Amalgam Vs. Composite; Which one is the better of the two? Essay

There are two types of dental fillings that most people know about, the amalgam also known as those big silver fillings, which seem to be not the prettiest looking ones in your mouth. Or the other choice is the composite also known as tooth-colored fillings, which you can’t even tell they are in there.

The most common known that has been used for over one hundred and fifty years is the amalgam. The newest craze is the resin base composite filling that is tooth-colored, which first made its appearance in the 1960’s.I have found out by working for a couple of dentists that they will tend to use one more than the other. The big question is: which is the most reliable material to have placed? Both of these two restorative materials have good qualities and bad qualities. But like the old saying goes, “Which one is going to give you the most bang for your buck? ” There are many qualities that make these two materials so different like the amalgam is a compound material made up of a mixture of mercury, silver, tin and copper. Composite, first off, does not have any mercury and is not a metal-based filling.Mercury, which makes up about 50 percent of the compound in the amalgam, is necessary to bind the metals together to provide a strong, hard, durable filling. There are many supporting reasons that dentists and patients prefer amalgam fillings as opposed to composite fillings.

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Dentists often prefer dental amalgam because it is easier to work with than other alternatives. Many dentists consider amalgam stronger than the resin-based composite, and therefore use amalgam for back teeth fillings or when placing larger fillings.Many patients prefer dental amalgam for the same reasons, plus its cost-effectiveness and ability to fill cavities quickly. Amalgam is one of the best filling materials when dentists need to place fillings in areas of the mouth that are difficult to keep dry, such as molars (back teeth) or cavities below the gum line. There are some issues that have been brought up in the past from amalgam causing problems due to the compounds used in the amalgam material. Dr.Arvind Shenoy explains some of the issues that people have with using amalgam “Incidents of true allergy to mercury have been rare (only 41 cases have been reported since 1905), and attempts to link its usage with such diseases as multiple sclerosis and Alzheimer’s have not been scientifically proven, although there may be some association between amalgam restorations and oral lichen-oid lesions” (Shenoy). Wondering what a lichen-oid lesions, best explained as a canker sore which it not uncommon or contagious.

If allergy to mercury has been so rare why is it there are some dentists and patients who are concerned so highly about the amalgam fillings? Dr. Gary Unterbrink gives his opinion on this issue very well “Another controversy is the effect of mercury or other components of amalgam on human health. In my opinion, the available data indicate that amalgam should be avoided whenever possible; at the same time, the possible risks with other direct restorative materials also are inadequately assessed”(Unterbrink).

One of the reasons for concern is that the mercury is released into our bodies continuously.So if the amalgam lasts as long as ten plus years that means the mercury is being released for that amount of time until the filling is either replaced with a different material. Dr. George Feuer and Dr. Stephen Injeyan explain the process in which it occurs, “Mercury vapour is continuously released from dental amalgam and is ultimately absorbed into a variety of tissues. Experimental data have demonstrated that the uptake, tissue retention and excretion of mercury from dental amalgam is significant.

Evidence has accumulated indicating a relationship between tissue mercury levels and a multitude of clinical manifestations”(Feuer, Injeyan).Studies are constantly being done to help provide facts not assumptions on the harmful effects of using amalgam. One I found interesting was released from the American Dental Association in 2010, which says, “The findings of the studies published between January 1, 2004 and June 15, 2010 showed no consistent evidence of harm associated with dental amalgam fillings…There was no evidence demonstrating that some individuals are genetically susceptible to harmful effects from exposure to the low doses of mercury associated with dental amalgam fillings.Overall, studies continue to support the position that dental amalgam is a safe restorative option for both children and adults… it is important to make the distinction between known and hypothetical risks”(ADA). Everyone is going to have a different opinion about what “they” think is safe and what is not. Recently mentioned was a really good point made by the American Dental Association is: just because one says it isn’t safe until you do some research and know the true facts it may just be hypothetical.It is your dentist’s job to keep their patients informed on what they have been taught is the best. I think one of the best ways of being able to decide what material is best to have used on oneself is to actually know the difference between the two.

There is a huge difference in the materials and compounds that make up amalgam and what make up composite. Composite, as explained by the American Dental Association, are “a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling.They are sometimes referred to as composites or filled resins”(ADA).

Unlike amalgam fillings that have a chemical reaction that causes the filling to harden over time, the composite resin has to be light cured. Here a consumer for FDA gives an example of the many steps it takes to place a composite filling “After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that ‘cures’ or hardens each layer is applied.

When the multi-layering process is completed, your dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration” (Kurtzweil). Some reasons dentists choose to work with amalgam over the composite is because when using the composite everything has to stay dry in order for the filling to be placed and be secure. Working in the mouth area and keeping it “dry” is not necessarily an easy task to accomplish.There are many materials such as rubber dam, cotton rolls, cheek pads, matrix bands and use of the air water syringe that help keep the area dry. A rubber dam is a rectangular sheet of latex used with Mesial and Distal clamps to hold in and surround the tooth, protecting the tooth structure from not acquiring any moisture. Another material mentioned is the matrix band which is a metal or plastic band secured around the crown of a tooth to imprison the restorative material filling a cavity, so no moisture is able to get in.

If any part of the tooth or filling material gets saliva on it, the process is to be started over. This makes it a little more challenging to the dentist, the assistant working with the dentist and also the patient to help with keeping everything dry. After the composite resin base material has been placed and cured, keeping the tooth dry is not the only con to having this type of material placed. According to researchers there is not just one main problem that patients and dentists are having with the fillings when being compared to amalgam fillings.

Dr. Dent gives some examples “… ongevity and survival studies in posterior teeth continue to show that amalgam has a better track record than composite, further reinforcing the need to understand the failure mechanisms of dental composites” (Dent). The composite fillings have been known to shrink over time causing the original filling to break down. In this process it makes those teeth that have the composites that are breaking down more prone to collecting bacteria along the edge where the composite material has started to chip and no longer has full contact where is was originally bonded to the tooth structure.When this process happens that areas is more susceptible to gaining decay where the bacteria has been introduced underneath the existing filling. This is another reason dentists still choose amalgam fillings over composite, because they don’t have to replace the amalgam as often as composite. There are also some advantages to composite fillings. One is to be said that because of the bond used to place the composite to the tooth, composite fillings actually chemically bond to tooth structure, providing further support to the tooth.

The American Dental Association give some other good reasons as to why composite resin can be a good choice, “Aesthetics – the shade/color of the composite fillings can be closely matched to the color of existing teeth; is particularly well suited for use in front teeth or visible parts of teeth, Versatility in uses – in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth Tooth-sparing preparation – sometimes less tooth structure needs to be removed compared with amalgams when removing decay and preparing for the filling. (ADA) The general dentist that is working on your teeth is not the only deciding factor on which material that is going to be used to fill in the cavity. There is the cost of the materials that vary in many ways and most insurance companies will pay more for an amalgam filling to be placed than a composite filling. This is because over the years of research composite fillings have been in need of being replaced more so than amalgam fillings do. Most dental insurance plans cover the cost of the composites up to the price of the silver filling, then the patient must pay the difference.So how is it that the insurance companies decide what they are going to cover and for what type of material. Insurance companies are part of the reason the studies on different materials are tested, to figure out which material best suits everyone. Asbjurn Jokstad who is an Associate Editor of a popular dentistry journal the Evidence-based Dentistry explains “Society as a whole is left as the sole realistic source for potential future studies that will generate data describing the long-term clinical performance of dental restorations.

The financial costs and logistics associated with a prospective controlled longitudinal study over 10 years, randomised or not, are probably beyond the reach of any dental teaching institution” (Jokstad). With that being said in the end and you actually think about it are you even the deciding factor on which material is going to be used to fill the cavity? After knowing the general facts in amalgam and composite and what makes them so different from each other it is still hard to decide which material I would choose.Both are well known and commonly used by general dentists. I myself have both composite fillings and amalgam fillings that were used as a restorative to fill cavities. I have been known to choose the tooth-colored fillings over the silver ones because of aesthetics, they “look” better in my opinion. But with careful consideration I do have to say I would rather have a silver filling that is going to last longer and have a better chance of not causing re-occurring decay; over a better looking filling that will break down and have to be replaced sooner.

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