I have been practicing dentistry for over 34 years. During these decades, there have been many changes in dental materials. Perhaps the greatest changes have occurred with composites (white filling material), porcelains, and porcelain-like materials. The truth regarding all available dental materials is that they all have a place. There is no perfect filling material for all situations. Different situations require different materials. And, from my experience, some of the newer material may not be the best choice. In fact, for some patients, it may be a disaster.
Effect of Patient’s Saliva on Composite (tooth-colored) Fillings
One of the most important aspects of choosing a dentist is his/her experience with dental materials and how they react in different types of patients’ mouths. In my practice, I have found that composite restorations (fillings) do not do well in certain types of patients. Due to the nature of composite resins, there appears to be a link between leakage of resins (including new decay under the margin, or edges), and the proneness of the patient to decay overall. As I have recently learned, this may be due to the nature of the patient’s saliva. People with high decay rates should try to stay away from resin-based (composite) fillings where possible. Realistically, we must use resins in some cases, especially in the aesthetic zone (those areas that show when we smile.)
Composite Filling Drawbacks
Composite fillings have one important drawback compared to dental amalgam. They can create sensitivity that may be irreversible. Ask any competent endodontist, or root canal specialist, and they will tell you that deeper composite fillings are the reason why they are referred so many cases. In fact, some deep composite resins can cause a particular type of reaction in which the patient cannot pinpoint the source of the pain, resulting in increased time to locate the problem tooth. Once the tooth is located, a root canal is needed to remove the problem, with a crown after that, to restore the tooth to usefulness.
Amalgam Fillings as an Alternative for Breakdown-Prone Patients
When I predict that a patient is more prone to such breakdown, I sometimes turn to an old standby – amalgam fillings. Amalgam as a filling material has received a bad rap. Amalgam fillings have been in my own mouth, unchanged, for over half a century. Amalgam withstands wear, dental caries, abuse, acids, and other stresses, and has lasted in many of my 70- and 80-year old patients for just about a lifetime. I’ve had few complaints from patients regarding dental amalgams – they withstand the test of time.
Concerns About Amalgam Fillings
Several European countries, as well as several United States dental schools, have refused to accept dental amalgam as an alternative dental filling material. This is primarily due to the fact that it contains mercury. We know mercury to be toxic. However, the mercury in amalgam is an integral part of the metal filling and has little chance of escaping. Several sources have claimed that this amalgam is responsible for causing diseases or maladies, which has created unfounded fear in the eyes of the public. The jury is still out on the possible detrimental affects of amalgam in certain parts of the population, and I recognize that we should use diligence in its use. Using alternative materials is always an option.
Unnecessary Work Based on Questionable Fear Causes Real Problems
What concerns me about the fear of amalgam is that many dentists have used these fears and, without discretion, removed and replaced every silver amalgam in a patient’s mouth with crowns, onlays, or composite fillings. Patients who never had a problem with the amalgam then have the potential to become severely sensitive, and in some cases, even have their dental nerves die, necessitating root canal. After years of experience, and from seeing this happen many times, I’ve come to the belief that, if you don’t have a problem and the amalgam is intact, leave it alone! Dentists who complete unnecessary and possibly harmful work based on unfounded fears and who promote white fillings or crowns to replace existing amalgam fillings that are in good shape are wrong. They are creating work for themselves based on questionable fears and exposing patients to real side effects that can cost time, money, discomfort and an overall decrease in patient health due to diminished ability to eat a variety of healthy foods.
There are many different dental restoratives available on the market today. I am not against white filling milling machines, large composite resins, and other treatments that can restore a patient’s teeth properly. What I am against is indiscriminate use of such modalities, and refusal to advocate, in certain circumstances, materials that are time-tested and proven.
‘What’s best for the patient’ Must Come First
Choosing a good dentist is important for your dental and overall health. What is done, how it is done, and maybe the most important – recommending that nothing at all needs to be done, may be the best indication of who cares about you the most. In our fast-paced society of glitz and glamour, enchantment with the latest and greatest, insurance provider or not, we have somewhere lost the essence of what is real and what really counts in life. Thought, discretion, and the ability to put first that which is best for the patient embodies a truly caring dentist.
Experiencing pain? have questions about your old fillings?
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