Dentist not offering composite fillings

Go Tobban · 09-03-2017 10:20PM #1

Hi there,

Hoping someone could shed some light on this one

I visited my dentist last week and it turns out I need to replace four pretty heavily filled back teeth. He recommended inlays which would cost 1800e for the four or amalgams(450e for four fillings all in)

I asked why he couldn't offer composites on the teeth and he said they were too heavily filled and had slight decay underneath them. I have these fillings 8 or so years and they are genuinely in need of replacement

My question: Is there any reason why composites can't be offered over amalgams in certain cases?

Also, I have reservations about amalgam fillings from reading stuff online about mercury and it's effect on the body. Am I being too skeptical?

Thanks

davo10 · 09-03-2017 10:37PM

Composite fillings require dry surfaces in order to bond to dentine/enamel. Moisture control is extremely difficult when cavities extend below the level of the gum. Unless a perfect seal is formed bacteria can get inside tooth and nerve necrosis almost always follows. Composite fillings are not as strong as amalgam because there is no metal alloy so if there is little tooth support they are more likely to fracture/fail. For teeth with large/deep cavities in non cosmetic areas, they are probably the least preferable filling material.

All dentists offer composite fillings, but each clinical situation is particular to the patient's requirements and best interests. If it is not clinically wise to place a composite in a particular tooth, it would be negligent for the dentist to advise you to have it. For this reason he/she has offered you more suitable alternatives. Amalgam is stronger and a better seal can be obtained, a cast inlay is also stronger and a better seal can be obtained with a hydrophilic luring cement.

Go Tobban · 09-03-2017 11:16PM

davo10 wrote: »

Composite fillings require dry surfaces in order to bond to dentine/enamel. Moisture control is extremely difficult when cavities extend below the level of the gum. Unless a perfect seal is formed bacteria can get inside tooth and nerve necrosis almost always follows. Composite fillings are not as strong as amalgam because there is no metal alloy so if there is little tooth support they are more likely to fracture/fail. For teeth with large/deep cavities in non cosmetic areas, they are probably the least preferable filling material.

All dentists offer composite fillings, but each clinical situation is particular to the patient's requirements and best interests. If it is not clinically wise to place a composite in a particular tooth, it would be negligent for the dentist to advise you to have it. For this reason he/she has offered you more suitable alternatives. Amalgam is stronger and a better seal can be obtained, a cast inlay is also stronger and a better seal can be obtained with a hydrophilic luring cement.

Thanks for your helpful reply

That's actually what the dentist did say in relation to the moisture control issue and nerve necrosis . At least I know I'm not being told porkies!

Can I ask what your opinion is regarding my concerns over amalgam safety? Do Irish dentists still use liquid mercury as part of the filling?

Thanks

davo10 · 09-03-2017 11:29PM

Go Tobban wrote: »

Thanks for your helpful reply

That's actually what the dentist did say in relation to the moisture control issue and nerve necrosis . At least I know I'm not being told porkies!

Can I ask what your opinion is regarding my concerns over amalgam safety? Do Irish dentists still use liquid mercury as part of the filling?

Thanks

People often refer to amalgam fillings as "mercury" fillings even though mercury is a small constituent. With the invent of unidose capsules the content is precise and below levels which are harmful (so the manufacturers tell us). Amalgam has been around for over a hundred years and it's safety record is proven. Personally I have a lot of amalgam fillings and I wouldn't dream of having them changed. Composites are improving all the time and within the next 10 years I have no doubt that amalgam will be phased out for cosmetic reasons, whether that is a good thing only time will tell. We are not sure what exactly is in composite fillings because the manufactures will not divulge that for trade reasons so it is concivable that in time we may find that there are harmful constituents in them as well. A certain percentage of the population will always be susceptible to side effects of all materials, but the empirical evidence of over a hundred years of use suggests that you are not at risk. There is no such thing as the perfect material for all people.

august12 · 10-03-2017 12:08AM

Go Tobban wrote: »

Hi there,

Hoping someone could shed some light on this one

I visited my dentist last week and it turns out I need to replace four pretty heavily filled back teeth. He recommended inlays which would cost 1800e for the four or amalgams(450e for four fillings all in)

I asked why he couldn't offer composites on the teeth and he said they were too heavily filled and had slight decay underneath them. I have these fillings 8 or so years and they are genuinely in need of replacement

My question: Is there any reason why composites can't be offered over amalgams in certain cases?

Also, I have reservations about amalgam fillings from reading stuff online about mercury and it's effect on the body. Am I being too skeptical?

Thanks

I had a composite filling done on a back molar two years last November. The dentist at the time was unsure as to whether it would hold as I only had one original tooth wall. He felt I might be back for a root canal but all is well and it looks great compared to the amalgam filling on the opposite tooth. It has taken quite a bit of pressure as I also have braces on for the last year. Glad I got the composite.

davo10 · 10-03-2017 12:16AM

august12 wrote: »

I had a composite filling done on a back molar two years last November. The dentist at the time was unsure as to whether it would hold as I only had one original tooth wall. He felt I might be back for a root canal but all is well and it looks great compared to the amalgam filling on the opposite tooth. It has taken quite a bit of pressure as I also have braces on for the last year. Glad I got the composite.

Two and a half years is not the timeframe that should be used to measure the success of a filing, ten, fifteen, twenty years is a more quantitative timeframe. Amalgams can last a lifetime and I have seen patients with amalgams for over fifty years. Will a composite be there in fifteen years? At the moment, doubtful particularly if they are big fillings. But they are improving all the time.

Is your dentist concerned about the likelihood of you needing a root canal on the tooth with the amalgam?

august12 · 10-03-2017 09:45AM

davo10 wrote: »

Two and a half years is not the timeframe that should be used to measure the success of a filing, ten, fifteen, twenty years is a more quantitative timeframe. Amalgams can last a lifetime and I have seen patients with amalgams for over fifty years. Will a composite be there in fifteen years? At the moment, doubtful particularly if they are big fillings. But they are improving all the time.

Is your dentist concerned about the likelihood of you needing a root canal on the tooth with the amalgam?

yes, he would have had the same concern regardless given the condition of the tooth when I attended. I am aware two years is not a guideline but given the fact I didn't expect it to last even this long, I am pleasantly surprised.

Dentist not offering composite fillings

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