially inlays, while amalgam is a paste that fills the cavity. The inlay (both gold and porcelain) has to be bonded to the tooth with glue like zinc phosphate or polyacrylate. These cements can contain also metal oxides, which we want to get out with the amalgam in the first place.
- Since nothing is wrong with my amalgam fillings, the dentist advised not to fiddle with them, as every procedure requires drilling away healthy tooth-substance.
Amalgam may not be exactly healthy, but neither are the other materials. Amalgam is cheaper and lasts longer, though.
They can be polished.
I go south of the border to Tijuana to see my dentist. I know he's not making a fortune as I pay him a fraction of what I used to pay here, but this isn't the first time he hasn't taken my money when I asked for a certain procedure. He wouldn't do the root planing I asked for, said I didn't need it. I don't trust the dentists here, it's all about the bottom line. The older ones who have retired were great, but the young ones who bought their practices are all about the money.