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Dental Fillings

Silver Amalgam is the most commonly used material in the restoration of decayed teeth in the world! It was invented in France in the early 1800's and introduced into the US by two french enterpreneurs, the Crawcour brothers. Due to its mercury content, it was denounced by a majority of the dental profession since mercury was known to be a poisonous material. What was not fully recognized at the time was that elemental mercury, especially when bound into a solid amalgam with other metals is not well absorbed into the human body. The belief in the severity of the toxicity of mercury was based upon the toxicity of soluble mercury salts and organic mercury compounds which had been used industrially in the manufacture of the felt used to make hats. Even though the dental profession of the day denounced the use of amalgam for the repair of the teeth, the brothers went on to repair huge number of mouths with it. In spite of appalling dentistry (they seldom removed the bulk of decay and violated every principle of dentistry known even at that time), they were not only successful entrepreneurs, but the teeth they repaired mostly remained successfully repaired for many years! Often, these restorations seemed to work better than the expensive gold restorations placed by the "expensive dentists". Furthermore, the predictions of widespread mercury poisoning proved to be false. 

Indirect Filling
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Indirect Filling

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Another type of restoration, less common due to their much higher cost, are called "indirect" restorations. These "fillings" justify their expense by being more durable (in other words, properly cared for, they should last longer than regular indirect restorations), and also more esthetic (better looking because they are actually built by a laboratory technician on a lab bench without the difficulties imposed by the time constraint and the poor access the dentist faces working in a patient's mouth). Indirect fillings, made in a dental laboratory, are known as inlays and onlays. 

Indirect fillings used to be more common when gold and ivory were the principal dental materials. With the advent of porcelain laboratory produced restorations, most dentists today prefer the superior strength and esthetics of "full coverage" of the tooth in the form of crowns or veneers rather than simply filling cavities with laboratory processed gold or porcelain fillings. For a side by side comparison of the characteristics of all indirect filling materials please see my reproduction of the American Dental Association Table of indirect restorative dental materials.

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Resin Composite Fillings
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Resin Composite Fillings

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Having sung the praises of Amalgam restorations, I will now state flatly that I have given them up in my own practice in favor of the new generation of composite restoration. The reasons follow my description of composite filling materials. Composite fillings are what people think of when they say "white fillings" or "porcelain fillings". We call them tooth colored fillings to distinguish them from amalgam, gold and temporary filling materials. There are a number of different formulations of composite filling, but the type most commonly used today is made of microscopic glass, or porcelain particles of varying shapes and sizes (depending on the intended use) embedded in a matrix of acrylic. The glass particles account for between 60% and 80% of the bulk of these materials, so these restorations could more properly be called porcelain fillings.

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Direct Filling
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Direct Filling

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When most people think of a "filling", they imagine an item made out of some sort of material, either metal or plastic that is placed directly in a hole in a tooth, carved to resemble the original shape of the tooth, and then allowed to harden inside the hole to restore the form and function of the tooth. Of course, it also must relieve the pain associated with the cavity. In fact, these "direct" restorations, though far and away the most common types due to their lower cost are only one half of the equation. 

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Silver Amalgam Dental Fillings
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Silver Amalgam is the most commonly used material in the restoration of decayed teeth in the world! It was invented in France in the early 1800's and introduced into the US by two french enterpreneurs, the Crawcour brothers. Due to its mercury content, it was denounced by a majority of the dental profession since mercury was known to be a poisonous material. What was not fully recognized at the time was that elemental mercury, especially when bound into a solid amalgam with other metals is not well absorbed into the human body. The belief in the severity of the toxicity of mercury was based upon the toxicity of soluble mercury salts and organic mercury compounds which had been used industrially in the manufacture of the felt used to make hats. Even though the dental profession of the day denounced the use of amalgam for the repair of the teeth, the brothers went on to repair huge number of mouths with it. In spite of appalling dentistry (they seldom removed the bulk of decay and violated every principle of dentistry known even at that time), they were not only successful entrepreneurs, but the teeth they repaired mostly remained successfully repaired for many years! Often, these restorations seemed to work better than the expensive gold restorations placed by the "expensive dentists". Furthermore, the predictions of widespread mercury poisoning proved to be false. 

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Composite Dental Fillings
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Composite (combination of glass/porcelain particles in a plastic matrix)

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Temporary Filling Materials
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  • When a patient presents at my office with pain attributable to a cavity, I sometimes place a temporary filling in the tooth and reappoint the patient for a final permanent filling at another visit. Sometimes, this is done in order to save time, especially if we have slipped the emergency patient between two regularly scheduled patients. Sometimes it is done in order to save money. 
  • Temporaries are the least expensive (and most temporary) way to fill a tooth. Temporary fillings can be done quickly, because they are usually inserted without any of the time consuming rituals associated with a permanent filling. The patient is anesthetized, the decay removed and the temporary filling is mixed and inserted, generally simply by pushing it into the cavity preparation with a gloved finger. The patient bites into it while it is still soft in order to adjust the height, and the patient leaves the office without even waiting for a final set on the material. In a phrase, a temporary is "fast and cheap'.
  • But there is another reason that may indicate that a temporary is the best way to treat the patient, even if time or money is not an issue. Temporary fillings are different from permanent amalgam or composite fillings because they are fillings. This means that they tend to soothe an inflamed nerve in a tooth, and may make the difference between the tooth needing a root canal (or an extraction), or simply filling the tooth later on, after the nerve has calmed down. Sometimes a temporary filling is the best course to relieve pain.
  • Temporary fillings are made of two major components: Oil of clove (eugenol), which has been used for centuries to relieve toothaches, and Zinc Oxide which is the ingredient that makes Desitin diaper rash ointment white. Zinc oxide is an excellent disinfectant. The oil and oxide mix together to make a stiff paste that eventually hardens into a waterproof substance which soothes the nerve of the tooth and kills germs while protecting the cavity like a hard band aid. When used as a temporary filling material or cement, this material is called "zinc oxide and eugenol", or ZOE for short.

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Gold Dental Fillings

Gold Dental Fillings

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Fused Porcelain Dental Fillings
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