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Dental fillings, also referred to as cavity fillings, are most commonly used to fill minor dental cavities (decaying teeth). Before the filling is placed, a portion of the decaying tooth is removed. Then your dentist fills the cavity with a tooth-colored or metal dental restoration.
There are many uses for cavity fillings. For example, the restorations close the spaces in teeth where bacteria and food particles can enter, which prevents the progression of the decay. Fillings also repair broken, chipped, or worn-down teeth.
Dental caries, also called carious lesions, is the process that results in tooth cavitation. Incipient lesions are considered “microcavities.” These lesions are limited to enamel only, so they can be "stopped" without a dental filling.
The lesions create chalky white spots on the surfaces of teeth. These white spots turn dark brown or black over time, which is the earliest sign of cavity formation (tooth decay).
There are six different classes of dental caries that result in cavitation, including:
These carious lesions form in the fissures and pits of teeth, which is why they are called “pit-and-fissure lesions.” They typically occupy the biting surfaces of posterior (back) teeth and the grooves on the top and bottom molars.
These lesions occupy the interproximal surfaces of posterior teeth (in between). This includes premolars and molars.
These lesions occupy the interproximal surfaces of anterior teeth (in between). This includes incisors and canines, but not the biting edges of the teeth.
These lesions are found on the gum line of both anterior and posterior teeth. Plaque buildup on the gums is common, which may result in white spots on teeth.
These lesions form on the cusp tips of premolars, molars, and the incisal (biting) edge of incisors and canines.
If cavities are left untreated, tooth loss can occur.
Small cavities usually do not cause any symptoms, which is why consistent dental evaluations with x-rays are necessary to catch them early. If a small cavity isn’t filled in time, it will get larger and symptoms typically begin to develop. Although, by the time the symptoms are noticeable by the patient, the cavity is past the point of being fixed with just a filling. Common symptoms of big cavities include:
Plaque formation is the leading cause of cavities. Plaque forms due to the long-term buildup of food particles, oral bacteria, acid, and saliva.
The high acidity content in the plaque attacks the tooth enamel, causing holes and dark spots on teeth. If plaque is left untreated it can turn into hardened dental plaque, also called tartar, which is difficult to remove. The earlier a cavity is caught, the easier it is to treat. Common causes of cavities and plaque buildup include:
The primary cause of cavities is from foods and drinks high in sugar, including fruit juices and candy. White starches, such as pasta, bread, chips, and crackers can even cause cavities over time due to their high carbohydrate levels (sugars). Mouth bacteria feed off of simple sugars, which eventually converts into acid plaque.
Smoking itself doesn't cause cavities. Tobacco's main role in cavity formation is the fact that it causes dry mouth, which allows for greater plaque buildup. Over time, smoking can also create dark stains on the teeth. Dentists recommend smokers to avoid acidic foods and drinks that can cause worse stains, such as coffee, soda, and tea. The combination of sugary foods (mentioned above), acidic liquids, and dry mouth can lead to enamel breakdown and cavity formation.
Dry mouth occurs when the salivary glands in the mouth cannot make enough saliva, which is typically caused by some medications. Over time, dry mouth often results in cavity formation. Medications that lead to dry mouth include:
Brushing twice a day, flossing every day, and rinsing with mouthwash regularly are essential for cavity prevention. Visiting the dentist every six months for teeth cleanings and yearly x-rays is also essential. Doing so allows dentists to catch cavities early and prevent further decay with treatment.
There are three main types of direct cavity fillings available, which are restorations made inside of the mouth during one office visit. Direct filling types include:
Composite is a tooth-colored, adhesive bonding material made of glasslike filler particles and acrylic resin. Composites are the most common restorative material for cavity fillings, broken teeth, and chipped teeth. This material fills cavities in posterior teeth (premolars and molars).
Amalgam is an alloy (mixture) of mercury with silver, tin, and copper. The amount of each element in amalgam varies because there are many different types of alloys. Mercury in dental amalgam is not toxic, strong, and more stable than methyl mercury. Amalgam fillings usually restore posterior teeth (premolars and molars).
There are two types of glass ionomer fillings:
Indirect dental fillings are made outside of the mouth, typically in a dental laboratory. They are custom made for each patient depending on their needs, tooth structure, and severity of tooth decay.
Indirect restorations fill cavities that are too large for a simple dental filling (direct filling) and take two office visits to complete.
Types of indirect fillings include:
General dentists, family dentists, and pediatric dentists are the main providers of dental fillings for children and adults. They also specialize in other dental care procedures and treatments, including teeth cleanings, restorations, and sealants.
The cost of a dental filling depends on the type and the dentist’s location. Since fillings are used to treat cavities, decay, or trauma-related dental conditions, part or most of the procedure is covered by a good dental insurance policy. The prices below reflect procedure costs without insurance:
Amalgam (Silver) Filling
$50-$200 (per tooth)
$90-$300 (per tooth)
$90-$300 (per tooth)
Indirect Gold or Porcelain Filling
$500-$4500 (per tooth)
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Lygre, David G. General, Organic, and Biological Chemistry. John Wiley, 2003.
Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.
American Dental Association (ADA), Tackling tooth decay. 2013. https://jada.ada.org/article/S0002-8177(14)60378-0/fulltext