Talking to Patients About Dental Composites

March 25, 2020

Dentists work with and read about composites all the time, yet patients often have no idea what they are. Below is a guide to help doctors talk to patients about dental composites without patronizing them or boring them with science.

Chances are patients have never heard of dental composite unless their dentist has mentioned it to them. However, after learning about dental work that involves a filling or a crown, patients might ask about white fillings or tooth-colored fillings. In these cases, dentists should have some layperson language ready to help patients understand what that tooth-colored filling is - and comments about polymerization or bisphenol A-glycidyl methacrylate should not be part of your explanation. 

How should dentists describe dental composites? The Academy of General Dentistry offers an easy-to-understand definition on its website: “A composite filling is a tooth-colored plastic and glass mixture used to restore decayed teeth.1

The American Dental Association (ADA) takes a different tack. Their consumer-facing description includes more detail on the uses of the material, saying it can “provide good durability and resistance to fracture in small to mid-size fillings. ...”2 Furthermore, they hit on the benefit of how natural the fillings look,2 which is a significant consideration for many patients. 

Related content: Why dentists should take a fresh look at new restorative innovations

Delta Dental offers the most succinct definition for resin composite: “ceramic and plastic compound,”3 which is probably more than sufficient for most patients. 

Lastly, Colgate has an excellent explanation of how composite resin works, especially for a patient who has a mouth full of amalgam and doesn’t know what to expect. Their definition reads, “The ingredients are mixed and placed directly into the cavity, where they harden.4 Dentists can also walk patients through what to expect in the chair, taking them step-by-step from anesthesia to decay removal, etching, application and polish.4

How One Doctor Talks to His Patients About Composite

Tim Bizga, DDS, FAGD, is a dentist in private practice just outside Cleveland, Ohio, and a national lecturer. His practice is amalgam-free, as most patients where he practices don’t want amalgam and haven’t for a long time. 

Dr. Bizga’s experience has taught him to recognize several types of patients, each with various motivations for seeking treatment. The first comprises people who haven’t had a checkup in some time and want to know whether they have cavities. The second group already knows they have a cavity because they have a toothache or sensitivity, and they want to get it fixed. The third group includes people with various problems who are looking for a second opinion. And a fourth group of people are referrals from existing patients. 

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“These are the ones who are looking for a new dentist. Perhaps their co-worker, their mechanic or insurance agent comes here. They come in thanks to that word-of-mouth validation of who we are and what we do,” Dr. Bizga says of the last group. 

Dr. Bizga adds that the conversations differ depending on his audience. For example, if the patient were unaware of their condition, and Dr. Bizga found cavities, he would explain the various options to best treat their condition. 

“The next question that I usually get is, ‘What kind of filling? Is it a tooth-colored filling or a silver filling?’” Dr. Bizga explains. “And I tell them tooth colored. Then they say, ‘OK. Good!’”

Same goes for crowns, Dr. Bizga says. A patient recently needed one, and he recommended gold, which is his preferred material. However, he also told the patient he could do tooth colored. The patient asked whether there was a price difference, and Dr. Bizga told him there wasn’t, so the patient went with gold. 

Some of Dr. Bizga patients do not want gold and instead ask for tooth-colored restorations, ostensibly because of the esthetics. Esthetics can be an essential consideration. Dr. Bizga notes that he had his posterior teeth done in ceramic.

“Here I know gold is the best, and I got all mine done in ceramic. So I’m just as vain,” Dr. Bizga admits. 

Honesty About Possible Disadvantages

Importantly, dentists should include information about the advantages and disadvantages of dental composite for their patients. Again, doctors should avoid discussion of the polymerization shrinkage-strain rate or the benefits of self-etch over total-etch or vice versa. While these details are ultimately crucial to the patient because of their effects on the restoration and the outcomes, they are likely too technical for the typcial patient. 

Delta Dental lists the advantages in simple terms:5

  • They are invisible, blending into the surrounding tooth structure or teeth. 

  • They stick to the tooth easily. 

  • The preserve the most amount of healthy tooth structure, so they do not require as much drilling as other materials. 

Likewise, Delta Dental is straightforward about the drawbacks of composite resin fillings:5

  • They need to be replaced more often than fillings with other materials, like amalgam. 

  • They take longer to place than amalgam fillings. 

Another critical drawback dentists should share is that insurance might not cover dental composites the same way they do amalgam fillings. The ADA also points out that composite fillings cost more than amalgam ones, which may or may not be accurate depending on the dentist’s practice.

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When Dr. Bizga talks to patients about treatment, he asks about their budget. Although the practice is fee for service, he does have patients with insurance, and they submit their paperwork. 

“We do check because people want to know what they have,” Dr. Bizga says of insurance benefits. “For basic coverage, it’s pretty close to full coverage. Most of the discussions we have are on major work like root canals, crowns and implants.”

A Proactive Approach to Replacing Amalgam

Another discussion that Dr. Bizga has with patients centers on replacing old amalgam fillings. When he sees old fillings that are beginning to fail, he prefers to take a proactive approach. If patients wait to replace the old fillings, they could later be faced with a much more serious - and expensive - treatment plan.

“Sometimes they come in, and the dental work is already broken. If the crack propagates, I see people lose teeth fast, and now they need an implant,” Dr. Bizga says, adding that this process can frustrate patients, especially when the fillings start failing all at once. “It’s like some people hit that season where they need a lot of maintenance.”

More details on dental composites: Dental Composites Continue to Transform Clinical Dentistry

Dr. Bizga does not think doctors should dig out all the amalgam fillings “because they are poison.” However, if they are showing stress, he thinks a discussion with the patient about replacing them with composite, or whatever is necessary, can benefit them. Moreover, today’s technology makes that discussion easy. 

“That’s the beauty of digital today. You can take scans and/or show people video of the problem. Once patients see it, they get it,” Dr. Bizga says. “We have some exciting tools today that make it easy to explain the necessity of treatment.”

Dr. Bizga thinks that this preemptive conversation is vital. Patients respond well to it because it gives them a chance to plan, he says. 

“When you don’t have problems, that is the best time to choose,” Dr. Bizga says. “When you come in for an emergency, circumstances may dictate your options. The decision may already be out of our hands. Avoiding that situation is what resonates with people.”

References

1. “What is a Composite Resin (White Filling)?” knowyourteeth.com. Web. 17 March 2020. < http://www.knowyourteeth.com/infobites/abc/article/?abc=f&iid=286&aid=1241>.

2. “Composite Fillings.” www.mouthhealthy.org. Web. 17 March 2020. < https://www.mouthhealthy.org/en/az-topics/c/composite-fillings>.

3. “The facts on fillings: Amalgam vs. resin composite.” Deltadentalins.com. Web. 17 March 2020. < https://www.deltadentalins.com/oral_health/amalgam.html>.

4. “What is a filling?” colgate.com. Web. 17 March 2020. < https://www.colgate.com/en-us/oral-health/procedures/fillings/what-is-a-filling>.

5. “The facts on fillings: Amalgam vs. resin composite.” Deltadentalins.com. Web. 17 March 2020. < https://www.deltadentalins.com/oral_health/amalgam.html>.