Dental fillings are generally used to treat a hole or cavity within a tooth normally caused by tooth decay. However, as you will read below there may be other incidents where a filling may be an appropriate route of treatment.

During the procedure, a dentist will need to carefully remove the decayed portion of the tooth, and then recreate the shape of the tooth by “filling” the remaining part.

Fillings can also be used for teeth that are broken, chipped or worn down from teeth grinding or nail-biting.

Believe it or not, the earliest dental filling was made from beeswax and was discovered in Slovenia having taken place around 6,500 years ago, but the amalgam filling we are familiar with today was first invented in 1819 by the English chemist, Jacob Bell.

What is the procedure of having a filling?

Firstly, you should be reassured that having a filling is one of the most common dental treatments in the UK.  Around 84% of adults in the UK have at least one filling so you can relax in the knowledge that your dentist will be well rehearsed when it comes to this type of procedure. 

Each filling is slightly different due to the unique nature of the level of decay, location and size, but generally fillings are performed as follows:

1. Usually the dentist will numb the area with a local anaesthetic. Anaesthetic is quick-acting and you should feel numb within a couple of minutes
2. The dentist will carefully remove the decay using a drill. The patient may feel a vibrating sensation but this won’t be painful due to the numbing
3. The dentist will check the area intermittently with a probe or other instrument to check the area is decay-free
4. The material of choice should have been discussed prior (usually either amalgam or composite) and this will be used to fill the cavity.  When using composite, there are addtional steps used prior to filling the cavity to help adhere the composite to the tooth
5. Once filled, the dentist will finish and polish it

What materials are used for fillings?

In the UK, the most common filling materials are amalgam (silver) and composite (tooth-coloured). Both materials have advantages and disadvantages.

Amalgam Fillings (Silver)

Advantages:

• Durable
• Very strong (metal)
• Expense - usually the cheaper option

Disadvantages:

• Poor aesthetics - silver and doesn’t match the tooth
• Destruction of more tooth - extra healthy parts of the tooth may need to be drilled to allow room for the amalgam to hold
• Discolouration - amalgam can create a grey colour for the remainder of the tooth
• Cracks and fractures - over time, the material will experience expansion and contraction from hot and cold liquids, leading to cracks and fractures
• Allergy - a very small percentage of patients can experience sores

Composite Fillings (White)

Advantages:

• Aesthetics - composite is tooth-coloured so can blend in with the remaining tooth and a lot of fillings are unnoticeable
• Bonding to tooth structure - composite is glued into the cavity, providing more support
• Less tooth structure needs to be removed for the material to hold, composite is adhered to the structure as soon as it is decay-free

Disadvantages:

• Lack of durability - will wear out sooner due to not being as strong as metal fillings
• Increased chair time - composite fillings take longer to complete due to process of applying the material
• Expense - composite materials are usually more expensive

What is a temporary filling and why would I need one?

The most common material used in temporary fillings is a tooth coloured compound called glass ionomer, which bonds to the tooth enamel, and can help in calming aggravated tooth nerves. Temporary fillings can be used in a variety of situations:

• For veneers and crown appointments whilst waiting for the veneer/crowns to be made
• Following root canal treatment
• Allow the nerve to settle if experiencing toothache due to inflamed pulp
• Emergency dental treatment

Temporary fillings are not meant to last, hence the reference to ‘Temporary’ as they are weaker and more prone to wear, and may need to be replaced.

Are amalgam fillings safe?

Concerns have been raised over the last decade of using dental amalgam, because it contains the toxic substance mercury. Some believe that amalgams are responsible for causing diseases such as Alzheimer’s, Multiple Sclerosis and Autism. However, any strong link is still unproven. Amalgam also contains tin, zinc, copper and silver, that when mixed together, amalgam forms a stable alloy that dentists have used for the last 100 years to fill and preserve teeth.  This is according to the United States Food and Drug Administration which is a Federal Agency of the Department of Health and Human Services.

Here in the UK the NHS, Oral Health Foundation and British Dental Association all take a similar stance to the FDA and “considers dental amalgam fillings safe for adults and children ages 6 and above” based on the best available scientific evidence.

Views differ across Europe however, and dental amalgam is banned in both Norway and Sweden as well as other mercury-based products for environmental reasons.

What should I do after having a filling?

After having a filling, it is advisable to take things a little more carefully when it comes to eating and drinking as you may experience some initial tenderness and discomfort.  Some immediate practical tips that you can follow after having a filling include:

• Avoid very hot or cold drinks and food – this can help reduce any sensitivities after the procedure
• Avoid hard foods – being a little extra cautious after having a filling can ensure that you minimise the opportunity to dislodge any new filling – bite and chew carefully being mindful of the procedure you have just had
• Avoid sugary foods and drinks – try and reduce the amount of acid that can cause further sensitivity
• Take your time when eating – you may feel some soreness so slowing down when it comes to eating can help manage any feelings of malaise

How can I prevent needing a filling

The priority is to prevent tooth decay occurring and progressing. Good oral hygiene practice can help prevent tooth decay. This includes brushing twice a day with a toothpaste containing fluoride and flossing regularly. In addition, seeing your dentist and hygienist regularly for cleaning and a balanced diet without large amounts of sugar will help keep your teeth and gums healthy.

Want to keep learning? Find more articles from Dr Keval Chavda - Kev The Dentist:

• Dental Tips for Children
• Dentophobia: Fear of the Dentist
• Help on How to Effectively Manage Toothache
• Meet The Expert - Dr Keval Chavda, Dentist
• HealthHubble Podcast: Introducing Dr Kev Chavda, NHS Family and Cosmetic Dentist