How do you know if you need a filling?
When you feel pain? Truth is, many decayed, cracked or worn-down teeth may not necessarily be painful. Some signs to look out for are:
- Sensitivity to hot or cold beverages
- Sensitivity to sweets
- Sensitivity to chewing
- Rough or sharp edge on a tooth
- Food catching between teeth
- Obvious or visible stains or dark spots
- Dental floss fraying or catching in certain spots
It is important that you see a dentist regularly for routine check-ups because most signs and symptoms in the early stages are intermittent and easily missed. When detected early, the treatment required is usually simple, cost effective and less invasive.
A filling can be used to repair cracked, broken, decayed and/or worn-down teeth. The aim is to restore function, so that you may eat comfortably, relieve pain and to rebuild to the original form of the tooth, which is important especially in the cosmetic area of your front teeth.
There are several types of materials used to restore teeth, including amalgam, composite resin (white filling), glass ionomer cement (glass), gold and ceramic.
Amalgam fillings have been used by dentists since the 1800’s and are made from a mixture of metals, consisting of an alloy of silver, tin and copper mix with liquid mercury.
Amalgam fillings are noted for their durability, high strength and affordability. It is especially useful in cases where fillings may need to be placed in areas of high moisture, where other available dental materials such as composite resin, may not adhere well to the tooth. However, it is not as commonly used nowadays due to their appearance and concern with mercury in the material. There is no available evidence at this stage to show the use of dental amalgam leading to adverse health effects but it is important to discuss with your dentist if you are sensitive or allergic to mercury, or other metals in the amalgam including silver, copper or tin.
It is not recommended to have your existing amalgam fillings removed or replaced if the fillings are in satisfactory condition. Removal of a sound filling may result in unnecessary loss of healthy tooth structure and exposes the tooth to possible risk of further damage to the pulp (nerve). Intact amalgam fillings should not be removed for the purpose of preventing any disease or medical condition, unless considered medically necessary by your health care professional.
Composite resin fillings are fast replacing amalgam fillings due to its more cosmetically pleasing appearance. Although the scientific data strongly supports that amalgam fillings are safe, new generation of composite resins that are stronger, more durable and cosmetically pleasing are gaining popularity.
What is composite resin? Dental composite resin is a dental material used for fillings made from silica (glass) or quartz filler added to a resin medium (Bis-GMA).
What are the advantages? There are many advantages to using dental composite resin with the “tooth-like” appearance being the main reason it is the material of choice for the anterior (front) teeth region. New generations of composite resins are available in a wide range of tooth colours, strength, finish and polish allowing the filling to be closely matched to the natural tooth and thus providing highly cosmetic filling. This allow composite resin or “white-filling” to be used not only to fill a cavity, but to also repair chipped teeth, to fill gaps between teeth (diastema) and to shape crooked or worn teeth.
Unlike the traditional amalgam filling, composite resin is designed to bond to the tooth through micro-mechanical tags within the different depths of the tooth. The stronger the bond the better the longevity of the filling. Due to the bonding nature of the filling, the preparation of the cavity within the tooth where the filling will be placed, will only need to be cleaned sufficiently but minimally. Preserving healthy tooth structure is possible when the filling naturally retains within the cavity, without the need for slots or grooves.
What are the disadvantages? The most common complication is shrinkage and this may increase the risk of decay reoccurring around the filling, or staining on the filling affecting its appearance. There is also concern in the past regarding its durability, as compared to amalgam fillings especially in extensive fillings. However, with continual development of composite resin over the years, the newer composite resins are greatly improved in durability and shrinkage. The technique of successfully placing composite resin material however still requires skill, training and time, which is why the general cost of a composite resin filling is greater than amalgam fillings.
Glass Ionomer Cement
This is another “tooth-coloured filling” made of a mixture of silicate glass powder and an acid. This filling bonds well to the tooth and also releases fluoride contained within the filling, which helps to prevent decay. It is commonly the filling of choice for the sealant of permanent molars, fillings for deciduous “baby” teeth and as a base for deep fillings close to the pulp (nerve).
Inlays and Onlays
Inlays or onlays, are fillings constructed outside of the mouth, custom-fitted to the shape of the cavity prepared on the tooth and fitted or cemented in the mouth. This is different from a filling that is placed directly in the mouth. Therefore, they are also known as an “indirect restoration”.
Inlays and onlays can be constructed from gold or ceramic. Gold is an excellent material to be used as it is strong, can be casted accurately producing a well-fitting filling and non-abrasive, thus protecting the opposing teeth. This is suitable for non-high cosmetic area such as molars and especially beneficial for heavily worn down teeth and for patients with heavy grinding.
Ceramic inlays and onlays provide an aesthetic “tooth-like” filling where gold may not be a satisfactory choice. There are many types of ceramics with varying strengths. In stress-bearing areas, ceramics need to be placed in thicker cross-sections to increase stiffness, reducing the risk of fracture so more tooth preparation will be required. Unlike gold, ceramic is also abrasive to opposing teeth, so may not be a suitable material of choice for patients with heavy wear or grinding.
It is important that the appropriate material be selected for your individual needs. Your dentist will discuss this at length during treatment planning.