Dental Fillings

Overview

A dental filling is a way to repair a tooth that has a small hole or damaged area in it. Dentists most often use fillings to fix tooth decay (also called a cavity) — a soft, damaged spot that forms when acid wears away the hard outer layer of a tooth. The dentist cleans out the damaged part and fills the space with a strong material so the tooth can look, feel and work normally again. Fillings can be silver-coloured or matched to the colour of your tooth, and they can last many years with good care.

Very common. Tooth decay is one of the most widespread health problems worldwide, and millions of fillings are placed every year. Almost everyone will need one at some point.

Anyone with teeth can get decay, at any age. It is especially common in children and teenagers who eat and drink a lot of sugar, and in older adults whose gums have pulled back or who have dry mouth. People who find brushing hard — for example because of arthritis, a disability or memory problems — are also more likely to need fillings.

Symptoms

Common symptoms

• Toothache, sometimes only when you bite down
• Sharp or lingering sensitivity to hot, cold or sweet food and drinks
• A visible hole, dark spot or groove on a tooth
• Food getting stuck in the same place again and again
• A rough or sharp edge you can feel with your tongue
• Bad breath or an unpleasant taste from one area
• No symptoms at all — many cavities are only found at a check-up

Symptoms in children

• Saying a tooth 'hurts' or pointing at the mouth, especially at mealtimes
• Avoiding chewy or cold foods, or chewing only on one side
• Fussing, crying or refusing food and drink
• A white, brown or black spot on a baby tooth
• Poor sleep or being clingy when a tooth is sore
• Sometimes no complaint at all — children often adapt without telling anyone

Symptoms in older adults

• Decay at the gum line where gums have pulled back and roots are exposed
• New decay around the edges of older fillings, crowns or bridges
• Dry mouth from medicines, which raises the risk of decay
• Less sensitivity than expected, so a cavity can grow quietly
• Difficulty holding a toothbrush or floss because of arthritis or tremor
• Fillings that feel loose, chipped or 'different' when biting

Causes

Main causes

• Tooth decay: bacteria in a sticky film (plaque) feed on sugar and make acid that softens the tooth surface
• Damage or wear to an existing filling, crown or bridge, letting decay in at the edges
• A crack, chip or worn spot on a tooth from grinding, biting hard foods or an accident
• Acid erosion from stomach acid or frequent acidic drinks, which thins the tooth surface
• Gum recession, which exposes softer root surfaces that decay more easily

Risk factors

• Frequent sugary snacks and drinks, especially between meals
• Not brushing twice a day with fluoride toothpaste, or finding brushing difficult
• Dry mouth, often caused by medicines or certain health conditions
• Acid reflux, vomiting often, or an eating disorder
• Older fillings that have been in place for many years
• Teeth grinding or clenching (sometimes called bruxism)
• Smoking or using other tobacco products
• Limited access to a dentist, or long gaps between check-ups
• Being very young, pregnant or older — times when mouth care is often harder

When to see a doctor

See a doctor urgently if:

• Any swelling of the face, jaw or neck — see a dentist or doctor the same day, and call emergency services if breathing or swallowing is affected
• Severe pain that stops you eating, sleeping or working
• A broken or knocked-out tooth, or a lost filling with sharp edges
• Bleeding from the gums that will not stop, or a gum boil leaking pus
• Fever with tooth or jaw pain

Book a routine appointment if:

• Tooth sensitivity to hot, cold or sweet things that lasts more than a few seconds
• A dark spot, hole or rough patch you notice on a tooth
• Food catching in the same place, or a filling that feels different
• Bad breath or an odd taste that does not go away
• A regular check-up — most dentists suggest one every 6 to 12 months, or as often as they advise

Diagnosis

A dentist looks at your teeth and gums, gently examines each tooth with a small mirror and a thin probe, and asks about pain, sensitivity and what you eat and drink. Small cavities on the biting surfaces are often found this way. Cavities between teeth or under old fillings are harder to see, so the dentist may take an X-ray. Sometimes a small photo of the tooth is taken so you can see the problem yourself.

Tests that may be done

• Visual check of all teeth and gums
• Gentle probing of grooves and edges for soft or sticky spots
• Dental X-rays to look between teeth and under existing fillings
• A cold or air test to see how the tooth nerve responds
• Tapping or biting on the tooth to check for cracks
• Photographs of the tooth to explain the plan to you

What to expect at your appointment

The check is painless and usually takes a few minutes. X-rays use a very small amount of radiation and are safe; tell the team if you are pregnant or think you might be. The dentist will explain what they found, whether it needs a filling now or can be watched, and the choices of filling material. You can ask about cost and take time to decide.

Treatment

Treatment means removing the soft, decayed part of the tooth and filling the gap so the tooth is strong again. Most fillings are done in one appointment. The dentist numbs the tooth and the gum around it with a gel or a small injection, so you should feel pressure but not pain. They clean out the decay, shape the space, and build the filling up in layers. Tooth-coloured fillings are set with a special blue light. The dentist then shapes and polishes the filling so your bite feels right.

Self-care at home

• Wait until the numbness has fully worn off before eating, so you do not bite your tongue or cheek
• Start with soft foods and chew on the other side for the first day
• Expect some sensitivity to cold for a few days to a couple of weeks — this usually settles
• Keep brushing twice a day with fluoride toothpaste, including the filled tooth, but be gentle at first
• Avoid very hard or sticky foods such as boiled sweets or chewing ice on a fresh filling
• If the filling feels too high when you bite, ring the dentist — a quick polish fixes it
• Ask your dentist or pharmacist which everyday pain relief is safe for you if you need it

Medical treatments

There are several filling materials, and the right one depends on where the tooth is, how big the cavity is, and what you prefer. Silver-coloured (amalgam) fillings are very strong and long-lasting and are often used on back teeth. Tooth-coloured (composite) fillings are matched to your tooth shade and are popular for front teeth and visible areas. Glass ionomer fillings release fluoride and are sometimes used for roots, baby teeth or temporary repairs. Ceramic inlays fit like a small puzzle piece into a larger cavity. Your dentist will explain the pros and cons, including cost and how long each is likely to last. For very deep decay, they may suggest other options such as a crown, root canal treatment, or removal of the tooth if it cannot be saved. You will always be asked to agree before treatment starts.

When is surgery considered?

A filling is not surgery, but sometimes a dentist needs to do a small procedure in the mouth. This may happen if the cavity is too large for a filling and a crown is needed, if the nerve is infected and root canal treatment is required, or if a tooth is broken below the gum and must come out. These are usually done with numbing and can often be arranged at a specialist clinic or hospital dental service if you are very anxious or have complex needs.

Living with this condition

A filled tooth can last for decades. The key is keeping the edges of the filling clean, because that is where new decay tends to start. Brush last thing at night and at one other time in the day, clean between the teeth daily, and keep sugar to mealtimes rather than all day long. Have a check-up as often as your dentist advises, and mention any new sensitivity early.

Lifestyle tips

• Keep sugary treats and fizzy or sugary drinks to mealtimes rather than sipping or nibbling all day
• Choose water or plain milk as everyday drinks
• Chew sugar-free gum after meals if your dentist says it is fine for you — it helps make saliva
• If you grind your teeth, ask your dentist about a night guard
• Stop smoking, and ask for help if you want support to quit
• Tell your dentist about all medicines you take, as some cause dry mouth

Diet and exercise

You do not need a special diet, but the pattern of eating matters more than the amount. Every time you eat sugar, your mouth becomes acidic for about half an hour, so five small sweets spread through the day do more harm than one pudding at lunch. Finish meals with cheese, plain yogurt, nuts or a piece of fruit, and drink water afterwards to help wash sugar away. Regular movement is good for your general health and helps with weight, sleep and mood — and feeling well makes it easier to keep up mouth care.

Mental health and emotional wellbeing

Dental problems can weigh on you. Pain disturbs sleep, and many people feel embarrassed about their teeth or anxious about the dentist. Dental anxiety is very common and treatable — tell the team before you sit down, agree a signal to pause, and ask about a first visit that is just a look and a chat. If worry about your teeth is affecting your mood or daily life, speak to your doctor or dentist; support is available and you deserve it.

Prevention

Most fillings can be prevented, and early decay can sometimes be stopped or even reversed before a hole forms. The two big wins are fluoride and less sugar frequency. Brush twice a day with fluoride toothpaste, spit out afterwards rather than rinsing, and clean between your teeth once a day. Keep sugary food and drinks to mealtimes. See your dentist for regular checks so small problems are caught while they are easy to fix.

Screening programmes

A routine dental check-up is the main screening test for decay. Your dentist may also apply a fluoride varnish or, for children, a protective sealant on the chewing surfaces of back teeth. Children and young people are usually seen more often than adults. If you are pregnant, have dry mouth, or wear braces or a denture, ask how often you should be checked.

Complications

If left untreated

• The cavity gets bigger and may reach the nerve, causing severe toothache
• Infection can build up at the root, forming an abscess with pus and swelling
• The tooth may become too damaged to fill and need a root canal, crown or removal
• Pain and infection can disturb sleep, eating, school and work
• In rare cases, an untreated dental infection can spread to the face or neck, which is a medical emergency
• Losing teeth early can make chewing harder and shift the other teeth

Long-term outlook

Very good. A well-placed filling with good home care often lasts many years, and many people never have trouble with a filled tooth again. If a filling wears out or a new cavity starts at its edge, it can usually be replaced simply. Seeing your dentist regularly means problems are found small — which means simpler, cheaper and more comfortable treatment.

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