Restorations

When you go for a check up, your dentist checks your fillings and may suggest that you replace any loose, leaking or broken ones. Your dentist also looks for signs of decay, such as brown or black spots and may want to use X-rays to take a closer look at problem spots. He may also want to place fillings in your teeth to remove cracks or fractures in your teeth before the tooth fails and needs a crown.

If you have a cavity, your dentist may keep an eye on it (if it's small) or fill it right away. The decision to fill or watch often depends on location, your diet and how well you keep your teeth clean. If a large cavity is not filled, it can get bigger, cause pain and require a root canal. The tooth may even have to be removed and replaced with a false (or artificial) tooth.

Metal Fillings - Dental amalgam is the most common type of filling used today but other metal, such as gold fillings may be appropriate depending on your oral health needs.

Tooth-colored Fillings - Composite and ceramic fillings that are the same color as your natural teeth.

If you have a cavity and it needs a filling, there are different kinds of fillings to do the job.

Your dentist cares about you and your oral health. If you have any questions or concerns about fillings, talk to your dentist. He or she will advise you on the type of filling that works best in your particular case, and inform you about the aesthetic and cost implications for each type.

Before you get a filling, tell your dentist about changes to your health since your last visit:

• Are you taking or is there a change in your medication?
• Do you have allergies?
• Are you pregnant?
• Do you have indigestion, GERD’s, acid reflux or sleep apnea?
• Have you had any changes in your medical history?

There are several different types of fillings that can be used to fill a cavity, but the final decision on which type of filling is placed in your mouth is yours alone.

How Fillings Are Done

To fill a cavity, your dentist will numb you up so you do not feel any pain. Your dentist then takes out all traces of decay, shapes the preparation, fills it, polish it and adjusts your bite.

Most fillings are done in two ways:

1. Direct Filling - These fillings go right into the cavity, after your dentist has cleaned out the decay. Amalgam (or silver) fillings and plastic (or white) fillings are examples of direct fillings. They harden quickly. Most of the time, you will be able to have a direct filling put in place in one appointment.
2. Indirect Filling - Examples of this type of filling are crowns (or caps) onlays and inlays. They are custom made in a lab to fit your tooth. Your dentist cements or bonds the filling in place. Most indirect fillings take two or more appointments to complete.

Dental amalgam is the best-known direct material. Newer generation dental amalgam has removed much of the mercury rich layer found in the very old silver filling material. Recently, the ADA has stated this material is still safe for fillings. Cast gold alloy, the very best material in the past, is slowly being replaced by ceramic restorations. These newer materials are tooth colored and seal better because they can be bonded to the tooth.

Remember, your dentist is interested in you and your oral health. If you are concerned about having any particular dental restorative materials placed in your teeth, talk to your dentist and be a partner in decisions about your oral health care.

Metal Fillings

1. Dental Amalgam Fillings

Dental amalgam fillings are sometimes called "silver" fillings. Due to cost concerns, they are the most common type of filling used today. Because these fillings are silver in color, they are primarily used to fill back teeth. They are a mixture (amalgam) of metals such as mercury, silver, copper, zinc and tin.

- Advantages

• These fillings are the least expensive type of filling.
• They last a long time.
• They are easy to put in place; because they are a direct filling, one visit to your dentist will do the job, in most cases.

- Disadvantages

• The silver color may not appeal to people who want a "natural" look.
• Large silver fillings can weaken your teeth and will give it a blueish-gray color.
• Large fillings can cause sensitivity to temperature
• Silver fillings can corrode and eventually start leaking.
• Plaque can more easily attach to large silver fillings which can irritate your gums.
• Pregnant women in need of a filling can have dental work done after the first trimester is completed. Limited emergency work can be done during the first trimester. If you have any questions contact your obstetrician.

Cast Gold Fillings

Cast gold fillings are made from a model (or cast) of your tooth. Cast gold fillings are a mixture of gold with other metals such as silver and copper. These other metals make gold fillings more durable.

A cast gold filling is made in a dental lab and sent back to your dentist, who cements it in place in your mouth. You will need at least two visits to the dentist to get the job done. During the first visit, your dentist cleans out all the decay and makes a mold of your tooth. The hole is filled with a temporary filling until the final filling is ready.

- Advantages

• Gold is stronger than amalgam.
• Gold fillings last a long time.
• Gold fillings resist wear.

- Disadvantages

• Gold costs more than other kinds of fillings.
• Gold fillings and crowns are indirect fillings, so they require at least two appointments.
• The gold color may not appeal to people who want a "natural" look.
• The cement can wash out around gold fillings and re-decay.
• Gold fillings, because they are not bonded, can not strengthen your tooth.

Tooth-colored Fillings

Composite Fillings

Composite fillings are also called plastic or white fillings. See link entitled “White Colored Fillings” above.

Glass Ionomer Materials

Glass ionomer materials are only used in teeth where you do not bite down hard. There have not been many studies about how long this kind of filling lasts. Newer forms of the filling may be stronger and last longer. Research is underway to evaluate the effectiveness of these materials. They are primarily used as fillings in baby teeth.

- Advantages

• These fillings are the same color as your natural teeth.
• They contain fluoride, which helps stop recurrent decay in the tooth.
• They do not have to be put in layer by layer; thus, they are simpler to put in than composite resins.
• They are direct fillings and can be done in one appointment, in most cases.
• They cost less than gold fillings.

- Disadvantages

• They are not as strong and will not last as long as other fillings.
• They cost more than amalgam fillings.

Ceramic Materials

There are various ceramic materials that can be used for dental fillings. They are hard and brittle and thus are not good choices for clenchers and grinders. The big advantage is that these fillings are bonded to the enamel and thus are stronger and seal better that silver fillings.

- Advantages

• Dental ceramic is the same color as natural teeth.
• These fillings last a long time.
• Reduced leakage because they are bonded fillings.

- Disadvantages

• Not indicated for patients that clench and grind their teeth unless they also wear a soft mouthpiece at night.
• They are indirect fillings, so at least two appointments will be needed.
• They cost more than most other types of fillings.