Fillings

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Fillings

A filling is a type of dental treatment used to replace holes (cavities) in the tooth. A wide range of dental restorative materials can be used to help fill in any missing part(s) including metal and metallic alloys, cement, porcelain (ceramics) or synthetics.

Types of filling

There are many types of filling that are used by dentists when carrying out dental restoration. These include:

Amalgam fillings (silver coloured):

Amalgam fillings consist of a number of metals including silver, tin, copper and mercury, which gives them their silver colour. Amalgam is a very tough and long-lasting material, which is why this type of filling is normally used by dentists to fill holes in teeth at the back of your mouth which are used for chewing and grinding. Amalgam fillings usually last for 15-20 years.

However the mercury in amalgam fillings is an on-going safety concern for many people. Extensive research into the effect of amalgam fillings on health has shown that they do not pose a risk.

Tooth-coloured fillings:

Tooth-coloured fillings, or white fillings, are offered to dental patients as a natural-looking alternative to amalgam fillings. They are not as sturdy as amalgam fillings and are therefore not always suitable for the back 'chewing' teeth. However, their natural appearance makes them ideal for filling cavities in the front teeth, i.e. teeth that show when you smile or talk. They are also sometimes used to build up the edges of chipped or worn teeth.

Tooth-coloured fillings are split into two main types; composite fillings and glass ionomer fillings:

• Composite fillings are made from powdered glass quartz, silica or other ceramic particles added to a resin base. Composites are quite tough but not as durable as amalgam or porcelain materials and can shrink with age, causing sensitivity. They can also produce a tiny gap between the filling and your tooth that may attract bacteria and lead to further decay.

This type of filling is bonded onto the affected area and a light is then shone onto it to help it set. Once fitted, the surface can then be shaped and polished.

• Glass ionomers bond chemically to dental hard tissues and release fluoride for a relatively long period, which helps prevent decay. They are not very weak and as a result are usually only used for children's teeth, or for small back fillings and fillings on root surfaces.

Inlays and onlays:

Inlays and onlays are similar to fillings. An inlay is small and is placed within the biting surface of the tooth, while an onlay covers a larger area. They can be made from gold, porcelain or composite material.

Gold and porcelain are both very strong and long-lasting filling materials. Another advantage of gold is that it doesn't tarnish, while the added benefit of porcelain is that it can be coloured to match your tooth's natural appearance. However, these types of fillings can be quite expensive.

Like crowns, inlays and onlays are made in a laboratory using a putty-like mould of the tooth. While this is being done a temporary filling is fitted to protect the tooth. Once the inlay or onlay has been produced and sent back to your dentist, he or she will then remove the temporary filling and cement the inlay or onlay to the tooth using special adhesive.

Choosing a filling

Your dentist will be able to advise you on which type of filling best suits your condition. However, before agreeing to any filling treatment, make sure you request a treatment plan and a written estimate on the costs involved.

Although white fillings have always been considered less long-lasting than silver amalgam fillings, there are now new materials available with properties similar to silver amalgam, which are proving to be very successful. The life expectancy of a white filling can vary, although those provided on the NHS are automatically guaranteed for one year.

You should only look at changing your filling when your dentist decides that an old filling needs replacing, at which point you can ask to have it replaced with a tooth-coloured material. Note that some dentists may prefer not to put white fillings in back teeth as they are not always successful, so one alternative option would be to use crowns or inlays. However, this can mean removing more of the tooth and will cost you more in the process.