Fillings

(we do not use silver amalgam filling materials)

Fillings are used to restore teeth damaged by tooth decay or broken by trauma. Although fillings restore appearance and function, it is not all good news, particularly if they are not done to a high standard. You need to be aware of their limitations, and not rely on them to keep your mouth healthy. You must play your part by brushing with fluoride toothpaste, flossing, and having a sensible diet.

They have little positive effect on preventing decay, instead creating new inaccessible areas allowing bacterial growth, causing more decay and/or gum disease. Once filled, a tooth is more likely to go through cycles of decay and repair:

Figure: Tooth repair cycles depending on prevention and timing of treatment.

A tooth decaying in adolescence may have five or six treatment cycles during a lifetime, and each cycle more expensive than the last. Even later in life a move to prevention (the green area) helps keep a heavily repaired tooth healthy, so never think it's too late.

An alternative (not advocated by us) is not to treat, allowing nature to takes its course, which means early loss of the tooth. Although a filling may promote further decay over years, untreated decay can destroy a tooth in months. Although we hope the outcome is unintended, the current NHS system favours late or little intervention, with higher risks of early tooth loss. Treatment is neglected for many people, who remain in ignorance as they progress rapidly to worsening dental health. Once it dawns on them, it is too expensive or too late to avoid dentures.

Our approach is to minimise the number of treatment cycles by providing high quality restorations. The smaller a restoration the longer it is likely to last, because weakening of the tooth is minimised. To keep a restoration small early identification of decay is necessary and we have the newest technology to help us. This is effective for our regular patients on the maintenance plan. Unfortunately, many of our new patients arrive with large cavities beyond minimal intervention.

Where it is necessary to fill a tooth a number of considerations are made

• the amount of tooth damaged. If half of the crown or more is destroyed we would tend to favour a crown or onlay rather than a filling.
• the forces the tooth is subjected to. For example one not used for chewing could be filled, but one that is may be better crowned.
• how accessible the decayed surface is. Where a surface is very difficult to access and there is risk to other teeth it may be better to accept extraction and if necessary deal with the space.
• where the decay is. Whether the decay is under gum level will determine the type of material used

Small fillings are usually straightforward and we judge the complexity and hence the time allocated to the number of surfaces involved. So they may be any number of surfaces from one to five (front, back, top and two sides, although we rarely advise greater than a three surface filling. Greater than that we generally advise a crown to overcome problems of weakness and improve quality of finish.

Even though patients join us later in life having gone through several cycles of repair we aim to provide longer-term, stable solutions and break the cycle by using adjuncts to fillings such as HealOzone and PAD to ensure decay is eradicated prior to placing a filling or crown. When in doubt we may also use an intra-oral camera to magnify the tooth by up to 40x to check no decay remains. Often, when fillings are rushed spots of decay remain causing a repeat cycle much sooner than expected. We avoid rushing by allocating sufficient time to do the job properly first time.

Minimal Intervention

Early identification of decay allows us to treat without using fillings at all, or very small fillings with very little loss of tooth. Backed up by education and you carrying out good oral hygiene, these approaches aren't likely to need repeating for many years. Perhaps requiring two cycles of repair in a lifetime. The cost of this approach works out at a twentieth of the cost of the large filling cycle mentioned to the left of this page.

This is the type of care we prefer for our patients, and those with us from childhood are usually in this category.