The basics of fillings

Do you need a filling or not?

Your dentist will use a lot of methods to find out whether you have tooth decay. Some of these methods are

observation - the discoloured spots on your teeth may be a sign of decay but not all of them are. Your dentist will use an explorer to probe for possible tooth decay. An explorer is a metal instrument with a sharp tip. Healthy tooth enamel is hard and it will resist the pressure from the explorer. Decayed enamel is softer and it can be spotted by your dentist during observation. The instrument will stick into it slightly. Explorers have to be used with caution because if they are used haphazardly, they can damage a healthy tooth
cavity-detecting dye - this can be rinsed over your tooth and it will stick to the decayed areas. It will rinse cleanly on healthy areas
X-rays - X-rays can help your dentist spot decays that can not be seen with the naked eye. However, X-rays aren't accurate in detecting the smaller cavities, the fillings, and other restorations made on your teeth

Tooth decay is not the only reason you may need a filling. Some of the other reasons will include

cracked teeth
broken teeth
grinded teeth
teeth that have been worn due to nail-biting
teeth that have been worn out because they were used to open things

What are the steps to a filling?

When you go to your dentist for a filling, the first thing done is to administer local anaesthesia. This will numb the area. Then, the dentist will remove the decay from the tooth using hand instruments and drills. Air abrasion and lasers can also used to remove the tooth decay.

A drill or as dentists call it, a hand piece, uses metal cones called burs to cut through enamel and remove any tooth decay. The burs come in several shapes and sizes and your dentist will choose the right ones that are fit for the size and location of your tooth decay.

First, your dentist will use a high speed drill to cut through the tooth enamel. This is the instrument that has a familiar high whining sound. Your dentist will precisely outline the cavity with the drill and remove just the right amount of tooth so that the filling can be placed properly. Once the drill reaches the dentin or the second layer of the tooth, a lower speed drill is needed. This is because the dentin is softer than the enamel layer.

Throughout the removal of the tooth decay, your dentist will test the area with the explorer to see if all the decay has been removed. When all of the decay is removed, your dentist will shape the space so that it is fit for filling.

Different types of fillings require different types of shaping procedures in order to keep them in place. Your dentist may put in a base or a liner in order to protect the tooth pulp which is where the nerves are located. The base or the liner can be made up of composite resin, glass ionomer, eugenol, zinc oxide, and other materials. Some of these materials even release fluoride in order to protect the tooth from any further decay.

If your dentist is placing a bond filling then the tooth will be etched with acid gel before the filling is placed. Etching will make tiny holes in the tooth's enamel surface and it will allow the filling to bond tightly with the tooth. Bonded fillings can reduce sensitivity and they can also reduce the risk of leakage or decay under the filling. This is because the etched surface of the tooth and the filling material has a mechanical bond. Bonding can be done with composite fillings or amalgam.

There are certain types of fillings that become hard because of a special light. Your dentist will shine a blue light on this resin so that it will harden the material and make it strong. Finally, after the filling is in place, your dentist will use the burs to finish and polish the tooth.

What happens after a tooth filling?

Many people feel sensitive after their teeth have been filled. Their tooth will feel sensitive to pressure, air, sweet foods, heat, and the cold. Composite fillings are the ones that cause most sensitivity but the other types of material can cause sensitivity as well.

In most cases, this sensitivity will subside over one to two weeks but you should still continue to avoid anything that causes the sensitivity. If your tooth is extremely sensitive or if the sensitivity of your tooth stays after two weeks then you must contact your dentist right away.

It is important that you let your dentist know about the sensitivity of your tooth and how it feels. If you need a filling in the future then your dentist may use other materials in order to reduce the sensitivity. People will vary in their response to different types of materials and your dentist has no way of predicting whether your tooth will react to a certain type of material or not.

When you talk to your dentist about the sensitivity of your teeth, you must try to describe it as accurately as possible. This information will help in determining the next courses of action. Your dentist may decide to take out the old filling and put in a new one. Your dentist may add a base, liner, or desensitizing agent on the tooth. If the filling was very deep then you may need to go through a root canal treatment to solve the problem.

Aside from the sensitivity, people may feel uncomfortable when they bite down. Two types of pain occur and they have different causes. The first type of pain happens when you bite. This will get worse over time. It is caused by a filling that interferes with your bite. When your anaesthetic wears off, you will notice it right away. You must contact your dentist and have your filling reshaped in this case. The second type of discomfort is a sharp shock that manifests itself when your teeth touch. This is known as the galvanic shock. It is caused by two metals producing an electric current in your mouth. One of the metals is in the newly filled tooth while the other metal is on the tooth it's touching. For example, this can happen if you have a new amalgam filling in a bottom tooth and a gold crown on the tooth above it.

Your dentist will polish the filling after it is set into place. On some occasions, there will still be sharp edges. If you find one then you should contact your dentist as soon as possible. You must have it smoothed so that injury will be avoided in your tongue and in your mouth. Do not try to smooth it by yourself as you may damage the filling and the tooth.

What are temporary fillings?

Temporary fillings are usually white, off-white, or gray. You may get temporary fillings if

your treatment needs more than one appointment
your dentist wants to wait for a short period of time so that your tooth heals
you have a deep cavity and the pulp becomes exposed during the treatment
you require emergency dental treatment

Temporary fillings will make your tooth feel better because the filling seals the tooth. This will protect the pulp from bacteria and it will reduce sensitivity significantly. Temporary fillings often have eugenol. It is an active ingredient in most over-the-counter toothache remedies. It is also a component of oil of cloves, a remedy used by people to alleviate toothaches.

Temporary fillings are not meant to last. They will usually fall out, fracture, or wear out after a month or two. If you get a temporary filling, you must make sure that your dentist gives you a permanent one later on. If you do not have a permanent filling, your teeth can become infected and can cause more problems in the future.

Why should you replace a filling?

Fillings can not last forever. They can become discoloured like when amalgam or silver fillings corrode and tarnish. Composite, tooth-coloured fillings will pick up stains and become yellow over time. When you chew, your teeth and its fillings will be subject to high pressures. Even if no other problems come up, your fillings will wear out and have to be replaced at some point in time. Fillings will need to be replaced much earlier especially if they fall out, leak, or crack.

Food debris and bacteria can seep down under a filling that has cracked or leaked. Since you are unable to clean in that area, the bacteria will feed on the food debris and form acid that will eventually cause your tooth to decay. Decay under a filling can become extensive before you notice it. It can cause pain unexpectedly as well. You must have your fillings checked regularly and have them replaced when problems are spotted.

Why do fillings fall out?

Fillings can fall out for many reasons. Some of them are

when you chew too hard on a large filling, it will either break the filling or the tooth
when a filling material was used that cannot restore the tooth to its proper form and function, it may simply break. Some dentists will use a composite material to replace a chipped tooth. If you bite too hard on this, it may simply break especially if it is on one of your front teeth
when the cavity was contaminated with saliva when the filling was placed. For composite resins, this will disrupt the bonding of the material and will result in weak attachment. This will cause the filling to fall out

Why do fillings crack?

Both amalgam and composite fillings can crack. They can crack after they are placed or after the fillings have been in place for awhile. If the filling is higher than the rest of the tooth surface, it will bear most of the force from a bite. Over time, cracks can occur in the filling due to the forces from chewing and biting. Smaller cracks can occur at the edges of a filling and are usually caused by its wear over time. The cracks can usually be repaired by your dentist.

Why do fillings leak?

A filling is described as leaking if the side of the filling does not fit tightly against a tooth. Debris and saliva can seep down between the filling and the tooth which can lead to decay, discoloration, and sensitivity. Amalgam and composite fillings have the potential to leak. As with amalgam filling, it has a tendency to leak slightly after it is placed. You will notice sensitivity after it is put in position. This sensitivity should go away after the next two to three weeks. It should disappear altogether after a month. During this period, the amalgam corrodes naturally. The corrosion will seal the edges of the filling and it will stop any leaks.

Regarding composite fillings, contamination with saliva will cause a weak bond between the filling and the tooth. This will cause leakage. There will be small gaps between the tooth and the filling. The gaps are a result of the shrinkage of the filling. The sensitivity after receiving a composite filling will disappear over time. If it doesn't go away in time then the filling must be replaced. Fillings can also leak as a result of wear and tear over time. When fillings begin to leak, they have to be replaced immediately.

How do fillings wear out?

Fillings can last for more than fifteen years however, some fillings should be replaced after five years. See your dentist regularly so that you can find out whether you fillings have to be replaced.

How do clenching and grinding affect your teeth?

When you clench or grind your teeth, you will have more problems with your fillings. The forces placed on your teeth can lead to tooth sensitivity and will wear down your fillings. Clenching or grinding your teeth will cause your fillings to crack or to develop small craze lines. These are fine cracks that you can spot when you shine a light on your tooth.

How can you make your fillings last?

Fillings can last for several years. In fact, the average life of amalgam fillings is five to seven years. Some can even last for up to fifteen years. On the other hand, composite fillings may not be able to last this long.

Your dentist will take a look at your fillings during your check-ups. You may need some X-rays done if your dentist thinks that a filling is cracked, leaking, or if there is a decay under the filling. You should have an appointment with your dentist if

your tooth is sensitive
you spot a crack on the filling
part of a filling seems to be missing

In order to help your fillings last, you should visit your dentist on a regular basis, brush your teeth with fluoride based toothpaste, and floss everyday. If you have several fillings or very large fillings then your dentist may prescribe fluoride gel that you can use at home. The fluoride will help you strengthen your teeth and prevent any future cavities. Your dentist or hygienist can apply a fluoride varnish around the edges of these teeth during your regular check-ups.

How are fillings replaced?

Your dentist will talk to you about several treatment options before removing your old fillings. Sometimes it is possible to remove an old filling and repair it instead of removing it and replacing it altogether. If the entire filling has to be replaced then the dentist may re-evaluate the kind of filling material to be used. You can talk to your dentist about the preferences for appearance, form, and function. Afterwards, your dentist will be able to select the appropriate material that is suited for you.