Dental Materials Fact Sheet

WHAT ABOUT THE SAFETY OF FILLING MATERIALS?

 

Patient health and the safety of dental treatments are the primary goals of California’s dental professionals and the Dental Board of California. The purpose of this fact sheet is to provide you with information concerning the risks and benefits of all the dental materials used in the restoration (filling) of teeth.

The Dental Board of California is required by law* to make this dental materials fact sheet available to every licensed dentist in the state of California. Your dentist, in turn, must provide this fact sheet to every new patient and all patients of record only once before beginning any dental filling procedure.

As the patient or parent/guardian, you are strongly encouraged to discuss with your dentist the facts presented concerning the filling materials being considered for your particular treatment.

 

ALLERGIC REACTIONS TO DENTAL MATERIALS

 

Components in dental fillings may have side effects or cause allergic reactions, just like other materials we may come in contact with in our daily lives. The risks of such reactions are very low for all types of filling materials.

Such reactions can be caused by specific components of the filling materials such as mercury, nickel, chromium, and/or beryllium alloys. Usually, an allergy will reveal itself as a skin rash and is easily reversed when the individual is not in contact with the material.

There are no documented cases of allergic reactions to composite resin, glass ionomer, resin ionomer, or porcelain However, there have been rare allergic responses reported with dental amalgam, porcelain fused to metal, gold alloys, and nickel or cobalt-chrome alloys.

If you suffer from allergies, discuss these potential problems with your dentist before a filling material is chosen.

 

TOXICITY OF DENTAL MATERIALS

 

Dental Amalgam

Mercury in its elemental form is on the State of California’s Proposition 65 list of chemicals known to the state to cause reproductive toxicity. Mercury may harm the developing brain of a child or fetus.

Dental amalgam is created by mixing elemental mercury (43-54%} and an alloy powder (46-57%) composed mainly of silver, tin, and copper. This has caused discussion about the risks of mercury in dental amalgam. Such mercury is emitted in minute amounts as vapor. Some concerns have been raised regarding possible toxicity. Scientific research continues on the safety of dental amalgam. According to the Centers for Disease Control and Prevention, there is scant evidence that the health of the vast majority of people with amalgam is compromised.

The Food and Drug Administration (FDA) and other public health organizations have investigated the safety of amalgam used in dental fillings. The conclusion: no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergy. The World Health Organization reached a similar conclusion stating, “Amalgam restorations are safe and cost effective.”

A diversity of opinions exists regarding the safety of dental amalgams. Questions have been raised about its safety in pregnant women, children, and diabetics. However, scientific evidence and research literature in peer-reviewed scientific journals suggest that otherwise healthy women, children, and diabetics are not at an increased risk from dental amalgams in their mouths. The FDA places no restrictions on the use of dental amalgam.

 

TOXICITY OF DENTAL MATERIALS

 

Some Composite Resins include Crystalline Silica, which is on the State of California’s Proposition 65 list of chemicals known to the state to cause cancer.

It is always a good idea to discuss any dental treatment thoroughly with your dentist.

 

DENTAL AMALGAM FILLINGS

 

Dental amalgam is a self-hardening mixture of silver-tin-copper alloy powder and liquid mercury and is some-times referred to as silver fillings because of its color. It is often used as a filling material and replacement for broken teeth.

Advantages

  • Durable; long lasting
  • Wears well; holds up well to the forces of biting
  • Relatively inexpensive
  • Generally completed in one visit
  • Self-sealing; minimal to no shrinkage and resists leakage
  • Resistance to further decay is high, but can be difficult to find in early stages
  • Frequency of repair and replacement is low

Disadvantages

  • Refer to “What About the Safety of Filling Materials”
  • Gray colored, not tooth colored
  • May darken as it corrodes; may stain teeth overtime
  • Requires removal of some healthy tooth
  • In larger amalgam fillings, the remaining tooth may weaken and fracture
  • Because metal can conduct hot and cold temperatures, there may be a temporary sensitivity to hot and cold
    Contact with other metals may cause occasion-al, minute electrical flow
  • The durability of any dental restoration is influenced not only by the material it is made from but also by the dentist’s technique when placing the restoration. Other factors include the supporting materials used in the procedure and the patient’s cooperation during the procedure. The length of time a restoration will last is dependent upon your dental hygiene, home care, and diet and chewing habits.

 

COMPOSITE RESIN FILLINGS

 

Composite fillings are a mixture of powdered glass and plastic resin, sometimes referred to as white, plastic, or tooth colored fillings. It is used for fillings, inlays, veneers, partial and complete crowns, or to repair portions of broken teeth.

Advantages

  • Strong and durable
  • Tooth colored
  • Single visit for fillings
  • Resists breaking
  • Maximum amount of tooth preserved
  • Small risk of leakage if bonded only to enamel
  • Does not corrode
  • Generally holds up well to the forces of biting, depending on product used
  • Resistance to further decay is moderate and easy to find
  • Frequency of repair or replacement is low to moderate

Disadvantages

  • Refer to ‘What About the Safety of Filling Materials”
  • Moderate occurrence of tooth sensitivity; sensitive to dentist’s method of application
  • Costs more than dental amalgam
  • Material shrinks when hardened and could lead to further decay and/or temperature sensitivity
  • Requires more than one visit for inlays, veneers, and crowns
  • May wear faster than dental enamel
  • May leak over time when bonded beneath the layer of enamel

 

GLASS-MONOMER CEMENT

 

Glass ionomer cement is a self-hardening mixture of glass and organic acid. It is tooth-colored and varies in translucency. Glass ionomer is usually used for small fillings, cementing metal and porcelain/metal crowns, liners, and temporary restorations.

Advantages

  • Reasonably good esthetics
  • May provide some help against decay
  • Minimal amount of tooth needs to be enamel and the dentin beneath the enamel
  • Material has low incidence of
  • Usually completed in one dental visit

Disadvantages

  • Because it releases fluoride
  • Removed and it bonds well to both the producing tooth sensitivity
  • Cost is very similar to composite resin (which costs more than amalgam)
  • Limited use because it is not recommended for biting surfaces in permanent teeth
  • As it ages, this material may become rough and could increase the accumulation of plaque and chance of periodontal disease
  • Does not wear well; tends to crack over time and can be dislodged

 

RESIN-MONOMER CEMENT

 

Resin ionomer cement is a mixture of glass and resin polymer and organic acid that hardens with exposure to a blue light used in the dental office. It is tooth colored but more translucent than glass ionomer cement. It is most often used for small fillings, cementing metal and porcelain metal crowns and liners.

Advantages

  • Very good esthetics
  • May provide some help against decay because
  • Minimal amount of tooth needs to be removed beneath the enamel
  • Good for non-biting surfaces
  • it releases fluoride
  • and it bonds well to both the enamel and the dentin
  • May be used for short-term primary teeth restorations
  • May hold up better than glass ionomer but not as well as composite
  • Good resistance to leakage
  • Material has low incidence of producing tooth
  • Usually completed in one dental visit

Disadvantages

  • Sensitivity
  • Cost is very similar to composite resin (which costs more than amalgam)
  • Limited use because it is not recommended to restore the biting surfaces of adults
  • Wears faster than composite and amalgam

 

PORCELAIN (CERAMIC)

 

Porcelain is a glass-like material formed into fillings or crowns using models of the prepared teeth. The material is tooth-colored and is used in inlays, veneers, crowns and fixed bridges.

Advantages

  • Very little tooth needs to be removed for use as crown because its strength is related to its bulk
  • Good resistance to further decay if the restoration fits well
  • Is resistant to surface wear but can cause some
  • Resists leakage because it can be shaped for a
  • The material does not cause tooth sensitivity

Disadvantages

  • Material is brittle and can break under biting forces
  • May not be recommended for molar teeth
  • Higher cost because it requires at least two office visits and laboratory services

 

NICKEL OR COBALT-CHROME ALLOYS

 

Nickel or cobalt-chrome alloys are mixtures of nickel and chromium. They are a dark silver metal color and are used for crowns and fixed bridges and most partial denture frameworks.

Advantages

  • Good resistance to further decay if the restore
  • Excellent durability; does not fracture under stress
  • Does not corrode in the mouth
  • Minimal amount of tooth needs to be removed
  • Resists leakage because it can be shaped for

Disadvantages

  • Is not tooth colored; alloy is a dark silver metal color
  • Conducts heat and cold; may irritate sensitive teeth
  • Can be abrasive to opposing teeth
  • High cost; requires at least two office visits and laboratory services
  • Slightly higher wear to opposing teeth

 

PORCELAIN FUSED TO METAL

 

This type of porcelain is a glass-like material that is “enameled” on top of metal shells. It is tooth-colored and is used for crowns and fixed bridges.

Advantages

  • Good resistance to further decay if the restoration fits well
  • Very durable, due to metal substructure
  • The material does not cause tooth sensitivity
  • Resists leakage because it can be shaped for a very accurate fit

Disadvantages

  • More tooth must be removed (than for porcelain) for the metal substructure
  • Higher cost because it requires at least two office visits and laboratory services

 

GOLD ALLOY

 

Gold alloy is a gold-colored mixture of gold, copper, and other metals and is used mainly for crowns and fixed bridges and some partial denture frameworks.

Advantages

  • Good resistance to further decay if the restoration fits well
  • Excellent durability; does not fracture under stress
  • Does not corrode in the mouth
  • Minimal amount of tooth needs to be removed
  • Wears well; does not cause excessive wear to opposing teeth very accurate fit
  • Resists leakage

Disadvantages

  • Is not tooth colored; alloy is yellow
  • Conducts heat and cold; may irritate sensitive teeth

 

Comparisons of Direct Restorative Dental Materials

 

TYPES OF DIRECT RESTORATIVE DENTAL MATERIALS
COMPARATIVE FACTORSAMALGAMCOMPOSITE RESIN (DIRECT AND INDIRECT RESTORATIONS)GLASS IONOMER CEMENTRESIN-IONOMER CEMENT
General descriptionSelf-hardened mixture in varying percentages of a liquid mercury and silver-tin alloy powder.Mixture of powdered glass and plastic resin; self-hardening or hardened by exposure to blue light.Self-hardening mixture of glass and organic acid.Mixture of glass and resin polymer and organic acid; selfhardening by exposure to blue light.
Principle UsesFillings; sometimes for replacing portions of broken teeth.Fillings, inlays, veneers, partial and complete crowns; sometimes for replacing portions of broken teeth.Small fillings; cementing metal and porcelain/metal crowns, liners, temporary restorations.Small fillings; cementing metal and porcelain/metal crowns, and liners.
Resistance to Further DecayHigh. Self-sealing characteristic helps resist recurrent decay; but recurrent decay around amalgam is difficult to detect in its early stagesModerate. Recurrent decay is easily detected in early stages.Low to moderate. Some resistance to decay may be imparted through fluoride release.Low to moderate. Some resistance to decay may be imparted through fluoride release.
Estimated Durability (permanent teeth)Durable.Strong, durable.Non-stress bearing crown cement.Non-stress bearing crown cement.
Relative Amount of Tooth PreservedFair. Requires removal of healthy tooth to be mechanically retained; no adhesive blond or amalgam to the tooth.Excellent. Bonds adhesively to healthy enamel and dentin.Excellent. Bonds adhesively to healthy enamel and dentin.Excellent. Bonds adhesively to healthy enamel and dentin
Resistance to Surface WearResistant to surface wear, but abrasive to opposing teeth.Resistant to surface wear; permits either metal or porcelain on the biting surface of crowns and bridges.Similar hardness to natural enamel; does not abrade opposing teeth.Harder than natural enamel but minimally abrasive to opposing natural teeth; does not fracture in bulk.
Resistance to FracturePoor resistance to fracture.Porcelain may fractureDoes not fracture in bulk.Does not fracture in bulk
Resistance to LeakageVery good. Can be fabricated for very accurate fit of the margins of the crowns.Good to very good, depending on design of the margins of the crowns.Very good to excellent. Can be formed with great precision and can be tightly adapted to the tooth.Good to very good. Stiffer than gold; less adaptable, but can be formed with great precision.
Resistance to Occlusal StressModerate. Brittle material susceptible to fracture under biting forces.Very good. Metal substructure gives high resistance to fracture.Excellent.Excellent.
ToxicityExcellent. No known adverse effects.Very good to excellent. Occasional/ rare allergy to metal alloys used.Excellent. Rare allergy to some alloys.Good. Nickel allergies are common among women, although rarely manifested in dental restorations.
Allergic or Adverse ReactionsNone.Rare. Occasional allergy to metal substructures.Rare. Occasional allergic reactions seen in susceptible individuals.Rare. Infrequent reactions to nickel.
Susceptibility to Post-Operative SensitivityNot material-dependent; does not conduct heat and cold well.Not material-dependent; does not conduct heat and cold well.Conducts heat and cold; may irritate sensitive teeth.Conducts heat and cold; may irritate sensitive teeth.

TYPES OF DIRECT RESTORATIVE DENTAL MATERIALS (continued)

COMPARATIVE FACTORSAMALGAMCOMPOSITE RESIN (DIRECT AND INDIRECT RESTORATIONS)GLASS IONOMER CEMENTRESIN-IONOMER CEMENT
Esthetics (Appearance)Excellent.Good to excellent.Poor. Yellow metal.Poor. Dark silver metal.
Frequency of Repair or ReplacementVaries. Depends on biting forces; fractures of molar teeth are more likely than anterior teeth; porcelain fracture may often be repaired with composite resinInfrequent. Porcelain fracture can often be repaired with composite resin.Infrequent. Replacement is usually due to recurrent decay around margins.Infrequent. Replacement is usually due to recurrent decay around margins.
Relative Costs to PatientHigh. Requires at least two office visits and laboratory services.High. Requires at least two office visits and laboratory services.High. Requires at least two office visits and laboratory services.High. Requires at least two office visits and laboratory services.
Number of Visits Required.Two, minimum. Matching esthetics of teeth may require more visits.Two, minimum. Matching esthetics of teeth may require more visits.Two, minimum.Two, minimum.

Comparisons of Indirect Restorative Dental Materials

TYPES OF INDIRECT RESTORATIVE DENTAL MATERIALS
COMPARATIVE FACTORSPORCELAIN (CERAMIC)PORCELAIN (FUSED-TO-METAL)GOLD ALLOWS (NOBLE)NICKEL OR COBALT-CHROME (BASE-METAL) ALLOYS
General DescriptionGlass-like material formed into fillings and crowns using models of the prepared teeth.Glass-like material that is “enameled” onto metal shells. Used for crowns and fixed bridges.Mixtures of gold, copper, and other metals used mainly for crowns and fixed bridges.Mixtures of nickel, chromium.
Principle UsesInlays, veneers, crowns and fixed bridges.Crowns and fixed bridges.Cast crowns and fixed bridges; some partial denture frameworks.Crowns and fixed bridges; most partial denture frameworks.
Resistance to Further DecayGood, if the restoration fits well.Good, if the restoration fits well.Good, if the restoration fits well.Good, if the restoration fits well
Estimated Durability (Permanent Teeth)Moderate. Brittle material that may fracture under high biting forces. Not recommended for posterior (molar) teeth.Very good. Less susceptible to fracture due to the metal substructure.Excellent. Does not fracture under stress; does not corrode in the mouth.Excellent. Does not fracture under stress; does not corrode in the mouth.
Relative Amount of Tooth PreservedGood to moderate. Little removal of natural tooth is necessary for veneers; more for crowns since strength is related to its bulk.Moderate to high. More tooth must be removed to permit the metal to accompany the porcelain.Good. A strong material that requires removal of a thin outside layer of the tooth.Good. A strong material that requires removal of a thin outside layer of the tooth.
Resistance to Surface WearResistant to surface wear, but abrasive to opposing teeth.Resistant to surface wear; permits either metal or porcelain on the biting surface of crowns and bridges.Similar hardness to natural enamel; does not abrade opposing teeth.Harder than natural enamel, but minimally abrasive to opposing natural teeth; does not fracture in bulk.
Resistance to FracturePoor resistance to fracture.Porcelain may fracture.Does not fracture in bulk.Does not fracture in bulk.
Resistance to LeakageVery good. Can be fabricated for very accurate fit of the margins of the crowns.Good to very good, depending on design of the margins of the crowns.Very good to excellent. Can be formed with great precision and can be tightly adapted to the tooth.Good to very good. Stiffer than gold; less adaptable, but can be formed with great precision.
Resistance to Occlusal StressModerate. Brittle material susceptible to fracture under biting forces.Very good. Metal substructure gives high resistance to fracture.Excellent.Excellent.
ToxicityExcellent. No known adverse effects.Very good to excellent. Occasional/ rare allergy to metal alloys used.Excellent. Rare allergy to some alloys.Good. Nickel allergies are common among women, although rarely manifested in dental restorations.
Allergic or Adverse ReactionsNone.Rare. Occasional allergy to metal substructures.Rare. Occasional allergic reactions seen in susceptible individuals.Rare. Infrequent reactions to nickel.
Susceptibility to Post-Operative SensitivityNot material-dependent; does not conduct heat and cold well.Not material-dependent; does not conduct heat and cold well.Conducts heat and cold; may irritate sensitive teeth.Conducts heat and cold; may irritate sensitive teeth.
TYPES OF INDIRECT RESTORATIVE DENTAL MATERIALS (continued)
COMPARATIVE FACTORSPORCELAIN (CERAMIC)PORCELAIN (FUSED-TO-METAL)GOLD ALLOWS (NOBLE)NICKEL OR COBALT-CHROME (BASE-METAL) ALLOYS
Frequency of Repair or ReplacementVaries. Depends on biting forces; fractures of molar teeth are more likely than anterior teeth; porcelain fracture may often be repaired with composite resin.Infrequent. Porcelain fracture can often be repaired with composite resin.Infrequent. Replacement is usually due to recurrent decay around margins.Infrequent. Replacement is usually due to recurrent decay around margins.
Relative Costs to PatientHigh. Requires at least two office visits and laboratory services.High. Requires at least two office visits and laboratory services.High. Requires at least two office visits and laboratory services.High. Requires at least two office visits and laboratory services.
Number of Visits RequiredTwo, minimum. Matching esthetics of teeth may require more visits.Two, minimum. Matching esthetics of teeth may require more visits.Two, minimum.Two, minimum.

 

Glossary of Terms

General Description. Brief statement of the composition and behavior of the dental material.

Principle Uses. The types of dental restorations that are made from this material.

Resistance to further decay. The general ability of the material to prevent decay around it.

Longevity/Durability. The probable average length of time before the material will have to be replaced. (This will depend upon many factors unrelated to the material, such as biting habits of the patient, their diet, the strength of their bite, oral hygiene, etc.)

Conservation of Tooth Structure. A general measure of how much tooth needs to be removed in order to place and retain the material.

Surface Wear/Fracture Resistance. A general measure of how well the material holds up over time under the forces of biting, grinding, clenching, etc.

Marginal Integrity (Leakage). An indication of the ability of the material to seal the interface between the restoration and the tooth, thereby helping to prevent sensitivity and new decay.

Resistance to Occlusal Stress. The ability of the material to survive heavy biting forces over time.

Biocompatibility. The effect, if any, of the material on the general overall health of the patient.

Allergic or Adverse Reactions. Possible systemic or localized reactions of the skin, gums and other tissues to the material.

Toxicity. An indication of the ability of the material to interfere with normal physiologic processes beyond the mouth.

Susceptibility to Sensitivity. An indication of the probability that the restored teeth may be sensitive of stimuli (heat, cold, sweet, pressure) after the material is placed in them.

Esthetics. An indication of the degree to which the material resembles natural teeth

Frequency of Repair or Replacement. An indication of the expected longevity of the restoration made from this material.

Relative Cost. A qualitative indication of what one would pay for a restoration made from this material compared to all the rest.

Number of Visits Required. How many times a patient would usually have to go to the dentist’s office in order to get a restoration made from this material.

Dental Amalgam. Filling material which is composed mainly of mercury (43-54%) and varying percentages of silver, tin, and copper (46-57%).

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