Fillings

Fillings are probably the most common dental procedure performed in dentistry today, and the technique has not changed much over the years. It is amazing to see how some fillings have lasted in patients' mouths for over 20 or even 30 years! How many things can you buy today that can last that long? So the motto has been: "If it's not broken, why fix it?"

However, in the late 1980s and early 1990s, some changes in the materials dentists used for fillings took place. Until then, the routine procedure was to place amalgam (silver) fillings in all back teeth, with white porcelain fillings only in the front teeth. They changed for two reasons. The first was many patients wanting something more aesthetic than dark amalgam fillings, even in the back teeth. Another was due to the release of some studies linking a toxic effect to the release of mercury from amalgam fillings. The challenge presented to the profession at that point was the creation of a white composite filling that would be strong enough to withstand the biting pressures of the back teeth. The 1980s yielded many failed attempts by dentists and manufacturers to come up with such a material. Finally the challenge was conquered. Materials used today are quite impressive, and usually last almost as well as the old faithful amalgam.

The only other type of material used for fillings would be gold. These fillings are truly superior to both of the above mentioned ones. They are usually cast in a laboratory after a mold of your tooth is taken and then cemented in your tooth similar to a cap. These are usually referred to as gold inlays. They are usually more expensive, and some patients find the gold unaesthetic. This has lead to the development of a similar type of inlay that is made out of porcelain that is also made in the lab and is subsequently bonded to your tooth. Consult with your dentist about your different options and what will work best for you.

FAQ

Is it true about mercury poisoning? Should I really have all my silver fillings replaced with white ones?

The truth is that there really is no conclusive scientific evidence one way or another. We recommend taking a compromise route in this debate. If you have a very high number of very large and old amalgam fillings, it may be in your interest to replace the ones that are due for replacement with white ones. However, if you just have a few small and still functional silver fillings, we recommend that you do not replace them just to make them white. This is also the official opinion of the American Dental Association at this time.

My dentist says that I have cavities and that I need to have fillings. Why is that, since I have no pain?

Your dentist is probably right. Remember a good dentist is one who tries his best to keep you out of pain. The reason the cavities don't hurt is because the cavities have not reached the pulp (nerve) yet. But if they are left alone, it is only a matter of time before they do. Remember, it is usually too late when you feel the pain!

My dentist says my old filling is too big to be replaced and that I need a cap now. Why is that?

Any time an old filling is replaced it ends up being slightly larger than the old one. This is because the dentist needs to clean out any decay that occurs around the edges of the old filling. If the old filling is very large, sometimes this additional size is just too much for the tooth to support, and may place the tooth in jeopardy of a serious fracture. Your dentist will usually recommend a crown (cap) in these cases to make sure this does not happen.

Why do fillings have to be replaced?

Fillings have to be replaced after a certain amount of time because the seal between the tooth and the filling will begin to break down. This will create a gap between the tooth and the filling where a new cavity can take place. It is always best to replace them early when this begins, because the longer you wait, the bigger the new fillings will become.