My local dentist says I need fillings; what is the difference between metal versus white fillings? Can cosmetic dentistry replace all my fillings?

What are 'metal' (amalgam) fillings and 'white' (composite) fillings?

Amalgam dental fillings – commonly called "metal" fillings or "silver" fillings are made of a mixture of metals, typically silver, copper, tin, mercury, and other metals. Thus, they are called "amalgam" to reference the mixed nature of the filling materials. Amalgam fillings have been used for over 150 years and are known for their strength and durability, and your local dentist will be well-trained in the procedures. They are also relatively inexpensive compared to other filling materials. However, some patients are concerned about the dark color of the filling as it can be visible depending on the area of the mouth and each individual's smile.

Composite dental fillings – commonly called "white" fillings – are made of a mixture of quartz or glass material inside a resin. They are a newer method of dental fillings, but your local dentist will also be well-trained in all modern composite filling techniques. They are offered in multiple colors and 'shades' to match the color of your natural teeth. Composite fillings bond directly to the tooth, which can help support the remaining tooth structure and help minimize the amount of 'natural' tooth removed from the dental restoration process. Composite fillings are less noticeable than amalgam fillings, which makes them preferred for almost all restorations in the mouth – but particularly for cosmetic dentistry on front teeth, as they are most visible. However, composite fillings tend to be more expensive than amalgam fillings as the materials are more advanced and require additional skills, experience, and steps to complete.

Are composite fillings better than amalgam?

As with adequate consideration of any topic, the answer is "It depends." Generally speaking, nowadays, all patients prefer composite fillings due to their "invisible" nature when matching the same shade of the natural tooth. Additionally, some patients worry about the mercury content in an amalgam filling (although it is considered very safe, see Do Fillings Cause Mercury Poisoning?), and composite fillings avoid their concern.

Dental fillings are restorations for an otherwise healthy tooth. Thus they are subject to the same strong bite forces we put on our natural teeth. Because of this, all fillings will suffer some wear. Typically, amalgam fillings will be stronger than composite fillings and, in fact, stronger than your natural teeth. Because of this, in some cases, it can serve as a better restoration than composite fillings. And equally, in other cases, it can be more harmful because it is stronger than your teeth – it can increase the probability of a crack forming. Moreover, amalgam fillings don't have as complex bonding and physical access requirements during the procedure – this means that amalgam fillings can be a better solution for specific cavities in the back of the mouth or for patients with unique conditions, but the local dentist will be able to provide a specific professional opinion for you.

Benefits of composite fillings

In contrast, the benefits of composite fillings for the patient are easier to consider. Because of the bonding characteristics of modern composite materials, the dentist can minimize the amount of enamel removal and preparation of the natural tooth – thus preserving more of your natural tooth. Additionally, this bonding property has been shown to better protect against further cracks in the natural tooth. The primary drawback of composite fillings is that the preparation takes much longer for the dental team, and a skilled dentist must follow specific operations to ensure proper restoration. In addition to the additional materials cost, this leads to a more expensive cost compared to amalgam fillings.

Specific to The Ivory Dental, we default to composite fillings on your dental treatment plan unless: 1) Dr. Yu has determined, based on a specific situation, that an amalgam filling is the best clinical choice for the patient's long-term care, or 2) the patient specifically requests amalgam fillings (typically to reduce cost).

Should I replace my metal fillings with white?

It can be tempting to consider changing your older metal fillings with white with cosmetic dentistry – especially if your dental insurance covers a portion of the cost. This is a popular question and can be an elective procedure for the patient. However, our dentist typically only recommends replacing amalgam fillings if the older restoration is either failing / loose due to wear or if a cavity has started to form, which would require a replacement anyways. The reasoning is that replacing an otherwise issue-free metal filling would require shaving and preparing at least some (even minimal) natural tooth structure and further disturb the tooth. Particularly for 'deep' fillings, the risk may not be worth the replacement.

Ultimately, we strive for every patient to be able to make their own well-informed decisions. So if you have any questions about your own specific amalgam fillings and potentially replacing them – as your local dentist, we are always happy to discuss and explain your unique considerations and potential risks.

What are the advantages/disadvantages of white and metal fillings?

In short, both 'white' composite fillings and 'metal' or 'silver' amalgam fillings are excellent dental restorations that help protect from / help minimize further tooth decay and cavities. When it comes to a decision between the two, our staff will always be able to provide a recommendation specific to your situation. However, the general pros and cons are:

White composite fillings:

• Pros:

• They are more cosmetic/aesthetic as they blend in with the color of your teeth and are the most popular choice for obvious areas. They can also help in cosmetic dentistry for darkened spots from cavities, calcification, or staining. Patients often whiten their teeth before having fillings placed on their front teeth to match their desired shade.

• Strong bonding properties to help seal and discourage cracks from forming on the tooth

• Minimal removal of tooth structure, so less of the tooth is disturbed, and more can be preserved.

• Cons:

• More costly and time-consuming than metal fillings

• Although composite fillings have improved significantly, they may still not last as long as amalgam fillings.

Amalgam fillings

• Pros

• More robust and durable and can last longer than composite fillings

• It can be placed quickly and reliably, which enables successful restoration in more situations.

• Less costly than composite fillings and are often covered with less out-of-pocket cost when using dental insurance

• Cons:

• They can be more visible and noticeable as they are silver in color depending on the location (when smiling or opening the mouth)

• Metal fillings require the removal of more tooth structures to prepare for and secure the filling, which can weaken the tooth.

If you need any help deciding if you need dental fillings or need a professional opinion from a local dentist in Winter Park for what is best in your specific situation – please book an appointment with us or give us a call!