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Dental Fillings

 

When might I need a dental filling?

If one or more of your teeth is suffering from tooth decay, and the decay is not too serious, your dentist will remove all the decay under local anaesthetic and restore the tooth by filling the cavity.

 

What causes tooth decay?

Every time you eat or drink something containing sugars – and this means the sugars found in fruit and carbohydrates as well as actual sugar - the bacteria present in the mouth breaks down the sugars and they produce acid. The acid attacks the teeth and starts to soften and dissolve the enamel, the hard protective outer coating of the tooth. About an hour after eating or drinking, the natural action of your saliva neutralises the acid, causing the enamel to re-mineralise and harden again; however snacking between meals can increase the risk of decay as the teeth do not have enough time to recover between acid attacks.

 

Once the acid has eaten through the enamel, bacteria and acid can continue into the dentine, which lies below the enamel and makes up most of the tooth, and eventually into the pulp, the soft tissue containing blood vessels and nerves at the heart of the tooth.

 

Tooth decay is generally seen in the molars and premolars situated at the back of the mouth, which are used to chew food. Food debris can easily get stuck between the molars and premolars because of their shape, leading to the formation of plaque and dental cavities. These teeth are also harder to reach with a toothbrush, creating prime conditions for the accumulation of plaque and bacteria.

 

Is a filling always the best option?

Depending upon the extent of the tooth decay, other treatments may be preferable:

 

As each of the adult molars (back teeth) appears, and if the tooth is free from decay, a ‘pit and fissure sealant' can be used to protect the tooth; this is a plastic coating that fills all the little crevices in the tooth surface, creating a flat surface that is easier to clean. This is most often used in children’s dentistry (see The Good Dentist Guide to Childrens’ Dentistry) but adults can also have this treatment if the teeth are free from decay. Your dentist will discuss whether this is right for you.

 

In the very early stages of decay, your dentist may apply a fluoride varnish onto the area. This can help stop further decay and help ‘remineralise' the tooth. However, it is important to follow the cleaning routine your dentist or hygienist suggests, using fluoride toothpaste to prevent decay starting again.

 

If a tooth is significantly damaged and its strength is compromised, then there may not be enough support left to hold a filling in place and maintain functionality. Your dentist may then recommend a dental crown or a partial crown (see The Good Dentist Guide to Dental Crowns)  instead of a filling: and so will drill away the decayed portion, shape the remaining portion of the tooth and fit a gold or porcelain crown over it. 

 

If tooth decay is so far advanced that the pulp – the blood vessels and nerve supply at the heart of the tooth -has become infected, your dentist will need to carry out root canal treatment (See The Good Dentist Guide toRoot Canal Treatment) by removing all the infected tissue within the tooth and its roots, then restoring the tooth with a filling and perhaps also a crown. 

 

If the tooth is so badly decayed that it cannot be restored, the dentist may have to take the tooth out to prevent the infection from spreading. Extracting a tooth can affect other teeth and can lead to bone loss, so your dentist may recommend replacing the extracted tooth with a dental implant (See The Good Dentist Guide to Dental Implants).

 

What types of filling and filling materials are there?

Depending upon the extent and position of the decay in your tooth, your dentist may decide to fill the tooth directly, using a soft material that can be placed directly into the cavity and shaped before being allowed to harden or being “cured” by the application of light; or indirectly, by fabricating the filling outside of the mouth from a hard material based upon impressions and measurements of the tooth, the filling subsequently being cemented into place.

Direct fillings

Historically the most common material for direct fillings has been amalgam, a silver-coloured mercury and silver alloy which is long lasting (in some cases 10-20 years), hardwearing and inexpensive. Frequently used for the back “biting” teeth, amalgam has been used for fillings for over 150 years; however recently concerns have been raised about the safety of using mercury (which is toxic to humans) with claims that the mercury in amalgams is responsible for health issues such as headaches and Alzheimer’s disease. 

Many dentists and patients now prefer to avoid amalgam because of the concerns about mercury and also the less appealing look of silver teeth.

 

Tooth-coloured composite materials (“white fillings”) are now a more widely used option to amalgam although the life expectancy of a white filling can depend greatly on where it is in your mouth, the size of the filling, and how heavily your teeth come together when you bite. The technique for placing these fillings is more complicated because the tooth must be kept free of moisture during the process. So white fillings take longer to place and cost more. Recent improvements in white filling materials and a desire for a better cosmetic look have made these fillings very popular.

 

Glass ionomer cement is a relatively new material which bonds chemically with the tooth and may also release fluoride, which helps to prevent further tooth decay. This type of filling is best suited to low-stress situations such as baby teeth and non-biting surfaces (such as around the necks of the teeth). Little preparation is needed as the filling bonds directly to the tooth.

Indirect fillings

Depending upon the tooth needing filling, these can be inlays or onlays. An inlay is small and fills the space in between the cusps, or rounded edges, at the centre of the tooth surface. An onlay additionally covers one or more cusps or the entire biting surface of the tooth. Because of their extensive coverage, dental onlays are sometimes referred to as "partial crowns"; however much less of the tooth needs to be removed in preparation than is the case with a dental crown. See The Good Dentist Guide to Dental Crowns.

 

Gold is the most long lasting and hard wearing indirect filling material; however porcelain is an attractive option as it is tooth-coloured and less expensive.  As with other indirect restorations, your dentist will take an impression of the prepared cavity and send it to a dental laboratory for a technician to make the inlay or onlay. In the meantime a temporary filling will be placed in the cavity. Once the inlay or onlay has been made, your dentist will fit it in place with dental cement.

Alternatively the inlay or onlay may be made and fitted in a single visit using the CEREC technology (see The Good Dentist Guide to CEREC). 

 

For porcelain inlays and onlays CEREC is becoming an increasingly popular option. 

How do I look after my teeth after filling?

Filled teeth should be treated just as you treat your un-filled teeth: maintain good oral hygiene and see your dentist at least once a year. Avoiding sugary foods and drinks, and not snacking between meals, will help to avoid tooth decay.

 

How long will my dental filling last?

This depends upon the extent and position of the filling, and the material from which it is made.  Gold fillings can last for 15-20 years; your dentist will be able to advise on your particular case. Studies have proved that good quality CEREC fillings will also last 20 years.

 






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