Dental cavity or caries is a common problem across all age groups. The best treatment for a cavity is to tend it to as early as it is diagnosed. Dental fillings are the treatment of choice for cavities. Dental fillings are of several types and depending on the type size and location of caries on the tooth the dentist will determine which is the most suitable filling material.
Dental amalgam has been in use for a long time. It is a very versatile and robust restorative material and is mostly used in the molar tooth. Due to its appearance and possible mercury toxicity, use of dental amalgam is on a decline.
Composite is a tooth-colored resin which is used widely as a restorative material. It is a material of choice for all kinds of cavities. Porcelain and gold tooth fillings are also another options. Let us understand in detail why we need filling and what are the different types of tooth filling materials.
Dental fillings procedure
Most people required at least one tooth filling in their lifetime. Dental fillings are the most common procedure done in a dental office.
The dental filling material is not only used to treat cavities, but they are also used to repair chipped or broken teeth or teeth that have been worn down over time.
Diagnostic x rays are taken to determine the extent of the cavity. If the size of the cavity is extensive, the procedure is done under local anesthesia.
The decay is removed from the affected teeth till healthy tooth surface is seen. The tooth is restored using a composite or amalgam filling.
If a ceramic or gold onlay or inlay is to be made, the dentist makes an impression of the treated teeth which is then sent to a dental laboratory. The dentist meanwhile restores with a temporary restoration.
Bite check is done after finishing the restoration to make sure your teeth align comfortably. Some restorative materials like composite may require a 24 hour follow up.
How does the dentist select a restorative material?
The material of your filling depends on the size, location, and extent of the cavity. An amalgam filling is an alloy of metals, including mercury, silver, tin, and copper.
Because of its silver color, amalgam fillings are typically used in those parts of the mouth which are hard to see. They are durable fillings and are preferred for high-stress chewing areas, such as molar teeth.
This tooth-colored material blends in easily and comes in different shades hence color matching can be done effectively. Gold and ceramic fillings, which are more costly but extremely durable.
Types of restoration techniques also depend on the extent of the decay. If the cavity is restricted only to the inner grooves of the tooth, direct restoration or an inlay may be used.
For cavities covering the chewing surface of the tooth, including a cusp tip, an onlay is appropriate (3). While filings are ideal for small cavities, more extensive areas of decay may require a crown, which covers the entire tooth (4).
It is a reliable long-term restoration in load-bearing areas and has low technique sensitivity, self-sealing property, and longevity. The mercury component in amalgam, however, makes it a concern for patients (5).
The main reason dental amalgam is not suitable as filling material is that the content is not dimensionally stable and continually expands with time.
- Ease of manipulation by a dentist
- Greater long-term resistance to surface corrosion
- Minimal placement time compared to other materials
- Initially, corrosion products seal the tooth-restoration interface and prevent bacterial leakage
- One appointment placement
- Long lasting if placed under ideal conditions
- Often can be repaired
- Metal fillings have a longer lifespan
- Resistant to damage from chewing and grinding
- Cheaper treatment
- Larger filling size
- Destruction of sound tooth tissue
- Poor esthetic qualities
- Long-term corrosion of the restoration interface may result in ditching leading to replacement
- Galvanic response potential exists (6)
- Local allergic potential
- Metallic appearance
- Possible health hazards and allergic reaction(7)
A composite filling is a tooth-colored resin and filler mixture used to restore decayed teeth (8). Composite restoration can also be used for cosmetic improvements of the smile by changing the color of the teeth or reshaping a disfigured teeth.
The composite resin as a material is dimensionally unstable. When a dentist places a composite filling in your mouth, it is in a putty form. It is then cured with a high-intensity blue light, and the material solidifies and hardens.
This process is called polymerization and with it comes shrinkage. Due to this, the filling becomes smaller than the cavity it sits. The primary goal of a dental filling is sealing the cavity effectively.
But due to polymerization shrinkage, the cavity is compromised over time, and secondary caries begins around the restoration. Dentist thus requires a follow up after the filling to check for any form of polymerization shrinkage and make any corrections.
- Chemical bonding to enamel
- Tailored to match the natural color of teeth
- Less tooth removed for filling
- Easy to repair
- Less technique sensitivity
- Aesthetic corrections can be made
- Can be used for indirect veneer
- They can stain over time
- Polymerization shrinkage
- Shorter lifespan compared to metal fillings
- Higher wear rate
- Longer procedure time
- More post-operative sensitivity
Porcelain is the best restorative material owing to its strength and appearance. It helps restore the oral health for the long-term, decades even, with proper care. Porcelain is also the most aesthetic restorative material (9).
The restoration is designed precisely to fit in the designed cavity. This restoration is made in the dental laboratory and then glued in the cavity.
Porcelain restoration is costly than amalgam and composite restoration, and these fillings take longer to make. Porcelain fillings are made either by a dental technician or Computer Aided Design – Computer Aided Manufacturing (CAD-CAM) system. This technology means that porcelain restorations can be made and cemented during the same appointment.
- Being almost undetectable
- No opportunity for shrinkage
- Aesthetic appeal
- Long lasting
- Natural tooth opposite to the porcelain restoration can wear over time
The best restorative material adapting to our oral environment is gold (10). It has similar qualities to porcelain and is very stable and robust.
However, gold restoration lacks aesthetic appeal, and it stands out contrasting against the natural tooth color. Typical gold dental fillings will consist of 75% gold with the remainder being made up of palladium, silver, and other minor metals.
The price of gold is another factor, and also it is expensive to manufacture. Gold fillings have to be done over two appointments and are made by a skilled dental technician. For these reasons, gold restoration is rarely used today.
- Dimensional stability
- Excellent adaptation to the teeth
- Opposing tooth wear to an absolute minimum
- Most biocompatible material
- Highly expensive
- Technique sensitivity
- Multiple seating
FAQs for Tooth Filling
What is a tooth filling?
Tooth fillings are an amalgamation of synthetic materials that are compatible with the dental tissues. A tooth filling is placed after removing the decayed portion of a tooth. Some of the materials used for tooth filling include amalgam, gold, ceramic, composite, and glass ionomer.
The primary purpose of a tooth filling is to restore the tooth structure and make it functional for biting and chewing. Some of the dental problems treated by tooth filling include –
- tooth decay
- cracked tooth
- chipped tooth
- worn-out tooth surface
- abraded tooth surface
How long should a tooth hurt after a filling?
Usually, in cases of minor tooth fillings, a person may not feel pain or sensitivity. However, in the case of deep restorations, the patient’s tooth may remain sensitive to heat or cold for a minimum two to three days. The pain or sensitivity is very mild post tooth filling. Moreover, it gradually subsides, leaving the patient comfortable.
How to temporarily fill a hole in your tooth?
Temporary fillings are typically used in the following cases –
- to cover the tooth that requires indirect gold fillings
- to include a root canal treated tooth
- for deep caries management
- emergency dental treatment that requires a follow-up appointment
temporary dental materials are available at the dental office; the dentist removes the decayed portion or performs the root canal and places the temporary filling. The temporary filling does not last long. Therefore, a follow-up appointment is made within the next few days to replace the filling with a permanent dental material.
How long do tooth fillings last?
Typically, people who take proper care of their oral restorations can enjoy the benefits of tooth filling for over 5-10 years.
What are tooth fillings made of?
There is a wide range of dental materials that are used to fill a tooth. Some of the accessible dental materials for tooth filling are listed below –
Amalgam – silver filling
Amalgam is typically made from silver alloy and mercury. It is one of the strongest and affordable dental materials. The longevity of amalgam is usually 10-15 years. Additionally, amalgam has excellent wear strength that can withstand the chewing forces.
Cast gold is another dental material which is known for its high strength and non-corrosive property. Like amalgam, cast gold is also a durable dental material that can last for as long as 10-15 years. Some patients are also fascinated with gold as a tooth filling and prefer it over silver fillings.
Composite is one of the most advanced types of dental material that comes in a variety of tooth-colored shades. It is typically used to restore the front teeth. Unlike amalgam and cast gold, composite chemically bonds to the tooth structure.
Glass ionomer is a unique mixture of acrylic and glass. It is typically used to restore tooth structure near or below the gumline. Additionally, glass ionomer is popularly used for tooth fillings in children. One of the unique properties of glass ionomer is fluoride release, which helps to strengthen the teeth and fight cavities.
Why does my tooth hurt after a filling?
Some of the reasons for tooth pain or sensitivity after a tooth filling procedure may include the following –
- usually, in deep tooth decay, the dentinal tubules remain open. Placing a foreign dental material over the open dentinal tubules can make the tooth sensitive to hot, cold, and pressure for a few days.
- Fractures tooth filling or loose tooth filling can allow microleakage that can cause secondary tooth decay. Moreover, it causes discomfort every time the patient bites on the cracked tooth filling.
- Allergy to dental material, especially amalgam or cast gold.
How to fill a hole in the tooth at home?
Usually, there are emergency dental home kits available in the market that consist of temporary tooth filling material. In case of a lost tooth filling, scoop a small amount of the material provided in the kit. The role the material between your fingers to make a compact ball of the dental material.
Place the tooth filling on the concerned tooth cavity and apply gentle pressure to cover the tooth surface adequately with the filling material. Book an appointment with your dentist as early as possible to replace the tooth filling with a permanent one.
How much does it cost to get a tooth filled?
Usually, the cost of tooth filling may differ depending on the type of tooth, dental material, and location of the dentist. The cost of tooth filling per tooth with different tooth materials is listed below –
- Silver fillings – $100-$200
- Composite – $130 – $250
- Cast gold – $250 – $4500
Most of the insurance policies cover the cost of tooth filings. However, in some cases, it may only cover a part of the payment. You can contact your insurance provider to check with their tooth filling policies. Moreover, you can also ask your dentist for some discount plans to reduce the cost of the tooth filling.
Final words on dental fillings
Discuss with your dentist the treatment options and wisely choose the filling material. Dental amalgam is the most economical dental filling material. However, its metallic appearance makes it less preferable choice.
Composite is the second most economical choice and has a wide range of applications. It can be used to repair broken teeth, make minor corrections in the shape and size of the tooth, close diastema, and they can also be used as veneers.
Gold dental fillings are rarely used because of the cost factor and its contrasting appearance against the tooth surface. Porcelain restoration is the most sturdy and durable material. Though the cost is still on the higher side, this restoration can easily last for decades. The material does not change its dimension, and color and has the same appearance throughout its life.