All About Tooth Filling

Treatments for tooth decay is a process that, dentist removes the decayed parts of your tooth and then fills the prepared cavity with special tooth filling materials to restore the strength and function of the tooth. Dental fillings are also used to repair cracks and fractures. Additionally tooth filling materials are also used to rebuild broken and worn down teeth, such as attrition due to severe grinding. That said, in case when there is a lot of tooth damage, porcelain veneers or crowns will be recommended.

What is the material for tooth filling?

Nowadays, there are different types of filling for teeth. Gold fillings, ceramic (porcelain), silver amalgam (silver color), and composite fillings . There are also materials that contain powdered glass and are known as glass ionomer and work very similar to composite resin; although, form a chemical bond with your tooth rather than mechanical bond. It is said that glass ionomer may release fluoride that helps to prevent further tooth decay.

What are the stages of a tooth filling?

1. First, the dentist might need to apply dental local anesthesia to numb the tooth. With a dental drill and slow speed dental hand piece or another specialized tool like laser, the damaged area of the tooth are removed. It is the dentist who chooses which hand piece to use based on patient needs and comfort.
2. The dentist drills away all the decayed area then does the final check that no decay left. Once tooth decay is completely removed, the tooth is cleaned from any bacteria and foreign particles then prepares the rest of the tooth to ensure a good fit now  is ready for filling.
3. When the decay is very close to the pulp (nerve tissue), but decay has not yet reached the pulp, a protective material is applied, leading to healing and remineralization layer, this is called indirect pulp cap. In addition, under some circumstances, if pulp tissue has been exposed. After removal of some affected dentin but decay bacteria has not yet reached the pulp a biocompatible material is placed directly over the tooth’s pulp, which is called direct pulp cap. 
4. Now it is time for dental filling materials to be placed in the prepared cavity.
5. Finally, the dentist will adjust the bite and polish the tooth filling.

There are a few more steps for composite fillings because the way material is placed on the tooth is different. Composite resin is placed layer by layer inside the tooth. Each layer will be cured by a curing light and then the next layer is placed on top of it, and so on until the tooth is filled. Then the material is shaped and the excess material is removed and the tooth has its final polishes.

Advantages and Disadvantages of Each Type of Cavity Filling

We will discuss about advantages and disadvantages of most common tooth filling materials:

Advantages of cast gold fillings

• These materials are highly durable and last for at least 10 to 15 years. And usually even longer.
• Gold does not corrode.
• Gold can withstand chewing forces due to its perfect strength. 
• some people find gold more pleasing to the eye than silver amalgam fillings. Interestingly aesthetic is one of gold fillings advantages.

Disadvantages of gold filling

• Gold is quite expensive  as it is up to ten times pricier than the cost of the common amalgam fillings.
• Gold filling requires at least two dental visits to place it. So more dental visits required. 
• If a gold filling placed immediately next to a silver amalgam filling, it may cause sharp pain occurs due to galvanic shock. The interaction between the metals in metal fillings and oral saliva causes an electrical current to occur, although this is rare.
• A recent report attributes gold’s drop in popularity for dental work to the fact that this precious metal is no longer so precious when it comes to cosmetic dentistry treatments. This is a trend in which Many people do not find the golden color of gold filling pleasant and prefer tooth-colored fillings like improved dental ceramics or tooth-colored composite resins.

Advantages of amalgam filling

• The most important advantage is that silver filling is extremely durable. It typically lasts more than 10 to 15 years. Whereas composite resin is not as strong as metal. 
• Due to their strength, they can fill fairly large cavities within the teeth without having to worry about withstanding the strong chewing forces.
• Amalgam filling is the least expensive among all other fillings. The lower cost of amalgam fillings can be a relief to people on a budget.

Disadvantages of amalgam filling

• Metal amalgam fillings are unattractive and very noticeable. Everyone can notice that you have had decay in your teeth. They look even worse during the time. Amalgam fillings can start out silver, but they can tarnish or rust, turning black. When this happens, it can even make the entire tooth turn dark in color.
• Another major concern of Amalgam filling is that it can weaken the teeth. A portion of some tissue of the tooth has to be removed first, to make a deep enough cavity, in order to install these fillings.
• silver amalgam can cause sensitive teeth, due to the metal reaction to varying temperatures in the mouth. Because of the nature of mercury and metal alloy, used in amalgam fillings which is very conductive, A lot of people have reported that their teeth treated with amalgam are more sensitive to heat and cold straight after getting amalgam fillings.

tip :

Although all dental restorations react to temperature changes, however, since an amalgam filling is made of around 50% mercury, a metal, which is exclusively used in thermometers, due to its capability to adjust to the temperature, amalgam fillings can affect dimensional change following expansion and contraction with temperature changes . 

When you eat hot or cold foods, the expansion and contraction of the filling, eventually resulting in cracks and fractures. It is why the fracture rate of amalgam fillings is higher than other tooth filling materials.

• A small percentage of people (around one percent) are allergic to the mercury in amalgam. Bear in mind that no research finds relationship between fillings and symptoms of mercury poisoning. The amount of mercury is released from amalgam restoration during the placement or removal of it, is far below the current health standard. Whilst Mercury  is an Inhaled vapor and is almost completely absorbed by the lungs about up to 80%, Exposure to a large amount of mercury vapor is associated with brain and kidney complications. According to the cause, it is recommended not to use silver amalgam in children under 6 years of age.

Advantages of Composite Resin Fillings

• Composite resin fillings have excellent color matching capabilities. can be prepared to match those color shades precisely, so your restored teeth look natural and blend well with your other teeth.
• Composite bonding restorations, create a mechanical bond called micromechanical retention, that lock into the tooth giving it greater strength, which helps prevent breaks and fractures. Additionally They can be repaired if damaged.
• Composite bonding restorations harden in seconds instead of days like other materials. Furthermore, they can be applied during a single visit.
• Other benefit of the composite fillings is that they require very little tooth preparation. With the development of stronger bonding materials, composite resins can rebuild even very large defects in teeth caused by trauma or decay with little structural removal and still last for many years without any damage.

Disadvantages of composite resin fillings

• composite bondings are not as durable as metals. Due to this their lifespan is five to seven years on average, about half of an amalgam filling.  For this reason, composite is not used to fill large cavities and teeth, because it may not last under pressure. For this reason, it is mostly used for front teeth that are under less pressure.
• Since composite filling is considered “technique sensitive” and your tooth must be kept free of saliva during the bonding, they’re more labor intensive for your dentist to place on your tooth. Consequently Placement takes longer, which could make a situation more difficult for patients with dental anxiety, special needs, or kids.
• They may stain from frequent and/or prolonged exposure to teeth-staining foods, which the most common ones are: coffee, tea, red wine, soy sauce, curry, Tomato-based sauces, Balsamic vinegar, Cola.
• composite bonding restorations often cost more than amalgam fillings.

Advantages of ceramic fillings

• Ceramic filling can restore the natural appearance of the tooth after it has been placed in, consequently, the obvious benefit of ceramic fillings is that they are virtually indistinguishable from the healthy teeth.
• Compared to composite, ceramic filling is more durable and withstands more severe chewing forces, makes it suitable for restoring back teeth.
• Offering an average lifespan of around 10 to 15 years is another benefit of ceramic fillings.
• Ceramic fillings are more resistant to staining and abrasion than other types of fillings specially in comparison to Composite fillings.

Disadvantages of ceramic filling

• Perhaps its most important drawback is its higher cost. They can be as expensive as gold fillings. 
• Installing ceramic fillings, needs more than one session.
• Ceramics are brittle and abrasive, which may break down the road.

Glass Inomer Filling Material

Glass inomer filling is a type of filling material that is less common than other options such as composite or amalgam. Glass ionomer is made of acrylic and a component of glass- ‘flouroaluminosilicate’.  Since glass inomer can be bonded to the surface of the tooth using a chemical reaction, its bond to the tooth is very strong. That’s why no specific preparation is necessarily needed. 

This tooth filling material is typically used in class 5 dental restorations (cavities near the gumline), and also by pediatric dentist in primary dentition (children’s teeth). In addition Glass ionomers have preventive effects on the teeth due to the capacity of releasing fluoride, resulting in reducing the possibility of tooth marginal decay. However, the drawback of the glass inomer fillings is, they are a lot weaker than other filling materials and is prone to quick wear and tear. They typically last around 5 years. It is worth mentioning that the colour is rather close, instead of being a perfect match to the original tooth colour.

Inlay and Onlay and their differences with regular tooth fillings

Similar to composite restorations, Inlay and Onlay are used to rebuild the structure and function of severely damaged teeth, except from one major difference. While a standard filling is placed directly into/onto your tooth and hardens in your mouth, inlays and onlays are custom-made by lab technicians and then cemented in place,  that makes it take two visits to accomplish. Once adequate tooth’s surface has been removed and completely prepared, patient’s dental impression which has been taken will be sent to the laboratory for lab technician to build this restoration. Based upon this procedure, they are called indirect restorations.

What are the indications for inlays and onlays?

when the remaining tooth structure is not sound enough to support the filling material that is placed in the cavity, yet, it is not damaged enough to need a crown. Accordingly, They are indicated when teeth are weakened and extensively restored. 

An inlay is a restoration that is applied inside a cavity on your tooth, whereas an onlay is used to replace the cusp(s) (tips) of your tooth. These two terms are often used interchangeably.

The durability and longevity of indirect dental restorations are  considerably more than other standard fillings and they can last up to 30 years in a good condition. Indirect tooth filling can be made of composite resin, ceramic or gold. Onlay is used to protect a severely damaged tooth because it covers dental cusps to restore the chewing surface of the tooth and distributes sharp pressure from the opposite tooth, evenly.

Dental Filling Silver Vs White – Which Is Better?

Dental composite, which is white material, and silver amalgam, which is black and dark material, are two commonly used types of filling materials to fill teeth.

Dental amalgam is a mixture of metals, consisting of mercury (liquid element) and a powdered alloy composed of silver, copper, and tin. Roughly half (50%) of amalgam filling is elemental mercury by weight.  

Since dental amalgam fillings are highly visible, because the silver fillings are dark, turning even darker with age; these materials are aesthetically unappealing to be applied on front (anterior) teeth. 

Amalgam fillings used to crack due to the shrinkage and expansion with hot and cold foods and beverages. Zinc was the component of dental amalgam that caused the expansion, which caused the cracking. However, the good news is from the year 1976 amalgam fillings went zinc free.

Composite fillings are made from materials matching the color of the natural teeth and designed to mimic the exact shade of your original tooth as they are very natural looking. However, it is worth mentioning that they often cost more than amalgam fillings. Also, Composite resin is not as strong and durable as metal, makes it lasts half the lifetime of an amalgam filling.

What type of tooth filling is best for you ?

Position and extent of tooth decay, your budget and cost of the treatment, and your dentist’s recommendations determine the best type of tooth filling for you.

When teeth need to be filled?

Toothache is usually the most common symptom to determine if your tooth needs a filling. However, please be advised, if you  desire to avoid tooth damage to such an extent, it is recommended not to neglect symptoms such as tooth sensitivity to cold or heat or pressure. The longer you ignore  your dental cavity, which is caused by progressive tooth decay, or neglect to treat it, the larger that cavity will grow. If you experience sharp or sudden pain when chewing, your tooth may need a filling. That said, since the tooth decay is progressive, when your tooth decay is left untreated, it is highly likely that it reaches the soft tissue (pulp) in the middle of your tooth, then you may need root canal treatment.

Warning sign symptoms of needing a filling?

• Dark spots in the tooth
• A hole in the tooth and tooth discoloration that you can see it or feel with your tongue.
• Food always gets stuck on or between certain teeth.
• Floss string tears or smells each time you floss a particular tooth.
• Where is a chipped or fractured tooth.
• A previous filling is cracked, broken or missing

Expert Tips for Taking Care of Your Tooth Fillings

The most essential tip to prolong the lifespan of your dental restoration, and maintain your tooth filling is to practice good oral hygiene. Also, you should attend dental check-up on a regular basis at least once every 12 to 24 months, and some people may need to undergo regular dental cleanings.

Make sure you always brush your teeth applying fluoride toothpaste and floss regularly twice a day. Rinsing your mouth using mouthwash once a day to reduce the amount of bad bacteria may help prevent decay and gum disease, which can damage your dental fillings.

If your dentist suspected hidden caries in your tooth, your dental team will take dental X-rays to help them diagnose level of decay on or between teeth, whether small or large. If the dentist advises you to fill the tooth, follow his advice right on time.

If your tooth is very sensitive or you’ve noticed that the edges of your teeth are growing less and less smooth, as tooth enamel wears down due to decay,  or you think that you may have a broken tooth/filling, please make an appointment with your dentist, so that they can make a treatment plan for how best to approach restoring your tooth.