Tooth fillings: White is the new silver

Before and after composite

Written by Dr Amrita Jain

August 9, 2021

 In earlier centuries the concept of a dental chair and dental drill was very new. Various substances, mostly metals like gold, platinum, silver, and lead were used for tooth fillings back around in the 1800s. Tin then became a popular metal, for tooth fillings in the 1820s. However, today there are so many materials with much-advanced properties and benefits over metal ones.

How did silver fillings become so popular?

In the 1830s, Parisian physician Louis Nicolas Regnart found that tooth filling materials can be made by adding mercury to base metals like silver. Silver fillings consist of an alloy of silver, copper, tin, and zinc combined with mercury.  After conducting a few experiments and practically trying it in the patient’s mouth, he realized that people were not showing any signs of sickness post-filling treatments. The low cost of the material also contributed to its popularity.

Amalgam has been used in dentistry for over 150 years and is still being used due to its low cost. People still approach dentists to get a silver filling done. Amalgam fillings (silver fillings) are generally used to fill large tooth cavities on back teeth because it is considered the strongest material for fillings. Metal fillings being strong, silver fillings were used in areas that can bear more chewing forces. Though silver fillings are more strong, what people don’t know is that silver fillings do have some drawbacks and they should not let the cost of the treatment take over their health.

silver amalgam

Why are silver fillings banned in some countries?

Due to the mercury content in the mixture silver fillings are now banned in various countries. The materials used to make silver fillings have detrimental health effects, environmental pollution, and also hamper aesthetics. Silver fillings also have some health-related concerns that include more cutting healthy tooth structure in order to fit in the metal fillings, silver staining of the teeth, black staining of the tissues in the mouth, leaching of mercury content in the saliva, and mercury toxicity in the body.

Drawbacks of silver fillings

Aesthetics

The color of silver fillings does not match the color of the tooth and this is one of the major drawbacks of silver fillings. People can easily make out if you have tooth filling and is not aesthetic at all. Hence, dentists, as well as patients, prefer tooth color fillings over silver fillings these days.

Mercury toxicity

Apart from looks one of the major concerns related to silver fillings is mercury toxicity. Dental procedures like placing the silver fillings in the tooth as well as removing the filling from the tooth expose patients to various toxicity levels of mercury. Even after the dental procedure is complete, the mercury content still leaches out from the fillings in the saliva causing mercury toxicity at a slower rate. The mercury exposure depends on the number and size of fillings, composition,  grinding of teeth, brushing of teeth, and many other physiological factors. Mercury toxicity in any form, for example, even as a vapor, can cause breathing difficulties (asthma) and various other alarming health concerns.

Allergic reactions

Amalgam is capable of producing allergic reactions in some patients. These reactions can include any oral symptoms like ulcers, blisters, irritations, wrinkling of the tissues in the mouth, etc. Constant exposure to mercury in silver fillings may also increase the risk of pre-cancerous lesions in the mouth. These lesions are rarely noticed and cause no discomfort. Hence, one needs to be careful as at times there may not be any signs and symptoms.  

Mercury exposure in dental professionals

Even dental professionals are at a high risk of mercury toxicity as they handle the materials all by themselves. Right from mixing the materials filling it in the patient’s mouth, dentists are likely to develop mercury toxicity. Hence, dentists do not prefer the use of silver fillings either.

Tooth color fillings over silver fillings

Newer tooth filling materials have developed and gained attention due to their benefits over silver fillings. Tooth color fillings are more aesthetic and can also bear the forces of chewing without any damage. There are 3 types of tooth color fillings to choose from. Usually, the dentist is the one to choose the type of filling best suited for your case. But if given a choice they differ in their durability and price.

Glass and Resin Ionomers fillings

The glass ionomer filling material as the name suggests, is made up of acrylic and glass powder. It requires less drilling of the tooth to use these cements in comparison to silver fillings. One good thing about the glass ionomer cement material is that it leaches a small amount of fluoride that helps prevent tooth decay. But these materials, however, are weaker in comparison to silver and composite fillings which means they have a low resistance to fracture. Both glass as well as resin ionomer types of cement are tooth-colored, but lack the translucency of enamel. This means they do not exactly look like the teeth and are not much aesthetic. They wear off quickly when placed on chewing surfaces. Hence, both these types of cement are only used to fill the areas of the tooth, which do not bear more chewing forces. They are used to fill tooth cavities between two teeth and cavities on the roots of the teeth etc.

Porcelain filling materials

Porcelain materials are used to make inlays and Onlays. Inlays and Onlays are tooth fillings that are made outside the mouth in the labs and directly fitted on the tooth with a bonding material. This material is very strong and durable. These fillings are made by skilled dental technicians with a lot of precision to make it fit accurately in the tooth. (edited) . The process of fabricating a filling in the lab may take about 2-3 days, meanwhile, a temporary filling is placed. The entire process takes between one to two weeks but is a long-lasting option. 

composite filling

Resin Composite fillings 

Composite resin materials are made from a resin-based substance and an inorganic filler. This makes the material resistant to wearing off. This material is also translucent which means it exactly looks like the tooth, giving it a natural look. This is why patients, as well as dentists, prefer this material for tooth fillings over any other filling materials. Composite fillings stick to the tooth chemically which gives them enough strength to withstand the chewing forces. Unlike silver fillings, these do not require extra drilling to fit in the cement. Composite fillings can be used to repair cavities chipped teeth, broken or fractured teeth, and worn off teeth. 

Should I Replace My Metal Fillings with White Fillings? 

Although silver fillings are very strong and are still preferred in certain cases, white fillings are more natural-looking and favorable to some for aesthetic reasons. 

If your metal fillings are painful, cracked, fractured, or re-infected by decay, or extremely hurtful, it is important to replace them to protect the long-term health of your tooth.  Consult your dentist to replace your silver fillings with composite fillings as white is now the new silver

Highlights

  • Silver amalgam fillings offer less benefits in comparison to tooth color filling materials.
  • Tooth color fillings like composite filling materials have taken over silver fillings as they have more benefits.
  • Silver fillings face a ban in many countries due to the risk of mercury toxicity and risk of pre-cancerous lesions.
  • Consider replacing your metal fillings if they are causing you any trouble.

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Dr. Amrita Jain is a practicing dental surgeon since 4 years. She completed her B.D.S in 2016 and was has been a rank holder throughout her course. She suggests “Holistic dentistry is the best dentistry”. Her treatment line follows a conservative pattern which means saving a tooth is of utmost priority and preventing your teeth from getting decayed rather than curing it with a root canal treatment. She inculcates the same while consulting her patients. Apart from her interest in clinical practice, she has developed interest in research and writing over a period of time. She states “It is my clinical experience that motivates me to write and spread dental awareness”. Her articles are well researched with a combination of technical knowledge and clinical experience.
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