One of the most common questions asked in our practice concerns our choice of the material that we use to repair cavities in teeth.
Amalgam: The old stuff (we don't use this)
Silver-mercury (amalgam) fillings were introduced to dentistry over 100 years ago. At the time, this mixture of silver and mercury was considered a miracle material (of course, at that time, so was indoor plumbing).
Is it safe?
Today, amalgam fillings are made of a mixture of silver/zinc/tin/copper alloy and mercury. And as of today the American Dental Association believes that amalgam is a safe and effective material for use in the human mouth. They are entitled to their opinion. Here is my personal opinion about amalgam:
It is possible that the mercury in amalgam is not harmful to us. However, mercury is a toxic substance and according to the EPA, must be disposed of in a Toxic Waste Disposal Site. In my opinion, anything that must be disposed of in a Toxic Waste Disposal Site should maybe not be placed in our mouths.
But this may simply be an over-cautious position on my part. I do not actually know what the long term outcome of on-going research will be. I do know that some European countries and a couple of states in the U.S. have regulated amalgam use, mostly because of environmental contamination reasons. Some European countries have banned the use of amalgam in pregnant women and young children.
I want to be clear on this. I have not used amalgam since April of 1982. And I'm not going to use it again. And the reason has nothing to do with its safety or non-safety. The jury may still be out on that.
So what do I like?
The reason I do not use amalgam is that, in my opinion, it is a poor restorative material compared to newer materials we have now. Like everything else, improvements have been constant over the last 100 years. It took science until the 70’s to develop an alternative to amalgam, and into the 2000s to improve it to its current excellent level.
The material I favor and use as my first choice is bonded composite resin. This material is extremely biocompatible and flexes and wears like natural teeth. A silver-mercury restoration has no bond to tooth structure. Expansion and contraction of amalgam over the years causes cracks in teeth and eventually, many teeth will fracture. You may have had this happen to you, even when you were eating something soft. Amalgam tends to leak after five or ten years, causing recurrent decay. Amalgam corrodes and turns black.
M.I.D.
Another reason I like to use bonded resin is because I am a strong proponent of what dentists call Minimally Invasive Dentistry. Those of us who have this philosophy believe that as much natural tooth structure as possible should be preserved when restoring teeth to good form and function. You would think that every dentist would believe this, but they don't. It is easier to drill away teeth and make crowns than to artfully sculpt and bond modern resins onto the natural tooth. It takes time, skill and care. But it's better for the tooth and that's what matters to me. Crowns are very appropriate in many situations, but not as often as many dentists use them. I prefer to preserve if possible. The easy way is not always the best way.
M.I.D.
Another reason I like to use bonded resin is because I am a strong proponent of what dentists call Minimally Invasive Dentistry. Those of us who have this philosophy believe that as much natural tooth structure as possible should be preserved when restoring teeth to good form and function. You would think that every dentist would believe this, but they don't. It is easier to drill away teeth and make crowns than to artfully sculpt and bond modern resins onto the natural tooth. It takes time, skill and care. But it's better for the tooth and that's what matters to me. Crowns are very appropriate in many situations, but not as often as many dentists use them. I prefer to preserve if possible. The easy way is not always the best way.
I also restore teeth with various types of wonderful ceramic materials (usually called porcelain) and the always terrific old standby, gold. You can use these in minimally invasive ways also.
When aging amalgam restorations are replaced by bonded composite resin or ceramic restorations, the strength of the tooth is improved and underlying tooth structure is sealed.
Plus, of course, composite resin and ceramic restorations are tooth colored and are so much more attractive and natural looking than metal fillings.
Let's talk about cost
Now let me talk with you about the economics of composite resin. Composite resin and ceramic restorations are more technique sensitive and are more time consuming to place. Special care must be exercised to operate in a controlled environment that can be moist when desired and dry when desired. These bonded restorations are more sensitive to moisture control procedures than amalgam. When placing these fillings, we use bonding agents to seal the dentin against bacterial infiltration and protect the dental pulp from irritation. As a result of this necessary expertise and the increased time associated with composite and ceramic placement, the cost of restoring teeth is a little higher than with amalgam.
Cost is not the same as value
Teeth matter. They deserve the best chance for lifetime function, comfort and good appearance. Replacing teeth is much more costly than preserving them. We opt for the best value for our patients.
You have insurance? That's good! But...
Insurance companies are slow to embrace newer techniques, especially when it could cost them money to provide state-of-the-art care to their insured. Many insurance companies will only cover the cheapest material to restore teeth. Yup, that’s amalgam, and many will pay their amalgam benefit even when composite resin or ceramic materials are used. Yes, they are allowed to do that. That should irritate you, in my opinion.
My patients have mostly learned about the ways insurance carriers pay benefits. For example, they have learned not to be fooled by the “usual and customary fee” jive. They know that this is bogus and is intended to drive a wedge between patient and doctor. If you are concerned about anything you read in an Explanation of Benefits you receive, just call us. We’ll explain it with straight, honest talk. You don't have to be my patient to get advice; we'll be glad to help anyone.
The bottom line
Composite resin, porcelain and gold are wonderful, modern, state-of-the-art beautiful materials we use to help you have the strong, functional teeth and great smile you have always wanted.
