Hi, I'm Dr. Pham. Today we're talking about fillings.
When is a filling needed?
When you have decay in a tooth that isn't big enough and does not involve the nerve, a filling is indicated. Essentially, a filling involves removing that decay, making sure everything is decay-free and cleaned out, and then we put a composite material in the hole where the decay used to be and make it look like part of the tooth.
Do you use silver fillings?
I personally don't use silver fillings or amalgams, I don't see the need for them. Composite nowadays, back in the day, amalgam was definitely the better option. Its properties were nice; it did well with saliva, and you didn't have to isolate as much. However, with improved composite today, even though you do have to maintain a very nice environment when packing those composites, they tend to last just as long as amalgam. They don't bite like amalgam does and essentially last for a very long time.
Amalgam is so strong compared to composite and does not absorb forces. That's why we sometimes recommend replacing small amalgam fillings. But when we see those big, massive amalgam fillings with fracture lines radiating from them, that's a good opportunity to actually put a crown over a tooth.
When is a crown recommended instead of a filling?
When you have extensive decay, say decay that's compromising more than 50% of the tooth, when we drill to remove and clean that decay, we take more tooth structure than the actual decay. You have to take that out, and then you have to clean everything out to get a nice, clean, healthy tooth surface to bond. When doing that, there's very little tooth structure left to bond the composite or the filling material to the tooth. We don't want to risk the tooth breaking from having such a big filling. That's when a crown would be a better option. It's kind of like a 360-degree helmet that you just pop onto the tooth and fix the problem.