Is a filling a filling or do I have a choice?

Traditionally dentistry was extremely limited in how a tooth could be treated. Many of us still remember when the only choice was to take the tooth out or have an amalgam filling. Options were limited and so were the techniques that were used. It was not anyone’s fault because it was simply the only options available at the time. So how about now?

Dentistry has come a long way and modern dental techniques have evolved to give you a lot of choice. Depending on your values and budget the filling could last from only a few years to 30 years! Every dentist is different, with their own sets of beliefs, clinical experiences, ethical and moral standards. Just like all artists create different masterpieces so are dentists in how they perform their fillings and how they relate to you. One thing is certain, some dentists still perform fillings just as they did 10-20 years ago and so they may not even know to give you the options that lead to very different outcomes. Most of the time the conversation goes something like this:

Dentist: “You have a hole. You need a filling.”

Patient: “Ok doc, if you say so.”

Dentist: “The filling will take 40mins to do. Let’s go out to the receptionist so she can book you in.”

The patient takes the dentist’s word for it because they can’t see their tooth that far back. The patient often doesn’t know what material will be used for the filling or that they ever had a choice on that matter. They also don’t know how the filling will be done. For instance, will there be anesthetic, will the rubber dam (rubber raincoat) be used to prolong the lifespan of the filling, will antimicrobial agents be used to kill bacteria and inhibit the enzymes in the tooth that break down the glue that holds the filling in place? Fair enough, some patients might not even want to know this much information. However, in the end of the day it is important you make an informed decision as it is your tooth and your health!

Dentists are now recommended to practice ‘Shared Decision Making’ with their patients. It is an interactive process that focusses on achieving a shared understanding of treatment goals. In this process a patient’s values and preferences are incorporated into the decision making process. So in other words, you have a choice! A ‘filling’ is not a ‘filling’ and you have a voice in what material your fillings are made from and the way in which it is done! If the only information you are given is ‘you need a filling’ you can ask what material will be used and what are the options. If only one option is presented to you it may mean that this particular dentist only has the technical ability to do a traditional white plastic filling and not the more modern techniques. 

Incase this concept is new to you and you have only ever had this one option presented to you here is some more information for you to ponder on:

Filling options range in what type of material the filling is made from. For example, there’s the straightforward white plastic (composite resin) fillings and there’s 3D scanned & milled porcelain fillings, also referred to as ‘inlays’ and these can even be made of gold too! The difference lies in the strength of the material and how much load it can take under the pressure of our strong jaws. The filling needs to withstand the chewing forces of eating three meals a day, everyday, not to mention snacks, chewing gum and clenching/grinding of teeth. The difference in materials also lies in something dentists refer to as ‘shrinkage on polymerisation’ which in simple terms means how much the filling shrinks after it dries. Compare the volume of a fresh young leaf on a tree to a dried up leaf on the ground. As things dry they tend to shrink, and same goes for some filling materials such as the most commonly used white plastic ‘composite resin’ filling material. So what’s the problem? The problem lies in the fact that as it shrinks it creates microscopic gaps between the filling and tooth. Bacteria and food debris love to nest themselves in these crevices within teeth and overtime develop into holes/decay underneath or around plastic fillings. Sadly this means they’ll need to be replaced over and over as time goes on. Each time they are replaced they usually get bigger and bigger, until one day there’s hardly any tooth left to hold the filling at all. So the material chosen for the filling does matter as they’re not all the same.

Dr Tiv and the team of associate dentists at Balnarring Dental are skilled in all of these filling materials and techniques, and would be more than happy to answer your questions or give you a complimentary consultation. You don’t need to feel embarrassed and it’s never too late! We hope that this little bit of advice empowers you to take charge of your dental health and never be ashamed to ask your dentist questions. You have a voice and at Balnarring Dental we are happy to listen!

Written by: Darina Nirmalann 

(Oral Health Therapist at the Balnarring Dental Centre & PhD candidate at the University of Melbourne)