Do you know your options when you need to get a tooth filled? Most of us just keep our mouths shut figuratively, and open our mouths literally, and let the dentist do their thing. But what are your options, and what exactly is your dentist putting in that tooth?

Dentists select from a variety of filling materials based on:

  • Type and location of the cavity or tooth damage
  • The type of materials insurance will cover
  • Other fillings in the mouth
  • Patient preference

Sometimes there's really only one choice, as a specific tooth or type of damage can only be repaired properly with one material. Sometimes, though, it's a matter of preference, affordability, or even allergy to certain materials.

Here are pros and cons of the four types of materials most often used to fill cavities and fix broken teeth:

1. Gold fillings

The pros: Gold fillings are durable, well tolerated, and can be expected to last 15 to 20 years or more. According to the American Dental Association (ADA), gold can be used for inlays, onlays, crowns and bridges.

The cons: The most obvious drawback is that it doesn't match natural tooth color. It's also the most expensive filling material, and not always covered by insurance. In some people, a gold filling placed next to a silver filling can cause a reaction that might feel painful, sensitive, or like an electric shock (though that reaction is uncommon). Gold fillings are made to order and cemented in place, which requires the patient make to multiple office visits. Once a gold filling is completed though, you can expect great results for decades.

2. Amalgam (silver) fillings

The pros: Amalgams are a mixture of mercury and silver alloy powder that forms a hard, solid metal filling. They're durable and can be expected to last at least 10 to 15 years. Amalgams are used primarily to restore back teeth because they're able to withstand the heavy force applied to teeth during chewing.

The cons: While they're both durable and less expensive than other options, they do not match tooth color, so they're not generally used for visible teeth. However, the biggest problem stems from potential toxicity. "Many patients are experiencing mercury toxicity from their amalgam fillings and are having to have them replaced with other materials," says Liesa Harte, MD, member of the American Academy of Oral Systemic Health. Based on these risks, she doesn't recommend them.

3. Composite resins

The pros: Composites are made of a mixture of glass and/or plastic and acrylic, and form a solid, tooth-colored restoration. They're color-matched to the patient's other teeth and used for veneers or fillings on visible teeth.

The cons: They're not always the best choice for very large fillings because they're more vulnerable to chipping than either gold or amalgams, but they are expected to last five to ten years or more. They're also vulnerable to staining from coffee, tobacco or other dark substances. They're much less expensive than gold, but more expensive than amalgams and they may require multiple visits to complete repairs.

4. Porcelain fillings

The pros: All-porcelain fillings are ceramic or glass-like fillings that are used for inlays, onlays, veneers, and crowns. They're color-matched to the patient's other teeth, custom-made in a dental lab, and bonded to the remaining tooth or to an underlying metal structure created for the damaged tooth.

The cons: Porcelain fillings are highly resistant to wear, but they can cause wear to surrounding teeth. They're more resistant to staining than composite resins, but they're subject to cracking if subjected to impact. Their cost is similar to gold fillings.

How do you choose what material to use? Talk to your dentist about your options, then weigh the pros and cons of materials, cost, appearance, and durability, and make the choice that's best for you.

Liesa Harte, MD, reviewed this article.


American Dental Association

Comparison of Indirect Restorative Dental Materials

Dr. Liesa Harte, M.D. Functional Medicine, Founder, Elite Care