• Explanation of direct vs. indirect fillings

• The types of direct fillings
  • Silver Amalgam
    • The MERCURY issue
    • The properties of amalgam fillings
    • The MERCURY issue--an entire page devoted to the subject
  • Tooth colored fillings (Composite fillings)
• Causes of post operative discomfort after a filling
  • Tooth pain associated with any type of filling
  • Tooth pain associated specifically with composite fillings
• Why I no longer use amalgam
• Should I have all my amalgam fillings replaced with composite?
• When should a tooth be crowned rather than filled?
• What if the dentist recommends a crown but I opt for a filling instead?
• Temporary fillings (ZOE and IRM)

• Comparison Chart of direct restorative materials 

• Comparative chart of indirect restorative materials

• Can teeth with fillings cause cancer or other systemic diseases? 

Another type of restoration, less common due to their much higher cost, are called "indirect" restorations. These "fillings" justify their expense by being more durable (in other words, properly cared for, they should last longer than regular indirect restorations), and also more esthetic (better looking because they are actually built by a laboratory technician on a lab bench without the difficulties imposed by the time constraint and the poor access the dentist faces working in a patient's mouth).   Indirect fillings, made in a dental laboratory, are known as inlays and onlays. 

Indirect fillings used to be more common when gold and ivory were the principal dental materials.  With the advent of porcelain laboratory produced restorations, most dentists today prefer the superior strength and esthetics of "full coverage" of the tooth in the form of crowns or veneers rather than simply filling cavities with laboratory processed gold or porcelain fillings.  For a side by side comparison of the characteristics of all indirect filling materials please see my reproduction of the American Dental Association Table of indirect restorative dental materials.

The types of fillings

There are three major types of direct filling materials (direct fillings are placed in a prepared hole in a tooth, carved or molded to look like a tooth, and then light cured or allowed to harden;

• silver amalgam, made of a mixture of an alloy of silver-tin and liquid mercury
• composite (combination of glass/porcelain particles in a plastic matrix)
• temporary filling materials

There are also three major types of indirect filling material;

• gold (and other semi precious metals)
• fused porcelain
• composite (There is an indirect form of composite which some dentists use.)  

For a side by side comparison of the characteristics of all non temporary direct dental materials, please see my reproduction of the American Dental Association Table of direct restorative Dental Materials.

Silver Amalgam and the "mercury issue"--Are my fillings killing me??

Silver Amalgam is the most commonly used material in the restoration of decayed teeth in the world!  It was invented in France in the early 1800's and introduced into the US by two french enterpreneurs, the Crawcour brothers.  Due to its mercury content, it was denounced by a majority of the dental profession since mercury was known to be a poisonous material.  What was not fully recognized at the time was that elemental mercury, especially when bound into a solid amalgam with other metals is not well absorbed into the human body.  The belief in the severity of the toxicity of mercury was based upon the toxicity of soluble mercury salts and organic mercury compounds which had been used industrially in the manufacture of the felt used to make hats.  Even though the dental profession of the day denounced the use of amalgam for the repair of the teeth, the brothers went on to repair huge number of mouths with it.  In spite of appalling dentistry (they seldom removed the bulk of decay and violated every principle of dentistry known even at that time), they were not only successful entrepreneurs, but the teeth they repaired mostly remained successfully repaired for many years!  Often, these restorations seemed to work better than the expensive gold restorations placed by the "expensive dentists".   Furthermore, the predictions of widespread mercury poisoning proved to be false. 

Prior to the introduction of amalgam, the only materials available to repair decayed back teeth were tin foil, lead plugs and gold leaf.  Tin has a nasty habit of falling out of the cavity preparation, Lead was known to be poisonous, and gold leaf was very time consuming and so expensive that only the very wealthy could afford it.  Cast gold did not become available until 1910.  On the other hand, dental amalgam was not especially technique sensitive and it required much less time (and consequently less pain) to prepare the teeth.  The amalgam itself is quite inexpensive, and after the introduction of Coca Cola in 1886, the demand for affordable dentistry skyrocketed.  Even in those days, Americans realized that the average Joe was being discriminated against because of the lack of choice in dentistry, and dentists were forced to reevaluate the use of amalgam.  They discovered (to their consternation) that NO ONE who had their teeth filled with amalgam suffered from any of the symptoms associated with mercury poisoning.  Many dentists still refused to use amalgam, and they formed the core of the burgeoning anti-amalgamist movement.  They were very angry, since a bunch of newcomers to the profession were taking away their core business.  Unfortunately, since no one was exhibiting the symptoms of mercury poisoning, the anti-amalgamists had to rely on scaring the public with horror stories about diseases like diabetes, arthritis, gout, etc. for which the medical profession had no explanation.  Unfortunately for the anti-amalgamists, the list of diseases that dental amalgam supposedly caused kept shrinking as the real causes of these diseases was discovered by researchers.  Today we know that there is no known statistical difference in the health status of persons with amalgam fillings compared to those with no fillings in their teeth!

Please refer to the following links: The US Food and Drug Administration's statement on dental amalgam: The Multiple Sclerosis Society's statement on dental amalgam: The American Dental Association's statement on dental amalgam: The Department of Health and Human Services (HHS) statement on dental amalgam: also The US Public Health Service website on the safety of dental amalgam

In the meantime, the rest of the dental profession had moved on and accepted dental amalgam as one of the major armaments in the fight against decay.  A dentist named G.V. Black (1836-1915- pictured to the right) finally laid the foundation for the correct use of the new material and essentially revolutionized the profession of dentistry by standardizing the repair of teeth and making dentistry affordable to everyone. 

Today, silver amalgam is still the most popular tooth filling material in the world.  It has been used extensively worldwide for nearly 200 years, and almost everyone in the industrialized world has at least one or two amalgam filling in his/her teeth.

I have devoted an entire six page essay to this subject.  It includes documentation from  scientifically respected sources which cite peer reviewed statistics to help counter the misinformation found on the huge number of websites which advocate removal of amalgam fillings.  Click on the icon to the right to read this page.  Some of the information on this page has been reproduced there.

Amalgam's properties--the reason it has been so successful

Silver amalgam's main disadvantage is its appearance in the teeth. It tends to be gray or black, or sometimes silver if the patient brushes regularly with a toothpaste that contains an abrasive. Older forms of amalgam tended to corrode imparting a dark usually bluish stain to the teeth.  This stain could permeate the dentinal tubules and is very difficult to remove when replacing the old filling.  The advantages to metallic fillings are that they are incredibly durable, not likely to break, and last a LONG time. Five to ten years is the average, however, in a very clean mouth not exposed to too much sugar, twenty years is not an uncommon lifespan for a well done amalgam. It is not very technique sensitive, which means that the skill of the dentist is less important to the wear of an amalgam than it is with the other types of restorations.

Amalgam tends to be self sealing which means that once it is placed, a small amount of corrosion takes place underneath the filling and this corrosion fills microscopic voids between the tooth and the filling. Moreover, this corrosion is water resistant and once in place prevents further corrosion and the entry of fluids containing sugar and bacteria which are the agents that cause more decay. This self sealing property is unique to amalgam, and is one of the main reasons why amalgam fillings resist recurrent decay better than the older, more expensive cast gold restorations.  They are also more reliable than composite posterior fillings in resisting recurrent decay, especially in patients who use a lot of sugar.  Finally, they are less expensive than gold or composite restorations because they take less time to place. 

Resin Composite fillings (sometimes called "porcelain" fillings)

Having sung the praises of Amalgam restorations, I will now state flatly that I have given them up in my own practice in favor of the new generation of composite restoration. The reasons follow my description of composite filling materials.

Composite fillings are what people think of when they say "white fillings" or "porcelain fillings". We call them tooth colored fillings to distinguish them from amalgam, gold and temporary filling materials. There are a number of different formulations of composite filling, but the type most commonly used today is made of microscopic glass, or porcelain particles of varying shapes and sizes (depending on the intended use) embedded in a matrix of acrylic. The glass particles account for between 60% and 80% of the bulk of these materials, so these restorations could more properly be called porcelain fillings.

The glass particles give the composite restoration their color (and their stiffness in the unset state). The acrylic is the plastic matrix that holds the glass particles together. Most composite restorations today are "light cured" which means that the acrylic remains fluid until a very bright light is shined on it causing it to harden. Light curing allows the dentist time to work with the material, building and shaping it correctly, and when ready, to harden it immediately with the light. The light curing also makes for a more color stable restoration. The new tooth colored composite restorations do not get yellow or brown with age as the older ones did.

The porcelain particles also give the restoration a great deal of resistance to wear. Amalgam fillings will probably always wear less than composite restorations, however the recent advances in particle formulation and shape have made the newest posterior composites quite competitive for filling back teeth. Five to seven years is average. Composites are even stronger than amalgams in shear strength which makes them better for overlaying large biting areas.

Composite fillings have been used in front teeth for years, but only recently has the technology in composite formulation improved enough to allow their common use in back teeth. Prior to acrylic/glass composites, other types of composites were used in areas where esthetics was important. This is why even in the early twentieth century people were not forced to have silver amalgam fillings in their front teeth. However, even in the 1980's the technology had not yet advanced enough to allow the routine use of composite to restore chewing areas of the back teeth.  

Composite resins are still not as popular with dentists for repairing back teeth as old-fashioned amalgam.  In fact, only about 25% of dentists currently use them routinely for restoring posterior teeth.  The reasons for this are that they are not as wear resistant as amalgam restorations, they are more technique sensitive than amalgam, and there is a tendency for more prolonged tooth sensitivity to cold after the restoration is done.  On the other hand, as the materials continue to improve, they have become tougher and more wear resistant while improvements  in placement technique have reduced cold sensitivity.   However, the greater difficulty in placing these restorations remains a deterrent for many dentists, and continues to keep the cost of the service higher than for an a comparable amalgam restoration.

For those interested in the more technical aspects of composites and dental cements please click on the button below to visit my page on dental materials.  Here I discuss the different types of composites and cements, their formulations and their uses.

Post operative discomfort after  fillings (why they sometimes cause prolonged sensitivity to cold or pressure)

When any type of filling is done on a tooth, some sensitivity to cold and pressure is normal.  This often lasts for as much as a month after the filling is done.  The amount of post operative discomfort associated with any given filling depends on the depth and extent of the cavity preparation which in turn depends upon the depth and extent of the original area of decay or of the old filling which is to be replaced.  

• In many instances the living nerve in the tooth is not especially healthy at the time the filling is done, and the trauma caused by removal of the decay or the old filling can push the nerve over the edge causing an irreversible pulpitis (inflammation of the nerve) which will lead to the eventual death of the nerve.  Situations in which the nerve of the tooth remains exquisitely sensitive to cold, or hurts spontaneously without an external stimulus may have a dieing nerve, and the only solution to this problem is either to perform a root canal treatment or extraction on the tooth. 

• A second problem that can cause prolonged sensitivity to cold or pressure on a recently filled tooth is hyperocclusion.  This is a technical term that means that the filling is simply too "high" and strikes the opposing teeth with too much force when the patient closes his mouth.  This can cause very severe sensitivity to cold and sensitivity to pressure, especially pressure applied to the side of the tooth.  This is a very common problem because the patient is generally numb when the dentist carves the top of the tooth.  The patient may not be closing into his normal bite and the dentist may miss a high spot.  The solution to this problem is to return to the dentist for an occlusal adjustment, which means that the dentist determines what spots on the tooth are high and grinds them down.  

• Finally, removal of an old filling or decay may reveal a crack in the floor of the cavity preparation.  This can lead to cracked tooth syndrome which means that the tooth hurts whenever pressure is applied to one or more cusps (points) of the tooth.  Cracked teeth happen all the time in dentistry, and they are one of our most challenging diagnostic problems.  The sudden appearance of cracked tooth syndrome does not mean that the dentist did something wrong.  It is generally due to a pre existing crack which suddenly allowed the tooth segments to spring apart when the old filling was removed, or when the dentist cut a new surface in order to remove decay.  The management and prognosis for cracked teeth is complex and I urge you to read the page I have provided to explain it.  

Composite fillings present unique technical challenges to the dentist which he or she does not face when placing an amalgam filling.  These difficulties are the primary reason why many dentists refuse to place composite fillings in back teeth.  The technique for composite fillings is more demanding than that used for amalgam fillings.  Iatrogenic (dentist caused) problems associated with  composite fillings are generally due to one or more of the following: 

• Undercured composite--Modern composite filling material begins as a paste which is placed in the cavity preparation after a proper bonding technique has been performed.  The paste is packed into the tooth and then hardened using a very bright light which triggers a chemical reaction causing the paste to harden into a very hard tooth colored filling.  As light curing became more and more perfected, both the composition of the filling material and the construction of the curing lights evolved over time.  Newer curing units (lights) are extremely bright while the older units were much less bright.  A brighter light means deeper and faster curing of the composite.  Many of the older curing lights were perfected before composite had evolved enough to be placed into back teeth.  Because of the depth of the fillings in back teeth, many of these older lights are not bright enough to cure the full depth of a posterior composite filling.  This problem can be overcome by filling the tooth in thin increments and curing each increment thoroughly before placing the next increment.  On the other hand, the newer arc lights, and laser curing units, which are much more expensive than the older standard units are so bright that they can cure to a greater depth quite quickly.  (The newest curing unit in dentistry uses LED's which are less bright, but concentrate the light energy into wavelengths that are more likely to harden the composite.)  If the composite used to fill your tooth was not cured enough, your tooth will remain sensitive for a very long time.  The only solution for this problem is to remove the filling and replace it with a properly cured composite or an amalgam.

• Shrinkage stress--All plastics tend to shrink when they transform from the liquid to the solid phase (similar to the way water tends to expand when frozen).  Modern composites have been formulated to minimize this problem, both chemically and by using very dense concentration of glass particles as fillers.  The glass, of course does not shrink, and much of the  contraction caused by the hardening acrylic matrix is counteracted by the close packing of the glass particles.   (See my page on dental composites for more on this.)  Even so, some microscopic shrinkage always happens, and this, when combined with the powerful bonding techniques available today, can cause the vertical walls of the preparation to be drawn together which can produce prolonged sensitivity to cold.  If the dentist suspects that this is the case, it is sometimes possible to release the stresses using a simple technique called "slicing", in which the dentist cuts a vertical groove from the top of the filling to the floor of the preparation from mesial (front) to distal (back) through the filling. This allows the cusps on either side to rebound relieving the stress.  The groove is then refilled with composite and the filling is then as good as new.  This procedure is fast and easy and saves a lot of time and trauma to the patient (as well as the dentist).

Light cured composites always shrink toward the light source.   Some of the shrinkage away from the walls of the cavity preparation, and to a to a certain extent away from the floor of the cavity preparation (see next paragraph) can be avoided by the use of a thin light-guide placed on the tip of the curing light.  This concentrates the light and allows the dentist to shine the light for a few seconds on each cusp of the tooth instead of directly on the filling material itself.  Thus, the light channels down the enamel and dentin of the tooth and causes the initial set of the material to draw toward the cavity prep walls rather than toward the chewing surface of the restoration.  Another way to avoid shrinkage away from the walls of the prep is to use clear plastic matrix bands. (A matrix band is used to contain the filling material inside of the tooth in areas where the walls of the tooth have been breached in order to remove decay. If a matrix band were not used in these cases, the filling material would penetrate between adjacent teeth under the gum line, and would also bond adjacent teeth together.  Most dentists use metal bands due to their ease of use.  Click on the image to see how one popular type of matrix, an Automatrix®, is placed on a tooth.)   A clear plastic matrix allows the curing light to be directed through the plastic from the side of the tooth.  This would cause the composite to be drawn toward the cavity prep walls and eliminate the shrinkage away from them.   Not too many dentists use a clear plastic matrix due to the difficulty (some may say "near impossibility") of placing a thin piece of pliable plastic between tight contacts between two adjacent teeth.  

• Shrinkage away from the floor of the cavity preparation--As mentioned above, light cured composites always shrink toward the light source.  Since the light source is usually directed from the top of the tooth, the composite tends to shrink toward the light, often causing the filling material to pull away from the floor of the cavity preparation allowing a tiny void to form underneath the filling between the bottom of the filling and the tooth surface.  This void eventually fills with fluid and can cause hydrostatic pressure in the dentinal tubules which leads to sensitivity to pressure on the filling.  This is the most common reason for pain when biting on a newly done composite filling.  The only solution for this problem is to redo the filling.  The dentist can often avoid this problem by placing the composite in increments that cover only part of the floor, or by the use of a self curing glass ionomer base used under the composite.  

Why I no longer use amalgam

1. When first invented, amalgam was great stuff.  It still is, in fact, but it isn't any greater now than it was 150 years ago. Technical improvements in it over the years have made minor differences in its physical properties, but other than the addition of trace elements to the mix for the purpose of reducing tarnishing, speeding the setting time and changing minor physical parameters, it really hasn't changed much since it was invented.  On the other hand the technology involved in composite formulations has made tremendous strides in improving the wear, strength, appearance, setting characteristics, water miscibility, and numerous other less obvious qualities. They continue to improve yearly. The newest generation of composite filling materials has finally overcome most of the difficulties which prevented their widespread use in restoring back teeth.

2. Composite fillings are routinely BONDED to the tooth structure. This takes the place of the water resistant layer of corrosion that seals amalgam fillings. It also helps to retain the filling inside the tooth while amalgam fillings depend on the use of undercuts in the cavity preparation to retain them. Amalgam fillings must engage undercuts within the cavity preparation so they will not dislodge. Amalgam also requires a minimum depth of a millimeter and a half in order to form its crystalline structure while composite fillings have no minimum depth. (If they are not deep enough, the amalgam will be too thin and tends to crack.) The use of bonded composites has made possible the use of very small fillings that do not have the mechanical retention necessary to retain an amalgam. It has also made possible the use of shallow and thin cavity preparations which do not require the use of anesthetic to cut due to their very small size.

Note that it IS possible to bond amalgam fillings to the tooth. However, the process takes so long that the cost of such a bonded amalgam filling is actually greater than the cost of the comparable bonded composite.  While most US dentists still use amalgam, very few of them bond it to the tooth.

3. There is NO comparison between the appearance of a composite filling and an amalgam. The results are so esthetically superior, that most people opt for the slightly more expensive composite over the less expensive amalgam. Since many people have quite a few fillings in their back teeth, the difference between a mouth with composite fillings versus the same mouth with amalgams is striking. After a year or so of offering both to my patients and explaining these differences to them, I discovered that my amalgam was approaching its maximum shelf life, so I discarded it and never bought any more.

4. Composite restorations can be repaired while most amalgam restorations cannot. A tooth has five surfaces that can become decayed. The size (and cost) of a filling is judged by the number of surfaces it encompass. When a filling covers, say, 2 surfaces, that leaves three other surfaces untouched. But if the patient returns a year or two later with decay in one of those other surfaces, it is usually necessary to replace the entire amalgam that was done previously in order to place one that encompass the new decay. But since composite bonds reasonably to itself, the dentist can usually simply add the new surface to the old filling and avoid the trauma to the nerve that replacing the entire filling would entail. It is also less expensive to the patient. (In order to save time, many dentists DO repair old amalgam fillings, but the interface between the old and new materials is not chemically sealed as it is when repairing composite fillings.)

5. Before the advent of composite filling materials, many damaged teeth could not be repaired unless a root canal, post and core and crown were done.  This was because the working characteristics of amalgam required stringent techniques which were absolutely necessary, but not always achievable under real circumstances.  Once modern composites became available, it became possible to repair some of these teeth using "freehand" techniques impossible with amalgam.  Repair of these teeth is often not technically "perfect", but it offers an affordable alternative to the stark choices of extraction or a very expensive series of steps like root canals, posts and crowns.   

Q. Should I have all my amalgam fillings replaced with composites? If esthetics is of major concern to the patient, then you should request the replacement of all your amalgams with composites, or porcelain crowns. But beware! Every time you remove one filling and put another in its place, you run the risk of killing the nerve of the tooth and then needing a root canal or extraction! Remember that the presence of mercury in amalgams is NOT considered a sufficient reason to replace them, and no dentist should ever recommend replacing yours on the basis of "mercury poisoning".  We do not solicit the replacement of any old filling provided that it is still serviceable and the patient does not object to its appearance! 

When is it more appropriate to place a crown on a tooth instead of a filling?

A filling is a repair to an otherwise healthy, intact tooth.  The term "filling" implies that the repair should be contained within the boundaries of that tooth.  In other words, the filling should be surrounded by natural tooth structure insofar as it is possible.  In practice, of course, dentists frequently replace large sections of teeth with large, bulky fillings.  As the filling gets larger and larger, the amount of natural tooth structure necessary to retain the filling decreases.  The ultimate consequence of this is that the filling becomes a rickety patchwork of artificial materials that is inherently weak and may break out at any time.  

Furthermore, as the natural tooth structure becomes thinner, replaced by more filling material, it becomes more and more likely to break off necessitating an even larger repair.  The larger a filling is, the more technically difficult it is for the dentist to do, and the larger the tooth/filling interface.  This means that very large fillings are likely to be unstable and to leak over time leading to recurrent decay and replacement with even larger fillings.  This process of patching or replacing already large fillings is what we call "patchwork dentistry".  

In most situations, patchwork dentistry ultimately leads to the loss of the tooth, or at minimum to very expensive methods of repair.  If your dentist recommends placing a crown on the tooth, he is attempting to stop this cycle of recurrent decay, breakage and repair before it becomes necessary to do a root canal and post and core in order to have anything left above gum line to repair.  

A crown is a cast metal covering, generally overlain with porcelain, which is placed over the tooth in order to hold it together and to withstand the forces of chewing.  Sometimes the entire crown is made out of porcelain in order to attain the greatest esthetic (appearance) value possible.  The crown may even be made entirely out of gold if that is the wish of the patient.  While no dentist can guarantee that a crown will repair the tooth forever, it is still the very best restoration possible for a severely damaged tooth, and may be the only way that some severely damaged teeth can be repaired at all.  

The following is a list of reasons that a crown might be more appropriate than a filling:

• A tooth should be crowned if the filling would make up more than half the bulk of the clinical crown of a tooth (that part above the gum line).

• A tooth should be crowned if the filling would make up more than half of the surface area of the clinical crown.

• A tooth should be crowned if the clinical crown is cracked or seriously mechanically weakened.

• A tooth should be crowned if the filling is very deep under the gum line since a filling under these circumstances is difficult to do and is more likely to leak.  This leads to recurrent decay a year or two later.

• All back teeth with root canals should be crowned as the tooth structure tends to become brittle after the living nerve is no longer present.

• All front teeth that have root canals and also have large fillings should be crowned.

• Teeth that are unsightly (ugly) and embarrass the patient should be crowned.  This is especially true in front teeth that have root canals.

• Teeth with circumferential decay (decay at the gum line that encircles more than one surface of the tooth) should be crowned in view of the near impossibility of properly repairing this type of decay with simple fillings. 

• Teeth that are worn down due to attrition from bruxing (grinding and clenching) are often best crowned.

   

  Consider doing it! When the dentist says you need a crown, you really ought to think twice before rejecting the advice! Even though a good dentist can repair almost any tooth with a filling, he or she may recommend a crown instead.  Lots of people choose the filling anyways since it is always cheaper.  This is often a bad choice.   Very large fillings are technically very difficult to do!  You may leave the office with what looks and feels like a tooth only to find that a year or two down the line, there is recurrent decay under the filling.  It may be near impossible for the dentist to make the filling contact the tooth next to it leaving a gap which jams food between the teeth.  Pieces of the tooth or the new filling may break off over time.  The filling may even have required just enough removal of tooth structure to cause the nerve to die which will lead to a root canal followed by a crown, or even an extraction.  These problems are not the fault of the dentist.  There is a limit to what even the best and most conscientious dentist can accomplish with a very large, difficult filling.  Opting for a filling on a tooth that the dentist feels needs a crown may be opting for an extraction a year or two later.

Temporary filling materials (ZOE and IRM)

When a patient presents at my office with pain attributable to a cavity, I sometimes place a temporary filling in the tooth and reappoint the patient for a final permanent filling at another visit. Sometimes, this is done in order to save time, especially if we have slipped the emergency patient between two regularly scheduled patients. Sometimes it is done in order to save money. 

Temporaries are the least expensive (and most temporary) way to fill a tooth. Temporary fillings can be done quickly, because they are usually inserted without any of the time consuming rituals associated with a permanent filling. The patient is anesthetized, the decay removed and the temporary filling is mixed and inserted, generally simply by pushing it into the cavity preparation with a gloved finger. The patient bites into it while it is still soft in order to adjust the height, and the patient leaves the office without even waiting for a final set on the material. In a phrase, a temporary is "fast and cheap'.

But there is another reason that may indicate that a temporary is the best way to treat the patient, even if time or money is not an issue. Temporary fillings are different from permanent amalgam or composite fillings because they are "sedative" fillings. This means that they tend to soothe an inflamed nerve in a tooth, and may make the difference between the tooth needing a root canal (or an extraction), or simply filling the tooth later on, after the nerve has calmed down. Sometimes a temporary filling is the best course to relieve pain.

Temporary fillings are made of two major components: Oil of clove (eugenol), which has been used for centuries to relieve toothaches, and Zinc Oxide which is the ingredient that makes Desitin diaper rash ointment white.   Zinc oxide is an excellent disinfectant. The oil and oxide mix together to make a stiff paste that eventually hardens into a waterproof substance which soothes the nerve of the tooth and kills germs while protecting the cavity like a hard band aid. When used as a temporary filling material or cement, this material is called "zinc oxide and eugenol", or ZOE for short.

Zinc Oxide and Eugenol (ZOE) is not very durable, and it wears away after just a few weeks, but it works to relieve pain, calm the nerve and protect the tooth until an appointment can be made to get it filled permanently. During the Vietnam war, the US Army invented a more durable form of ZOE called Intermediate Restorative Material (IRM) which is fortified with plastic powder. (It originally came in red, white or blue colors.)  IRM is used almost universally in dental offices throughout the world for temporary fillings. The increase in durability allows the temporary to last three to 6 months (sometimes even longer).

Never plan to keep a temporary filling more than 6 months.  They are not meant to last that long, and while the eugenol lulls the patient into a false sense of security, the restoration wears rapidly and begins to leak. If you wait too long, the nerve could die, the temporary filling will wear away, the tooth will decay further, and then you will need a root canal or extraction.

How dentists set their fees

Dental Materials

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