White Fillings in Vestal, NY

Every filling we place is tooth colored. That has been true here for a long time and it is not really a selling point any more, it is just what a filling is now.

The question worth a page is the one patients actually ask in the chair: what about the silver ones already in my mouth, and should I be doing something about them?

Should You Replace the Amalgam Fillings You Already Have?

Usually not. A sound filling that is doing its job is best left where it is.

Removing a sound filling means drilling away more of the healthy tooth around it, since the new restoration has to be larger than the old one. Every replacement cycle costs tooth structure you cannot get back, and a tooth only has so many cycles in it before the answer becomes a crown.

Regulatory guidance says the same thing. The position of the FDA is that existing amalgam fillings in good condition should not be removed, because the removal process itself releases more mercury vapor than leaving them alone does. Separately, it advises that certain groups, including people who are pregnant or nursing, young children, and people with particular neurological or kidney conditions or a known mercury allergy, may be better served by alternative materials when a new filling is being placed and a suitable option exists. That is a sensible, narrow recommendation, and it is not the same as saying everyone should have their old fillings taken out.

If you would prefer not to have amalgam for aesthetic reasons, that is an entirely legitimate choice and we are happy to do it, and where the tooth is visible when you smile, direct bonding techniques apply. We will just make sure you are choosing it with the trade-off in front of you rather than because of a scare.

When a Silver Filling Genuinely Should Come Out

There are clear cases, and these are the ones we will raise with you unprompted:

• Decay has started again at the margin, where the filling meets the tooth
• The filling is cracked, or the tooth around it has visible crack lines running from it
• It has worn down, or a corner has broken away, leaving a ledge that traps plaque
• The tooth has become sensitive to pressure or temperature, which can mean the seal has failed
• It is a very large old filling with thin walls of tooth left around it, which is a fracture waiting to happen

That last one deserves attention. A big amalgam expands and contracts with hot and cold slightly differently from the tooth around it, and over decades that works like a wedge. Replacing a large one before it splits the tooth is genuinely preventive, and in those cases a milled ceramic onlay from our CEREC system often makes more sense than another filling, because it rebuilds and reinforces the tooth rather than just plugging it.

What Composite Does Better

The appearance is the obvious part and the least interesting. Two things matter more.

It bonds to the tooth. Amalgam sits in a cavity and is held by its shape, which means the cavity has to be cut to retain it, sometimes removing healthy tooth that was not decayed. Composite chemically bonds to enamel and dentin, so the preparation can be limited to the decay itself. Less drilling, more tooth left. Our Learning Center covers what to know before replacing amalgam and how composite fillings behave over time.

It does not conduct temperature the way metal does. Patients with large metal fillings often report sensitivity to hot and cold that improves after switching, though this varies.

Worth knowing in the other direction: a well placed amalgam in a large back-tooth cavity is extremely durable, and composite is more technique sensitive. It has to be kept dry while it is placed and built in layers. Done carelessly it fails sooner. Done properly it lasts a long time, and that difference is about the dentist, not the material.

White Filling Questions We Hear

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  How long do white fillings last?
  Modern composites commonly last a decade or more in the right situation, and the range is wide because so much depends on the size of the filling, which tooth it is in, how heavily you bite and whether you grind. Small composites in front teeth can last a very long time. Large ones taking heavy chewing force in molars work harder. If you grind, a night guard extends the life of every restoration in your mouth.
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  Do white fillings stain?
  The margins can pick up staining over years, particularly with coffee, tea and tobacco, and the surface can dull. A polish at a routine cleaning usually restores a lot of that. What composite will not do is lighten during whitening, so if whitening is in your plans, do it before any visible filling is placed and we will match the new shade.
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  Why is my tooth sensitive after a new filling?
  Mild sensitivity to cold or to pressure for a few days up to a couple of weeks is common, especially after a deeper filling, because the nerve has been irritated by the decay and by the procedure. It should steadily improve. What is not normal is sensitivity that is getting worse, pain that lingers after cold, or pain when you bite in one specific spot after two weeks. Call us for those rather than waiting it out, because a high spot takes two minutes to adjust.
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  Is there mercury in my old fillings, and is it dangerous?
  Dental amalgam does contain mercury bound into an alloy with silver, tin and copper. The consensus among the FDA, the ADA and major health bodies is that amalgam fillings are safe for most people, and the FDA's guidance is specifically that fillings in good condition should not be removed. Its narrower advice concerns choosing an alternative material for new fillings in certain higher risk groups. If you have a specific health condition you are worried about, tell us and we will plan around it, and if you would simply rather not have metal, that is reason enough on its own.
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  When is a filling not enough?
  When there is not enough sound tooth left to support one. Past a certain size, a filling becomes a wedge sitting between thin walls, and the tooth eventually fractures around it. At that point an onlay or a crown, which wraps and protects the remaining structure, is the more conservative choice despite sounding like the bigger one. We will show you on the intraoral camera why a particular tooth has crossed that line rather than just telling you it has. See our knowledge and technology for what that involves.
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  Does insurance cover white fillings on back teeth?
  Most plans cover fillings, though some older plans reimburse a posterior composite only at the amalgam rate and leave you the difference. Some cover them identically. We check your specific plan and tell you the actual out of pocket figure before treatment rather than after. Our payment options page lists the plans we work with.