Replacing dental fillings. Amalgam or Composite?

[Wildcat]

You're told three very old (like close to 30 years old!) and medium-sized fillings need replacing, two of which are on the chewing surface of bottom molars, one on each side of your mouth, so they'll get lots of chewing use.

Do you choose composite or amalgam? Why? 

 

 

[prairiewindmomma]

I choose composite each and every time over the aesthetic issue alone. Once you add in the potential safety issues of amalgam fillings, I think it becomes a no-brainer.  I do realize that they don't last as long....but it's worth the tradeoff to me. Also, I hope your dentist made you aware that when you are talking about medium sized fillings in a person over 40----there's a chance that's ending up as a crown. 

 

[Mona]

Do dentists even use amalgams anymore? I thought it was standard practice to use composite only these days.

Okay, I had to look it up. I guess the ADA says it’s okay, but the FDA warns about it.

However, the last four dentists I talked to all said that they don’t use amalgams.

My dentist retired and I’ve gone to different ones for myself or with family members on the search for a good fit and none of them use amalgams.

Edited April 1, 2021 by Mona

[Spryte]

Composite. Because of the FDA.

[prairiewindmomma]

I would .02 that the poster lives in TX or the South. There are definite regional differences to dentistry practices. I was offered amalgam fillings by my TX dentist and was horrified. 

[Sneezyone]

2 hours ago, prairiewindmomma said:

I would .02 that the poster lives in TX or the South. There are definite regional differences to dentistry practices. I was offered amalgam fillings by my TX dentist and was horrified. 

This. I blame it on the lack of dental schools. My first Arkansas dentist, who really needed to retire, tried to give me amalgam claiming the risks were overblown. The composite work I had her do failed too, within 5 years, way too soon. If your dentist isn’t bothering with a dental dam and that sour cord stuff that recesses your gums for gum-level cavities...RUN!! If you really need the strength of metal, it’s gold or nothing.

Edited April 1, 2021 by Sneezyone

[gardenmom5]

mine have been replaced with composite and gold crowns.  (gold expands and contracts at the same rate as your natural tooth.  they will last.)

I feel they are safer than amalgams (though they've probably changed the composition of the material for those.)

[gardenmom5]

5 minutes ago, Sneezyone said:

This. My first Arkansas dentist, who really needed to retire, tried to give me amalgam claiming the risks were overblown. The composite work I had her do failed too, within 5 years, way too soon. If your dentist isn’t bothering with a dental dam and that sour cord stuff that recesses your gums for gum-level cavities...RUN!! If you really need the strength of metal, it’s gold or nothing.

don't underestimate the sour!!!   eh, it's awful.  He had to do it twice for my last crown because the crown didn't fit, and all the molds had to be redone.  blech blech blech.  (I think my tooth moved in the original molding stage.)

[PeterPan]

Composites definitely.

[Amethyst]

There are definitely still indications for amalgam. But generally most people expect composite resin restorations nowadays. Composites are much more sensitive to a wet field, so if I absolutely can’t keep the area dry, I may attempt an amalgam restoration. There are sometimes other considerations, such as the person has no insurance and wants the cheapest out of pocket expense possible.  I also believe the amalgam risks are overblown. And I also agree that gold crowns are the absolute best crowns (because the margins can be burnished perfectly and they last and last) if it’s not going to be seen when smiling. 

[Sneezyone]

32 minutes ago, Amethyst said:

There are definitely still indications for amalgam. But generally most people expect composite resin restorations nowadays. Composites are much more sensitive to a wet field, so if I absolutely can’t keep the area dry, I may attempt an amalgam restoration. There are sometimes other considerations, such as the person has no insurance and wants the cheapest out of pocket expense possible.  I also believe the amalgam risks are overblown. And I also agree that gold crowns are the absolute best crowns (because the margins can be burnished perfectly and they last and last) if it’s not going to be seen when smiling. 

I have VERY weak teeth and have since I was a preteen. Sealants only helped until my early 20s. I’m, honestly, tired of fighting dentists to be MORE aggressive with my treatment, go with gold (I CAN PAY!), and be more responsive to my pain management needs. I warn each and every one that I need to be over-numbed and each and every one insists I don’t know what the hell I'm taking about. My best dentist ever suggested gold for my back molars from the beginning and that lasted 16-17 years. One has just failed. I have a chip in the natural tooth. None of the work I’ve had done since lasted as long as his. I’m on the hunt for a practitioner in SE Virginia who follows the latest dental school/continuing education protocols as a result. Know anyone? 🧐 If I can’t find someone good I’m gonna scrap the whole mess and invest in implants. I’m tired of being treated like a cash cow b/c of my genetics.

[Sneezyone]

2 hours ago, gardenmom5 said:

mine have been replaced with composite and gold crowns.  (gold expands and contracts at the same rate as your natural tooth.  they will last.)

I feel they are safer than amalgams (though they've probably changed the composition of the material for those.)

My dentist in Olympia, a UW grad, was a freaking rock star. I didn’t care what he charged me, the work was worth it. I haven’t met his like since. Using the dental dam keeps things dry and clean. His gold crown and veneers outlasted everything I’ve had done since. These things really do matter.

Edited April 1, 2021 by Sneezyone

[Katy]

1 hour ago, Sneezyone said:

I have VERY weak teeth and have since I was a preteen. Sealants only helped until my early 20s. I’m, honestly, tired of fighting dentists to be MORE aggressive with my treatment, go with gold (I CAN PAY!), and be more responsive to my pain management needs. I warn each and every one that I need to be over-numbed and each and every one insists I don’t know what the hell I'm taking about. My best dentist ever suggested gold for my back molars from the beginning and that lasted 16-17 years. One has just failed. I have a chip in the natural tooth. None of the work I’ve had done since lasted as long as his. I’m on the hunt for a practitioner in SE Virginia who follows the latest dental school/continuing education protocols as a result. Know anyone? 🧐 If I can’t find someone good I’m gonna scrap the whole mess and invest in implants. I’m tired of being treated like a cash cow b/c of my genetics.

I have the same issues. Search for someone that treats dental anxiety, IME they take pain medicine more seriously. My last few dentists don’t use novocaine, they used some other anesthetic “from Europe “ that I don’t recall the name of that works much better. 

[gardenmom5]

1 hour ago, Sneezyone said:

My dentist in Olympia, a UW grad, was a freaking rock star. I didn’t care what he charged me, the work was worth it. I haven’t met his like since. Using the dental dam keeps things dry and clean. His gold crown and veneers outlasted everything I’ve had done since. These things really do matter.

UW does have a good dental school.   

my dentist did his internship in Miami.  a lot of "old" gold crowns.  in perfect condition. a friend's son (and ds's friend) was the one that told me about the expansion and contraction rates the same as the original tooth.  he was in dental school at the time.  that's a big reason why other materials fail, and why gold lasts.

[Wildcat]

21 hours ago, prairiewindmomma said:

I choose composite each and every time over the aesthetic issue alone. Once you add in the potential safety issues of amalgam fillings, I think it becomes a no-brainer.  I do realize that they don't last as long....but it's worth the tradeoff to me. Also, I hope your dentist made you aware that when you are talking about medium sized fillings in a person over 40----there's a chance that's ending up as a crown. 

 

I'm not worried about the aesthetic issue since there is already silver there and it's way in the back and I don't seem to be one of those who is sensitive to amalgam fillings, which is why I was really wanting it.

Actually, he did not explain that to me, but I figure that's what will happen eventually if I do this, and I don't want a crown. I've known too many people who have had them pop off, etc, so I'm a bit paralyzed as to what I will do.  Thanks for putting the crown info out there, though as that should have been told to me!!

21 hours ago, Mona said:

Do dentists even use amalgams anymore? I thought it was standard practice to use composite only these days.

Okay, I had to look it up. I guess the ADA says it’s okay, but the FDA warns about it.

However, the last four dentists I talked to all said that they don’t use amalgams.

My dentist retired and I’ve gone to different ones for myself or with family members on the search for a good fit and none of them use amalgams.

They do, actually, and this is the first one I've heard of that only uses composite. I now see that amalgam fillings are going the way of VHS tapes.

 

18 hours ago, Amethyst said:

There are definitely still indications for amalgam. But generally most people expect composite resin restorations nowadays. Composites are much more sensitive to a wet field, so if I absolutely can’t keep the area dry, I may attempt an amalgam restoration. There are sometimes other considerations, such as the person has no insurance and wants the cheapest out of pocket expense possible.  I also believe the amalgam risks are overblown. And I also agree that gold crowns are the absolute best crowns (because the margins can be burnished perfectly and they last and last) if it’s not going to be seen when smiling. 

Thanks. The info in your post is what I read, too.... since these teeth are molars which get lots of use, it seems amalgam is a more appropriate choice.  Interestingly, our insurance (a good PPO dental plan) only covers amalgam. That's loads of fun when the dentist doesn't even offer those!

17 hours ago, Sneezyone said:

I have VERY weak teeth and have since I was a preteen. Sealants only helped until my early 20s. I’m, honestly, tired of fighting dentists to be MORE aggressive with my treatment, go with gold (I CAN PAY!), and be more responsive to my pain management needs. I warn each and every one that I need to be over-numbed and each and every one insists I don’t know what the hell I'm taking about. My best dentist ever suggested gold for my back molars from the beginning and that lasted 16-17 years. One has just failed. I have a chip in the natural tooth. None of the work I’ve had done since lasted as long as his. I’m on the hunt for a practitioner in SE Virginia who follows the latest dental school/continuing education protocols as a result. Know anyone? 🧐 If I can’t find someone good I’m gonna scrap the whole mess and invest in implants. I’m tired of being treated like a cash cow b/c of my genetics.

I'm so sorry you not only have to deal with weak teeth but also have to deal with horrible medical care. I've seen this over and over again and it just ticks me off to the Nth degree to have to fight to be heard!!

15 hours ago, Seasider too said:

Yep. And maybe a root canal if your nerves flare up over the work. 
#teamcomposite 

That's my other fear. 😢 I've only ever had fillings and know my time is coming for crowns & root canals and I'm not looking forward to that. At. All.

Edited April 2, 2021 by Wildcat

[Wildcat]

Well ladies, thank you for all the info and opinions! I appreciate every response.

I'm not sure what I'll do, though! I guess I'm leading towards just waiting and see if anything happens since it looks like two of the teeth he wants to replace the fillings in are medium-sized already. Since he'd have to drill out a bit more tooth for the composite, and since I'm in my 50s, I'm thinking that I'll wind up with a root canal/crown not long after messing with something that "ain't broke and don't need fixing".... Ugh. I hate this wishy-washy stuff. LOL.

I will say that y'all convinced me to get composite, though. It sounds like I'll have a heck of a time finding someone around here who takes my insurance AND does amalgam fillings AND is someone I like. And I do like this new dentist, so composite it is if/when I decide to proceed.

Thanks again!!