Want to feel like a million bucks? Why not get a gold filling? Dental records taken from the US Civil War-era in the 1800s show that gold was the most popular and most preferred filling material owing to its strength and durability.

Although other filling materials like tin and amalgam were present and less expensive, gold remained the “gold standard” in those days and other materials were held in low regard.

However, getting a gold filling in the early days was a nightmare, especially since it was difficult to place. As Dr. Martin S. Spiller revealed in Dr.Spiller.Com:

“The cohesive gold foil technique consisted of removing decay, laboriously refining (preparing) the shape of the cavity and then hammering tiny pieces of cohesive gold foil into it until the cavity preparation was filled – a tedious and painful procedure. It required the removal of all decay and the minute refinement of the cavity preparation in order to create a retentive and stable space for the gold.”

Thankfully, advances in modern dentistry have changed all that. Gold is still used today since it can withstand chewing forces and last as long as 15 – 30 years. Gold is also pleasing to the eye and some people find it more acceptable than other fillings.

On the downside, gold is quite expensive – up to ten times higher than the cost of the more common amalgam fillings. It requires at least two dental visits to place and can be irritating for some people since it conducts heat and cold.

“A gold filling placed immediately next to a silver amalgam filling can cause a sharp pain (galvanic shock) to occur. The interaction between the metals and saliva causes an electric current to occur – it’s a rare occurrence, however,” explained the editors of WebMD.Com and the Cleveland Clinic Department of Dentistry.

Amalgam or silver fillings remain the most commonly used material to fix decayed teeth. They are a mixture of mercury (from 43 – 54 percent) and powdered alloy made mostly of silver, tin, zinc and copper. Amalgam was supposedly used by the Chinese to fill teeth in the 7th century but the French dentist Auguste Taveau is credited as the inventor of this material.

In 1816, Taveau developed his own amalgam filling from silver coins and mercury which he first used in 1826. His material was cheaper than gold but had to be heated for the silver to dissolve and set in place. It also had a tendency to expand after it was placed. Because of this, its use was abandoned.

“Amalgam in those early days had serious drawbacks since its physical characteristics depended on the exact proportions of silver and mercury, and the mixture often expanded on setting causing the tooth to crack,” Spiller said.

Taveau’s formula was later brought to the United States by two French quacks. The Crawcour brothers saw its potential and packaged it under the name of “Royal Mineral Succedaneum.” Many dentists denounced this since the brothers had no dental training whatsoever and they warned that mercury was poisonous. But this didn’t affect the brothers’ business.

“When the Crawcour brothers opened for business in New York in 1833, they didn’t have to wait long for their first clients. To anyone with tooth troubles, the brothers’ advertisements were irresistible. Why pay a fortune to have your cavities plugged with gold when two brilliant dentists from Europe could fix them with a miraculous new sort of filling. With their amazing Royal Mineral Succedaneum, they could make a tooth as good as new – cheaply, painlessly and in just two minutes,” according to Stephanie Pain in The New Scientist.

In spite of the criticisms that later formed the basis of the anti-amalgam movement, the Crawcour brothers treated large numbers of patients successfully – none of whom developed the symptoms of mercury poisoning. How this did happen? This clearly illustrates the safety, relative ease in placing amalgam fillings, and their durability that can extend up to 15 years. (Next: Disadvantages of amalgam fillings.)

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Dental Fillings are divided into two broad categories:

• Conventional Amalgam Fillings: These are also called as silver fillings or even mercury fillings.

• Composite Resin Fillings: These are the colored fillings and are also called as white fillings.

You will mostly find that clinics offering dental fillings prefer doing the composite resin fillings. In the past if you have undergone any amalgam filling then there will be additional procedure to safely remove the amalgam. The reason clinics do not prefer doing the amalgam filling is because it contains mercury which is harmful for the whole body. So the amalgam filling is removed using rubber dam and a high power suction. The idea of using high power suction pump is to avoid mercury entering the body.

However the reason why white fillings is preferred because these are chemically bonded with the teeth and do not require numbing of teeth.

After your dentist has removed the decay, the material for dental fillings will then be placed inside the tooth. Furthermore it will be hardened by curing light.

Undergoing the procedure of dental fillings is a very simple process and you can expect little to no sensitivity. You won’t need more than one visit to the dental clinic. However if you are undergoing multiple fillings then you might have to visit clinic more than once.

Advantage of Dental Fillings

As mentioned before these fillings are also called as white fillings and this is the biggest advantage of undergoing this treatment. They match the natural color of teeth and the appearance as well. Furthermore they also restore 85-90% of the original strength of the tooth. There is no fixed location for their use. They can be used for rear or front teeth because they do not affect the aesthetics of your gums. Dental fillings may cause some sensitivity but then it gets over within two-three weeks.

Cost of Dental Fillings

The cost depends upon the size and depth of fillings. Before the procedure is started your dentist will examine your teeth and will also inform about the number of cavities that will be treated. You will have to make it a point that regular dental visits are taken every six months. The reason is that the white fillings get discolored with time. Furthermore your teeth will be examined for any new cavities.

Care of Dental Fillings

There is no rocket science involved in the care of dental fillings. You have to take care of them just like the regular teeth. Proper dental hygiene is the key here. Make sure that you brush and floss twice a day. Rinsing with fluoride mouthwash ensures that you do not have plaque accumulated. Here you need to take care that neither do you swallow the mouthwash nor do you eat anything for next 30 minutes. Apart from all this visit your dentist regularly to check the condition of fillings.

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It’s hard to imagine any era of human life where cavities didn’t exist. Tooth decay, or dental caries, is a disease caused by bacteria. In extreme cases, cavities can cause death. So when did the use of fillings begin? Was Mercury the first filling material used? Let’s take a look at the evolution of the filling.

Hypotheses of what may have caused teeth to decay have been found in texts of ancient Sumeria, Japan, China, Egypt and India. “Tooth worms” were to blame according to these cultures. Nearly perfect holes in the teeth of skulls found in Pakistan dating back over 9,000 years are believed to be the work of primitive dentistry. But evidence of using fillings is not found.

Teeth were likely pulled in many cases where pain was an issue. Ancient writings document cases of tooth extraction. It is not entirely certain precisely when the use of fillings began. Doctors used many filling materials including cork, stone chips, lead and gold more than 500 years ago. A silver paste is reported to have been found in a tooth dating-back over 2,600 years in China; but evidence of this as a regular practice cannot be found.

The best evidence for the start – and continuation – of the practice of filling teeth with some sort of material, leads us to French physician Ambroise Pare who used cork and lead to fill patients’ teeth in the 1500s. In 1603, German Tobias Kreilius boiled a concoction of copper, acids and mercury which was poured as a hot liquid onto diseased teeth! I wonder which pain was the greatest!

There is an actual “Father of Amalgam”. This name was given to a Frenchman, Louis Regnart. He improved on a boiled mineral cement by adding mercury, which greatly reduced the high temperature originally needed to pour the cement onto a tooth. Amalgam was originally used in France around 1826.

Amalgams became unpopular over the next several years. Respected dental research included in some of the first textbooks of American dentistry discouraged the use of amalgam. The use of mercury was specifically mentioned as “mischievous.” Although it offered certain benefits since 1833, when the French Crawcour brothers brought amalgam across the sea to America, gold, platinum, silver, tin and lead were preferred in the 1840s.

So what might Doc – John Henry – Holliday have used during his short life as a dentist? Literature including the use of dental fillings in the United States during the 1860s makes it very clear what was accepted as professional practice when fixing rotting teeth with filling material. Two texts used by American dentists of this time were, “A Practical Treatise on Operative Dentistry” written by J Taft, and “The Principles and Practice of Dental Surgery”, written by Chapin A Harris.

Taft’s text was published in 1859, Harris’ in 1863. They stated that beginning in the early 19th century, eleven types of metallic fillings were used in teeth damaged by dental caries. The simple process of rolling metal into pellets to be placed into cavities was common. These pellets were made of some of the aforementioned materials like gold, lead, platinum, silver and amalgam as well as aluminum. The texts also cited early uses of materials by various doctors as far back as the 18th century when Pierre Fauchard recommended the use of lead.

The respected Taft and Harris texts make it clear what was used as filling material. We now know much of what was practiced on a regular basis from the 18th century through to the Civil War. One other material that hasn’t been mentioned yet appears in the Harris text. Asbestos was used in the 1850s for its non-conductive properties to be placed under the filling of a sensitive tooth.

At the time, doctors were aware of the dangers of some of these materials. Lead and Mercury were known to be unhealthy, yet they were still used. Graves from the American Civil War were found to contain various soldiers with conventional and odd filling material.

What was recommended by Taft and Harris and what was actually used as fillings were sometimes quite different. Gold was preferred – but very expensive. What was likely a shotgun pellet was found as a filling in one specimen. Thorium, a radioactive element – not known to be radioactive back then – was found in another. Amalgams, tin and iron were found in others.

Today’s dentists may offer alternatives to fillings, depending on the level of tooth damage. Gold and amalgam are still used. Porcelain and composite resin – which can offer the same color as a patient’s healthy teeth – are also used. The Evolution of the Filling has been rather slow and varied, and today we still find materials used that were materials used in the early days of recorded dental practices.

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One of the most common dental problems experienced all over the world today is dental decay. The usual treatment procedure for dental decay is the placement of a restorative. In earlier times, the restorative used was unsightly materials such as gold or silver amalgam. These days, it is much more common to see tooth colored or white restoratives. Tooth colored fillings are preferred restorative choices both in front teeth as well as in the back teeth.

In earlier times, the white colored restoratives that were available did not have much strength. This made them fragile and subject to breakage if any hard force was exerted on them. Therefore, for filling a molar tooth or a premolar tooth, materials such as silver amalgam or direct filling gold were commonly used. However, the advent of science has resulted in a lot of improvements in tooth colored fillings.

The advanced white fillings have better bonding to the structure of the tooth, do not need any etching process and have superior strength in comparison to the materials that were available in the past. The strength of tooth colored fillings that are available today are comparable to silver amalgam and direct filling gold restoratives. Thus,  they are suitable for use in any tooth including molars, where force of mastication exerts lots of stress on the material.

Advantages of Tooth Colored Fillings

There are many advantages of using these fillings over other materials used for restoring a tooth.

The main advantage that one can get by using white fillings is the esthetic finish of the restoration. The restorative material is available in many different shades to match the shade of the tooth to be restored, thereby providing superior esthetics, which is not possible when using materials like amalgam or gold.

When material like amalgam has to be placed, lot of tooth structure has to be compromised in order to hold the material in its position within the tooth. This is because, there is no direct bonding between amalgam and the tooth, and it is only held with mechanical retentive properties of the preparation. In tooth color fillings, a direct bonding between the tooth and the restorative occurs with the help of a bonding agent. This reduces the amount of tooth reduction that needs to be made, thus preserving the strength of the tooth being restored.

Earlier versions of this filling material had problems like development of sensitivity in the restored tooth. This was mainly caused due to the etching process before filling the tooth and also due to marginal leakage between the tooth and the restorative material. However, advent of the material has eliminated etching process and negated the marginal leakage, thereby reducing the occurrence of sensitivity.

The improved strength of the tooth color fillings has resulted in better resistance to fracture, especially in fillings that do not have much support from the tooth. So, fillings using tooth colored restorative materials seem to have better life in comparison to materials like amalgam or gold.

Procedure

During the initial visit, the dentist will examine the tooth and also take X-rays to evaluate the depth of the decay and determine if this filling material is suitable for restoring the tooth. In the following visit, the tooth will be prepared to rid all the dental decay.

Once the tooth preparation is completed, the tooth is isolated to avoid contamination from saliva. The prepared area of the tooth is then coated with a thin layer of a bonding agent and then cured with a suitable light source. After this, the tooth colored filling material is then placed in the prepared area, shaped to match the tooth anatomy and then cured with the light source.

This process is repeated in increments till the entire prepared structure is restored. After this, the bite is checked and adjusted to make the filling comfortable in the mouth. The restoration is then finished and polished using suitable polishing materials.

Tooth colored fillings is a suitable material for restoring the strength of a tooth that has been damaged by decay. These materials are not only strong, they are also esthetic, thus avoiding unnecessary embarrassment of having to see unsightly filling materials in the mouth.

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Amalgam fillings are those silver coloured fillings, sometimes referred to as “silver” or “mercury” fillings that were a very popular restoration material used by dentists during the “drill & fill” era in the 1970’s.

There is a lot of controversy concerning the mercury component of this filling material as patients who have amalgam fillings are exposed to a daily dose of mercury. Whilst exposure is extremely low, there are concerns over the health effects regarding constant mercury exposure as there is a potential for illness, disease and disorders. Amalgam as a dental filling material contains silver, tin and copper but half of the filling material in weight consists of Mercury.

There is no doubt that when the time comes for you to have a filling, clinical studies prove that choosing an alternative material to dental amalgam is your best option but what about if you already have a mouthful of Amalgam fillings? Should you have them removed and replaced with an alternative filling material?

Certainly it is better not to have had the amalgam filling in the first place but removing the old mercury filling can expose the patient to excess mercury during the removal process. This excess exposure can be reduced!

There is no conclusive evidence to suggest whether it is safer to leave Amalgam fillings in place or to remove them. Some dentists believe that dental amalgam is a safe material and continue to use it whilst others think the opposite. Dentists do not usually recommend removing old amalgam fillings unless the patient has mercury sensitivity but millions of old amalgam fillings are removed every day throughout the world with most patients being excessively exposed to mercury particles and vapor. Amalgam fillings don’t last forever and people today want a natural look that is more aesthetically pleasing as well as choosing a safer material. This is why we should look for guidance from dentists about the safe removal of amalgam fillings.

Dentists nowadays can reduce the mercury exposure that the patient receives by following some simple common sense rules which have been put together by leading dental professional bodies such as IAOMT and the ADA. Patients regularly travel to Hungary for amalgam removal because the procedure is less expensive and the high tech clinics have all of the necessary equipment to safely remove amalgam and replace with a strong safer material.

Cut not Grind

Grinding away the amalgam can form mercury particles which can be inhaled. Our Hungarian dentists cut the amalgam into chunks which will aerosolise the amalgam less. Also spraying with water will keep temperatures lower and reduce vapor pressure within the mercury. It has to be said that proper inspection of the tooth is done to ensure that all of the amalgam has been excavated from the area.

Evacuation

Our dentists keep that high volume evacuation (HVE) suction system right next to the patients tooth and we make sure it discharges outside of the building. Some systems will pump mercury vapor back in the room. Dams Our dentists swear by rubber dams to isolate the area and catch amalgam debris. Saliva ejectors are also placed behind the rubber dam and once the amalgam is removed the rubber dam is also removed and rinsed.

Protection

Our dentists also like to cover the face so that no amalgam particles can land on the skin or in the eyes. A separate airway is also provided.

Finally

Amalgam has been in use since dentists first started to restore teeth but what is more shocking is that it is still used by dentists in Great Britain today as it is not yet a regulated or restricted material. There are conflicting views over the use of Amalgam as it contains mercury but some dentists still favour this material as it is cheap, durable and easy to use.

Some countries have banned Amalgam, but still patients should consent to it’s use before allowing a dentist to place Amalgam fillings into the mouth in which mercury is the main component.

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