What are the Options for Filling a Tooth?

There are 3 main types of material used for filling standard teeth today- they are:

What are the Alternatives?

An alternative to fillings, are porcelain or gold inlays.

These are a great option, but we will deal with them separately because they are examples of indirect restorations (a restoration that is made outside of the mouth and involves a laboratory phrase). Normal fillings in dentist speak are termed ‘direct restorations’- they are placed directly into the cavity in the tooth.

If a large amount of tooth is missing then a dental crown
is another good option and if the tooth is at the front of the mouth, a veneer may also be considered.

The other treatment options that exist are doing nothing, simply smoothing or re-contouring (re-shaping) the tooth -(only suitable for a minor chip).

Do I Have to Have a Filling?

Do I have to have a filling?

The simple answer is no- you don’t have to do anything- it is your choice and your mouth.
However it is the responsibility of the dentist to tell you in his opinion what needs to be done to get you back to health and the consequences/risks of not having it done.

Reasons to have a filling may include:

  • To make cleaning easier- stop the area trapping plaque
  • To prevent sensitivity to hot, cold and sweet things
  • To prevent the decay affecting the nerve and stop you getting pain
  • To improve the look of the tooth and your smile
  • Previous attempts at trying to arrest the problem with preventative dental measures have failed i.e. there is evidence of a progressing problem.

It is worth saying that caries or decay progresses slowly and can take many months even years in some cases to get to a point where it actually needs a filling. Your teeth, as explained in dental decay are constantly de-mineralizing (breaking down) and re-mineralizing (re-forming) and even when you have active decay, it is sometimes possible to get it to stop. Studies have shown that if you can do this, then the area of ‘arrested decay’ is in fact more resistant to future decay. Now this is certainly not possible with all fillings but sometimes with what we call ‘smooth surface caries’- it is! These teeth have easily cleanable surfaces .

Decay may be stopped or arrested with large changes in dietcleaning habits and additional fluoride. If the dentist decides to monitor you – it is very important that you keep the next appointment and if there is any sign of progression then a filling should in most cases be done. If you manage to stop the decay (arrested caries), then no treatment is needed unless the’ look’ bothers you.

If your dentist advises you to have a filling, the decay will likely continue to progress if you do not take their advice. What does this mean? It means, that what was once a potentially easy filling, may become more difficult, involve more surfaces of your tooth (compromising the strength and structure of your tooth) and end up costing you more money.

Most importantly, it will get ever nearer to the nerve of the tooth and if allowed to progress too far will cause irreparable damage and cause the nerve to die off. If this happens, then just simply filling the tooth becomes no longer viable and a root canal treatment or extraction will be needed.

Are there Occasions When you Don’t Necessarily Need a Filling?

  • If the area in question is because of toothbrush abrasion, then the most important thing is to change your brushing technique. If it is not sensitive, very clean and not trapping plaque then your dentist can simply monitor the tooth.

If you just have a tiny chip, it may be better to smooth the tooth rather than try and bond such a small amount of material to it.

What Type of Filling is Best for Me?

In certain health systems, such as the NHS in the UK, amalgam continues to be the filling material of choice for the time being, due to it’s proven effectiveness and ease and speed of placement.

In private practice, it is used less often, but is particularly good where controlling saliva is difficult and composite would be likely to fail. It is also useful for repairing existing amalgams or where access is very difficult such as a wisdom tooth which you have decided to keep and where the ‘look’ is less important. In my opinion amalgam for these reasons still has its place in modern dentistry.

In private practice, composite is preferred, as the demand for natural ‘good looking’ fillings increases. Research nowadays is largely focused in this area. Composite is best for smaller fillings but has been used with success in larger cavities too, taking into account the limitations I have discussed. When many tooth surfaces have been lost and a natural tooth look is needed, a porcelain restoration in the form of an inlay or onlay (even a crown) is a better long-term solution with the best aesthetics. Because it takes longer to prepare and involves a lab stage to make the porcelain restoration, they are much more expensive than fillings.

Glass ionomer cements are useful in areas that are not highly visible for those of you who are high risk of decay or as a temporary filling to check how a tooth is going to respond to deep decay. It is also excellent as a lining material and useful for sticking in crowns and bridges.

Your dentist will advise you of the most appropriate filling material (or alternative) after assessing and discussing the following things:

  • Your mouth:

– The amount of tooth remaining

– If the tooth has been root filled

– The importance of the tooth in your smile

– The position of the tooth

– Your ability to keep the filling dry (amount of saliva and size of your tongue)

– How far you can open your mouth.

  • Your expectations: 

– How quickly do you need it done?

– How important the look is to you?

– How long you want it to last?

  • Your finances:

– How much are you prepared to pay?

– Don’t be afraid to ask questions! As dentists, we want to do what is right for you and for you to be happy… this involves a two-way conversation. It is our job to answer your questions and concerns and educate you on the reasons something is or is not advisable or indeed possible.

  • Occasions when posterior composites (white composite fillings for your back teeth) might not be the best choice:

– If the decay and cavity extend far underneath the gum

– Large restorations involving multiple cusps

– Poor moisture control

– Children

– Bruxism, heavy occlusion.

In these circumstances, it may be better to consider one of the alternative choices such as an amalgam, GIC, or for the extensively broken down tooth an inlays/onlay or crown.

See also White fillings versus silver fillings for more information.