The Right Smile Center: composite filling.

Wednesday, May 14, 2014

The Mercury Filling Controversy - Dentist Sandy Springs

Whenever I hear a patient ask about amalgam restorations (mercury fillings), I wonder why this question refuses to go away. For decades, amalgams have been considered the primary restorative material for posterior teeth (the ones in the back) because of their long time success. After enormous amounts of study, the World Health Organization, the FDI World Dental Federation, and the American Dental Association continue to endorse the use of amalgam to restore teeth. Yet it continues to be demonized by the public, in particular in urban legends over the internet.

As a result the trend is towards the diminished use of amalgams and the increased use of composite resins to restore posterior teeth. One of our consultants, Tom Limoli of Limoli and Associates notes that US third-party payment data reflects that 65% of direct posterior restorations last year were resin-based composite, while 35% were amalgam. So regardless of the empirical evidence that refutes these concerns, the patient pool is demanding composite restorations.

Every dentist will need an alternative material to use in the restoration of posterior teeth as this trend continues because composite resins only have a life expectancy of 5 to 8 years. Given the patient’s desire to be rid of the potential or theoretical health hazards that have been formulated in recent years, amalgam restorations will ultimately be eliminated by the slow and natural death of attrition. While amalgam has been the material of choice for decades and still remains the primary source of teaching in dental schools today, it may not be in the future. Given the patient demand for composite restorations and what appears to be the dentist’s propensity to capitulate, we are going to need a better solution to posterior restorations if we want to achieve the same longevity that is achieved through amalgam restorations.

The internet has continued to create an uncertainty on the part of the lay public about amalgams similar to the controversy that surrounds cell phones and brain tumors. It is interesting to note the dilemma faced by dentists today, when we know that amalgam is the better choice for the restoration, but the popular demand or path of least resistance is a composite restoration. This disconnect creates some interesting food for thought.[1]

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

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[1] Additional sources of information came from Gordon J. Christensen, DDS, James F. Simon, DDS, and Howard E. Strassler, DMD. Compendium of Continuing Education in Dentistry, July/August, 2011.

Tuesday, July 31, 2012

Dentist Marietta: How much do dental fillings cost?

The cost of a filling can vary greatly, depending on who you go to, the type of filling and degree of restoration required. An amalgam ("silver/mercury filling") is cheaper than a composite (white/resin filling), but will last significantly longer if you are unconcerned about aesthetics and the back and forth debate over whether or not amalgams may be linked to other health issues. The US Food and Drug Administration (FDA) and the American Dental Association (ADA) found there is no danger from an amalgam filling, but some specialists and consumers remain unconvinced by the findings.

One of the ways to find out the actual range of cost is to just call a local dentist from the internet and ask them. You are going to find some hesitancy to quote over the phone because each person presents a different set of restorative circumstances, but you should be able to get a range of costs or a free consultation.

While costs vary from one area to the next and from one office to the next, the cost of typical amalgam filling ranges from approximately $75 to $175 per filling, whereas a composite resin filling ranges from $125 to $300 for a single surface restoration. You should expect about 3 to five years (possibly 7 years) of use from the composite and as many as 20 years or longer from an amalgam restoration. Actually a well-cared-for amalgam filling can last a lifetime, so the expensiveness of the filling really becomes a minor consideration.

Restorative circumstances are going to vary from tooth to tooth and decay may be found in one small spot or throughout a tooth. The restorative fees are based on the number of surfaces needing filling in a single tooth. A silver amalgam filling on one or two surfaces averages $75 to $175, while for three or more surfaces it could go as high as $120 to $300 or more. The same type of logic follows with respect to composite restorations. Since composite resin fillings are more time consuming and require greater skills to completion they are more expensive than amalgam fillings and weigh in on the more expensive side of caries restorations.

Typically dental insurance covers most or all of the costs of a silver amalgam filling, but only 50 to 80 percent of the cost of a composite filling because the higher charge for the tooth-colored material is considered a cosmetic option. One exception is when an old amalgam filling is cracked or broken and is replaced with a composite filling.

Your dentist should be advising you of the type of filling based on the size of the cavity and the location of the tooth in your mouth. Amalgams are more likely to be placed in the back of your mouth while composites are more likely to be used on more-visible front teeth. WebMD.com gives an overview of typical filling procedures and Colgate.com lists pros and cons of different types of fillings.

Amalgam Advantages

Amalgam fillings are strong and can withstand the forces of chewing.
They are relatively inexpensive and last a long time, compared with alternatives.
An amalgam filling is completed in one dental visit.

Amalgam Disadvantages

Amalgam doesn't match the color of your teeth.
Healthy parts of your tooth often must be removed to make a space large enough to hold an amalgam filling.
Amalgam fillings can corrode or tarnish over time, causing discoloration where the filling meets the tooth.
A traditional amalgam filling does not bond (stick) to your tooth, so the cavity preparation developed by your dentist requires undercuts or ledges to provide retention of the filling. Your dentist may have to remove additional tooth structure to establish good retention for the filling.
Some people may be allergic to mercury or be concerned about its effects, although research shows the amount of mercury exposure from fillings is similar to what people get from other sources in the environment.

Composite Advantages

Your fillings will match the color of your teeth and therefore undetectable.
A filling should be completed in one dental visit.
Composite fillings can bond directly to the tooth, making the tooth stronger than it would be with an amalgam filling.
Less drilling is involved than with amalgam fillings because your dentist does not have to shape the space as much to hold the filling securely. The bonding process holds the composite resin in the tooth.
Indirect composite fillings are heat and light cured increasing their strength.
Composite resin can be used in combination with other materials, such as glass ionomer, to provide the benefits of both materials.

Composite Disadvantages

Although composite resins have become stronger and more resistant to wear, they generally don’t last as long as amalgam fillings under the pressure of chewing.
The composite may shrink when placed; this can lead to more cavities in the future in areas where the filling is not making good contact with your tooth.
This restoration takes more time and skill to place because they are usually placed in layers. The increased time and labor involved also contribute to the higher cost (compared with amalgam fillings).
Indirect fillings and inlays take at least two visits to complete. Your dentist takes impressions at the first visit and places the filling or inlay at the second visit.
In large restorations, composites may not last as long as amalgam fillings.

The trick is to find a qualified, well trained dentist, and that requires you to educate yourself about the dentist you choose and a basic knowledge about dentistry. If we can be of service or answer any questions or concerns please feel free to contact us, we’re just a stone’s throw from Cobb County.