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[C1090]Cost Of Dental Fillings

by Syamack, Sya

Dental Fillings Overview:

Although Ifind myself placing composite fillings 99% of the time, but alwaysreview all of the options with patients before deciding on what typeof filling material will be placed in their tooth. As a dentist I do notendorse products of one company versus the other, but I find peace of mindusing products of reputable manufacturers. Dental fillings must survivein the extreme conditions of the mouth. The human mouth is a perfectenvironment to test any material to its limits. It is mostly neutralin pH (due to neutralizing effect of saliva), but depending on the foodcontent it can have rapid upward or downward spike in pH. The samething can happen with temperature swings of up 60 degrees Celsius (from icecold to coffee hot). Any type of filling material has toendure normal chewing forces and also abnormal para-functional grindingwhich can put up to 20 times more pressure on the teeth compared to normalchewing forces. This article aims to inform the prospective dentalpatient of their different options, because not all dental fillings are createdequal.

1.Amalgam Fillings: Composed mainly of Mercury, Silver, Tin, Copper andsometimes Aluminum alloys.

Advantages:Very durable; works in wet or dry environment when placed; releasesantibacterial silver ions that fight future cavities that may form around thefilling.

Disadvantages:Has mercury; does not match tooth color; most amalgams are not bonded to thetooth which may render back teeth in people who grind their teeth moresusceptible to tooth fracture; in general teeth with metal filling may becomemore sensitive to cold drinks.

2.Composite Fillings: Composed of inorganic fillers such as Silicon Dioxide,organic resins and photo initiators.

Advantages:Color match with the tooth; can be polished to a very high luster; is bonded tothe tooth vs. just sitting in it; the only type of filling that can be placedin very shallow cavities (does not require thickness for strength.

Disadvantages:Require dry field during placement; can absorb stains over time; more sensitivethan other types of filling to left over decay in the tooth.

3.Porcelain or Ceramic Fillings (Onlay): Composed mainly of inorganicminerals.

Advantages:Excellent color match to the tooth; lasting luster and does not staineasily; very durable but prone to fracture in people who grind or clenchtheir teeth; is bonded to the tooth; can be used on severely broken down teeth;excellent replication of the tooth anatomy since is made by a lab technician.

Disadvantages:Cost (more expensive that amalgam or composite fillings); requires twoappointments.

4.Gold Fillings (Onlay): Composed of gold alloys in different quantities of goldfrom 30% up to 90%.

Advantages:The most durable type of dental filling.

Disadvantages:Cost; no color match; takes two appointments.

5.Glass Ionomer Fillings: Composed mostly of inorganic fluoride releasingsalts, and organic matrix, may also contain photo initiators ans oxygeninhibitors.

Advantages:Can be placed on wet or dry environment; is white in color (butdoes not exactly match tooth shade); bonds to the teeth; releases fluoridehence has decay fighting properties.

Disadvantages: Not very durable; used mostly on baby teeth, not the best choice foradult teeth specially on the load bearing surfaces.

Inearly 2008 several European countries made the move to ban use of dentalamalgam in concern about safety of mercury vapors released during placement onthe filling. So far there has not been a strong evidence showing healthrisks associated with dental amalgam. US Food & Drug administration(FDA) and American Dental Association (ADA) endorse safety of the dentalamalgam.

Author:Syamack Ganjavian, DDS

The treatment recommendation for a dental cavity is based primarily on the diagnostic classification of the stages of the disease progression. The main criteria are: (1) carious lesions without pulpal involvement (these lesions are normally small and do not have any pain symptom); and (2) carious lesions with pulpal involvement (these lesions are normally large and cause painful symptom).

The carious lesions without pulpal involvement are divided into three subtypes:

1. Incipient caries lesion - The decay area is limited to the outermost layer of the tooth (enamel). The best treatment for the incipient caries consists of fissurotomy, preventive filling, and sealant. These procedures always can be performed without the use of local anesthetics (numbing shots).

2. Moderate carious lesion - The decay area completely penetrates through the enamel layer of the tooth and reaches the dentin layer. Most dentists recommend amalgam and composite fillings for these lesions. These procedures may require the use of local anesthetics. About 95% of the operations can be done without the numb shot, when an air abrasion or a hard tissue laser is used to remove the decay.

3. Advanced carious lesion - The decay area is within the dentin layer but not reaches the pulp yet. The treatment commonly recommended for these advanced lesions includes indirect (laboratory) porcelain or gold inlays, onlays, and partial crowns. The procedure is done by taking the impression of the defect, making a porcelain or gold restoration in the dental laboratory, and cementing the restoration to the defected tooth. Normally it would take two dental visits to finish the operation; however, the dentist can complete the whole operation in one seating, if the CEREC (CAD/CAM) technology is available.

The carious lesions with pulpal involvement are also divided into two subtypes:

1. Severe carious lesion with reversible pulpitis - The decay area is approaching the pulp and causing pulpal inflammatory hyperemia. Cold and hot application to the normally increases the pain; however, the pain disappears quickly after the stimulus is removed. The electrical pulp testing for the tooth in question shows normal vitality reading. The common treatment recommendation for these lesions consists of a direct or indirect pulp capping with a calcium hydroxyl appetite medication (dycal), placing a temporary sedative filling (IRM) on the defect for 4-6 weeks, and restoring it with the final restoration once the pain symptom completely disappears. Because the insurance companies typically do not pay for the sedative fillings, some patients elect to place the permanent restoration immediately. These patients take the risk of paying in full for the retreatment, when the inflamed pulp fails to reverse to its healthy state.

2. Severe carious lesion with irreversible pulpitis - The decay area reaches the pulp and causes constant toothache. Cold and hot application increases pain and the pain lingers for more than 30 seconds after the stimulus is removed. The tooth is sensitive to slight tapping and touching. The electrical pulp test shows abnormal vitality reading. The recommended treatment for these lesions is either a root canal therapy with a final crown or a tooth extraction with a final bridge or implant restoration.

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Both Syamack & Minh Nguyen, D.d.s. are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Syamack has sinced written about articles on various topics from Medicine, Dental Practice. Doctor of Dental Surgery. Syamack's top article generates over 590 views. to your Favourites.

Minh Nguyen, D.d.s. has sinced written about articles on various topics from Food and Drink, Dental Surgery and Bad Breath. For information, visit . SoftDental (. Minh Nguyen, D.d.s.'s top article generates over 18100 views. to your Favourites.