Types of Fillings Used in Children

Fillings in children — in both primary and permanent teeth — can be metal or tooth-colored. Metal fillings are also called amalgam. Tooth-colored fillings include composite resins. There is also a tooth-colored filling called a compomer. It is a combination of a composite with small glass particles. Another type of tooth-colored filling is the glass ionomer. There's also a combination type of glass ionomer called a resin-modified glass ionomer.

Metal

Amalgam has been used as a filling material for more than 100 years. It still is used to fill children's teeth. The advantages of amalgam are that it:

• Has a long history of successful use, especially in the back teeth (molars), which are exposed to extreme biting and chewing forces
• Generally, takes less time to place than plastic fillings
• Is more reliable if the decay is between two back teeth or involves several tooth surfaces

However:

• Some people are concerned about the mercury in dental amalgam. Still, no study has shown that the type of mercury in dental fillings causes any ill health effects.
• More of the tooth has to be removed to place an amalgam filling. That's because amalgam is not bonded chemically to the tooth like plastic fillings. Instead, it is held in the tooth by the way the dentist shapes the tooth by friction.

TOOTH-COLORED

Tooth-colored fillings have several advantages:

• They match the tooth color and shading. They therefore blend in with the rest of the tooth and other teeth.
• They are bonded to the tooth. This helps seal the filling and prevent decay around it.
• Glass ionomer and resin/modified glass ionomer fillings release fluoride and also absorb fluoride from saliva, or from fluoride containing toothpastes and rinses. The fluoride mineral helps strengthen the tooth and prevent more decay.
• Usually, the dentist can make a smaller opening in the tooth for a plastic filling than for an amalgam filling. That's because chemical bonding helps to hold the filling in place.
• A type of plastic filling is the dental sealant. Sealants are typically placed over the pits and grooves of a tooth in areas where food gets caught and cavities can develop. A well-placed dental sealant can cover a groove or pit that has questionable or a minimal cavity. Sealants should be checked by your dental hygienist or dentist to make sure that they are effective.
• A new approach to slow the progression of cavities between the teeth is called resin infiltration. The material used flows into the “pores” that have been made in the tooth by the cavity and fills these areas preventing growth of the cavity.

However:

• Some plastic fillings contain Bisphenol A (BPA). BPAs can present health risks because they have some properties similar to estrogen, a human hormone. The amount of BPA that is present is reduced by your dentist when they clean the filling surface after placement.
• Placing a tooth-colored filling involves a few more steps than placing a metal filling, and the success of this type of filling is much more dependent on keeping the tooth dry. This means your child may spend more time in the dentist's chair, and filling placement is typically more efficient with an older, more cooperative child.
• Tooth-colored restorations work especially well for small cavities. Metal restorations are less likely to wear down if subject to heavy biting and chewing forces when placed in large cavities in the back teeth, and they also last longer and allow fewer new cavities to develop around the edges of the filling.
• Some children are allergic to methyl methacrylate, one of the ingredients in some plastic fillings. This is rare.

Sedative Fillings

Sedative fillings are placed on a tooth to reduce pain. Irritated or inflamed pulp can be the source of this pain. The pulp is the center part of the tooth that contains the blood vessels and nerves. A sedative filling calms the pulp. This reduces the chance that saliva or bacteria will leak into the tooth and irritate the pulp in the future.

Sedative fillings often are placed directly into the tooth. One of the most common types of sedative filling is zinc oxide and eugenol. This contains oil of cloves. Glass ionomers or resin/modified glass ionomers also are used for this type of filling. These materials may be placed on the tooth without any drilling.

A sedative filling is considered a temporary measure. It often is used in very young children who are unable to sit in a dentist's chair long enough to receive a regular filling. A sedative filling also may be used for a child who has a tooth injury and needs immediate relief.

Sedative fillings typically last about three to six months. Your dentist should regularly examine the sedative filling to be certain it is still in place and is fulfilling its purpose.

Updated- November 20, 2020

References:

• https://www.aapd.org/research/oral-health-policies--recommendations/pediatric-restorative-dentistry/ (Accessed 10-01-2020)
• https://www.aapd.org/globalassets/media/policy-center/treatingtoothdecay.pdf (Accessed 10-01-2020)
• Yengopal V, Harnekar SY, Patel N, Siegfried N. WITHDRAWN: Dental fillings for the treatment of caries in the primary dentition. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD004483. doi: 10.1002/14651858.CD004483.pub3. PMID: 27748505; PMCID: PMC6464136.
• Uribe S. Which filling material is best in the primary dentition? Evid Based Dent. 2010;11(1):4-5. doi: 10.1038/sj.ebd.6400697. PMID: 20348886.
• Moraschini V, Fai CK, Alto RM, Dos Santos GO. Amalgam and resin composite longevity of posterior restorations: A systematic review and meta-analysis. J Dent. 2015 Sep;43(9):1043-1050. doi: 10.1016/j.jdent.2015.06.005. Epub 2015 Jun 24. PMID: 26116767.
• https://www.aapd.org/assets/1/7/G_Restorative1.pdf (Accessed 10-01-2020)