White Fillings versus Dental Amalgam Fillings

I have been staring at old dental amalgams for nearly 30 years wondering why the teeth containing them fracture or break up & why there is almost always dental decay beneath them when I go to fix them.

Silver Fillings vs White Fillings
At Milford Dentists, North Shore, I haven’t placed a Dental amalgam (silver/metal) filling since 1999. I have placed white fillings aka composite resin fillings successfully instead – this is because white filling bio-mimics tooth structure i.e. it behaves very similarly to the tooth that has decayed or snapped off that it is replacing 

But what is going on here? Why have I opted for Milford Dentists to be Mercury Amalgam Free since 1999?

Over the last couple of years clever researchers, some of whom are dentists have worked out why dental amalgam fillings end up making teeth snap, fracture & decay; eventually making the tooth fail. This has reinforced my own theories that Mercury Dental amalgam fillings are a disaster for teeth & conversely white composite resin fillings are a much better more biomimetic (life like) alternative.

There are a few physical processes going on when you have a dental amalgam filling sitting in your tooth.

1. Temperature changes making the filling expand & contract
2. The tooth cusps & dental amalgam filling all moving in different directions during chewing 
3. The actual dental amalgam cavity preparation destroying parts of the tooth that actually hold the tooth together

Temperature Change in Mercury

Around 50% of dental amalgam is made up of mercury. Mercury has been used in thermometers for years because it expands and contracts a great deal with temperature change. So when you, say, have a hot drink, the mercury in your dental filling heats up & expands making the filling bigger. This puts a whole lot of pressure on your tooth & eventually your tooth can’t take the strain & cracks/fractures/snaps.

Conversely when you have something cold to eat or drink – say ice cream, your filling contracts leaving a gap around it. Conversely, white bonded composite resin fillings have a similar co-efficiency of expansion as the tooth with temperature change i.e. composite resin expands & contracts just like your tooth with temperature variations. White fillings are also bonded or “glued” into the tooth cavity which means there are no gaps around the edges.

Everything is moving when you chew

When you chew you are putting a lot of pressure on your teeth (approximately 150-newton centimeters of torque). Surprisingly, for something so solid, a tooth will twist and bend a little under this pressure. In tests on teeth (in vitro), a tooth with a medium sized amalgam filling will flex 26 times more than a tooth with a similar sized bonded white filling.

In fact, the tooth with a bonded white filling will flex almost the same amount as a healthy tooth. This is because the white filling not only fills the cavity, it also bonds the tooth back together again biomimetically, so the tooth & white filling are swaying & twisting as one.

Essentially the teeth tested with the amalgam fillings are twisting & bending in all different directions i.e. the cusps are moving away from each other & the amalgam filling is jiggling around in the cavity, as the mercury amalgam is just a hole filler & does not “glue” anything to anything.

The actual dental amalgam cavity preparation

Because mercury dental amalgam is a hole filler it needs to be “keyed” or locked into the tooth by undercuts so that it doesn’t fall out. At dental school, this type of dental cavity preparation is called a “G V Blacks” cavity. The cavity shape destroys “girders” of enamel that hold the tooth together.

In the last 10 years, dentists have discovered that the tooth is a lot more complicated structurally than we had thought. There is a complex framework of stronger enamel spokes that connect together within a strong enamel rim running around the tooth on the biting surface. If the spokes and or the rim is cut during a dental amalgam cavity preparation the tooth is weakened, eventually leading to the tooth snapping.

Imagine trying to ride a bike with some of the spokes broken or part of the wheel rim missing.

As already mentioned a bonded composite resin filling glues the tooth back together & because white fillings are bonded they do not need to be “keyed” into the tooth. This means cavities for white fillings are smaller than corresponding cavity shapes for an amalgam filling. 

Read about safe dental amalgam filling removal here

A lot of the time teeth can be repaired using white composite resin filling material. As well as strengthening the tooth with the bond or "glue" holding each part of the tooth to the rest of the tooth these restorations look very natural -

If the tooth is weakened by tooth cracks or decay sometimes the optimal option to strengthen & hold the tooth together for the longer term & at the same time improving its appearance is a dental porcelain crown or overlay. This acts like a crash helmet for the tooth holding everything together.

Posted by Andrea Clarke BDS

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements - From Devonport and Belmont up through Takapuna, Castor Bay, Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest & the Whangaporoa Peninsula.

White Fillings - How Long Will They Last ?

When considering dental restoration or repair, a common question asked by our current and prospective clients is “How long do white fillings last?"

However, although we have many clients with long-life white fillings; the answer is - it depends. 

While early research has shown that the average tooth – coloured filling lasts for a minimum of five years, our experience has shown there are many things both the dentist & the patient can do to extend the life of a white filling beyond that to ten years or more.

Continued below you will find a range of practical recommendations for increasing the longevity of your dental restoration work.

The Lifespan of A Filling

The lifetime of a filling is partly determined by choice of material used to fill the cavity. Is it silver or a white filling, porcelain or gold? There are advantages for differing filling types, where they are used, and the dental care and maintenance you provide that can all affect the life expectancy of a dental filling.

Is A White Filling Better Than Silver?

Composite or white fillings have become the preferred choice of dental filling material, are recommended by our staff and considered to be stronger, safer and more durable than traditional amalgam fillings.

At Milford Dentists, we have been amalgam free for all restoration work since 1999, and believe there is no advantage, (but instead a distinct disadvantage), to using dental silver amalgam vs. composite resins for reasons of durability. 

Why Choose White Fillings?

Our clients find tooth-coloured (or composite resin) fillings with their white tooth-like appearance, more aesthetically pleasing than silver amalgam fillings, and the adhesive nature of composite fillings allows us to perform what is termed "minimally invasive" dentistry enabling you to retain more of your original teeth.

New to Milford dentists? Discuss your personal dental history before deciding what is most effective & appropriate for you. Contact us here

What Is A White Filling

These are the very popular white, tooth coloured fillings for restoration and treating decay that blend seamlessly into your smile, making the dental work almost invisible. They are an incredibly strong, successful treatment for most cavities.

Because of the materials that Milford Dentists white (composite) fillings are made from, they bond to your tooth tissue from the inside, strengthening your teeth and providing them with additional support for many years.

Composite fillings cavities are smaller than a comparative amalgam cavity. This is because composite resin fillings are bonded into the cavity whereas amalgam filling, generally, is mechanically retained and the cavity needs undercuts and retention locks prepared into the hole to keep the mercury amalgam from falling out.This means less tooth structure is removed ie less drilling, when placing a white filling than when placing an amalgam filling. Once bonded, the composite filling does not change shape over time and will wear at a similar rate to your own tooth, keeping your dental repair stable and secure. 

Making Your White Fillings Last Longer

While many factors affect the longevity of fillings, remember that generally, all fillings will last longer if you take care of your oral hygiene with daily brushing, flossing and regular dental checkups.
The many factors for white filling longevity can include

• Filling Size

• Filling Location (On The Tooth Surface)

• Filling Location (In The Mouth)

• Clenching & Grinding

• Existing Dental Damage Or Issues

• Diet & Drinks

• Oral Hygiene

• Filling Materials Used

• Effective Dental Techniques

Filling Size

An important consideration for a white filling is, will the placing of the composite restoration be suitable for its application? Smaller fillings will generally last longer than a large filling because there are fewer issues that can occur, although, with continuing improvements in the composition of bonding materials, this is becoming less of consideration.

Clenching and Grinding

Do you clench or grind your teeth? If so, you may have more problems with your fillings. The additional forces placed on your teeth from grinding or clenching can lead to tooth sensitivity and extra wear on your fillings. These actions can also cause your fillings to crack or develop tiny vertical cracks (craze lines) in your teeth.

Smoking

Delays in oral healing and increased likelihood of gum disease cause considerably higher possibility of dental issues and failure of tooth restorations. If you are a smoker and are considering quitting – talk to us to see how we can help.

Dietary choices

Do you regularly drink carbonated or other high sugar drinks? These beverages you should be avoided or the frequency you have them decreased along with highly acidic things like, e.g., Grapefruit juice or apple cider vinegar gargles - using these regularly can damage the tooth enamel by dissolving it, increasing the possibility of problems occurring around your fillings.

Effective Dental techniques

Placing bonded restorations is very technique sensitive – so it is important your dentist use best practice standards and technique for long-life results for your fillings. The tooth requires proper isolation during the procedure, and composite restorations need a specific environment in which to be placed - completely saliva (moisture) free and dry when the resin material is being applied and cured. 

Do Composite Fillings Last A Lifetime Or Can They?

According to early findings, like from this small Belgian study, composite fillings can last between five and seven years on average, yet other recent larger reviews such as Opdam (2010) and Kim (2013) indicate 10 - 11 years.

With correct procedures and proper care and maintenance by you, we can significantly improve the lifespan of your white fillings. Also as new techniques, technology & materials are developed to extend the lifetime of all our dental procedures, we expect the longevity of tooth coloured fillings to continue to be extended.

So if you are considering a white filling, contact Milford Dentists to learn more or schedule a visit today. We will check out your dental history, discuss your treatment options, and get you back on track towards optimal oral health <  > with a brand new bright, white smile.

What Are White Fillings Made Of?

What Are White Fillings Made Of?

The purpose of a filling is to help restore your damaged or decayed teeth, to help them regain their normal function and shape. A white (or composite) filling is typically made of a tooth-coloured acrylic resin with a powdered glass mixture (hardened using a high-intensity blue light) which offers many advantages over an amalgam (or silver) filling. 

See our comparison of white fillings vs. amalgam here.

Due to the materials that the filling is made from, these natural coloured alternatives can be shaded to match the colour of your existing teeth, making them much less visible than silver. As more of our clients want natural-looking smiles, composite fillings have become increasingly popular, for cosmetic improvements of the smile by changing the colour of the teeth or reshaping damaged or misshapen teeth.

Composite or white fillings are our preferred choice of dental filling material, are recommended by our team, and we consider them to be stronger, safer and more durable than traditional silver amalgam fillings.

Do White Fillings Contain Mercury?

White or composite fillings do not contain mercury, while traditional amalgam (or silver or grey metal fillings) have typically 50% mercury in them along with tin, copper, silver or zinc. Many dental practices continue to use amalgam fillings which are considered by some as controversial, but at Milford Dentists, we have been amalgam - mercury free for all of our restoration work since 1999.

Durability and the preservation of your natural tooth are of great importance to us, so our team consider there to be no advantage, (but instead a distinct disadvantage), using dental silver amalgam vs. composite resins (white fillings).

You can find all the need to know facts about white fillings here.

Other options for fillings include gold and porcelain.

• Gold is one of the most durable and long-lasting options for dental restorations; however, gold fillings are amongst the most expensive and need to be mechanically retained, i.e., they need to be keyed into a cavity which can destroy tooth unnecessarily.
• Porcelain fillings are another indirect option that while higher in cost provide a very natural appearance, helps stop the spread of decay, protects the strength and function of teeth and can be used to correct an uneven tooth surface.

So although there is a range of options for fillings or restoration, contact Milford Dental today on (09) 489 6575, and we can help you identify the dental solution best suited to your needs.

White Fillings - Just The Facts

When you're considering dental fillings, what's the biggest decision you’re most likely to have to make before your appointment?

It's very probable that you need to make a choice between white or mercury amalgam (AKA silver or black) fillings.

So do you ask a friend what they recommend, or research online to see what others suggest? 

While we always advise both new and existing clients to be proactive and stay informed about your dental health, we also encourage you to always discuss your choices with either our Team or other dental professionals before committing to your appointments or procedures.

To help guide you when making the decision between white and amalgam fillings, Milford Dentists have gathered answers to some of the most common questions below.

What Are White Fillings?

With modern dentistry, there is a range of dental filling materials available. 

A composite or white filling is a mixture of tooth-coloured plastic and glass that contain no toxic substances and are used by dentists to restore decayed teeth or for cosmetics improvements.

Your teeth can also be filled with gold; porcelain or silver mercury amalgam (which consists of 50% mercury mixed with silver, tin, zinc, and copper) Learn more about white fillings here

  

Above: Old amalgam fillings replaced with white fillings

When Are White Fillings Used?

Fillings are typically used to repair decayed tooth and or teeth that have broken down, but early decay does not always mean you need a filling – talk to us about a simple dental hygiene check-up

While used to repair teeth that have decayed/fractured composite or white fillings are also used for cosmetic improvements of the smile by changing the colour of your teeth or reshaping teeth with a poor shape.

Above: Colour matched white fillings as amalgam replacement

If the size of your cavity is small to medium, or if your tooth gets a lot of chewing action a composite filling is generally strong enough to fix the problem.

Why Replace Amalgam With White Fillings?

At Milford Dentists, we have been replacing amalgam filled teeth for more than 30 years. We have discovered with the older amalgam fillings that the encasing tooth often has stress fractures present leading to cusp fracturing and there is almost always dental decay beneath them.

We believe white fillings along with crowns/overlays/caps are physically superior alternatives to traditional dental amalgam fillings and we consider them to be stronger, safer and more durable. Milford Dentists have opted to be Mercury Amalgam Free since 1999.

What Are The Advantages of White Fillings?

Dentists can closely match the colour of a composite or white filling to the colour of your teeth - these restorations are a much better more biomimetic (life like) alternative.

Composites can also be a better choice for people who are afraid of dental work, since these fillings are also bonded or “glued” into the tooth cavity, requiring less drilling. Learn more about the differences between composite and amalgam fillings here

How Long Do They Last?

While a long-term solution to dental decay or for cosmetic corrections, these tooth coloured fillings (as with most dental repairs) will eventually require attention. Studies indicate composites can last from 6 -7 years, although many of our patients have found the white fillings we placed lasting for far longer periods of time and consider composite resin fillings are a very durable option.

Want to know more about your choices for dental cavities and repair? Talk to us today to learn more about the benefits of composite resin (white fillings)  vs traditional amalgam fillings and why we have haven’t placed a dental amalgam filling since 1999

Mercury & Amalgam Silver Filling Removal

While mercury amalgam (aka silver, metal or black) fillings have been a mainstay cavity solution for more than 150 years, new dental techniques and technology have enabled the development of durable, high strength alternatives that include composite resin white fillings, dental crowns and porcelain overlays.

At Milford Dentists, we have used these more natural-looking materials for filling teeth cavities for more than 30 years and have opted to be mercury amalgam free since 1999. For a variety of reasons, a growing number of prospective and existing clients are requesting amalgam filling removal and replacing the silver with more aesthetically appealing white composite.

To help answer some of the many questions asked about silver filling removal we’ve compiled a simple FAQ guide below. And if there’s anything else you need to about removing mercury fillings, don’t hesitate to make contact here or call us on (09) 489 6575.

What Are Mercury Amalgam or Silver Fillings?

Although more commonly known as silver fillings, amalgam fillings contain very little silver. Instead, amalgam fillings are made from a variety of materials – a powdered alloy of silver, tin, zinc and copper, with liquid mercury making up almost 50 percent of the compound.

Mercury is used to bind the alloy metal particles together, resulting in a strong and durable filling for dental cavities.

Are White Fillings Better Than Amalgam?

Today there is a wider variety of dental filling materials available. Your teeth can be repaired not only with mercury amalgam but also gold, porcelain, or our preferred choice - natural tooth coloured composite resin fillings.

These composite or white fillings are a combination of tooth-coloured plastic and glass that are free of toxic substances and customisable to match your teeth, so are suitable not just for restoring decayed teeth, but also for cosmetic improvements.

While the FDA currently considers dental amalgam fillings safe, many clients prefer to have their fillings replaced with composite resin or choose white fillings for new and future dental repair work.

Why Choose White Fillings?

For almost two decades Milford Dentists have been using improved tooth coloured composite resin fillings and advanced bonded (or adhesive) dental techniques to mimic the strength and appearance of your original tooth. These composite white resin restorations are very strongly bonded to your teeth and make the tooth almost as strong as it was before decay occurred.

Amalgam fillings, however, are not actually attached or bonded to your tooth; they simply fill the gap where the cavity has been removed and do not strengthen teeth. An amalgam filling acts like a wedge. When biting down on the filling, the forces are transferred to the remaining tooth structure. This issue of twisting, bending and flexing of the amalgam filling occurs daily on teeth during ordinary chewing, putting further stress on amalgam fillings.

Also, when the amalgam filling heats up and expands (e.g. while drinking coffee) or cools down and contracts (e.g. while eating a frozen dessert), gaps open up around the filling - risking cracks and stress fractures in the tooth structure.

When using white coloured composites, the adhesion to the tooth means that if chewing or biting down, the force is distributed across the tooth structure more evenly than it is with amalgam fillings, reducing the likelihood of tooth cracking or fractures.

Consequently, when replacing old mercury amalgams with tooth coloured filling or porcelain crown/overlay, our team have frequently discovered undiagnosed cracks, fracture lines or decay.

And, many of these issues are not visible on the tooth surface or by x-ray.

Why Are Cavities Difficult To Identify Under Amalgam Fillings?

Because of their metal content, silver fillings are opaque to x-rays and therefore cavities below the fillings are difficult to identify (unless quite substantial). Industry experience has shown that without x-rays, only as much as 50% of these dental issues are visible during an examination and full x-rays will only display 80-85% of issues. 

The Benefits of Composite White Filling Bonding

At Milford Dentists, we have adopted the bonding process of pioneering US dentist Dr Dave Allerman that recreates the join between enamel and dentine to strengthen the tooth. We also, in certain circumstances, have utilised his protocol that bonds tooth fractures together using a high strength Ribbond mat – a material similar in structure to Kevlar used in bullet proof vests. As a result of implementing these processes, when replacing mercury amalgam fillings with white composite resin, the tooth can become stronger - almost as strong as the healthy tooth prior to decay.

What is The Procedure for Silver or Amalgam Filling Removal?

If you wish to cosmetically improve your smile or have concerns over your health with regard to existing amalgam, our staff can discuss with you the safe and easy removal of silver fillings at a consultation.

At Milford Dentists, during a single visit we can safely remove several amalgam fillings if required and use metal free alternatives to reconstruct your smile with either tooth coloured composite resin or porcelain CAD/ CAM E4d overlays, onlays and crowns.

1. Patients, when requested, receive oxygen to prevent inhalation of any mercury vapour or amalgam particulate during the procedure.

2. A dental or rubber/nitrile dam is placed and sealed over the tooth or teeth being worked on to isolate them from your mouth - essentially the rubber dam sheet when inserted keeps your tooth "outside your mouth during the procedure creating a very thin barrier. The dental dam makes the bonding process of creating long-lasting, beautiful restorations more predictable, quicker and easier to complete.

While using the rubber dental dam, a small yet powerful suction pipe or saliva ejector also removes any mercury vapour, saliva and amalgam particles or slurry from the the rubber dam working area.

3. The filling is then drilled out in chunks  (chunking or sectioning) These “chunks” can then easily be removed by a hand instrument or suction.

This process requires less drilling because our dentists only drill enough to segment the filling into chunks.

4. During the amalgam removal process, the drilling of amalgam fillings generates significant heat, which can cause an increase in the release of mercury vapour. To minimise this vapour release, the filling, whilst being removed, is cooled with water and air.

We are happy to work with your health practitioner who will often augment our dental treatment with IV or tablets of vitamin C, charcoal scavenger tablets, chlorella, etc.

If you want to know more about amalgam filling removal - get in contact here or call us on (09) 489 6575.

Posted by Andrea

What Are Composite Fillings Made Of?

Composite resins (a.k.a. white or tooth-colored fillings) provide a durable, strengthened alternative or replacement to traditional amalgam (a.k.a. silver or mercury) fillings. 

Modern composites can be applied to either front or back teeth. They are made from a blend of non-toxic tooth-coloured plastic and glass beads for dental restoration of decayed or fractured teeth and cosmetic improvements.

The use of dental composite resins began in the late 1960’s when composite resins were introduced as an alternative to silicates and unfulfilled resins which were then frequently used for restorative dental work.

Contemporary composite resins are typically formulated from:

• Bis-GMA (bisphenol A-glycidyl methacrylate)

• Dimethacrylate monomers (TEGMA, UDMA, HDDMA)

• Filler materials eg. Silica (Silicon dioxide) silica

• Synthetic photoinitiator

• Dimethylglyoxime

The physical properties of resin composites can be revised for specific dental needs by formulating unique concentrations of each of these constituents.

The Milford Dental team believe white fillings in addition to crowns, overlays or caps are a physically superior alternative to traditional dental amalgam fillings and consider them to be a stronger, safer and more durable dental solution.

As a commitment to providing the best dental services and products for our clients, Milford Dentists have opted to be Mercury Amalgam Free since 1999.

The History Of Composite Fillings

Initially, composites were set by a chemical reaction between two pastes containing an activator (tertiary amine) and an initiator (benzoyl peroxide). To overcome some procedural disadvantages, light-curing, UV resin composites were introduced during the 1970’s. However, limitations and risks from the first ultraviolet units meant they were later replaced by visible light-curing systems.

As the 1970’s came to a close, a new range of micro filled systems was introduced into the European market that provided increased colour stability and higher resistance to wear than previous composites.

By 1981, micro filled composites had been improved remarkably and a new acid etch technique was implemented and a bonding agent was applied.

Composite fillings are now bonded to the tooth, which strengthens its structure and restores some of the tooth's original dental integrity. Very high bond strengths to tooth structure, both enamel and dentin, can be achieved with the current generation of dentin/enamel bonding agents.

Composite Fillings Today

Composite resin fillings can now be used to repair chipped, broken or worn teeth which would not be suitable for repair using amalgam or mercury fillings. 

Minor damage to a composite filling can often now be easily repaired by adding additional composite material, whereas amalgam fillings often require a complete replacement.

Ideally, the best dental filling is no dental filling. You can significantly decrease the risk of cavities and other dental issues simply by:

• Brushing twice daily with fluoride toothpaste
• Flossing daily
• Eating a balanced diet
• Having regular dental visits

Considering a composite resin white filling for restoration or replacement? Contact Milford Dentists at (09) 489 6575 to learn more or schedule a visit today. We will check out your dental history, discuss your treatment options, and get you back on track towards optimal oral health with a brand new bright, white smile.

Posted by Andrea

The Tooth Decay Process: How To Reverse It And Avoid Cavities

No-one likes it, but we’re all used to it. Tooth decay and cavities can be avoided, yet most of us have experienced many painful trips to the dentist. Root fillings, tooth crowns, composite veneers – they’re no fun for anyone! If you want to keep your smile looking great for years to come, take care of your teeth before any problems arise. Here are five ways to reverse the tooth decay process.

Brush Twice Daily

Some of us are better at it than others, but we should all be brushing our teeth at least twice a day with good technique for 2 minutes. You know when you’ve crashed somewhere after a party, and your mouth is yuck and you scrape fuzzy stuff off your teeth? That’s plaque.

Plaque is the soft, sticky, bacteria-laden film that builds up on your exposed enamel. When left alone for too long, plaque can harden into tartar, which in turn can lead to gingivitis, an early stage of gum disease. Plaque can also cause tooth decay and – just as terrifying – bad breath.

Brushing your teeth regularly will remove plaque, leaving your mouth healthy and smelling fresh. Use a soft bristled toothbrush and brush in a gentle, circular motion. 

Floss Daily

Floss is an interdental cleaner, designed to clean the tight, hard to reach spaces in between your teeth. It may seem pedantic, but it’s really not. Brushing removes plaque from most of the surfaces of your teeth, but flossing removes plaque and food particles that are lodged in the parts the tooth brush doesn't reach.

Floss at least once a day.

 

Eat a Balanced Diet

A no brainer, right? What you eat affects your oral health. We all know that sugar causes tooth decay, but which foods are good for our teeth? Whole grains, fruits at main meal times, vegetables, lean sources of protein such as lean beef and legumes, and low fat and fat-free dairy foods are your friends.

But it’s not just what you eat – it’s how you eat it. Foods that are eaten as part of a meal do less harm to your teeth, as more saliva is produced during longer eating sessions. Saliva helps wash down food and lessens the effect of acids in food. If it’s not realistic for you to quit snacking, reach for something crunchy and fresh, like a stalk of celery!

Drink Plenty of Water

Did you know that saliva is 99% water? Having low levels of saliva causes a dry mouth, which leads to bad breath and all sorts of dental issues. As mentioned above, saliva washes down food and protects your teeth during meals. In fact, saliva is your mouth’s first defense against mouth decay.

Visit Your Dentist Twice a Year (Or More)

We recommend you visit a dentist twice a year for a regular check-up. If you are a smoker, pregnant or currently have a gum disease or are prone to mouth infections, you should make an appointment with your local dentist every 3-4 months. It’s cheaper to prevent tooth decay and cavities than it is to fix them, so be proactive and look out for your oral health!