A Guide to Choosing Fillings

Need to get a filling, but not sure what amalgam is?

Well, it’s important to know the difference between amalgam and composite fillings because the majority of us will have at least one or more fillings in our lifetime. If you’re like me, it’s easy to see the difference between the amalgam (silver) and composite (white), but not as easy to truly understand the distinction beyond color.

Despite concern over mercury content in amalgam fillings and BPA exposure in composite fillings, both are considered safe by the American Dental Association and are recognized as effective ways to treat tooth decay.

So what’s the best choice for you?

Amalgam vs. Composite

Amalgam fillings have been used by dentists for more than 150 years and are made from a mixture of metals, including silver, tin, zinc and copper. Amalgam fillings are noted for their durability, strength and affordability.

Composite fillings are the most popular alternatives to amalgam fillings. They are made from acrylic components and microscopic glass particles.  Many patients choose this option because it is more cosmetically appealing than silver fillings.

Amalgam Advantages:

  • Durability – “silver” fillings last at least 10 to 15 years
  • Strength – withstand chewing forces
  • Affordability – less expensive than composite fillings

Although amalgam fillings usually outlast composite fillings, the silver coloring may pose a problem for applying amalgam to the front teeth. Some people dislike that it does not match the natural tooth and creates a grayish hue to the surrounding tooth.

Amalgam Disadvantages:

  • Aesthetics – amalgam fillings don’t match the natural tooth color
  • Destruction of tooth – healthy parts of tooth must often be removed to make enough space for the filling
  • Cracks and fractures –material can expand and contract, causing cracks and fractures
  • Allergic reactions – 1% of people are allergic to the mercury present in amalgam material

Composite Advantages:

  • Aesthetics – composite fillings can be closely matched to the natural tooth color, a better choice for front teeth use.
  • Chemical bond – composite fillings chemically bond to tooth structure, providing additional support
  • Tooth-sparing – requires minimal removal of tooth structure for placement

Despite the cosmetic and structural advantages of composite fillings, there are a few disadvantages that affect the cost of such fillings.

Composite Disadvantages:

  • Lack of durability – wear out sooner than amalgam fillings and may not last as long as amalgam fillings under the pressure of chewing
  • Time – placing the filling can take up to 20 minutes longer than amalgam fillings
  • Additional visits – if used for inlays or onlays, more than one office visit may be necessary
  • Chipping – composite materials can chip off teeth
  • Cost –can cost twice as much as amalgam fillings

Dental Insurance and Fillings

Although both amalgam and composite fillings are deemed safe by the ADA, some dental plans only cover amalgam fillings.

Why?

Plans with an “Alternative Benefit Provision” provide benefits for the most cost-efficient yet effective dental services and treatments. This means your insurance carrier will pay for the less expensive treatment when other acceptable methods are available.

However, some plans cover composite fillings, such as those that contain a cosmetic rider, or if you have documented allergies to metal. If these exclusions do not apply and you choose a composite filling, your insurance carrier will pay the plan’s designated portion for the cost of an amalgam filling and you will be responsible for the difference in cost, in addition to any applicable coinsurance.

Each filling material has its pros and cons. Consult your dentist about which type of filling will work best for you.