[Dental Fillings Part II] WHITE OR METAL Fillings? How to make the RIGHT choice?

Your tooth needs fillings because they are broken or cavitated. Holes formed in the tooth, our body cannot repair it. Dental filling is hard, tooth like material used to be replaced the tooth structure after you have the bacteria in the cavity professionally removed.

Previously, we have discussed about the two commonly used dental fillings materials, Amalgam and Composite. But how to choose? There are difference in your choice...

"MORE: [Dental fillings Part 1] introduction to dental fillings, Are you scare of dental fillings?"

 

 Silver black amalgam filling.

Silver black amalgam filling.

Q: WHITE OR SILVER FILLINGS, WHICH ONE TO CHOOSE, ?

A: There are few factors you have to consider before you decide which type of fillings to choose, Amalgam (silver/ metal) or Composite (white/ tooth color)

1 – Amalgam fillings are stronger than composite fillings. 

Amalgam usually used on the back teeth. This is because that is where the majority of the forces are when you bite down. Since amalgam is made of various metals, it is a very strong material. Composite resin fillings wear down faster than amalgam fillings and need to be replaced more often. However, the strength of composite resin is improving with newer technologies. 

2 – Composite fillings are more expensive than amalgam fillings.

 At Malaysia private clinic, dentist will charge RM80-100 a amalgam filling in a back tooth and RM90-150 for a large composite filling in a back tooth. If you’re on a tight budget, amalgam may be your best choice.

 

3 – Amalgam fillings last longer than composite fillings. 


I’m sure that with future technological advancements, composite fillings will probably last as long as amalgam fillings. But for right now, if you want your filling to last a long time, you should choose amalgam.

 Look! This is an example of  fillings that's probably been placed for 20+ years!

Look! This is an example of  fillings that's probably been placed for 20+ years!

 

4 – Composite fillings are less noticeable/ looks more natural than silver amalgam fillings.

Silver metal filling may stain your teeth over time, and causing you to have silver smile. If you don’t like seeing silver in your mouth at all, then a composite filling is probably the way to go.

Amalgam Silver staining on the teeth, which can be very unsightly when you smile 

         Amalgam Silver staining on the teeth, which can be very unsightly when you smile
 
Amalgam Silver staining on the teeth, which can be very unsightly when you smile
  The old,   worn and stained   composite

The old, worn and stained composite

 

5 – Amalgam fillings contain mercury. 
 

  Mercury is used to incorporate the metals   in the   amalgam. According to America Dental Association, i  t is safe to used as the release of mercury from the   fillings is extremely in small amounts.

Mercury is used to incorporate the metals in the amalgam. According to America Dental Association, it is safe to used as the release of mercury from the fillings is extremely in small amounts.

The mercury in the amalgam fillings gets incorporated into the filling, thus the release of mercury is extremely in small amounts. The amount of mercury released is less than the amount of mercury you’d get from eating fish, but this does pose a problem for people with a mercury allergy.

Amalgam has been used for over 180 years without any major problems. The only absolute contraindication for an amalgam filling would be a mercury allergy. But if you are having amalgam fillings in your mouth, We don't recommend you to remove it. Because this will release the mercury inside the fillings, and thus more toxic than you keep it in the fillings. If you are concern about the mercury toxicity, Composite will be your filling material of choice.
.

6 – Composite fillings may leak out Bisphenol-A.


Bisphenol-A is a chemical that can be toxic in large enough doses. Based on the current evidence, Composite is still a safe material to use as research have shown that the amount of bisphenol-A released from a filling is unlikely to cause any harm. 

          The other products that contain Bis-phenol A

         The other products that contain Bis-phenol A

 

7 – Amalgam fillings require the dentist to remove healthy tooth structure.
 

 Amalgam fillings involving more tooth structure removed to keep the filling in place. Composite fillings bond to structure, without the extra tooth structure

Amalgam fillings involving more tooth structure removed to keep the filling in place. Composite fillings bond to structure, without the extra tooth structure

Amalgam fillings don’t bond to the tooth like composite fillings, the dentist has to make the filling wider at the bottom than it is at the top so that the tooth will hold the filling in place. In order to do this, the dentist usually has to cut away healthy tooth structure. With composite fillings, the dentist can simply remove the decay and then place the filling without cutting away healthy tooth structure to retain the filling.

 

8 – Composite fillings shrink when they harden. 

 Composite fillings Shrink when they harden, causing leakage ( gap between filling and tooth), will lead to new cavity Post-operative sensitive

Composite fillings Shrink when they harden, causing leakage ( gap between filling and tooth), will lead to new cavity Post-operative sensitive

Most composite fillings get somewhere between 2-5% smaller when they harden. Sometimes this can lead to gaps between the filling and the tooth which allow bacteria to enter and start a new cavity. Other times, when a large composite filling shrinks as it hardens, it can put stress on the tooth which results in increased post-operative sensitivity of the affected tooth. The effect of the shrinkage can be minimized if the dentist adds the composite in small, incremental layers. Now, the new composite has reduced the shrinkage problems, and I believe in short future we can have a composite filling with no or very few shrinkage. 

9 – Composite fillings are more technique-sensitive. 

  More steps are need for placing a composite fillings than   amalgam. Dentist with good experience will produce a   good job, and it can last a longer time.

More steps are need for placing a composite fillings than amalgam. Dentist with good experience will produce a good job, and it can last a longer time.

This means that the dentist has to pay close attention to detail when placing a composite filling. There are more steps that your dentist must follow precisely when filling your tooth with a white filling. If it is not properly done, the filling may not attach to the tooth tightly and could end up leaking and ultimately needing to be replaced after only a year or two.  Most dentists have lots of experience doing white fillings and will do a good job.  As long as they are following the steps mentioned below for the composite filling procedure, the filling should last you a long time.

                                      Comparision between Composite and Amalgam

                                     Comparision between Composite and Amalgam

Hopefully the above tips will help you figure out which type of filling will work best for you. Even if you are still uncertain, at least now you know what issues or concerns to further discuss with your dentist.

For more questions, don't hesitate to ask us :)

This post was created by Dr Tee Kang Long , updated on 5 May 2016 by Koh Wen Thong