How do I choose between types of fillings & crowns?
March 26, 2013 6:34 PM   Subscribe

I have fillings that need to be replaced, and I need to decide whether I want amalgam or composite fillings. I may also need a new crown, and I need to decide whether I want the basic option or to upgrade. How do I decide?

I need four fillings replaced; I think all are currently composite resin fillings. Two are cracked (one of those has cracked before, it's the second one in the same place), one has decay around it, and one is bothering me because it's not aligned correctly.

I've identified some factors, but I'm having trouble deciding whether I want resin or amalgam fillings. My insurance copay is $105 per filling for resin and $35 per filling for amalgam (all are two-surface fillings). I do prefer the white look of the resin. All four fillings are in the back of my mouth though, so I'm not sure how noticeable they'll be.

I've looked around for information on durability, but most of the information I can find is on insurance websites and dentists' websites, which I do not particularly trust as impartial. It is important to me that the fillings last a long time, especially the one that is prone to cracking.

I may also need a new crown (depending on whether I need a root canal redone); I have been offered a $385 basic crown, or a $695 "Zirconia" crown with a 7 year warranty. I would appreciate advice on how to make the decision of which to choose.

It may be relevant that I am in my late 20s so it's likely that all my dental work will eventually need to be replaced. Cheaper is better- money is a little tight - but I won't go in to debt even if I opt for all the most expensive options.

SUMMARY: What should I consider when deciding what materials I want the dentist to use in my mouth? Links to good explanations of the options very welcome.
posted by insectosaurus to Health & Fitness (9 answers total) 3 users marked this as a favorite
My dentist puts amalgam fillings in molars and composite resin only on the non-molar teeth, because he says the amalgam fillings are stronger and that's what's needed for molars. Especially my molars, because of the way they are shaped, my bite, my previous dental work, and my general dental history.

I'm not necessarily recommending that for you, though -- I'm recommending that you find a dentist who can talk to you about your teeth. I see you do not trust the information you find from insurance and dental websites. Do you also not trust your dentist? The very best part of getting dental advise from a dentist is that they have up-to-date information about dental things, they've been to dental school, and they are looking at your unique teeth.
posted by Houstonian at 6:50 PM on March 26, 2013

I agree that you must trust your dentist. If you don't, get another one, there are lots around.

My dentist, who I trusted, fixed many problems I had with childhood decay in my 20s. I got gold crowns on the teeth that had had large fillings, and he told me that if I take good care of them they will last the rest of my life. They were a hardship to pay for at the time so I did them one by one. I am now 40 and the crowns are still sound.

IMHO I would pay more for gold than a fancy amalgam crown by any name if it's not visible when you smile. Same goes for the fillings if your dentist feels that they won't need to be crowned at a later date.
posted by Deodand at 7:42 PM on March 26, 2013

My dentists works with composite because everybody wants white fillings, but he says if it were up to him, he would use amalgam because it lasts longer. This has been my experience, as well. I have some amalgam fillings in my mouth that have been there almost 30 years. And I have composites that have already been replaced twice in the less than 10 years I've had them. I have had amalgam fillings replaced, too, but that was strictly a vanity move (which I do not regret), not due to wear and tear. I've never had one fall out or otherwise need to be replaced. Nonetheless, if they did fall out, I'd replace them with composite. I have excellent dental coverage though, and the decision is totally about appearance over durability.
posted by looli at 7:43 PM on March 26, 2013

Late 20s. Composite. Repeat as necessary until nothing left to put composite on. Cheap and no risk.
posted by three blind mice at 12:35 AM on March 27, 2013

I'm a former dental assistant, and the dentist I worked for always told people to get amalgam unless it was a frontal, highly visible tooth. Amalgam is indeed stronger, and the only person who ever sees your back teeth is your dentist.
posted by Ursula Hitler at 1:24 AM on March 27, 2013

Amalgam fillings contain mercury. I wouldn't risk them.
posted by amro at 6:14 AM on March 27, 2013

I vote for amalgam where it doesn't show - I know people worry about mercury, and there are lots of anecdotes and theories about mercury in fillings, but there's no compelling evidence that they cause any harm.

Amalgam fillings last a lot longer than composite. I have some amalgam fillings in my molars and they're unnoticeable except maybe if I'm laughing and you're staring into my mouth. I would rather have durable fillings, because then you don't have to go back to get them filled as often, which means less visits to the dentist and you don't run out of tooth as quickly.

I don't know about crown materials. I have a gold crown but it's on my furthest back upper molar so no one ever sees it unless I want to show off my gold crown. It's great.
posted by mskyle at 6:30 AM on March 27, 2013

Amalgam fillings contain mercury the way table salt contains deadly chlorine.
posted by kamikazegopher at 9:42 AM on March 28, 2013 [2 favorites]

Thanks for the responses. I am not worried about mercury in amalgam fillings since there doesn't appear to be any actual scientific evidence that it's harmful. It sounds amalgam is more durable, so I've decided to go with amalgam for the three molar fillings and composite resin for the one filling that is not on a molar and may be more visible.

If anyone has insight in to selecting a crown, I'd love to hear it.
posted by insectosaurus at 6:05 PM on March 28, 2013

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