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For July 17, 2006 Health column:
Filling Cavities and Chips:
More Choices than Ever
By Tareq Khalifeh, DDS
For the past 100 years, dentists had very few
choices for repairing tooth wear or decay. When they had a filling
or a chip, most people received the silvery metal fillings known as
amalgam. Sometimes, for people who could afford it, the so-called “noble” gold
alloy was used.
Today, amalgam is still the most affordable and,
in many ways, most durable way to seal a cavity and prevent further
decay. But several other choices now exist for presenting a natural
smile to the world. Understanding the alternatives will help you make
an informed choice if you or a family member need a tooth repair sometime
in the future. So let’s take
a brief look at the types of fillings now in use.
The Old Standby: Amalgam
Dental amalgam is a stable alloy that combines elemental mercury, silver,
tin and copper. Used in dentistry for over a century, it has been thoroughly
researched and tested. It is very durable, making it particularly important
for large fillings, such as those in the back molars. It is also easy
for the dentist to work with, highly resistant to wear, and relatively
inexpensive compared to other materials.
Some people are concerned about the mercury content
in dental amalgam. They needn’t be. The major U.S. and international
scientific and health bodies, including the National Institutes of Health,
the U.S. Public Health Service, the Centers for Disease Control and Prevention,
the Food and Drug Administration, and the World Health Organization,
among others, have reviewed safety studies and concluded that dental
amalgam is a safe, reliable, and effective restorative material. And
two new studies of its safety for use in children were published in the
April 2006 issue of Journal of the American Medical Association. These
studies looked specifically neuropsychological and neurobehavioral effects
among children who received amalgam fillings versus those treated with
tooth-colored composite fillings. No statistically significant differences
Some people prefer not to have amalgam fillings because
of their silver color, particularly in the visible front teeth. The filling
do not cause discomfort, although they may be sensitive to heat and cold
for a short time after they are placed in the tooth. They are also considered “biocompatible,” meaning
they are well-tolerated by patients, with only rare occurrences of allergic
Composite fillings are tooth-colored material made from a mixture of
glass or quartz in an acrylic base. Many people prefer them for fillings
in areas of the mouth that are highly visible, because of their natural
look (although they can stain and discolor over time). They provide
good durability and resistance to fracture in small- to mid-sized cavities.
The dentist may not have to remove as much of the surrounding tooth
enamel when preparing a composite filling as with an amalgam filling.
Composite material can also be bonded to the tooth. Like amalgams,
composite fillings can usually be prepared and applied in one office
visit, and their cost is moderately higher than amalgams. Composites
are not appropriate for large fillings in back teeth where wear is
greater. Composites are also used for veneers, thin tooth coverings
used to cover worn or damaged teeth.
When a cavity occurs on the root surface of the tooth, near the gum line,
or between teeth, your dentist may recommend a glass or resin ionomer.
This is a translucent, tooth-color material made from acrylic acids
and fine glass powders. Glass ionomers release a small amount of fluoride,
which may be beneficial for patients who are at high risk for decay
at the filling site. Ionomer materials are best used in areas that
don’t have heavy chewing pressure, because they are less durable
than amalgams or composites. Ionomers are similar to your natural tooth
color, but don’t have the translucency of real tooth enamel.
For simple fillings, they can be applied in one office visit, and are
only moderately more expensive than amalgams. They are trickier for
the dentist to install, as the area must have absolutely no moisture
during application. Ionomers can also be used as liners in repairs
of large cavities, and as cements for crowns and bridges.
Gold alloys contain gold, copper, and other metals that result in a strong
effective filling, crown, or bridge. They are primarily used when a
large portion of a tooth surface must be replaced or repaired. They
are highly resistant to corrosion and tarnishing, and resist fracture
and wear. Gold alloys are also gentle to opposing teeth. Their unnatural
coloring is highly evident, however, and they are considerably more
expensive than other materials.
Porcelain is sometimes used as a filling material, because its color
and translucency mimic natural tooth enamel. Porcelain is also used
for veneers. Crowns and bridges can be made using porcelain fused to
a metal base. The materials above are the tools dentists can choose
from in filling a fairly routine cavity or a chip. For a more comprehensive
repair, such as a overlaying a large portion of the tooth structure,
covering a tooth with a crown, creating a replacement tooth or a bridge,
porcelain (ceramic) materials also come into play. Porcelain restorations
require two or more visits and are relatively expensive. The porcelain
is prone to fracture under tension, and its strength is very much determined
by how well it is applied and bonded. Porcelain restorations do not
wear, but their very hardness can be problematic to opposing teeth
if the surface of the porcelain fitting becomes rough.
For additional information and drawings of some of
the filling materials discussed in this article, visit http://ada.org/public/topics/fillings.asp.
Dr. Khalifeh owns the Philmont Family Dentistry located
on Rte 217 in Philmont, NY. A graduate of the New York City School of
Dentistry, he completed his residency at Albany Medical Center and practiced
in Albany until 2004. For more information, call 672-4077.