There has been a major shift in the type of filling materials and choices available for dental restorations. In 1990 approximately 70% of the fillings placed in teeth by the dentist were the amalgam or silver/mercury fillings. In 1999 that has changed to only 45% of the fillings composed of the amalgam type.
In the past most dentists were resisting the change to the white resin type of filling materials because they felt they could not compare to the amalgam for strength and durability. However, over the years dental science has become more technologically sophisticated and the filling material choices have improved significantly.
Cosmetic concerns and demands have been one of the reasons why the shift for more choices and improvement of dental materials has come about. Patients do not choose the grayish, black appearance of the amalgam in a tooth when presented with the choice of a tooth colored filling. Many are even requesting the non-mercury fillings and will even change dentists if they are given no choice.
In addition to the cosmetic issue, lawyers across the country have been leading anti-mercury lawsuits alleging health problems due to the mercury in amalgam. Amalgams are composed of approximately 60% mercury and the rest is a composite of various metals including silver, nickel, copper, and tin. The American Dental Association is still consistent with its stand on the viability of the amalgam filling material.
Although the demand for the non-mercury fillings is increasing, dental insurance companies have not caught up with all the demand for them. Most of the plans only cover the amalgam fillings and the patient has to pay the difference if they want the white fillings. However, as research continues to back and support the white resin fillings, the insurance plans will take notice, and a few do cover them now.
For the present time, dentists and their patients are weighing all their options. The amalgam has been around for over 100 years, it is durable, inexpensive and covered by all insurance plans. The disadvantage is that many reports are indicating that the mercury is released in vapor form and causing health hazards. The composite resin fillings are also durable, resistant to fracture, and have excellent aesthetic appeal. The disadvantage is that it may shrink slightly over time, permitting decay.
Other choices for filling material include gold. This is a very durable material, leak-resistant, and allergies to it are rare. It is expensive, however, has poor aesthetics, and conducts heat and cold. Porcelain filling materials have excellent aesthetics, moderate durability, and no known allergic reactions. They are just as expensive as the gold fillings.
As patients, it's wise to get informed and choose the filling material that is suitable for you, and no longer depend on the only choice used in the past: the gray, black "silver" fillings.