Composite Fillings - Composites are a fancy word for a plastic that starts as a flowable material and hardens with light-activated polymerization. Dental composites are wonderful because they are tooth-colored, have elastic and wear properties like enamel, are nonreactive (will not break down over time) and are easy to manipulate and polish. On the other hand, composites are not as strong as enamel and tolerate no moisture (spit) contamination before polymerization. They can crack and stain and leak if not placed in a very technique-specific way that requires extensive training.

Amalgam - I rarely use the amalgam these days because we have become so good at placing composites, which have better overall properties and look nicer than "silver fillings." Sometimes, however, amalgam is needed to repair a metal crown, repair a partially erupted (read: bloody mess) tooth, or where we cannot get moisture control. For special needs children, an amalgam filling may be a better alternative than having to go to the hospital to place a composite. Amalgams contain silver, tin, copper and zinc covalently bonded together by mercury. This inorganic mercury cannot be absorbed by the body and has proven to be safe for over a hundred and fifty years of use. Organic mercury, a neurotoxin found in seafood and air pollution, is often confused with inorganic mercury. Amalgams are silver in color and very strong. They are also brittle and break if not placed properly with attention to cavity preparation.

Porcelain - Porcelain is used to replace missing tooth structure in adult teeth. It is very "real looking" and durable but must be placed very carefully. Seams between tooth-to-porcelain are never completely invisible, so porcelain margins are hidden below the gumline. Given the expense and the changing gum height of growing children, we rarely place porcelain on children's adult teeth until at least age 14. We do not use porcelain on baby teeth.

Stainless Steel - Our temporary adult and baby tooth molar crowns are made of a nickel-chromium "steel" that wear like iron, completely seals a tooth and gives the tooth structure support from the outside to preserve tooth dimension. We use these extensively when not enough tooth structure is left for a filling to hold. If I could invent a "white steel," I would be sitting on a beach in the Bahamas. No suitable alternative to this "silver jewelry" exists yet. They are glued on with a glass ionomer cement. Baby teeth with crowns fall out just like baby teeth without them.