Definition and Overview

A dental filling is a restorative procedure that involves adding a protective substance into a tooth cavity to shield it against further structural damage and avoid the need for tooth extraction later on.

The tooth is one of the strongest parts of the body, especially because it is coated with a tough material known as enamel, the white portion of the tooth. However, the mouth is also composed of different kinds of bacteria that feed on sugar, which can be introduced through the food a person eats. Like any other organism, bacteria create by-products during digestion, which can make the environment of the mouth more acidic. Couple that with substances found in saliva, it creates an environment that can make the enamel more vulnerable to chipping and cracking, which can lead to the formation of a tooth cavity.

As cavities (caries) form in the tooth, the tooth becomes more sensitive to heat and cold. The presence of cavity also creates more areas in the mouth where the bacteria can thrive, causing more damage until they reach the gums and roots of the tooth.

Before this happens and the tooth becomes unsalvageable, fillings are used.

There are many different types of dental fillings and they can be permanent, indirect, and temporary.

  • Temporary fillings are meant to act as a substitute for a permanent or indirect filling, which normally requires a couple of dental appointments. They have to be changed to something more permanent within a few days or weeks. Otherwise, they will simply crack or fall out.
  • Permanent fillings are those that are intended to last for many years. They are available in various materials, such as gold, amalgam, and ceramic. The choice depends on many factors, like your preference, the location of the tooth to be filled, and the doctor's recommendation.
  • Indirect fillings are restorative options that are created in a lab rather than directly placed on the tooth's cavity. These include inlay (fillings that are placed within the cusps) and onlay (fillings that extend from the cusps). These are recommended when there's significant tooth damage but not enough to remove the entire structure.

Dental fillings may be combined with other restorative procedures such as bridges, as well as endodontic treatment also known as root canal.

Who should undergo and expected results

Dental fillings are ideal for those who:

  • Have developed tooth cavities, but the structure of the tooth has remained sound, and the damage does not extend to the roots and gums.
  • Need to have their fillings changed. It could be because what they have is temporary, their fillings are not meant to last for many years, or the filling itself is not durable enough
  • Have lost a considerable portion of the tooth, but there's enough structure for indirect filling
  • Are advised to go through a root canal procedure. Also known as endodontic treatment, root canal involves removing the infected pulp in the chamber. When this becomes hollow, filling is used to keep the tooth's structure together and avoid the buildup of bacteria inside.
  • Go through an emergency treatment such as managing a toothache

The results of the procedure can significantly vary depending on the kind of filling performed, the location of the affected tooth, the skill level of the dentist, and even the insurance coverage.

When it comes to direct fillings, for example, gold are some of the strongest, lasting for as long as 15 years. It can also stand constant chewing and doesn't experience corrosion. However, it's also very expensive and is thus less likely to be covered by insurance. Amalgam or silver filling, meanwhile, is one of the most popular. It's as durable as gold but significantly cheaper. Nevertheless, to use it means to remove a good portion of the healthy tooth. Composite fillings are flexible and are ideal for patients who want fillings that closely resemble their tooth but they are not durable and are prone to chipping.

How the procedure works

The first step is to assess the extent of the tooth decay through a dental x ray and other dental exams. Based on the results, the dentist will determine whether you need some other procedures before the filling such as a root canal.

During the actual filling process, local anesthesia is applied to the tooth and the gum area to reduce the discomfort and avoid pain. There's no need for sedation unless the patient develops severe anxiety because of the procedure.

Before the filling can be placed, any sight of decay has to be removed first, and this involves using electronic instruments and drill. Many clinics, however, are now utilizing laser, which is more precise, easier to control, and less likely to cause infection and excessive bleeding.

The cavity is then prepared for filling. Sometimes the cavity is already in close proximity to the roots of the teeth, which make them more sensitive to extreme temperature and vulnerable to more serious infections. Thus, the dentist may add a small layer of material first to act as a shield for the nerves before the actual filling is placed.

The filling is placed in layers, making sure that each of these layers is hardened usually through a curing light. Once everything is complete, the tooth is then polished.

If the filling is only temporary, the patient is expected to return to the dental office. In indirect filling, the first visit often includes obtaining an impression of the tooth to create the inlay or onlay.

Possible risks and complications

Depending on the filling, the tooth can still develop chipping and cracking, which means it needs to be refilled in the future. Moreover, some people may develop galvanic shock, which happens when gold and silver fillings end up being placed next to each other.

Also, a number of people have expressed concerns over the presence of mercury in amalgam fillings. Liquid mercury is used as a bonding material for all the other components, which then make up an alloy. According to Food and Drug Administration, there's no strong link between mercury and complications such as damage to the kidney and brain. Other possible risks are infection and excessive bleeding.


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