To repair holes in the teeth, the dentist uses very different materials. This depends on the size of the hole, whether it is a molar or a visible one. Of course, the costs for patients also play a role. We explain differences in use, advantages and disadvantages of amalgam and Co.
Dental fillings are used to repair holes in the teeth and otherwise reconstruct damaged areas on the teeth. Among other things, the filling material used by the dentist depends on the size of the hole to be repaired: The tooth itself must still have enough substance to hold the filling. This is especially important in molars that are subject to heavy loads due to chewing movements and pressure. Finally, optical reasons and the cost of selecting the filling also play a role.
Which fillings are there?
Basically, a distinction is made between plastic and rigid filling materials for dental fillings. This is associated with different manufacturing and processing techniques and significant cost differences.
The plastic fillings are introduced into the tooth as a moldable mass and harden there. The dentist can usually use them on a treatment appointment. On the other hand, rigid filling materials are cemented or glued into the tooth in the solid state as so-called inlay fillings. They must first be manufactured in the laboratory and machined to fit.
The production of an inlay requires a maximum of precision and thus a high workload. This is reflected in a much higher price and a longer treatment duration.
Plastic filling materials
The plastic filling materials essentially include amalgam and the so-called composites, colloquially they are also called plastic fillings . Both are used for permanent fillings. In addition, there are special cement materials and cement-plastic mixtures. These are only suitable for provisional fillings.
Amalgam: Proven, robust, but dangerous to health?
Amalgam is a mixture of equal parts of mercury and a powder of silver, tin and traces of other metals. Compared with the other filling materials, the often scolded dental filler is very inexpensive, extremely durable and, on top of that, easy to process.
Amalgam is mainly used in the posterior occlusal surface of the molars. Especially with large-scale, deeper caries , if missing enamel substance makes the adhesion of a plastic filling inadequate, it is considered the first choice.
A harmful effect of amalgam fillings could not be clearly demonstrated in studies. On average, mercury levels in people with amalgam seals are four times higher than those of amalgam-free people. However, the values are still well below health-endangered limits, the burden of amalgam-containing seals is low.
However, in the opinion of amalgam opponents, the fillings continuously release small doses of mercury due to attrition. Also, acids in the mouth and hot food and drinks to sweat out mercury, which could be deposited in the connective tissue and the organs and could even penetrate the blood-brain barrier. Neurological symptoms such as inner restlessness, fatigue, headache or gastrointestinal discomfort would then result. In addition, poisoning with the heavy metal can also affect chronic diseases.
Limitations in the use of amalgam since 2018
The environment and thus the food chain is also burdened with mercury – in the processing, the disposal of waste and the cremation of the deceased. In the long term, the use of amalgam should therefore be limited. According to an EU ordinance, since July 2018 amalgam in children, pregnant and nursing women is only allowed in exceptional cases. Since 2019, dental practices have had to collect amalgam residues separately and dispose of them safely. In addition, it should be examined whether dentists can do without amalgam as tooth filling in the long term (until 2030).
Replacement of fillings at own expense
Those who would like to have their amalgam seals replaced as a precaution, should bear in mind that the greatest danger of poisoning arises when inserting and drilling out the seals. Because it can release mercury in dangerous vapor form.
Anyone wishing to have their amalgam fillings replaced with other fillers without demonstrable damage to their health must pay for this themselves or take out a supplementary dental insurance. Also with new fillings the health insurance companies take over the costs for alternative materials only if medical reasons speak against amalgam fillings. This is the case, for example, if there is an allergy to amalgam or kidney disease.
Plastic fillings – composite
Plastic fillings (composite) primarily contain glass and quartz particles and, as the name implies, also various plastics. The tooth-colored fillings are very popular because of their better aesthetics, but their application is limited. Mostly they are for sooner
Small or medium tooth defects
recommended. Because the material can shrink slightly during curing. Since the shrinking process is less effective for smaller quantities, the dentist inserts the filling into individual layers. Between the individual layers, the filling material is cured with special lamps. Depending on the size of the filling, the treatment may take an hour or more. The cost of a filling amount to 30 to 180 euros.
Only for the anterior teeth (incisors, canines) does the health insurance cover the costs for composite fillings. When filling in the posterior region, only the subsidy is paid, which would have been paid for an amalgam filling. All additional costs must be borne by the patient. Exceptions to this rule are made with proven amalgam allergy, severe kidney problems, during pregnancy and tooth fillings of deciduous teeth.