When you visit a dentist and your dentist has noticed a hole or cavity in your tooth, the dentist may then recommend that you have a filling placed in your mouth. The next discussion will probably be whether you want a white filling or whether you want a traditional silver or amalgam filling. Source: http://muzzafarzaman.weebly.com/blog/advantages-and-disadvantages-of-white-fillings

1. Advantages and Disadvantages of
White fillings.
When you visit a dentist and your dentist has noticed a hole
or cavity in your tooth, the dentist may then recommend that
you have a ​filling​ placed in your mouth. The next discussion
will probably be whether you want a white filling or whether
you want a traditional silver or amalgam filling. Furthermore,
if you have an existing silver filling and that breaks or it
comes off and you need to have it replaced, again your
dentist will give you a choice as to whether you want another
silver filling in there or you would like a white filling. This is a
question that dentists do get asked a number of times every
day and there's lots of information on the internet and there
are also huge comments on this particular subject. In this
article, we have hopefully made a logical and sound summary based on the scientific studies
and ideas and not purely just on emotion.
Dental cavities are extremely common and more than
50% of all adults over the age of 20 will have had at
least one cavity in their permanent teeth. And these
cavities will have been filled at some point by a
dentist. In addition, about a quarter of people who do
have cavities in their mouth don't even have these
treated. The result of this is usually the cavity gets
bigger until the person gets sensitivity, ​toothache​, and
infection or even a ​dental abscess​. This then
becomes an emergency and often it is too late to save
that tooth. You usually cannot see a cavity by opening
your mouth in front of the bathroom mirror. The reason for that is that cavities are more
common at the back of the mouth and in areas which are hidden by direct vision. These
areas are called interdental areas and these are in between the teeth where they meet and
often near the gumline. In addition cavities can also occur on the biting surface of the tooth
and known as ​Pits and Fissures​. Pits and Fissures are the tiny tiny natural cracks on the
biting surface of your teeth. A significant amount of dental decay occurs in these cracks and
these are not readily visible by just looking at your teeth in the bathroom mirror.
So the first thing that you may notice that points to a cavity, is generalized or localized
sensitivity to hot, cold or sweet things. Initially it probably won't last for more than a few
seconds and if ignored, then this pain becomes more severe and it seems to come on for a
lot longer and eventually it will be continuous.

2. Dentists spend a lot of their time in their training trying to recognise and detect dental
cavities and the basics of this are that you need a good light, you need a dry tooth, and
sometimes you can use a ​dental probe​ which you can use to feel the surface of the tooth to
see if there are any changes in texture. In addition, dentists also use X-rays and these are
extremely valuable and essential to detect cavities, especially early cavities before they
become more extensive. ​X-rays​ taken at the dental surgery can also tell if the nerve of the
tooth is also under attack and whether the Decay has started to progress into the root of a
tooth causing an abscess. The detection of cavities is not an exact science. You can have
10 different dentists and they all see the same patient but they all come with a different
treatment plan. This does not mean one dentist is wrong and the other one is correct. It does
not mean that one dentist is trying to find more holes than necessary. It is not an exact
science and perhaps this is one of the reasons why when you do find a good dentist, you
should stick with that dentist so the dentist starts to get to know you, he gets to know your
habits, your ​tooth brushing technique​, your diet and also can keep an eye on you by
monitoring your teeth closely over a period of time. The science of dental cavities and decay
is also changing so what may be relevant 5 years ago will probably not be relevant now.
An example of this is observed when if there is a early or very early decay in a tooth: we now
know that rather than trying to fill it, we can give that cavity a chance to heal and repair itself.
Dentist needs to gauge at what point or how extensive this early cavity is. If the cavity is
gone beyond a certain point, then it cannot hear or repair itself. On the other hand, if the
cavity is at a certain early stage, certain treatments, advice and prevention programs can
cause that cavity to heal itself and repair. It is also interesting to note, that early cavities can
heal as a process called ​enamel remineralization​. the reformed enamel will be stronger than
the enamel that was originally there which means that the tooth as becomes even more
resistant to Decay. Some dentists also use lasers and air abrasion in order to treat dental
decay.
When a hole or a cavity makes it it's mark on the tooth, it is the human tooth enamel that has
been eroded away. Tooth enamel is the hardest wearing substance in the huge body in the
whole body. So in reality, it is quite difficult to find a replacement for something that is the
hardest substance in the body. In the past, dental amalgam also known as black fillings or
silver fillings, did tick many of the boxes that could be suitable as an option for dental fillings.
Dental amalgam does have some disadvantages however the advantages were such that it
quickly became very popular and the most extensively used material for fillings. As
technology has improved, dentists are now able to give you a choice as to a white filling or a
traditional silver amalgam filling.
Let's first look at the basics of silver fillings.
Silver fillings are also known as dark or black fillings. The technical name for these fillings is
known as dental amalgam fillings.
Dental amalgam is essentially metallic and in particular it is an ​alloy​. And alloy means that it
is a mixture of different metals combined with each other.

3. 50% of the alloy is made up of ​mercury​. Mercury is the only metal that is liquid at room
temperature. You will probably know from your chemistry days that when mercury is placed
on the bench or on the surface, it forms little drops or globules of shiny liquid metal. These
globules run around if the table or surface is tilted in
anyway. The other 50% of the filling is made up of three
additional metals. These three additional metals are ​silver​,
tin​ and ​copper​. There are also smaller amounts of other
metals but it is mainly Mercury, tin, silver and copper. So
overall 50% of dental amalgam is made up of mercury and
about a half of the other half left will be silver. Half of
what's left now will the tin and the remainder will be copper.
Dental amalgam has been around for more than 200 years
and we know that silver or amalgam fillings can last many
many years and we often see patients where they had
fillings placed in their teenage years and now they are in
their 50s. So one property of dental amalgam in is that it is very hard-wearing and it can
withstand being in the mouth for a very long time.
An important characteristic of dental amalgams is that they have a self-sealing property
which means that when the filling is placed initially there is a gap between the filling and the
wall of the tooth. It is important not to have a gap between the filling and the wall of the tooth
because bacteria can get in there and this is when further infection or decay can start.
Dental amalgam once it has set over a period of time it produces corrosion products and it is
these corrosion products that fill this micro gap between the tooth and the wall of the cavity.
Another huge advantage of amalgam it is that it is known to be very forgiving to use. Dental
amalgam is an extremely forgiving material and not very technique sensitive. This means
that conditions in the mouth do not have to be perfectly dry in order for amalgam to produce
a good result. This is important at the back of the mouth where there may be blood and
saliva present and it may be difficult to isolate the tooth properly from these fluids. Another
advantage at the back of the mouth for amalgam is that, amalgam is strong, and therefore it
can withstand the forces at the back of the mouth for example during eating and chewing.
Dental amalgam is also a relatively cost effective material.
Recently, the content of alloy has been changing to make the amalgam achieve better
properties. One of these changes has been to increase the copper content, and these
amalgams are known as high copper Dental amalgams. The high copper content means that
the dental amalgam is less likely to corrode or wear away at the edges of the cavity.
Once the dental amalgam has been compressed into the cavity, over the next 24 to 48
hours, it will Harden. This is why your dentist will tell you not to eat anything hard when you
initially have had your filling placed. You will be advised to eat on the other side of your
mouth.
Let's look at the Aesthetics of amalgam. Amalgam is definitely not an aesthetic material to
use. Having said that, quite often having a filling at the back of the mouth goes mostly
unnoticed. This may be because the filling is on your upper tooth at the back where nobody

4. can see it or it is right at the back on your lower teeth, again where people cannot easily see
that you have a filling there. Nevertheless, whether or not you can see it or not, patients still
don't like to know that they have a black or silver filling in their mouth.
Fillings made up of amalgam have had a lot of
criticism over the last 10-15 years due to
their health and safety concerns. ​Dental
amalgam​ or silver fillings have been used
for more than 200 years and multiple studies
have proved/ proven that they are safe.
These clinical studies come from reputable
experiments and are endorsed by the world
Health Organization, the American dental
association and the British dental Association. In a meeting by the Centers for disease
control and prevention, scientists formed the view that silver fillings ​do not​ cause any
significant risk to your health. There is obviously potential risk but so is everything else that
you do in life also has a potential risk and therefore the risk has to be balanced and
measured. The common misconception is that Mercury starts leaking out from your mouth
and then you will ingest this mercury. This mercury will then leak into your body's tissues
such as the brains, kidneys and liver. An important fact to note is that when the Mercury is
mixed with the other three metals as discussed above, it then becomes a stable alloy
because the Mercury is then bound on to the other metals so it is not free Mercury anymore.
Without a doubt, it is the free Mercury which is considered as the harmful Mercury. It is also
this free Mercury which is found in tuna and other fish and other products. Unfortunately
there are hundreds and hundreds of articles on the internet which scare people into thinking
how dangerous mercury fillings and can cause all sorts of terrible diseases. Unfortunately
most of these are, in fact all of these studies are not proper scientific tested studies and
often there is no basis for their findings whatsoever. Most of the evidence is very anecdotal.
This means that a person's arthritis could have started at a time when he went to a dentist to
have a filling placed. That person then automatically says that it was the filling that caused
the arthritis. However the person may also have had a particular food that day or they wore a
certain type of clothing or some other Factor happened at the same time that they developed
arthritis. An encouragement should be that dentists will not hesitate to have them placed in
their own mouth or in their children because they know dental amalgams are long-lasting,
hard-wearing, self-sealing and very technique for giving.
Once even if you decide that you do not want to have a silver filling placed in your mouth,
and you would like a white filling, here are certain things that you need to be aware of.
● White fillings also known as composite or glass ionomer, will
at best only lasts half as long as a traditional amalgam filling.
This means that the tooth will require future fillings at twice
the rate of the traditional amalgam fillings. With this in mind, it
is important to realise that every time a tooth is drilled again,
you are reducing its overall lifespan and increasing the risk of
complications by the filling becoming bigger, weaker and
deeper.

5. ● Many studies have shown where white fillings just do not last as long as silver fillings
at the back of the mouth. In addition, there is also a much higher rate of problems or
complications developing after a white filling has been placed, one of these
complications is something called post-operative sensitivity. Post-operative sensitivity
is pain from your tooth after you have had a white filling placed. This means that as
well as being painful and uncomfortable, you will need to go back to the dentist for
further treatment on that tooth. Sometimes this further treatment involves having the
filling taken out and having a temporary sedative filling placed to allow the tooth to
calm down. This therefore necessitates another visit to go back and have the filling
redone again. In other cases, the sedative filling still causes problems and it is not
uncommon to have a root canal treatment carried out. Root canal treatment mean
there is additional visits involved together with costs and additional treatment on the
tooth as the tooth might now need a crown or a cap to protect it. This also reduces
the longevity of the tooth because root fillings are not 100% certain.
● White fillings also does not mean that they do not
contain any harmful chemicals inside them at all. White
fillings also known as composite fillings or glass
ionomer fillings, contain many chemicals which we do
not know the long-term possible harmful effects of.
● White fillings can also discolour over time depending on
your drinks, diet and the general condition of your mouth. In addition certain
substances such as smoking or red wine will Accelerate the discoloration.
● White fillings do not have a natural seal producing property like the ones which silver
fillings have. This is a massive disadvantage. Has stated before, if the wall of the
cavity and the surface of a filling has a gap, bacteria
can easily infiltrate through this gap causing pain,
sensitivity and further Decay. The way around the
problem of this lack of seal is that a bonding agent is
used which closes the gap between the filling and the
wall of the tooth. This Bond can have weaknesses
because it cannot be easily seen whether a gap has
been eliminated or not. In contrast, you do not need to
worry about the marginal leakage gap in amalgam
because you know the material itself will close this gap
off naturally. This is why white fillings do seem to come up with complications
because of the gap which has not been formed properly. This is more likely when the
filling is large, the filling is at the back of the mouth and the filling is underneath the
gum line.

6. Conclusion.
Overall, there are advantages and disadvantages of whether you have a white filling or a
silver filling. This article has tried to give you a overall balanced view for you to make your
mind up as to which route you should go for. There is no right or wrong choice but the
choices made by carefully weighing up all the pros and cons of both a white filling or a silver
filling and whether you are going to have treatment done under the NHS or privately. Under
the ​NHS​, a dentist is not obliged to provide you with a white filling instead of a silver one as
those are not stipulated in NHS guidelines.