Fillings

Enamel is very hard covering of the top of the tooth designed to aid in chewing food and last for a long time even when repetitive erosive forces of chewing food act upon it. It is made of an organic and inorganic matrix. This means it has a scaffold of protein fibers that have been mineralized. These minerals come on and off the tooth in microscopic amounts throughout the day and are in equilibrium. Bacteria produce acids and promote demineralization and saliva has minerals in it that promote mineralization. Imbalance in this equilibrium can cause the tooth to become more and more demineralized and create caries also known as a cavity. If the demineralization has not passed the enamel layer, and the inorganic matrix is still intact, the tooth may be able to still remineralize naturally and a filling may not be needed. If the cavity has passed the enamel layer or the inorganic matrix is destroyed, a filling will need to be done. Under the enamel lays a softer layer of dentin that is designed to disperse shockwave forces produced from chewing in a way that allows the tooth to resist microfracture damage over time. This dentin layer cannot resist bacterial erosion nearly as well as enamel and can be destroyed a lot quicker when bacteria reach it. Fillings are designed to act as prosthetic enamel and dentin to fill areas that have been destroyed from caries or fracture. These replacement tooth materials are fake and not as good as natural healthy enamel and dentin but serve as a decent replacement when the natural dentin and enamel have been destroyed or compromised.

Choices of filling materials include gold, amalgam and composite.

Composite is the tooth colored filling material made of a mixture of resin plastics and glass filler. It is a good filling material that comes in different shades of color to attempt a match with your tooth’s color. It can be chemically bonded to the tooth for strength. Sometimes an exact match is not possible. An important thing to note is that different lighting can make a filling stand out as it has different optical properties than real enamel. Composite cannot be bleached either so if you whiten your teeth after a filling in the front is placed it will stand out. Composite can also take up colors that stain from smoking, berries, coffee and other foods.

Amalgam is a metal filling of a mixture of different metals typically silver, mercury and copper. It is one of the most studied medical substances and contrary to internet myths has not been proven to be harmful to overall health. It does however have some down sides. When removing it tiny particles can lodge into your cheek and tattoo the inside of your mouth. The silver color can leach into other parts of the tooth and turn it gray. It does not bond to the tooth and is only held in with mechanical retention techniques. The filling is silver in color and stands out. It can be a good restoration in certain circumstances. Discuss this option with your dentist for further details if you are interested.

Gold fillings are the most functional of the options. It acts the most like natural tooth and has the best seal. A good gold filling can last a very long time. Composites and amalgams can last one to two decades when a gold filling could last several more. They are more expensive and it becomes harder and harder to find dentists who can do them. Like all metal bases fillings it looks like metal. If you are trying to avoid the obvious sign of a metal glint hinting you have had dental work, gold may not be your choice.