The Wright Report

Silver Fillings (Amalgam) vs. White Fillings (Composite):

September 2013  •  Dr. Gary Wright, DMD

Silver fillings were the "gold" standard for close to 150 years. There has been much controversy over recent years because of their mercury content. Even though this material has been banned in some countries, there has yet to be a conclusive study done that shows any negative health issues arising from its use. Amalgam is comprised of select metals ground into a powder. These metals include silver, tin, zinc, and copper, and they are bound together with mercury (the "liquid" metal). Amalgams were called silver fillings because silver composed the greater percentage of the metals (around 30 percent of the total ingredients). In its separate, free, raw form, mercury is toxic to the body and becomes bound in the body's nerve tissue. However, when combined with the aforementioned metals, the mercury becomes part of an alloy, is no longer in the free state, and thus is no longer toxic. This alloy was used for many years quite successfully and was the best and most economical for filling the hole left in the tooth after the decay was removed. Yet the down side to silver fillings is that they are not very cosmetic, being dark and not matching the color of the tooth. Aside from this, the biggest negative is that the teeth that received these metal fillings were prone to cracking and breaking over time. Amalgams did not strengthen the teeth and many times the teeth would end up breaking a cusp (the point of a back tooth) off or even splitting. The amalgam would be very durable to the pressures of chewing and biting but the teeth, being weaker, could eventually break.

White fillings (composites) have now become the standard of care in dentistry NOT because of health issues but because they are a superior material. Compared to amalgam that only fills and seals the "hole," composites act more like an epoxy in that they are bonded into and actually strengthen the tooth better than amalgam. The big side-benefit is that they are very cosmetic, matching the shade of the tooth and, in most cases, even making the filling itself hard to see. There are more steps involved in placing the composite, causing it to take longer. Hence, this procedure is more expensive (about 20 percent more than amalgam). Unfortunately, many insurance companies are not covering for composites in back teeth even though they have become the standard of care in dentistry today. Often times when someone has a painful back tooth to bite down on and the tooth has an amalgam in it, there is usually a crack starting under the amalgam. The remedy for this is removal of the amalgam and then bonding a composite into it and "tying" the tooth back together. Usually the symptoms are removed and the tooth can be comfortably chewed on again.

Silver fillings do not need to be replaced if they are working well but when they have to be replaced, the best choice is with composite. Some people want their silver fillings replaced for cosmetic reasons and this is fine but is purely a personal choice and not a mandate.

Be assured that there are no negative health issues having silver fillings in your mouth if you already have them but we should be choosing the better materials when new or replacement fillings have to be done. This practice is amalgam free because our mission is to provide the best dentistry possible for our patients and amalgam, although integral to dentistry for many years, is no longer the best choice today. There are occasions when we have to use amalgam but these times are very few and far between.

There are other strong, bonded, cosmetic choices such as ceramics and crowns. Look for future articles about these.

Thanks for reading,

Dr. Wright

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