Modern Filling Choices
YOU NOW HAVE MANY CHOICES!...
Firstly, you should know that Dr. Chuck and I might have been considered "health nuts" long before our popular culture focused on organics and vitamins. We were vegetarians all through college and dental school. We have eaten organically for 25 years and wouldn't think of using chemicals on our garden. This, to impress upon you that we care deeply about the "unseen chemistry" in the world around us.
We are going to treat your health and safety with the same thoroughness. And we are going to pay special attention to the "total health" considerations of the dental materials we use. You should know that at Fiddlehead Dental, we are also constantly scrutinizing new horizons for you. Here are our thoughts on the subject of choices in common dental materials...
Modern dental fillings and procedures to restore teeth are many and varied, but there are 5 basic options when you have a tooth that needs repair:
1. Silver Filling
2. White Plastic Filling
3. Gold Filling
4. CEREC® porcelain restoration
5. Crown
All of these 5 options have benefits and drawbacks. The following information will help you understand your choices better and will give you our best advice on the materials that we use with our own families, our informed dental staff and their families.
AMALGAM (Silver fillings)
Silver filling was the most commonly used filling material for more than 150 years. They are made of the metals silver, copper, tin and mercury. As such, they are not the color of natural teeth, and will tarnish and darken over the years. Silver fillings have two advantages; they last a long time, and can be used successfully in teeth under challenging circumstances such as; adults with severely limited opening, children unable to cooperate, and teenagers whose soda drinking habit has weakened their enamel. That said, in our practice we rarely use silver fillings, and then, only in circumstances that make all other choices impractical or impossible.
Silver filling material has some drawbacks. Firstly, X-rays cannot pass through metal fillings. This leaves us unable to diagnose decay in some circumstances. Unseen leakage under silver fillings is very common and can lead to catastrophic failures. Without exception, when we remove a filling that has been in the mouth for longer than 30 years, there is some undetectable decay that is often surprisingly extensive. Secondly, our greatest concern in using silver fillings is that when it has been used to fill a very large cavity, the silver filling may eventually be associated with a cracked tooth. Daily you exert more than 200 lbs. per square inch of pressure on the filling, hundreds and hundreds of times, and it often acts like a wedge through the middle of your tooth. We have read a great deal of scientific research to the contrary, but in practice -Almost without exception - when we see a cracked tooth, there is an aging, large silver filling present and we often find extensive decay in and around the visibly cracked enamel.
Either way, and more to the point though, there are other dental materials that do not appear to be as frequently associated with cracked teeth and that do not contain mercury.
As you know, there are some questions about the element of mercury used in silver fillings. This issue is one of the most studied subjects in dentistry, world-wide. Dental amalgam is a compound of approximately 43-54 percent elemental mercury. To date, we have never seen any credible scientific research that conclusively demonstrates that the mercury in your silver fillings is harming you. However, there are environmental problems with the use of silver fillings that Vermont dentists are right on top of. We have all installed special separators that remove the mercury from the water that would go into the public waste water system.
Dentists will have differing opinions on "The Mercury Issue". Our stand is this: We feel that if there are better modern alternatives to silver fillings, then we will recommend those for the majority of our restorative procedures. We do not rule out silver fillings because we are afraid that the mercury in the silver filling will harm you. We simply find that in many circumstances, we have better materials to offer our patients. (As you will see when you read further on this page).
BOTTOM-LINE: If finances are a particular concern, then silver filling material is still a good choice. Silver fillings are still the most cost effective material that a dentist can use in certain circumstances and for that reason, silver fillings are likely to remain a material that is highly called upon in certain settings. IF FINANCES ARE NOT YOUR PRIMARY CONCERN, THERE ARE MUCH BETTER MATERIALS.
RESIN (White Plastic Filling Material)
The filling on the molar on the left is a resin. The filling on the tooth on the right is silver.
White "plastic" resin fillings have been commonly used in dentistry for more than 25 years. They have an advantage over silver fillings in that they are tooth colored and are "bonded" to the tooth. They can be more conservative than silver fillings because the dentist does not need to remove as much enamel to mechanically lock the filling in the tooth. In our practice, in the right circumstances, when we are doing small fillings, this is our primary filling material of choice.
The primary disadvantage to resin filling material is that it shrinks 1%-3% during the curing (hardening) process. For small fillings this shrinkage will have little consequence because there will not be enough force to pull the material away from the edge of your tooth. For medium to large fillings, this shrinkage will leave tiny gaps and micro-leakage around the fillings, making the life of the filling somewhat short (5-10 years). In some cases, this shrinkage can also lead to lasting biting pressure pain following the placement of a plastic filling. Certain types of enamel ("soft teeth") do not bond well with plastic filling material, and this may greatly shorten the life of a filling as well.
Plastic fillings can not be used in challenging circumstances. Very young children must be able to cooperate completely and even adults have complicated areas where it is difficult to place a plastic filling. The main problem is keeping the tooth completely dry throughout the procedure. If even the smallest amount of saliva contaminates the tooth during the placement steps, the filling will fail very quickly.
We recently have had several inquiries about BPA in these plastic fillings. To read more about that go to our "news" icon at the top of this web page.
GOLD FILLING (ONLAY or INLAY)
Gold fillings have been used for hundreds, if not thousands, of years. Because of its strength, longevity and biocompatibility, gold has long been the standard to which all other materials are compared. The drawbacks to gold are threefold: They require multiple visits to complete a single restoration,... They are expensive compared to resin and silver,... They lack the cosmetic appeal of modern white filling materials.
I (Dr. Lynda) had terrific luck with a number of gold fillings that I had put in my own teeth when I was in dental school. In the 1980's, no one cared that much about having white teeth. Now it's an expectation! The gold fillings are failing now, and I'm having Dr. Chuck replace them with the following dental material...
CEREC® ONLAYS (WHITE PORCELAIN RESTORATIONS)
CEREC® is the trademark of the most advanced dental technology in the world. CEREC® is a high-tech method of restoring teeth with porcelain inlay/onlay, or crown, in one visit using computer technology. Most dental practices use CEREC® to make one-visit "crowns", but we very rarely use it for crowns.
In our office we see the benefit of CEREC® as the best choice for "filling" a tooth in order to preserve the remaining healthy enamel. CEREC® allows us to avoid crowns 95% of the time. In short, we replace only the damaged portion of your tooth with a tiny porcelain puzzle piece.
With this expertise, your restoration is precision milled from a block of tooth-colored ceramic material and then bonded into place like a perfectly accurate puzzle piece. Besides the obvious cosmetic advantage of this white, enamel-like material, its main benefit is the preservation of tooth structure. With CEREC®, we are able to leave all of your tooth's healthy enamel by removing ONLY the old filling and/or decay. We create a conservative restoration called an "inlay," therefore avoiding the extensive removal of all the natural enamel required for typical crowns. (The "crowning" procedure is like putting your tooth in a pencil sharpener - Still a good choice sometimes, but only when necessary.)
Our patients love this technology because it is simply a "non-event" for them. The procedure is painlessly done in less than an hour, in one visit, and afterwards, most patients have almost zero awareness that they've had anything done, ..even the same day! Anyone who can compare having a CEREC done, to having had a crown done, would never let anyone do a crown for them again.
We are proud to be the first and only practice in our area to master this innovative technology. The top impartial researcher in the world, Dr. Gordon Christensen, has deemed this technology to be the "future of dentistry". (see our CEREC web page under "our services" for more information)
CROWNS (Caps)
Crowns have been a terrific, long lasting choice in dentistry for more than 100 years. They are sometimes the unavoidable best treatment for teeth with the most severe problems. Regrettably though, this procedure requires the removal of all the remaining enamel, good and bad. To prepare a tooth for a crown, we must shave the entire tooth down to a nub, so that a "cap" can cover it much like a thimble fits over your finger. Fine if there isn't much good left, but not necessary if there is a lot of healthy enamel to bond to.
Until recently, having a crown done was the only way to predictably restore visibly cracked teeth or teeth with extremely large fillings. And if CEREC isn't available, crowns are still a time-tested, fine, long-lasting restoration option.
The main drawback is the fact that crowns require 2 visits and the use of a temporary crown for 3-4 weeks. The first visit can be lengthy and challenging. Once you have a crown, you cannot reverse the process. This crown will need replacement several times in an average life-span.
We still use gold crowns for big repairs on last molars, way in the back of the mouth. Gold crowns are the best choice for people who grind, clench or otherwise traumatize their teeth. Not much can happen to a good old fashioned gold crown.