White filling, silver filling, tooth crown....yikes! What's the deal?

Aug 25 2013

White filling, silver filling, tooth crown….yikes! What’s the deal?

White filling, silver filling, tooth crown….yikes! What’s the deal?

I frequently see families who come to my practice searching for a second opinion in dealing with cavities. Given the hustle and bustle of parenthood nowadays, children are surpised kid in dental chairgetting cavities across the socioeconomic spectrum. If your child needs dental treatment such as a filling or crown, most likely, there is more that one way to tackle this issue. Not all dental providers spend the time to talk about your options. In this post, we’re summarizing the basics of these options to help you ask educated questions when speaking to your pediatric dentist. This is not  intended to be taken as medical advice as all must talk to their child’s provider to decide what is best for him/her.

Bonding to tooth structure

For several decades, dental scientists have improved adhesives that on a microscopic level bond to tooth surfaces (dentin/enamel). This material is the most commonly used material to fix teeth in the US. This filling material may be called Resin or Composite  by your dentist. (it’s basically tooth colored plastic). It can be used to partially (filling) or fully (crown) cover CERTAIN teeth. In the case of children, large fillings are typically not good candidates for composite fillings. If a large filling is done in a baby tooth, the enamel may break or leakage may seep underneath the filling caused by excess stress on the tooth.

Benefits: Great esthetics. Typically less healthy tooth structure needs to be removed by the dentist. The tooth can be sealed in areas next to the filling.

Downsides: May be more expensive. More technique sensitive and child needs to have good cooperation for longer time period. Not as strong as silver fillings or crowns.

Filling with amalgam

Silver fillings (or amalgam) are considered one of dentistry’s time tested materials. Like most dental materials in use now, its undergone multiple generations with improvements. Today’s amalgams are made of several different metal elements mixed together to give it the right strength and handling properties. Though some pediatric dentists refuse to offer amalgam as an option, pediatric dentistry’s leading scientific organizations including the American Academy of Pediatric Dentistry and American Dental Association have clear guidelines based on research that support its general safe use. The major area of concern to many parents, and clinicians is the presence of mercury, which is a known toxin and a potent one at that. But, quite a few quality scientific studies have failed to find support that mercury in amalgam causes toxicity in humans. You can bet, this controversy wont go away anytime soon and a parents’ preference is how we handle the use of this over alternatives.

Benefits: Usually its about 30% cheaper. Its pretty strong (though can still break easily in some scenarios).

Down sides: Mercury controversy. Not esthetic. Typically will force your dentist to remove more healthy tooth structure than composite. Cant be combined with sealants on the same tooth.


Crowns are used in cases when a tooth needs to be fully covered to prevent continued fracturing of it enamel. Thought the idea is the same, crowns (or caps) in children are much different than in adults. Tooth colored crowns (porcelain) is rarely ever used in the US for baby teeth. Though very recently, all white crowns made of zirconia are being introduced in the market for children, over 95% of crowns used for molars are made of stainless steel (or SSC). They are prefabricated crowns made of a mixture of metals that give it a typical stainless steel shine and gentleness to human tissues (think earrings used when piercing your daughter’s ears). They come in different sizes and shapes for the dentist to pick and custom fit to the tooth. The crown gets cemented to help retention. These crowns have been in use for a long time and have much better durability than large silver or resin fillings. Other commonly used crowns used on front teeth include resin crowns (or strip crown) and SSC’s with veneered facings.

Benefits of SSC: Full coverage protection against caries on all surfaces of teeth. Less technique sensitive than fillings. Great long term durability.

Downsides of SSC: Lack of esthetics. Can require recementation. More costly than fillings.

Benefits of resin crowns: Very esthetic. Full cover protection on all surfaces of teeth.

Downside of resin crowns: Can not be used on back teeth (molars). Can stain or break quite easily. More costly than fillings. Very technique sensitive and needs great cooperation by child during procedure.

Benefits of SSC with veneer: More esthetic than SSC due to its white facing.

Downsides of SSC with veneer: More healthy tooth structure removed compared to SSC (at times may force dentist to do an otherwise unnecessary root canal). Veneers can stain or even break off.

Here’s the official AAPD guideline for different common materials in used in pediatric dentistry:

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