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Thomas P. Connelly, D.D.S. Headshot

Dental Fillings 101: How To Choose

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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.