Amalgam vs Composite, Long-term
May 21, 2013 1:48 PM   Subscribe

I know amalgam fillings are more durable. However, they also require drilling away more of the tooth. Given this, which is a better choice for filling a molar in the long run for a young person?

I need my first filling! :-( Now I have to decide which kind to get. I am concerned about both mercury in the amalgam fillings and BPA in the composites. However, I found some good information on that topic, so that isn't what I'm asking about here (though if you have some expertise, feel free to share).

Since there doesn't seem to be a clean winner in terms of health risk, I am trying to determine which type of filling would be less likely to lead to me needing a crown in the future. I am 25, so whatever I choose, it will probably have to be replaced someday. From what I understand, amalgams tend to last longer, but they also require removing more healthy tooth. Does this outweigh their superior durability over many years, when the process has to be repeated? I have been thinking that maybe, if I get a composite, by the time it has to be replaced there will be new materials available that will be stronger and not contain either mercury or BPA, and then I would have more tooth left. I don't know if that is reasonable, though.

Thanks for your help!
posted by Comet Bug to Health & Fitness (15 answers total) 1 user marked this as a favorite
Composites also discolour more readily.

If you can see the filling in everyday smiling, get the composite. If not, amalgam.
posted by scruss at 1:59 PM on May 21, 2013


Not included in your parameters, but you could also consider porcelain fillings. They are purported to be stronger and longer lasting than composites (more expensive though).

FWIW my porcelain filling is going strong beyond its supposed expiration date.
posted by pakoothefakoo at 2:06 PM on May 21, 2013

Do you whiten your teeth? If the filling will be visible and you decide to get a composite filling, remember that it will not whiten.
posted by Cranberry at 2:07 PM on May 21, 2013

Despite regular brushing, my mouth chemistry isn't so tooth-friendly and the bite surfaces of my molars are full of amalgam fillings, many over 20 years old. None has ever failed. I have a couple of crowns that were necessitated by cracked teeth, because I clench my jaw and grind my teeth at night when I'm under exceptional stress. I suppose those teeth may have been weakened by the filling-related drilling and thus made more likely to crack, but that's pure speculation and I wouldn't consider that at all unless you're a clencher/grinder too.

I have had one composite filling on the side of a tooth fail -- twice, in rapid succession. After the second failure, my dentist ground the recess deeper to give the filling more to hold on to.
posted by jon1270 at 2:09 PM on May 21, 2013

Ive had amalgam in fist-size holes and had them all removed, when I was your age, good riddance.

Composite used to be a problem back in the seventies (but amalgam too, I had one break in two, for Pete' sake). I've had some of my present composite fillings for more than two decades (one actually three), whereas the third alternative (gold) has in fact kept falling out here and there. Since you are talking about a molar, just get composite and let your dentist spend some time and concentration on it.
posted by Namlit at 2:12 PM on May 21, 2013

Two months ago we had a similar question.

My dentist doesn't really give me a choice. He strongly believes that amalgam fillings are the right choice in the long run for molars, and he very much tries to conserve teeth. Maybe get another dentist -- they should come with experience, and should know what is best for your specific teeth. You shouldn't have to make these decisions based on a layman's understanding of teeth. This is what you pay your dentist the big bucks for -- their expertise is what's expensive, not the drilling.
posted by Houstonian at 2:15 PM on May 21, 2013 [1 favorite]

Scandinavia doesn't allow amalgam. Other parts of Europe are starting to move away from amalgam as well. Not sure if these concerns have validity, but it may be another factor in your decision.
posted by el io at 2:26 PM on May 21, 2013 [2 favorites]

I have an extensive amalgam filling in a molar which will shortly celebrate its 40th birthday. Amalgam for work, white ones for show.
posted by BenPens at 2:39 PM on May 21, 2013

I have composite fillings on almost all my molars, put in starting from childhood. None have ever failed, even 20+ years later. Also, I grind my teeth. My fillings haven't yellowed any faster than the surrounding teeth, so despite 15 years of a heavy coffee habit, my new dentist said the colour matching was still "exceptional." I really don't know why composites have all that bad reputation, or are said to last "2-10 years." The dentist who put mine in was a composite specialist, though, and a strong proponent of everyone switching to composite. I think part of the reason composites generally don't last as long is possibly due to lack of dentist skill? I'm really mystified from what I'm reading about composites, it hasn't been my experience at all. So you might want to see a composite specialist if you do go that route.

My mom and I weren't informed about BPA at the time (as it wasn't really a public concern that long ago) she chose composite because of the possibility of mercury poisoning from amalgam.
posted by 100kb at 2:46 PM on May 21, 2013

You should consider a gold filling.
posted by yoyo_nyc at 3:03 PM on May 21, 2013

I had several(like 7-8) composite fillings when i was about 9 years old. I'm now 23 and have had 0 issues. Most of them are in molars.

like 100kb above, it was done by a specialist at the dental department in a childrens hospital, and i'm question the skill of installation with the people who've had issues. I barely brushed my teeth for years in my teens, etc, and they've held up fine. I'd even say extremely well, to the point that i can't even tell which teeth exactly have them in there nor can i count or remember exactly how many fillings i had.
posted by emptythought at 3:58 PM on May 21, 2013

I am a nighttime clencher and grinder. I have all composite fillings on my molars. They haven't discolored at all (some are over 25 years old) and I've had no problems. If I had to do it again, I'd pick them over amalgam every time.
posted by quince at 4:39 PM on May 21, 2013 [1 favorite]

I have some composites that have been doing well for 15 years or so now, if that helps as a data point. I like them better than my amalgams, honestly, if only for the looks.
posted by RogueTech at 8:20 PM on May 21, 2013

In my experience and that of my family and several friends, the filling material matters a whole lot less from a durability point of view than the skill of the dentist.

Talk to people in your own neighbourhood about who's good.
posted by flabdablet at 12:14 AM on May 22, 2013

IANAD but I used to be an assistant. Here is what I consistently heard my boss (a root canal specialist) say to his patients:

- There is pretty much NO risk of mercury poisoning from amalgam. It's really not the way amalgam works.

- "Composite" fillings are made of plastic. The nature of these plastics is to start out in a more fluid state and then harden, but while they are in their more fluid state, the materials in them can travel through the dental tubules into the pulp. This can kill the pulp, requiring root canal treatment. Amalgam is more stable and less likely to be leached through the tubules and kill the tooth. (This is of course dependent on how deep the filling would be placed.)

- In his experience, offices which used more composite fillings referred more patients for root canals later on.

In my personal view, I find it kind of funny that people are all freaked out about amalgam fillings, which have been around and being refined for over 150 years, and yet they think nothing of composites, which are made of who-knows-what petroleum-based weirdness.
posted by overeducated_alligator at 6:39 AM on May 22, 2013

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