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Restoring teeth

If your teeth become decayed, worn or broken there is a range of treatments your dentist can offer. These include fillings, crowns, veneers, inlays and onlays.

Some of these treatments are available on the NHS, although you’ll usually still have to make a contribution towards the cost. Some treatments are only available on the NHS in certain circumstances. Ask your dentist about the cost of any treatment they’re recommending.

Tooth decay (also called dental caries) is a very common health problem in industrialised countries like the UK. It affects people of all ages, even young children. It’s mainly caused by sugary foods and drinks. When you eat anything that contains sugar, the bacteria on your teeth break down the sugar and produce acid. The acid softens and dissolves the hard protective outer surface (enamel) of your teeth. Over time, this can cause holes (cavities) to form in your teeth – this is tooth decay. Your teeth are more likely to be affected by decay if you don’t brush and clean between them regularly.

If you have tooth decay, the type of treatment your dentist recommends will depend on the extent of the damage to your teeth and which teeth are affected. Your dentist will discuss your options with you.

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  • Fillings Fillings

    Fillings are used to fill cavities that have formed in your teeth. They help to stop you getting toothache and prevent further decay. There are different types of fillings but the most common are amalgam (metal) and composite (tooth-coloured).

    If you need to have a filling, your dentist will usually give you an injection of local anaesthetic. This completely blocks pain from the area and you will stay awake during the procedure.

    Your dentist will remove the decayed and weakened parts of your tooth using a small drill. They may use a liner to coat the cavity so that there are no open passages to the nerve that could cause pain afterwards. Your dentist will then fill the cavity. For some types of fillings they then need to use a light to make the filling materials set hard.

    After the procedure, it may take several hours before the feeling comes back into the treated area of your mouth. Take care not to bump or knock your mouth or bite your tongue, particularly when you’re speaking, drinking or eating.

    Amalgam fillings

    Amalgam fillings are made of a combination of metals including mercury, silver, tin and copper. Amalgam is extremely hard-wearing which is why it’s especially good for fillings in your back teeth. An amalgam filling can last for more than 20 years if you take good care of your teeth. Amalgam has been used in fillings for at least 150 years.

    You may be concerned about the safety of amalgam fillings as they contain mercury, which can be poisonous. However, amalgam fillings contain only a very small amount of mercury. Research studies have not shown a link between amalgam fillings and ill health. Even so, dentists will try to use less amalgam in future because of an international agreement to reduce the amount of mercury in the environment.

    Some people are allergic to the metals in amalgam and may need to have another type of treatment, but this is rare. Ask your dentist for more information.

    Pregnant women are usually advised not to have amalgam fillings, as a precautionary measure. This is to reduce the chance of mercury being passed to your baby. If you’re pregnant, or think you may be, tell your dentist. They’ll probably advise you to wait until your baby is born before having an amalgam filling.

    Composite fillings

    Composite fillings are newer than amalgam fillings. They’re made to match the colour of your teeth and so look more natural. Composite fillings are often used in front teeth that show when you smile or talk. These tooth-coloured fillings aren’t as hard-wearing as amalgam and so aren’t always suitable for the grinding and chewing surfaces of your back teeth. They’re being improved, and being used more and more as time goes by.

    Root canal fillings

    You may be offered a root canal filling to save a tooth that your dentist might otherwise have to take out. This may be the case if you have very deep decay or a dental injury that affects the centre of your tooth. This central area, called the pulp, is made up of blood vessels and nerves that can become infected if exposed. The infection can then spread throughout the root canal system of your tooth. If this happens, you’ll need to have root canal treatment. This involves your dentist cleaning, shaping and filling the entire root canal of your tooth.

    An image showing the area treated when you have root canal therapy 

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  • Crowns Crowns

    Crowns are used to strengthen teeth and improve their appearance after they’ve been damaged or treated. They’re shaped like natural teeth and fit over your existing tooth once it has been prepared. There are a number of reasons why you may have a crown, including:

    • if your tooth is broken or has been weakened. This may have been caused by decay or a large filling
    • to cover up a filling that is discoloured
    • after root canal treatment to protect your tooth

    Crowns can be made from a variety of materials including porcelain, porcelain combined with a metal, gold mixed with other metals, or ceramic. New materials are being developed all the time.

    Your dentist will give you an injection of local anaesthetic before you have the crown fitted. They’ll prepare and shape your tooth so that there is room for the new crown. Depending on the amount of damage to your tooth, your dentist may need to fill it first. If you’ve had root canal treatment, you may need to have a post crown. This involves inserting a small post (or peg) into your tooth that will hold the crown in place.

    Once your tooth has been prepared, your dentist will make a mould (called an impression) of your tooth. This is necessary for a dental technician to make a crown that will fit it exactly.

    It may take a couple of weeks for your crown to be made, so in the meantime your dentist will fit a temporary one. The temporary crown won’t be as strong as your permanent one, but you’ll be able to chew as usual. You’ll have another appointment when your dentist will take off the temporary crown and cement the new, permanent one in place.

    After the procedure, it may take several hours before the feeling comes back into the treated area of your mouth. Take special care not to bump or knock your mouth or bite your tongue, particularly when you’re speaking, drinking or eating. If you look after your teeth carefully, crowns can last for many years.

  • Treatment for fillings, crowns and veneers

    Our Bupa Dental Centres offer a range of routine, specialist and cosmetic treatments including fillings, crowns and veneers. Find out more.

  • Veneers Veneers

    Veneers are a way of repairing chipped or uneven front teeth. They usually consist of a thin layer of tooth-coloured material, often porcelain, that fits over your existing tooth.

    Your dentist will prepare your tooth by removing some of the enamel outer layer. This is so that the veneer doesn’t make your tooth bigger or feel uncomfortable. It also makes it easier to attach the veneer securely. Your dentist will then make a mould of your mouth. A dental technician will then use the mould to make a veneer that fits in with the rest of your teeth.

    The colour of your veneer will be matched to your other teeth. You’ll need to go back for a second appointment to have the veneer glued onto your tooth. See our FAQ ‘I’m getting a veneer fitted. Will my tooth look odd between appointments?’ for more information.

    An alternative to a porcelain veneer is for your dentist to apply layers of composite material (like that used for white fillings) to your tooth.

    If you take care of your teeth well, veneers will last for many years, but they can be damaged in the same ways as real teeth. It may be possible to repair veneers without needing to have a whole new one.

  • Inlays and onlays Inlays and onlays

    Inlays and onlays are similar to fillings. An inlay is placed on the surface that you use for biting, whereas an onlay goes over a larger area of your tooth. Inlays and onlays are very hard-wearing. They are usually made of gold or porcelain. Porcelain can be made to match the colour of your existing teeth.

    Unlike with normal fillings, for inlays and onlays your dentist will take an impression of your tooth. The inlay or onlay will then be made by a dental technician. At the first appointment your dentist will also clean the hole and fit a temporary filling. This will protect your tooth while the inlay or onlay is being made. You’ll need to go back for another appointment when your dentist will remove your temporary filling and cement the inlay or onlay into place.

    Your dentist will probably give you an injection of local anaesthetic before you have your inlay or onlay fitted.

  • If I have my teeth whitened, will it whiten my tooth-coloured filling? If I have my teeth whitened, will it whiten my tooth-coloured filling?

    Answer

    No, tooth whitening treatments will only affect your natural teeth and not your fillings.

    More information

    The bleach used in whitening treatments only whitens your natural teeth. It won’t whiten any fillings, crowns or veneers you have. However, you may be able to have a lighter shade of composite (tooth-coloured) filling placed over your existing filling. Or your dentist may suggest a new composite filling is put in to match your whitened teeth, so they don’t look a different colour.

    Before starting your whitening treatment, ask your dentist about the effect it will have on the appearance of any fillings.

  • I’m getting a veneer fitted. Will my tooth look odd between appointments? I’m getting a veneer fitted. Will my tooth look odd between appointments?

    Answer

    Your dentist will try to make sure that your tooth looks as acceptable as possible during the time between your appointments.

    More information

    Your dentist will shave off a thin layer of enamel from the surface of your tooth when preparing it for a veneer. The appearance won’t be perfect while you wait for the veneer to be made but it shouldn’t be too obvious. It will also feel a bit rough against your tongue. Plan with your dentist when you will have the veneer fitted so that you aren’t waiting for it at the time of an important event.

    Your dentist may recommend you have a temporary veneer until your second appointment. They will try to make it as lifelike as possible. Temporary veneers aren’t as strong as permanent ones, so treat them gently while cleaning your teeth and eating to stop them coming loose.

  • What should I do if my filling falls out? What should I do if my filling falls out?

    Answer

    If your filling falls out, make an appointment with your dentist to have it replaced as soon as possible.

    More information

    Depending on what material your filling is made from, it can last for many years. However, it may fall out as a result of wear and tear, excessive biting pressure or because of tooth decay in the surrounding area.

    If your filling falls out, your dentist will clean the cavity and put a new filling in to replace the old one. They can only do this if there is enough of your original tooth left to support it. If your old filling was made of amalgam (metal), you may be able to have it replaced with a composite (tooth-coloured) filling. This means it will look more natural. However, this may depend on where in your mouth your filling is.

    It’s important to visit your dentist regularly, so that any problems with your fillings can be picked up early on.

  • Will having a filling hurt? Will having a filling hurt?

    Answer

    No, before you have a filling, your dentist will usually give you an injection of local anaesthetic to block pain from the area.

    More information

    While your dentist is doing your filling you’ll be able to feel the instruments in your mouth and some pressure. Even so, you shouldn’t feel any pain.

    Some people worry about having a local anaesthetic injection. If so, tell your dentist. They may be able to apply an anaesthetic gel to the area of your mouth that will be injected. This will numb your gum so that you won’t be able to feel the needle.

    After the procedure, it may take several hours before the feeling comes back into the treated area of your mouth. Be careful not to bump or knock your mouth or bite your tongue, particularly when you’re speaking, drinking or eating. Don’t eat or drink anything too hot while your mouth is still numb. You may burn your lip or mouth without realising because you can’t feel the area.

  • Resources Resources

    Further information

    Sources

    • Some dental and periodontal diseases. PatientPlus. www.patient.co.uk/patientplus.asp, published, 3 July 2014
    • Caries. The Merck Manuals. www.merckmanuals.com, reviewed October 2014
    • Dental decay. British Dental Health Foundation, www.dentalhealth.org, accessed 18 May 2015
    • Routine treatment. British Dental Health Foundation, www.dentalhealth.org, accessed 18 May 2015
    • Dental care for mother and baby. British Dental Health Foundation. www.dentalhealth.org, accessed 18 May 2015
    • Cosmetic dentistry. British Dental Health Foundation, www.dentalhealth.org, accessed 18 May 2015
    • Tooth decay. BDA Smile. British Dental Association. www.bdasmile.org, accessed 18 May 2015
    • Treatments. BDA Smile. British Dental Association. www.bdasmile.org, accessed 18 May 2015
    • Cosmetic dentistry. BDA Smile. British Dental Association. www.bdasmile.org, accessed 18 May 2015
    • The future use of dental amalgam. British Dental Association. www.bda.org, published 12 May 2015
    • Dental fillings. Dental Fear Central. www.dentalfearcentral.org, accessed 18 May 2015
    • What is root canal treatment and why would you want it? Dental Fear Central. www.dentalfearcentral.org, accessed 18 May 2015
    • The safety of dental amalgam and alternative dental restoration materials for patients and users. Scientific Committee on Emerging and Newly Identified Health Risks, European Commission. ec.europa.eu, 2015
    • Bonding and veneers. Canadian Dental Association. www.cda-adc.ca, accessed 18 May 2015
    • When a filling needs to be replaced. American Dental Association. www.ada.org, published July 2005
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    Reviewed by Dylan Merkett, Bupa Health Content Team, July 2015.

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