The Facts About Fillings

DENTAL BOARD OF CALIFORNIA 

                                 2005 Evergreen Street, Suite 1550, Sacramento, CA 95815                                                                                                            www.dbc.ca.gov


Dental Materials Fact Sheet

What About the Safety of Filling Materials?

Patient health and the safety of dental treatments are the primary goals of California’s dental professionals and the Dental Board of California. The purpose of this fact sheet is to provide you with information concerning the risks and benefits of all the dental materials used in the restoration (filling) of teeth.

The Dental Board of California is required by law* to make this dental materials fact sheet available to every licensed dentist in the state of California. Your dentist, in turn, must provide this fact sheet to every new patient and all patients of record only once before beginning any dental filling procedure.

As the patient or parent/guardian, you are strongly encouraged to discuss with your dentist the facts presented concerning the filling materials being considered for your particular treatment.

* Business and Professions Code 1648.10-1648.20

Allergic Reactions to Dental Materials

Components in dental fillings may have side effects or cause allergic reactions, just like other materials we may come in contact with in our daily lives. The risks of such reactions are very low for all types of filling materials. Such reactions can be caused by specific components of the filling materials such as mercury, nickel, chromium, and/or beryllium alloys. Usually, an allergy will reveal itself as a skin rash and is easily reversed when the individual is not in contact with the material.

There are no documented cases of allergic reactions to composite resin, glass ionomer, resin ionomer, or porcelain. However, there have been rare allergic responses reported with dental amalgam, porcelain fused to metal, gold alloys, and nickel or cobalt-chrome alloys.

If you suffer from allergies, discuss these potential problems with your dentist before a filling material is chosen.


Toxicity of Dental Materials

Dental Amalgam

Mercury in its elemental form is on the State of California’s Proposition 65 list of chemicals known to the state to cause reproductive toxicity. Mercury may harm the developing brain of a child or fetus.

Dental amalgam is created by mixing elemental mercury (43­ 54%) and an alloy powder (46-57%) composed mainly of silver, tin, and copper. This has caused discussion about the risks of mercury in dental amalgam. Such mercury is emitted in minute amounts as vapor. Some concerns have been raised regarding possible toxicity. Scientific research continues on the safety of dental amalgam. According to the Centers for Disease Control and Prevention, there is scant evidence that the health of the vast majority of people with amalgam is compromised.

The Food and Drug Administration (FDA) and other public health organizations have investigated the safety of amalgam used in dental fillings. The conclusion: no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergy. The World Health Organization reached a similar conclusion stating, “Amalgam restorations are safe and cost effective.”

A diversity of opinions exists regarding the safety of dental amalgams. Questions have been raised about its safety in pregnant women, children, and diabetics. However, scientific evidence and research literature in peer-reviewed scientific journals suggest that otherwise healthy women, children, and diabetics are not at an increased risk from dental amalgams in their mouths. The FDA places no restrictions on the use of dental amalgam.


Composite Resin 

Some Composite Resins include Crystalline Silica, which is on the State of California’s Proposition 65 list of chemicals known to the state to cause cancer.

It is always a good idea to discuss any dental treatment thoroughly with your dentist.

DENTAL AMALGAM FILLINGS

 Advantages
Durable; long lasting
Wears well; holds up well to the forces of       biting
Relatively inexpensive
Generally completed in one visit
Self-sealing; minimal-to-no shrinkage             and resists leakage
Resistance to further decay is high, but           can be difficult to find in early stages
Frequency of repair and replacement is         low

Disadvantages
• Refer to “What About the Safety of Filling       Materials”
• Gray colored, not tooth colored
• May darken as it corrodes; may stain
   teeth over time
• Requires removal of some healthy tooth
• In larger amalgam fillings, the remaining       tooth may weaken and fracture
• Because metal can conduct hot and cold       temperatures, there may be a temporary     sensitivity to hot and cold.
• Contact with other metals may cause             occasional, minute electrical flow
The durability of any dental restoration is influenced not only by the
material it is made from but also by the dentist’s technique
when placing the restoration. Other factors include the supporting
materials used in the procedure and the patient’s cooperation during
the procedure. The length of time a restoration will last is dependent
upon your dental hygiene, home care, and diet and chewing habits. 

COMPOSITE RESIN FILLINGS

Composite fillings are a mixture of powdered glass and plastic resin, sometimes referred to as white, plastic, or tooth-colored fillings. It is used for fillings, inlays, veneers, partial and complete crowns, or to repair portions of broken teeth. 

Advantages
Strong and durable
Tooth colored
Single visit for fillings
Resists breaking
Maximum amount of tooth preserved
Small risk of leakage if bonded only to            enamel
Does not corrode
Generally holds up well to the forces of          biting depending on product used
Resistance to further decay is moderate         and easy to find
Frequency of repair or replacement is             low to moderate
Disadvantages
Refer to “What About the Safety of Filling Materials”
Moderate occurrence of tooth sensitivity; sensitive to dentist’s method of application
Costs more than dental amalgam
Material shrinks when hardened and could lead to further decay and/or temperature sensitivity
Requires more than one visit for inlays, veneers, and crowns
May wear faster than dental enamel
May leak over time when bonded beneath the layer of enamel

GLASS IONOMER CEMENT

Glass ionomer cement is a self-hardening mixture of glass and organic acid. It is tooth-colored and varies in translucency. Glass ionomer is usually used for small fillings, cementing metal and porcelain/metal crowns, liners, and temporary restorations.

Advantages
 Reasonably good esthetics
May provide some help against decay             because it releases fluoride
Minimal amount of tooth needs to be             removed and it bonds well to both the           enamel and the dentin beneath the                 enamel
Material has low incidence of producing        tooth sensitivity
Usually completed in one dental visit

Disadvantages
Cost is very similar to composite resin             (which costs more than amalgam)
Limited use because it is not                             recommended for biting surfaces in               permanent teeth
As it ages, this material may become               rough and could increase the                           accumulation of plaque and chance of           periodontal disease
Does not wear well; tends to crack over         time and can be dislodged


RESIN-IONOMER CEMENT

Resin ionomer cement is a mixture of glass and resin polymer and organic acid that hardens with exposure to a blue light used in the dental office. It is tooth colored but more translucent than glass ionomer cement. It is most often used for small fillings, cementing metal and porcelain metal crowns and liners.

 Advantages
Very good esthetics
May provide some help against decay            because it releases fluoride
Minimal amount of tooth needs to be            removed and it bonds well to both the          enamel and the dentin beneath the                enamel
Good for non-biting surfaces
May be used for short-term primary               teeth restorations
May hold up better than glass ionomer          but not as well as composite
Good resistance to leakage
Material has low incidence of producing         tooth sensitivity
Usually completed in one dental visit
 Disadvantages
Cost is very similar to composite resin             (which costs more than amalgam)
Limited use because it is not                            recommended to restore the biting                surfaces of adults
Wears faster than composite and                     amalgam


PORCELAIN (CERAMIC)

Porcelain is a glass-like material formed into fillings or crowns using models of the prepared teeth. The material is tooth-colored and is used in inlays, veneers, crowns and fixed bridges.

Advantages
❤ Very little tooth needs to be removed for       use as a veneer; more tooth needs to be       removed for a crown because its                     strength is related to its bulk (size)
Good resistance to further decay if the           restoration fits well
Is resistant to surface wear but can                 cause some wear on opposing teeth
Resists leakage because it can be shaped       for a very accurate fit
The material does not cause tooth                   sensitivity
  Disadvantages
Material is brittle and can break under           biting forces
May not be recommended for molar teeth Higher cost because it requires at least           two office visits and laboratory services


NICKEL OR COBALT CHROME ALLOYS

Nickel or cobalt-chrome alloys are mixtures of nickel and chromium. They are a dark silver metal color and are used for crowns and fixed bridges and most partial denture frameworks.

Advantages
 Good resistance to further decay if the          restoration fits well
Excellent durability; does not fracture            under stress
Does not corrode in the mouth
Minimal amount of tooth needs to be             removed
Resists leakage because it can be shaped      for a very accurate fit
 Disadvantages
Is not tooth colored; alloy is a dark silver        metal color
• Conducts heat and cold; may irritate              sensitive teeth
• Can be abrasive to opposing teeth
• High cost; requires at least two office             visits and laboratory services
• Slightly higher wear to opposing teeth


PORCELAIN FUSED TO METAL

This type of porcelain is a glasslike material that is “enameled” on top of metal shells. It is tooth-colored and is used for crowns and fixed bridges.

Advantages
 Good resistance to further decay if the           restoration fits well
Very durable, due to metal substructure
The material does not cause tooth                   sensitivity
Resists leakage because it can be shaped       for a very accurate fit
Disadvantages
More tooth must be removed (than for          porcelain) for the metal substructure
• Higher cost because it requires at least           two office visits and laboratory services


GOLD ALLOY

Gold alloy is a gold-colored mixture of gold, copper, and other metals and is used mainly for crowns and fixed bridges and some partial denture frameworks.

 Advantages
 Good resistance to further decay if the           restoration fits well
Excellent durability; does not fracture             under stress
Does not corrode in the mouth
Minimal amount of tooth needs to be             removed
Wears well; does not cause excessive             wear to opposing teeth
Resists leakage because it can be shaped       for a very accurate fit
 Disadvantages
Is not tooth colored; alloy is yellow
• Conducts heat and cold; may irritate               sensitive teeth
• High cost; requires at least two office visits
   and laboratory services

                                                                DENTAL BOARD OF CALIFORNIA                                                                                                           1432 Howe Avenue • Sacramento, California 95825                                                                         www.dbc.ca.gov

                                                                                                               Published by                                                                                                                                                              CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS                                                              5/04

          The Facts About Fillings