California's Dental Materials Fact Sheet

Impeccable customer service is one of our core goals at FocusedCareDental.com. In our Encino dental office we put a premium on delivering gentle and careful VIP treatment that keeps our patients healthy and happy. Three-quarters of our patients have entrusted their dental care to Encino dentist Dr. Allan Melnick, DDS, for more than 20 years, and we attribute that to high-quality service in a non-threatening environment marked by mutual respect. We think our patients value full disclosure, so we make communication and patient education a priority.

We use the best dental materials available, and our Encino dental office meets and surpasses all standards set by the Occupational Safety and Health Administration (OSHA), the Centers for Disease Control (CDC) and the Dental Board of California. Below you will find a complete description of all materials that could be used in dental fillings and restorations as required by law, including their benefits and any potential risks.

We encourage all patients, parents and guardians to read this disclosure from the Dental Board of California prior to treatment in our office. If you have any questions, we would be happy to discuss your concerns. Encino dentist, Allan Melnick DDS

The Facts about Fillings

Source: Dental Board of California

What about the Safety of Filling Materials

Patient health and the safety of dental treatments are the primary goals of California's dental professionals and the Dental Board of California. The purpose of this fact sheet is to provide you with information concerning the risks and benefits of all the dental materials used in the restoration (filling) of teeth.

The Dental Board of California is required by law to make this dental materials fact sheet available to every licensed dentist in the state of California. Your dentist, in turn, must provide this fact sheet to every new patient and all patients of record only once before beginning any dental filling procedure.

As the patient or parent/guardian, you are strongly encouraged to discuss with your dentist the facts presented concerning the filling materials being considered for your particular treatment.

Allergic Reactions to Dental Materials

Components in dental fillings may have side effects or cause allergic reactions, just like other materials we may come in contact with in our daily lives. The risks of such reactions are very low for all types of filling materials. Such reactions can be caused by specific components of the filling materials such as mercury, nickel, chromium and/or beryllium alloys. Usually an allergy will reveal itself as a skin rash and is easily reversed when the individual is not in contact with the material.

There are no documented cases of allergic reactions to composite resin, glass ionomer, resin ionomer or porcelain. However, there have been rare allergic responses reported with dental amalgam, porcelain fused to metal, gold alloys and nickel or cobalt-chrome alloys.

If you suffer from allergies, discuss these potential problems with your dentist before a filling material is chosen.

Toxicity of Dental Materials

Dental Amalgam:
Mercury in its elemental form is on the State of California's Proposition 65 list of chemicals known to the state to cause reproductive toxicity. Mercury may harm the developing brain of a child or fetus.

Dental amalgam is created by mixing elemental mercury (4354%) and an alloy powder (46-57%) composed mainly of silver, tin and copper. This has caused discussion about the risks of mercury in dental amalgam. Such mercury is emitted in minute amounts as vapor. Some concerns have been raised regarding possible toxicity. Scientific research continues on the safety of dental amalgam. According to the Centers for Disease Control and Prevention, there is scant evidence that the health of the vast majority of people with amalgam is compromised.

The Food and Drug Administration (FDA) and other public health organizations have investigated the safety of amalgam used in dental fillings. The conclusion: no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergy. The World Health Organization reached a similar conclusion stating, "Amalgam restorations are safe and cost effective."

A diversity of opinions exists regarding the safety of dental amalgams. Questions have been raised about its safety in pregnant women, children and diabetics. However, scientific evidence and research literature in peer-reviewed scientific journals suggest that otherwise healthy women, children and diabetics are not at an increased risk from dental amalgams in their mouths. The FDA places no restrictions on the use of dental amalgam.

Composite Resin:
Some Composite Resins include Crystalline Silica, which is on the State of California's Proposition 65 list of chemicals known to the state to cause cancer.

Dental Materials: Advantages & Disadvantages

Note: The durability of any dental restoration is influenced not only by the material it is made from but also by the dentist's technique when placing the restoration. Other factors include the supporting materials used in the procedure and the patient's cooperation during the procedure. The length of time a restoration will last is dependent upon your dental hygiene, home care, and diet and chewing habits.

It is always a good idea to discuss any dental treatment thoroughly with your dentist.

Dental Amalgam Fillings
Dental amalgam is a self-hardening mixture of silver-tin-copper alloy powder and liquid mercury and is sometimes referred to as "silver fillings" because of its color. It is often used as a filling material and replacement for broken teeth.
- Advantages
  - Durable; long lasting
    - Wears well; holds up well to the forces of biting
      - Relatively inexpensive
        
        Generally completed in one visit
        
        Self-sealing; minimal to no shrinkage and resists leakage
        
        Resistance to further decay is high, but can be difficult to find in early stages
        
        Frequency of repair and replacement is low
        
        Disadvantages
        
        Gray colored, not tooth colored
        
        May darken as it corrodes; may stain teeth over time
        
        Requires removal of some healthy tooth material
        
        In larger amalgam fillings, the remaining tooth may weaken and fracture
        
        Because metal can conduct hot and cold temperatures, there may be a temporary sensitivity to hot and cold
        
        Contact with other metals may cause occasional, minute electrical flow
        
        Composite Resin Fillings
        Composite fillings are a mixture of powdered glass and plastic resin, sometimes referred to as white, plastic or tooth-colored fillings. It is used for fillings, inlays, veneers, partial and complete crowns, or to repair portions of broken teeth.
        
        Advantages
        
        Strong and durable
        
        Tooth colored
        
        Single visit for fillings
        
        Resists breaking
        
        Maximum amount of tooth preserved
        
        Small risk of leakage if bonded only to enamel
        
        Does not corrode
        
        Generally holds up well to the forces of biting depending on product used
        
        Resistance to further decay is moderate and easy to find
        
        Frequency of repair or replacement is low to moderate
        
        Disadvantages
        
        Moderate occurrence of tooth sensitivity; sensitive to dentist's method of application
        
        Costs more than dental amalgam
        
        Material shrinks when hardened and could lead to further decay and/or temperature sensitivity
        
        Requires more than one visit for inlays, veneers and crowns
        
        May wear faster than dental enamel
        
        May leak over time when bonded beneath the layer of enamel
        
        Glass Ionomer Cement
        Glass ionomer cement is a self-hardening mixture of glass and organic acid. It is tooth colored and varies in translucency. Glass ionomer is usually used for small fillings, cementing metal and porcelain/metal crowns, liners and temporary restorations.
        
        Advantages
        
        Reasonably good aesthetics
        
        May provide some help against decay because it releases fluoride
        
        Minimal amount of tooth needs to be removed, and it bonds well to both the enamel and the dentin beneath the enamel
        
        Material has low incidence of producing tooth sensitivity
        
        Usually completed in one dental visit
        
        Disadvantages
        
        Cost is very similar to composite resin (which costs more than amalgam)
        
        Limited use because it is not recommended for biting surfaces in permanent teeth
        
        As it ages, this material may become rough and could increase the accumulation of plaque and chance of periodontal disease
        
        Does not wear well; tends to crack over time and can be dislodged
        
        Resin Ionomer Cement
        Resin ionomer cement is a mixture of glass and resin polymer and organic acid that hardens with exposure to a blue light used in the dental office. It is tooth colored but more translucent than glass ionomer cement. It is most often used for small fillings, cementing metal and porcelain metal crowns and liners.
        
        Advantages
        
        Very good aesthetics
        
        May provide some help against decay because it releases fluoride
        
        Minimal amount of tooth needs to be removed, and it bonds well to both the enamel and the dentin beneath the enamel
        
        Good for non-biting surfaces
        
        May be used for short-term primary teeth restorations
        
        May hold up better than glass ionomer, but not as well as composite
        
        Good resistance to leakage
        
        Material has low incidence of producing tooth sensitivity
        
        Usually completed in one dental visit
        
        Disadvantages
        
        Cost is very similar to composite resin (which costs more than amalgam)
        
        Limited use because it is not recommended to restore the biting surfaces of adults
        
        Wears faster than composite and amalgam
        
        Porcelain (Ceramic)
        Porcelain is a glass-like material formed into fillings or crowns using models of the prepared teeth. The material is tooth colored and is used in inlays, veneers, crowns and fixed bridges
        
        Advantages
        
        Very little tooth needs to be removed for use as a veneer; more tooth needs to be removed for a crown because its strength is related to its bulk (size)
        
        Good resistance to further decay if the restoration fits well
        
        Is resistant to surface wear but can cause some wear on opposing teeth
        
        Resists leakage because it can be shaped for a very accurate fit
        
        The material does not cause tooth sensitivity
        
        Disadvantages
        
        Material is brittle and can break under biting forces
        
        May not be recommended for molar teeth
        
        Higher cost because it requires at least two office visits and laboratory services
        
        Nickel or Cobalt-chrome Alloys
        Nickel or cobalt-chrome alloys are mixtures of nickel and chromium. They are a dark silver metal color and are used for crowns and fixed bridges and most partial denture frameworks.
        
        Advantages
        
        Good resistance to further decay if the restoration fits well
        
        Excellent durability; does not fracture under stress
        
        Does not corrode in the mouth
        
        Minimal amount of tooth needs to be removed
        
        Resists leakage because it can be shaped for a very accurate fit
        
        Disadvantages
        
        Is not tooth colored; alloy is a dark silver metal color
        
        Conducts heat and cold; may irritate sensitive teeth
        
        Can be abrasive to opposing teeth
        
        High cost; requires at least two office visits and laboratory services
        
        Slightly higher wear to opposing teeth
        
        Porcelain Fused to Metal
        This type of porcelain is a glasslike material that is enameled on top of metal shells. It is tooth colored and is used for crowns and fixed bridges.
        
        Advantages
        
        Good resistance to further decay if the restoration fits well
        
        Very durable, due to metal substructure
        
        The material does not cause tooth sensitivity
        
        Resists leakage because it can be shaped for a very accurate fit
        
        Disadvantages
        
        More tooth must be removed (than for porcelain) for the metal substructure
        
        Higher cost because it requires at least two office visits and laboratory services
        
        Gold Alloy
        Gold alloy is a gold-colored mixture of gold, copper, and other metals and is used mainly for crowns and fixed bridges and some partial denture frameworks.
        
        Advantages
        
        Good resistance to further decay if the restoration fits well
        
        Excellent durability; does not fracture under stress
        
        Does not corrode in the mouth
        
        Minimal amount of tooth needs to be removed
        
        Wears well; does not cause excessive wear to opposing teeth
        
        Resists leakage because it can be shaped for a very accurate fit
        
        Disadvantages
        
        Is not tooth colored; alloy is yellow
        
        Conducts heat and cold; may irritate sensitive teeth
        
        High cost; requires at least two office visits and laboratory services

NOTE: The Dental Board of California - www.dbc.ca.gov - is required by law (Business and Professions Code No. 1648.10-1648.20) to make this fact sheet available to all licensed dentists in California. In turn, dentists should make this fact sheet available prior to beginning any dental filling procedure and be available to field questions and concerns expressed by patients.

DENTAL BOARD OF CALIFORNIA
1432 Howe Avenue
Sacramento, CA 95825
www.dbc.ca.gov
(Originally published by the California Department of Consumer Affairs)