The FactsAbout Fillings

DENTAL BOARD OF CALIFORNIA1432 Howe Avenue • Sacramento, California 95825

www.dbc.ca.gov

Dental Materials – Advantages & Disadvantages

DENTAL BOARD OF CALIFORNIA1432 Howe Avenue • Sacramento, California 95825

www.dbc.ca.gov

Published by

CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

5/04

The Facts About Fillings

PORCELAIN FUSEDTO METALThis type of porcelain is a glass-like material that is “enameled”on top of metal shells. It is tooth-colored and is used for crownsand fixed bridges

Advantages❤ Good resistance to further

decay if the restoration fits well

❤ Very durable, due to metalsubstructure

❤ The material does not causetooth sensitivity

❤ Resists leakage because it canbe shaped for a very accuratefit

Disadvantages• More tooth must be removed

(than for porcelain) for themetal substructure

• Higher cost because it requiresat least two office visits andlaboratory services

GOLD ALLOYGold alloy is a gold-coloredmixture of gold, copper, and othermetals and is used mainly forcrowns and fixed bridges andsome partial denture frameworks

Advantages❤ Good resistance to further

decay if the restoration fits well❤ Excellent durability; does not

fracture under stress❤ Does not corrode in the mouth❤ Minimal amount of tooth needs

to be removed

❤ Wears well; does not causeexcessive wear to opposingteeth

❤ Resists leakage because it canbe shaped for a very accuratefit

Disadvantages• Is not tooth colored; alloy is

yellow• Conducts heat and cold; may

irritate sensitive teeth• High cost; requires at least two

office visits and laboratoryservices

2

Dental Materials Fact Sheet

What About the Safety of Filling Materials?Patient health and the safety of dental treatments are theprimary goals of California’s dental professionals and theDental Board of California. The purpose of this fact sheet is toprovide you with information concerning the risks and benefitsof all the dental materials used in the restoration (filling) ofteeth.

The Dental Board of California is required by law* to makethis dental materials fact sheet available to every licenseddentist in the state of California. Your dentist, in turn, mustprovide this fact sheet to every new patient and all patients ofrecord only once before beginning any dental filling procedure.

As the patient or parent/guardian, you are strongly encouragedto discuss with your dentist the facts presented concerning thefilling materials being considered for your particular treatment.

* Business and Professions Code 1648.10-1648.20

Allergic Reactions to Dental MaterialsComponents in dental fillings may have side effects or causeallergic reactions, just like other materials we may come incontact with in our daily lives. The risks of such reactions arevery low for all types of filling materials. Such reactions can becaused by specific components of the filling materials such asmercury, nickel, chromium, and/or beryllium alloys. Usually,an allergy will reveal itself as a skin rash and is easily reversedwhen the individual is not in contact with the material.

There are no documented cases of allergic reactions to compos-ite resin, glass ionomer, resin ionomer, or porcelain. However,there have been rare allergic responses reported with dentalamalgam, porcelain fused to metal, gold alloys, and nickel orcobalt-chrome alloys.

If you suffer from allergies, discuss these potential problemswith your dentist before a filling material is chosen.

7The Facts About Fillings

PORCELAIN(CERAMIC)Porcelain is a glass-like materialformed into fillings or crownsusing models of the preparedteeth. The material is tooth-colored and is used in inlays,veneers, crowns and fixedbridges.

Advantages❤ Very little tooth needs to be

removed for use as a veneer;more tooth needs to be re-moved for a crown because itsstrength is related to its bulk(size)

❤ Good resistance to furtherdecay if the restoration fits well

❤ Is resistant to surface wear butcan cause some wear onopposing teeth

❤ Resists leakage because it canbe shaped for a very accuratefit

❤ The material does not causetooth sensitivity

Disadvantages• Material is brittle and can break

under biting forces• May not be recommended for

molar teeth• Higher cost because it requires

at least two office visits andlaboratory services

NICKEL OR COBALT-CHROME ALLOYSNickel or cobalt-chrome alloysare mixtures of nickel andchromium. They are a dark silvermetal color and are used forcrowns and fixed bridges andmost partial denture frameworks.

Advantages❤ Good resistance to further

decay if the restoration fitswell

❤ Excellent durability; does notfracture under stress

❤ Does not corrode in the mouth❤ Minimal amount of tooth needs

to be removed❤ Resists leakage because it can

be shaped for a very accuratefit

Disadvantages• Is not tooth colored; alloy is a

dark silver metal color• Conducts heat and cold; may

irritate sensitive teeth• Can be abrasive to opposing

teeth• High cost; requires at least two

office visits and laboratoryservices

• Slightly higher wear toopposing teeth

3

Toxicity of Dental Materials

Dental Amalgam

Mercury in its elemental form is on the State of California’sProposition 65 list of chemicals known to the state to causereproductive toxicity. Mercury may harm the developing brain ofa child or fetus.

Dental amalgam is created by mixing elemental mercury (43-54%) and an alloy powder (46-57%) composed mainly of silver,tin, and copper. This has caused discussion about the risks ofmercury in dental amalgam. Such mercury is emitted in minuteamounts as vapor. Some concerns have been raised regardingpossible toxicity. Scientific research continues on the safety ofdental amalgam. According to the Centers for Disease Controland Prevention, there is scant evidence that the health of the vastmajority of people with amalgam is compromised.

The Food and Drug Administration (FDA) and other publichealth organizations have investigated the safety of amalgamused in dental fillings. The conclusion: no valid scientific evi-dence has shown that amalgams cause harm to patients withdental restorations, except in rare cases of allergy. The WorldHealth Organization reached a similar conclusion stating, “Amal-gam restorations are safe and cost effective.”

A diversity of opinions exists regarding the safety of dentalamalgams. Questions have been raised about its safety in preg-nant women, children, and diabetics. However, scientific evi-dence and research literature in peer-reviewed scientific journalssuggest that otherwise healthy women, children, and diabetics arenot at an increased risk from dental amalgams in their mouths.The FDA places no restrictions on the use of dental amalgam.

Composite Resin

Some Composite Resins include Crystalline Silica, which is onthe State of California’s Proposition 65 list of chemicals knownto the state to cause cancer.

It is always a good idea to discuss any dental treatmentthoroughly with your dentist.

6

Dental Materials – Advantages & Disadvantages

GLASS IONOMERCEMENTGlass ionomer cement is a self-hardening mixture of glass andorganic acid. It is tooth-coloredand varies in translucency. Glassionomer is usually used for smallfillings, cementing metal andporcelain/metal crowns, liners,and temporary restorations.

Advantages❤ Reasonably good esthetics❤ May provide some help against

decay because it releasesfluoride

❤ Minimal amount of tooth needsto be removed and it bondswell to both the enamel and thedentin beneath the enamel

❤ Material has low incidence ofproducing tooth sensitivity

❤ Usually completed in onedental visit

Disadvantages• Cost is very similar to compos-

ite resin (which costs morethan amalgam)

• Limited use because it is notrecommended for bitingsurfaces in permanent teeth

• As it ages, this material maybecome rough and couldincrease the accumulation ofplaque and chance of periodon-tal disease

• Does not wear well; tends tocrack over time and can bedislodged

RESIN-IONOMERCEMENTResin ionomer cement is amixture of glass and resin polymerand organic acid that hardens withexposure to a blue light used inthe dental office. It is toothcolored but more translucent thanglass ionomer cement. It is mostoften used for small fillings,cementing metal and porcelainmetal crowns and liners.

Advantages❤ Very good esthetics❤ May provide some help against

decay because it releasesfluoride

❤ Minimal amount of tooth needsto be removed and it bondswell to both the enamel and thedentin beneath the enamel

❤ Good for non-biting surfaces❤ May be used for short-term

primary teeth restorations

❤ May hold up better than glassionomer but not as well ascomposite

❤ Good resistance to leakage❤ Material has low incidence of

producing tooth sensitivity❤ Usually completed in one dental

visit

Disadvantages• Cost is very similar to compos-

ite resin (which costs more thanamalgam)

• Limited use because it is notrecommended to restore thebiting surfaces of adults

• Wears faster than composite andamalgam

4

Dental Materials – Advantages & Disadvantages

The durability of any dental restoration isinfluenced not only by the material it is made

from but also by the dentist’s technique whenplacing the restoration. Other factors include thesupporting materials used in the procedure andthe patient’s cooperation during the procedure.The length of time a restoration will last isdependent upon your dental hygiene, home care,and diet and chewing habits.

DENTAL AMALGAM FILLINGSDental amalgam is a self-hardening mixture of silver-tin-copper alloypowder and liquid mercury and is sometimes referred to as silverfillings because of its color. It is often used as a filling material andreplacement for broken teeth.

Advantages

❤ Durable; long lasting

❤ Wears well; holds up well tothe forces of biting

❤ Relatively inexpensive

❤ Generally completed in onevisit

❤ Self-sealing; minimal-to-noshrinkage and resists leakage

❤ Resistance to further decay ishigh, but can be difficult tofind in early stages

❤ Frequency of repair andreplacement is low

Disadvantages

• Refer to “What About theSafety of Filling Materials”

• Gray colored, not tooth colored

• May darken as it corrodes; maystain teeth over time

• Requires removal of somehealthy tooth

• In larger amalgam fillings, theremaining tooth may weakenand fracture

• Because metal can conduct hotand cold temperatures, theremay be a temporary sensitivityto hot and cold.

• Contact with other metals maycause occasional, minuteelectrical flow

5The Facts About Fillings

COMPOSITE RESIN FILLINGSComposite fillings are a mixture of powdered glass and plastic resin,sometimes referred to as white, plastic, or tooth-colored fillings. It isused for fillings, inlays, veneers, partial and complete crowns, or torepair portions of broken teeth.

Advantages

❤ Strong and durable

❤ Tooth colored

❤ Single visit for fillings

❤ Resists breaking

❤ Maximum amount of toothpreserved

❤ Small risk of leakage if bondedonly to enamel

❤ Does not corrode

❤ Generally holds up well to theforces of biting depending onproduct used

❤ Resistance to further decay ismoderate and easy to find

❤ Frequency of repair or replace-ment is low to moderate

Disadvantages

• Refer to “What About theSafety of Filling Materials”

• Moderate occurrence of toothsensitivity; sensitive todentist’s method of applica-tion

• Costs more than dentalamalgam

• Material shrinks whenhardened and could lead tofurther decay and/or tempera-ture sensitivity

• Requires more than one visitfor inlays, veneers, andcrowns

• May wear faster than dentalenamel

• May leak over time whenbonded beneath the layer ofenamel