Dental Fillings FAQ

Dental Fillings FAQ

Amalgam Fillings

When repairing damaged teeth especially in the case of cavities, many direct restorations are made using the common material of amalgam. Amalgam is a safe, strong, durable and reliable alloy that has been in use for over two hundred years in dental applications. The material is composed of approximately 50% mercury and the rest from other metals such as silver, tin and copper. This blend of metals allows for the combination to remain soft enough for the dentist to put the filling into place during the procedure as well as being resistant to moisture during the positioning. As a restorative technique, amalgam fillings are known to last on an average of 12 years. Dental cement is used to hold the amalgam in place. The longevity of the material is not only due to its physical strength but its anti-microbial properties because of the mercury content. Despite the many positive reasons to choose amalgam for a dental restoration, there are a few drawbacks to the compound. Amalgam sets as silver in color. When a patient opens his/her mouth, a silver tone will show where the filling was installed. Another flaw of amalgam is the very prominent controversy of its mercury content. Much of the medical community and others believe that mercury is the cause of numerous illnesses. This is a highly debated subject with evidence on both sides of the argument.

Composite Fillings

Composite fillings offer an alternative to amalgam especially when it comes to aesthetics; however, they are not as widely chosen. When used in a patient's mouth, they resemble a normal tooth's color. Unfortunately, the fillings are not covered by insurance because they take much longer to place in the mouth and they have more reasons to fail. The composite material is created from a type of glass (quartz) and a plastic resin (giving it a natural tooth color) that is secured to the tooth and hardens as it is secured. This process involves the composite shrinking a small amount with light treatment and thereby gives a small amount of space for naturally forming bacteria to deposit. This lengthy photo-curing technique is part of what makes composite fillings more costly; it takes approximately ten to twenty minutes longer per tooth than a traditional filling. The bond in the resin of the composite filling is also very sensitive to moisture in the mouth. However, because less tooth structure is removed when preparing it for a filling than traditional amalgam fillings, composite fillings require less drilling and provide for smaller fillings. They also offer extra structure to the tooth thereby making it stronger. Unfortunately in the composite method, a small amount of bacteria can form in the empty space and this is the cause of tooth decay. The clear advantage of composite fillings is aesthetics but it comes with a real cost: about one and half to two times and this is a price that is not typically shared by many health insurance companies. Patients are also prepared for the fillings to last half as long as traditional fillings.

Alternative to Mercury Fillings

Although amalgam and composite fillings are wide spread in their use, there are some alternatives designed for specific purposes.

  • Glass ionomers are composed of an organic acid and glass mixture. It is a substance that is easily subject to fractures and therefore is not used on the load bearing portion of the mouth. Glass ionomers are used in instances below the gum line because of their translucency. A substantial benefit besides their appearance is that they release fluoride which helps to prevent tooth decay. While glass ionomers are brittle in comparison to other fillings, they serve an effective purpose.
  • Porcelain fillings are used in a pure cosmetic dentistry setting. The drawbacks are high such as the material having low durability, high cost and susceptibility to breakage.
  • Gold fillings made with either 14 or 18 karat gold are also an excellent filling material. Like amalgam fillings, they last a long time and are sturdy. However, they conduct heat and cold which is uncomfortable and has lead to the evolution of other composites in the dental world.

Mercury related illness

The debate over mercury related illnesses has been an enormous controversy since the inception of the material. While many patients are unaware of the content of their fillings, many governmental agencies discuss the health concerns not only in the United States but throughout the world. From a medical standpoint mercury buildup over time can lead to kidney damage, autoimmune disorders, mental disorders, oral lesions, multiple sclerosis, neurodegenerative diseases, chronic fatigue syndrome, autism, birth defects and more. Environmentalists even argue that mercury is not regulated at a federal rank accounting for a total 5% emission level which deteriorates the environment and is an expenditure to the government to clean up. Mercury is able to make its way into public sewer systems with waste from a dental office and this is a major health consequence for even those in a non-dental setting. For reasons such as this, amalgam has been banned in three European countries.

In order to determine the truth about the matter, many clinical and private trials have been conducted. Recently in 2006, two studies were administered to children (who are thought to be more susceptible to mercury illnesses) and the Journal of American Medical Association concluded two interesting points. In the first study, children were proved to require less dental care long term if they received amalgam fillings than composite. In the second study, the children had slightly higher mercury levels in their blood, but compared to a considered "safe" mercury level, the children were nowhere near a dangerous threshold. The researchers also did not find any negative cognitive or medical side effects.

A much anticipated study will be published in the summer of 2010 by the University of Bergen titled "Health Effects From Removal of Amalgam Restorations in Patients With Symptoms Allegedly Related to Dental Amalgam". This will hopefully put to rest some of the tension between the two sides who often find the research biased depending upon which division administers the research. For patients who are unsure of their own decision to use amalgam fillings, it can be a very confusing process that best be researched carefully.

How to find a mercury-free dentist

Mercury-amalgam fillings are still widely used despite the current debate and yet, public knowledge is increasing to the point where consumers are now opting to remove their mercury fillings and replace them with less toxic fillings. To begin the process, a patient can find a mercury-free dentist by doing a simple internet search. At the site, there are 117 listings for mercury-free dental offices in the United States. The dentist removing the filling will take extreme care and use devices that will allow the patient not inhale or swallow any mercury vapors. This procedure is not covered by typical insurance and is costly.

Dental lasers and pain-free alternatives to dental drills

The use of a dental laser is an exact and effectual tool in oral surgery. Because the laser is a ray of light, the dentist is able to control the output and duration of the beam that stays on the patient's gum or oral tissue without damage to other areas. An enormous benefit of the laser is that it allows for its use with no anesthesia which is not the case with the classic dental drill. Generally a laser is used in instances of tooth decay when a dentist must cut a piece of the gum to prepare it for a filling. Lasers are also used to reshape gums and eliminate bacteria to prepare the area for a root canal. Canker sores can be removed with a laser. Lasers are also used to remove a piece of skin to do a cancer biopsy, correct skin that causes sleep apnea and remove tumors. Lasers are also employed in the activation process of teeth whitening as well as aesthetic restoration. In all of the aforementioned procedures, traditional dental drills that are uncomfortable, loud and at times painful can be replaced by a laser. The laser also produces less bleeding and inflammation which is a positive for both the dentist and the patient. Unfortunately a laser cannot do everything that a drill is designed to do since they cannot be used on teeth that already have fillings and it is vastly expensive.

Another alternative is an air abrasion system that is also virtually painless compared to the drill. The technique is simply sandblasting using aluminum oxide particles that will treat the desired part of the tooth/gum. The dentist will use a guard around the spot being treated to make sure the particles do not escape the local area.

Are dental lasers safe for my kids?

Since dental lasers do not cause any pain, they are a great alternative to the anxiety caused to young children during their first impressionable visits to the dentist. While still not a cost effective option, laser treatment is the only way to avoid anesthetic needles and uncomfortable drills. Consultation with a dentist is absolutely worth the time.