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.
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.
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There are three major types of direct filling materials (direct fillings are placed in a prepared hole in a tooth, carved or molded to look like a tooth, and then light cured or allowed to harden;
- silver amalgam, made of a mixture of an alloy of silver-tin and liquid mercury
- composite (combination of glass/porcelain particles in a plastic matrix)
- temporary filling materials
There are also three major types of indirect filling material;
- gold (and other semi precious metals)
- fused porcelain
- composite (There is an indirect form of composite which some dentists use.)
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 entrepreneurs, 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.
Prior to the introduction of amalgam, the only materials available to repair decayed back teeth were tin foil, lead plugs and gold leaf. Tin has a nasty habit of falling out of the cavity preparation, Lead was known to be poisonous, and gold leaf was very time consuming and so expensive that only the very wealthy could afford it. Cast gold did not become available until 1910. On the other hand, dental amalgam was not especially technique sensitive and it required much less time (and consequently less pain) to prepare the teeth. The amalgam itself is quite inexpensive, and after the introduction of Coca Cola in 1886, the demand for affordable dentistry skyrocketed. Even in those days, Americans realized that the average Joe was being discriminated against because of the lack of choice in dentistry, and dentists were forced to reevaluate the use of amalgam. They discovered (to their consternation) that NO ONE who had their teeth filled with amalgam suffered from any of the symptoms associated with mercury poisoning. Many dentists still refused to use amalgam, and they formed the core of the burgeoning anti-amalgamist movement. They were very angry, since a bunch of newcomers to the profession were taking away their core business. Unfortunately, since no one was exhibiting the symptoms of mercury poisoning, the anti-amalgamists had to rely on scaring the public with horror stories about diseases like diabetes, arthritis, gout, etc. for which the medical profession had no explanation. Unfortunately for the anti-amalgamists, the list of diseases that dental amalgam supposedly caused kept shrinking as the real causes of these diseases was discovered by researchers. Today we know that there is no known statistical difference in the health status of persons with amalgam fillings compared to those with no fillings in their teeth!
Please refer to the following links: The American Dental Association’s statement on dental amalgam: The ADA FAQ on what other scientific sources say about dental amalgam
In the meantime, the rest of the dental profession had moved on and accepted dental amalgam as one of the major armaments in the fight against decay. A dentist named G.V. Black (1836-1915- pictured above) finally laid the foundation for the correct use of the new material and essentially revolutionized the profession of dentistry by standardizing the repair of teeth and making dentistry affordable to everyone.
Today, silver amalgam is still the most popular tooth filling material in the world. It has been used extensively worldwide for nearly 200 years, and almost everyone in the industrialized world has at least one or two amalgam filling in his/her teeth.
I have devoted an entire six page essay to this subject. It includes documentation from scientifically respected sources which cite peer reviewed statistics to help counter the misinformation found on the huge number of websites which advocate removal of amalgam fillings. Click on the icon to the right to read these pages. Some of the information on this page has been reproduced there.