As I believe an educated consumer makes the best choices, I want to review the current choices available in filling materials for you.  Many people either have dental insurance and go to a participating dentist who takes their plan without any thought as to what he is using or pay directly and will choose based solely on the fee charged, also while giving little thought to what material is used.  I have written previously about the use of gold in dentistry and discussed why I am a fan.  We still have no better material but if you are having a back tooth restored or not very concerned with esthetics I would urge you to look at gold first.

Gold crown and onlay with many years service.

Because they are inexpensive and esthetic, bonded white filling, also called composites are where most of the action is at today.  This is a paste-like material that contains glass filler particles in a resin matrix and can be bonded directly to tooth structure.  There are many different brands and the viscosities range from watery to firm.  It also comes in many shades so that getting an exact match is never a problem. They generally not as hard as tooth enamel so they may wear but will not wear opposing teeth. Some formularies contain fluoride others do not.  If this is an issue, speak to your dentist or contact the manufacturer. Most contain BPA.  This at first seems to be a bad thing but after speaking to a number of manufactures they say that it does not leech out of the filling and that if properly placed, such as, utilizing a rubber dam, they do not enter the body.  This is an issue I am keeping a careful watch on and represents an area where the material manufacturers are responding to public pressure.

A well contoured composite filling.

Closely allied with the composites are the ceramics, including porcelain.  These are used in crowns, veneers and to a lesser extent as direct fillings.  Like the composites they can be bonded directly to tooth and come in a variety of shades to match the existing dentition.  On the downside they are a bit more costly than the composites and if not placed properly can wear opposing teeth.  A newer type of ceramic based on zirconium is currently taking the dental community by storm.  Zirconium based crowns are inexpensive compared to gold, tough, resistant to chipping, and are now being used as a gold replacement.  There have been some issues with esthetics as well as bonding which delayed their introduction.  This has been addressed by the introduction of new primers and an expansion in the number of shades available. I have placed several zirconium-based crowns and am generally happy with the results.  On the downside, be cautioned that this is a relatively new technology and long-term studies are in progress but not yet complete.

Well contoured porcelain crown on lab die ready to be cemented. 

Finally I want to end by reminding you that many dentists are still using old-style silver fillings.  These are the kind of restorations that contain 40-50% mercury by weight. But that is far from their only problem. They also contain silver, tin, copper, and zinc.  This material has lingered in the dentists’ toolbox too long, mostly because it is inexpensive and easy to place. They cannot be bonded, so the fillings have to be larger and “undercut” to lock them in place. They also experience thermal expansion greater than tooth structure they tend to crack teeth over time.  While I have seen many articles on the toxicity of mercury, much like BPA it is locked into the filling matrix.  Unlike BPA it can be released by chewing.  While no study has demonstrated diseases in humans because of it, I do not consider placing this in your body a smart thing to do.  If your dentist uses this material, I would urge you to find a new dentist.

This is an old style silver (mercury containing) filling.  It has no place in modern dentistry.

Always remember that you have autonomy over your body and no one can put something into it without your permission.  Always ask questions. Much like good food, quality dentistry may cost more in short run but by requiring less replacement and superior compatibility with the human body, will pay dividends in the long run.