Why Fillings Are Necessary

Let’s play the filling game. What’s in your filling? Composite, amalgam, or ceramic? There are lots of options that modern dentists have to fill a tooth. But let’s start from the beginning: why is it necessary to do a filling?

Whenever we find decay on a tooth, that means there’s an unhealthy area that’s broken down and we need to remove that unhealthy tooth structure. The problem is that removing decay leaves us with a small hole or defect in the tooth, and if we leave it exposed like that, it’s going to break down further and cause pain and other issues. So, we have to fill that hole and restore the tooth to its natural shape and size.

An analogy I like to use is this: let’s say you lost the tip of your finger. There are a lot of options for restoring that finger, but ideally, we’d make something that looks and feels just like your finger did before you lost the tip. The tooth is the same way. When you have a hole or defect in it, our goal is to fill that hole and get the tooth feeling and looking almost exactly as it was before whatever caused that damage.

The Evolution of Fillings

Originally, we only had amalgam, which is the silver filling. It’s gotten a bad reputation because it has some mercury in it. For those of you who are concerned about mercury, that’s a valid concern. You should know that we really don’t use amalgam in the United States very often anymore. In fact, it’s even outlawed in parts of Europe. In our practice, we don’t use amalgam anymore.

One of the main reasons is that it’s darker, less aesthetic, and requires removing more tooth structure because it’s mechanically forced into place. Instead, we use composite resin, which allows us to match the color and appearance of the adjacent tooth. Our goal when we do a tooth-colored filling is to have it blend seamlessly with your mouth so it’s invisible, feels natural to your tongue, and supports your tooth when you bite, chew, and function.

Ceramic and Porcelain Options

The other option we have is porcelain or ceramic inlays and onlays. Without getting too technical, that’s where we build something outside your mouth and bond it in to specifically fit the space, almost like a jigsaw puzzle. One of the advantages is strength, and of course, they’re highly aesthetic and look just like a natural tooth.

When a Filling Isn’t Enough

Composite resins are great, and we use them often in our practice. The only downside is that if a filling gets really large, you can reach a point where you have more filling than natural tooth structure. That leaves the tooth vulnerable. While the filling does a great job of holding the tooth together, it can also create a wedging effect. If a tooth has a big filling, part of it might break off in the future because there isn’t enough healthy structure to support it. At that point, it’s more beneficial for the tooth to have a crown.

A crown goes over the top of the tooth, holding it all together and protecting it from breaking down.

Tooth Strength and Protection

If you’re wondering about the strength differences, your natural tooth is incredibly strong. In fact, enamel, the outer surface of your teeth, is the hardest material in your body, even stronger than bone. But when you start to lose enamel due to decay or fillings, the tooth’s overall integrity weakens. When a filling becomes large enough, the tooth may need a crown for protection.

Reflexiones finales

If you’re interested in an amalgam-free practice and want to sit down to discuss your options and materials, we’re an open book. One of my favorite things is having an informed patient, an educated patient, who makes better decisions and feels more comfortable with their treatment.

If you have questions about getting a filling or about existing fillings, give us a call. We’d love to meet you, take a look, and tell you what’s best for your mouth.

I’m Dr. Brett Langston, prosthodontist and owner of Dental Implant and Aesthetic Specialists here in Brookhaven, Georgia, and I’m here to help you watch your mouth.