4 May 2023
  • Dental filling materials have both advantages and disadvantages. For example, amalgam fillings are durable and long-lasting, but they are also visible and may contain mercury. Composite fillings are tooth-colored and blend in with natural teeth, but they are less durable and may require replacement sooner.
  • Indirect fillings are a type of dental restoration that are made outside of the mouth, such as in a dental laboratory. They are usually used for larger cavities or when a tooth has been severely damaged. Indirect fillings include inlays and onlays, which are made of porcelain or composite resin.
  • There has been some debate about the safety of silver amalgam fillings due to their mercury content. However, the American Dental Association (ADA) maintains that they are safe and that the amount of mercury released is minimal. Additionally, studies have shown that the risk of adverse health effects from amalgam fillings is low.
  • It is possible to be allergic to amalgam fillings. Some people may experience an allergic reaction to the metals used in amalgam, such as silver, copper, or mercury. Symptoms of an allergic reaction may include a rash, swelling, or difficulty breathing. If you suspect you may be allergic to amalgam, you should speak with your dentist. There are alternative filling materials available, such as composite resin or porcelain.

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What exactly are dental fillings?

Dentists use single or combinations of metals, plastics, glass, or other materials to repair or restore teeth with dental fillings. Fillings are commonly used to fill cavities resulting from decay that dentists have removed. They also repair cracked or broken teeth, as well as teeth that have been worn down due to misuse, such as from nail-biting or tooth grinding

What substances are used to create dental fillings?

Dental filling materials comprise gold, porcelain, silver amalgam (which mixes mercury with silver, tin, zinc, and copper), and tooth-colored composite resin fillings made of plastic and glass materials. Your dentist’s recommendation, the cost of filling material, the location and extent of decay, and your insurance coverage will help determine the type of filling that will best suit your needs.

Do different filler materials have advantages and disadvantages?

Yes. Advantages and disadvantages of the various dental filling materials are as follows:

Advantages:

  • Gold fillings are durable and can last 10 to 15 years, and some people find them aesthetically pleasing.
  • Silver fillings (amalgams) are also durable and can last at least 10 to 15 years. They are less expensive than composite fillings.
  • Tooth-colored composite fillings can be matched to the color of existing teeth and bond to the tooth, providing additional support. They are commonly used for repairs other than cavity filling and require less removal of the tooth compared to amalgams.
  • Ceramics or porcelain fillings last over 15 years and are more resistant to staining than composite resin material.
  • Glass ionomer fillings are commonly used for fillings below the gum line and release fluoride that helps protect against tooth decay

Disadvantages:

  1. Gold fillings:
  • More expensive than other materials.
  • May require more than one office visit to place.
  1. Silver fillings:
  • May require more tooth to be removed to make space large enough to hold filling.
  • Creates a grayish hue to the surrounding tooth structure.
  • May have a higher risk of tooth cracks and fractures due to wider degree of expansion and contraction.
  • Allergic potential in some people.
  1. Tooth-colored composite fillings:
  • Lasts at least five years, which is less than the 10 to 15 years of other materials.
  • May chip off the tooth depending on location.
  • Can cost up to twice as much as amalgams.
  • Can take more time to place and/or require additional visits.
  1. Ceramics:
  • Can cost as much as gold.
  1. 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.

How do indirect fillings work?

Indirect fillings are similar to composite or tooth-colored fillings, but they require two visits before placement because they are made in a dental laboratory. Dentists consider indirect fillings when there is insufficient tooth structure remaining to support a filling, but the tooth is not severely damaged enough to require a crown.

During the first visit, the dentist removes any decay or old filling and takes an impression of the tooth being repaired and the surrounding teeth. The dental laboratory uses this impression to create the indirect filling. Meanwhile, the dentist places a temporary filling to protect the tooth until the restoration is complete.

During the second visit, the dentist removes the temporary filling and checks the fit of the indirect restoration. If it fits properly, the dentist cements it permanently into place.

There are two types of indirect fillings:

  • Inlays lie entirely within the cusps on the chewing surface of the tooth and are similar to fillings.
  • Onlays, which are sometimes referred to as partial crowns, cover one or more cusps and are more extensive than inlays.

Inlays and onlays outlast traditional fillings by up to 30 years and offer greater durability. They can be made of tooth-colored composite resin, porcelain or gold. Although they do weaken the tooth structure, they do so to a much lesser extent than traditional fillings.

The type of inlay or onlay used depends on the amount of remaining sound tooth structure and cosmetic preferences. Direct inlays and onlays are another type that follows the same processes and procedures as the indirect kind, but are made and placed in the dental office in a single visit.

Why would I require a temporary filling? What is it?

You might need a temporary fillings:

These are some situations in which you may need to schedule multiple dental appointments or follow-up appointments:

  1. Complex fillings: If your dentist needs to place multiple gold fillings or indirect fillings that use composite materials, they may need to schedule multiple appointments to complete the treatment.
  2. Root canal therapy: After a root canal, your dentist may recommend a follow-up appointment to ensure the treatment was successful.
  3. Nerve irritation: If the pulp of your tooth becomes irritated, your dentist may recommend waiting for a period to allow the nerve to “settle down” before completing the treatment.
  4. Emergency dental treatment: If you experience a toothache or require immediate dental attention, your dentist may need to schedule an emergency appointment to address the issue.

Temporary fillings only last for a short time and tend to fall out, fracture, or wear out within a month. It is important to attend your appointment to have the temporary filling replaced with a permanent one to avoid complications such as tooth infection.

PROCEDURE DETAILS

What procedures are necessary to fill a tooth?

  1. Steps for getting a filling:
  • Numbing the area with local anesthesia
  • Removing decayed area with a drill, air abrasion instrument, or laser
  • Probing or testing the area to ensure all decay has been removed
  • Cleaning cavity of bacteria and debris
  • Adding a liner near the root if necessary
  • Applying filling material and finishing/polishing it
  1. Additional steps for tooth-colored fillings:
  • Applying tooth-colored material in layers
  • Using a special light to cure or harden each layer
  • Shaping the composite material to desired result
  • Trimming off excess material and polishing the final restoration.

RISKS / BENEFITS

Are fillings made of silver amalgam safe?

The ADA, the FDA, and several public health agencies assert the safety of silver (mercury-based) amalgam fillings. However, the FDA has recently released updated recommendations regarding the use of amalgam fillings in certain individuals. According to the FDA, individuals who may be at higher risk of potential harmful health effects of mercury vapors should avoid getting these fillings whenever possible..

  1. Pregnant women and their developing fetuses, as well as women who are planning to become pregnant, are at a greater risk of harm from dental amalgam due to the mercury content.
  2. Nursing women and their newborns are also at risk of exposure to mercury from dental amalgam.
  3. Children, particularly those under the age of six, are more vulnerable to the toxic effects of mercury.
  4. People with pre-existing neurological diseases such as Alzheimer’s disease, multiple sclerosis, or Parkinson’s disease are also at a greater risk of harm from dental amalgam.
  5. Individuals with impaired kidney function may be more susceptible to mercury toxicity.
  6. People who have sensitivity or allergy to mercury or other components of dental amalgam are also at risk of adverse reactions.

The FDA recommends that people at higher risk should not have their dental amalgam removed if it is in good condition, as doing so would increase their exposure to mercury vapor and pose more risks than benefits.

RECOVERY AND OUTLOOK

How should I take care of my filled teeth?

  1. Good oral hygiene practices: To maintain your fillings, it is crucial to follow good oral hygiene practices, which include brushing with a fluoride-containing toothpaste, flossing at least once a day, and visiting your dentist regularly for cleanings. Brushing helps remove food particles and plaque from your teeth, which can lead to decay and damage to your fillings. Flossing helps remove debris and bacteria from between your teeth and gums, reducing the risk of cavities and gum disease. Regular dental cleanings can help detect any problems with your fillings early on and prevent further damage.
  2. When to call your dentist: It is important to call your dentist if you experience extreme tooth sensitivity, feel a sharp edge, or notice a crack in a filling or a missing piece of the filling. These symptoms could indicate that your filling is damaged, cracked, or loose, which can lead to further decay and damage to your tooth if left untreated. Your dentist will be able to examine your teeth and determine the best course of action.
  3. X-rays: Your dentist may take X-rays if they suspect that one of your fillings is cracked or leaking. This can help detect any decay or damage that may not be visible to the naked eye. If your filling is leaking, debris and saliva can seep down between the filling and the tooth, leading to further decay and damage. Your dentist may recommend replacing the filling or performing a more extensive dental procedure to restore the tooth’s health.

What results in increased tooth sensitivity after a dental filling?

  1. Tooth sensitivity after a filling is common and can cause discomfort to pressure, air, sweet foods, or temperature.
  2. Sensitivity usually resolves on its own within a few weeks, but it is recommended to avoid triggers that cause sensitivity during this time.
  3. Taking pain relievers is usually not necessary.
  4. Contact your dentist if sensitivity persists for two to four weeks or is severe.
  5. Your dentist may recommend using a desensitizing toothpaste, apply a desensitizing agent, or suggest a root canal procedure to address the sensitivity and prevent decay.

Why do I get discomfort near my tooth filling?

  1. Pain after a dental filling can have different causes, including interference with bite, contact between different metal surfaces, deep decay affecting the tooth pulp, and referred pain.
  2. Depending on the cause of the pain, a patient may need to return to the dentist to have the filling reshaped, wait for the pain to subside naturally, or undergo a root canal procedure. Referred pain, on the other hand, should decrease on its own over time.

When and why might a dental filling require replacement?

Reasons for Replacing Dental Fillings:

  • Normal Wear and Tear: Dental fillings can wear down, chip, or crack over time due to constant pressure from chewing, grinding, or clenching. Although patients may not notice any changes in their fillings, a dentist can identify weaknesses during a regular check-up.
  • Filling Fails and Decay Develops: When the seal between the tooth enamel and the filling breaks down, food particles and bacteria can get trapped under the filling, causing decay. If left untreated, decay can lead to an abscessed tooth, which requires additional treatment.
  • Large Filling or Decay: If the filling is large, or there is extensive recurrent decay, there may not be enough tooth structure left to support a replacement filling. In such cases, the dentist may have to replace the filling with a crown to ensure that the tooth is adequately protected.
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Why does a fresh filling suddenly fall out?

The cause of new fillings falling out is likely improper cavity preparation, contamination of the preparation before placing the restoration, or a fracture of the restoration from biting or chewing trauma. Decaying or fracturing of the remaining tooth is typically the reason for the loss of older restorations.

ADDITIONAL DETAILS

Amalgam fillings—can they cause allergies?

According to the ADA, it is possible to experience an allergic reaction to amalgam, but fewer than 100 cases have ever been reported. In these rare instances, it is believed that mercury or one of the metals used in the amalgam restoration triggers the allergic response. Symptoms of an amalgam allergy are similar to those of a typical skin allergy, including skin rashes and itching. If an individual has had an allergic reaction to amalgam, it is likely that they have a medical or family history of allergies to metals. Once a confirmed allergy is present, a different restorative material can be used..

Do composite fillings fall under the scope of dental insurance?

Dental insurance plans typically cover the cost of composites up to the price of the silver filling, requiring the patient to pay the difference. If you have any questions or concerns about cost, it’s recommended that you contact your dental care insurance provider before undergoing any procedures..

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