All about the application of fillings in dentistry

A variety of dental fillings

Watch Dental Video about Dental Fillings

Which is the right filling, what types are there available, where, when and how?

The trend is towards white fillings and away from amalgam, titanium and gold. What was once a sign of prosperity a few years ago, namely a mouth full of gold inlays is no longer in.
People like the natural beauty of teeth, so white is now the color of choice. However, not all that glistens white is also “bio” and therefore good for your health!

There are countless white materials, including, for example: composite plastics, glasionomer cement (GIC), ceramic inlays and gold ceramic inlays. But be careful – not all of these are designed for permanent application in the mouth. GIC, should only be use for short periods of time, as a temporary filling for example. GIC normally holds fast for 1 – 2 years after which the fillings should be replaced, ideally with a longer-lasting material.

Composite plastics can be used to seal fissures and pitting in the chewing surfaces. The contact surfaces of molars can thus be treated with this material. Chewing surfaces shouldn’t be treated with plastics. Unfortunately this happens all the time and teeth with these fillings die after a few years, resulting in the need for root treatment.

Patients feel pains after a certain period of time after the filling is done and though these often die down it’s usually a sign that the dental nerve has sustained damage. The reason these fillings are not sustainable is this: The plastics consist of tiny rough ‘building blocks’ – so called monomers. These monomers are poisonous but through the hardening process become non-poisonous at first.

The hardening process starts as soon as the dentist exposes the filling to the lamp. The monomers join up with each other and form long chains, like Lego bricks. This process is called polymerisation – polymers are formed from monomers. The plastics become hard throughout but nonetheless the polymers are changed by chewing – they break up and once again poisonous monomer structures are formed which then damage the dental nerve. For this reason plastics do not belong in areas used for chewing.

There are some "Composite Gurus" who have specialized in the use of white fillings in the side teeth. By means of elaborate tricks they try to get around the negative properties of the materials – but there are no long lasting results. Such elaborately worked fillings are by then almost as expensive as ceramic inlays but for all that they still don’t last as long.

While we’re on the subject of ceramic inlays, these are, from a scientific point of view, designed for the side teeth. What is important is – this applies to all plastics and plastic adhesives – the correct handling, that is to say the adhesive procedure itself and the area of work – the use of a coffer dam (dental dam) is unavoidable!

Gold ceramic inlays are on the wane. They involved covering gold inlays with a thin ceramic layer but this thin layer broke up in time and the unsightly gold surfaces become visible again.
Not all that is shining white is recommendable. Don’t allow any plastic fillings in the chewing areas at the side of the mouth (teeth 4-8 when counting from the front).

Why fillings in any case?

No doubt you have fillings/crowns/inlays or missing teeth only or mainly at the side of your mouth! Why do you only have bad teeth on one side of your mouth – and maybe in the top, front teeth. Here you might have some half-moon shaped fillings – if you haven’t gone a step further and have crowns. But why are only certain teeth bad? Shouldn’t all of them be bad? But don’t worry, this is a common occurrence – if you have a look at anyone’s mouth you’d notice that all their bad teeth are always at the sides.

A patients side teeth affected by caries

A patients side teeth affected by caries

The reason is simple, the top teeth come in contact with wide areas, the bottom teeth come in contact with small areas. At the bottom your toothbrush usually reaches between your teeth – but not on top.

Caries therefore form between the teeth on top and if the fillings are next to the nerve then a root treatment is done. Crowns usually follow. Use a mouthwash and/or dental floss, and use them to clean your front teeth – as well as your other teeth – from behind too.

Now that you’ve read this article you know that there’s no such thing as bad teeth. Why do we have fillings at the side then? Since only the teeth that show, i.e. the front teeth are properly cleaned. Usually we just give a quick once over to the back teeth and let ourselves be deluded by the refreshing effect of the toothpaste. The material that isn’t cleaned away (lack of appropriate cleaning at the sides) causes caries – usually already in childhood and dentists don’t usually explain this, they just drill away. And that’s how we all have our fillings at the side. Bad habits and lack of information ruin our teeth!

Armed with this knowledge we can now change some things in our oral hygiene – so here’s how to clean teeth properly:

  • Start with the back teeth which all too easily get left till last
  • Use a mouthwash at least once a day. Don’t worry if at first your gums hurt and bleed slightly, this will usually cease soon.
  • Clean properly then take a plaque tablet (available from pharmacies) and wherever you see plaque stains (cheque the inner sides of the teeth too) should be cleaned again. By cleaning again you will reprogramme your mind and hand and have fun learning a new cleaning technique!

The aim is for you to learn how to clean your back teeth as well as your front ones. If then your dentist also does good work and provides your teeth with ceramic inlays for example then you should be able to avoid the drill for a long time.

A diligent dentist will explain how all this fits together in your first discussion. If this is before therapy starts then it could be that this – the explanation – is the only therapy. Furthermore, an investment in your teeth makes sense when it involves a change in your usual cleaning routines. The reason why you mainly have fillings in the side teeth lies in a defective cleaning technique for the back teeth. You can see more about this subject in the video "Tooth Anomalies" and "Cleaning Technique".

One differentiates between fillings that change with time and filling materials which only change very slowly, if at all – as long as you clean properly.

Amalgams, cements and plastics change their physical composition and these materials therefore become unstable over the years. Large plastic fillings do not belong in the side teeth and aches after such fillings often occur. The cause is chemical damage to the nerve and a root treatment is often the result.

Generally these fillings can last from 2 to 10 years, depending on:

  • The shape and size of the filling
  • The quality of the procedure
  • Your oral hygiene
  • Your chewing and eating habits

You can just imagine, if fillings need to be changed on average every 5 years, how little of the tooth will be left since with every change of filling ental material is lost. That’s why your largest filling is usually in your 6th tooth – it’s the first tooth you change.

Young people should therefore invest in long-lasting treatments, such as:

  • Gold inlays
  • Ceramic inlays
  • Titanium inlays

These filling materials hardly change or don’t change at all, providing that there is good oral hygiene in place. Without this then even the best gold inlay would become loose. With a change of cleaning habits and a one time investment your teeth could last you forever. Have your dentist inform you about which treatments he frequently does since the best materials are useless when the procedures are inappropriate.

This post is also available in: German

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