You might need to have treatment to restore your teeth if you have tooth decay (also called dental caries). This is a very common health problem in developed countries like the UK, and can affect people of all ages, even young children. Tooth decay is often caused by consuming 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.
If you have tooth decay, the type of treatment your dentist will recommend will depend on the extent of the damage to your teeth and which teeth are affected. Your dentist will go through your options with you.
Your teeth are more likely to be affected by decay if you don’t brush and clean between them regularly. For more information on how to look after your teeth see our separate topic: Caring for your teeth. And see our toothbrush trivia infographic below for some interesting facts about cleaning your teeth.
Other reasons why you might need to have teeth restored include the following.
- Erosion. This is when teeth break down for reasons other than a bacteria attack. For more information about erosion, see our blog: Acid erosion and your teeth.
- Abrasion – this is physical wear of a tooth, which can be caused by aggressive toothbrushing, for example.
- Attrition. This is physical wear that happens when one tooth moves against another, such as if you grind your teeth. For more information, see our blog: Grinding your teeth: tips to ease the symptoms.
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 type of fillings but the most common are amalgam (metal) and composite, which match the colour of your teeth.
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’ll stay awake during the procedure.
Your dentist may need to remove the decayed and weakened parts of your tooth. 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 type of fillings they’ll need to use a light to make the filling materials set hard.
After the procedure, it may take a few hours before the feeling comes back into your mouth. Take care not to bump or knock your mouth or bite your tongue, particularly when you speak, drink or eat.
Amalgam has been used in fillings for over 150 years. 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 20 to 40 years if you take good care of your teeth.
Although amalgam fillings contain mercury, which can be poisonous, they are completely safe. Once it’s combined with the other materials in the filling, its chemical nature changes so that it’s harmless. Researchers have studied these fillings for decades and haven’t found 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.
It’s possible that you might be allergic to the metals in amalgam, although this is rare. More commonly, you might be allergic to composite (see below). If you do have an allergy to these, you’ll need to have another type of treatment. Ask your dentist for more information.
If you’re pregnant, your dentist will probably advise against 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. You might need to wait until after you have your baby to have an amalgam filling.
Composite fillings are made to match the colour of your teeth and so look more natural. They’re often used in front teeth that show when you smile or talk. Composite fillings aren’t as hard-wearing as amalgam so they aren’t always suitable for the grinding and chewing surfaces of your back teeth. But they’re being improved, and being used more and more as time goes on.
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 involves your dentist cleaning, shaping and filling the entire root canal of your tooth. You can read more about this procedure in our separate topic: Root canal treatment.
Crowns are shaped like natural teeth and fit over your existing tooth. They’re used to strengthen teeth and improve their appearance if they’ve been damaged. Just some of the reasons why you might need a crown include:
- if your tooth is broken or is weakened because of decay or from having a large filling, for example
- to cover up a filling that’s discoloured
- after root canal treatment to protect your tooth
Crowns are 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 your tooth prepared for the crown. They’ll then prepare and shape your tooth so that there’s 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 will enable a dental technician to make a crown that will fit it exactly. This might take a week or two so in the meantime, your dentist will fit a temporary one. The temporary crown may be more noticeable but you won’t have it for long. You’ll have another appointment for your dentist to take off the temporary crown and cement the new, permanent one in place. This procedure may also require a local anaesthetic.
After the procedure, it may take a few hours before the feeling comes back into your mouth. Take special care not to bump or knock your mouth or bite your tongue, particularly when you speak, drink or eat.
If you look after your teeth carefully, crowns can last for many years. Ask your dentist how long they expect yours to last.
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 outer enamel layer. This is so 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 match your other teeth.
You may need to go back for a second appointment to have the veneer glued onto your tooth. For more information, see our FAQ: Veneer fittings – will my tooth look odd between appointments?
If you take care of your teeth well, veneers will last for many years, but they can be damaged in the same way as real teeth. Sometimes it’s possible to repair veneers without needing to have a whole new one.
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. This method can be particularly useful as it allows more of your existing tooth to be preserved during the repair. But, unlike porcelain, the composite can sometimes pick up food and drink stains over time, so may need to be replaced more frequently. However, newer composite materials mean this is becoming less of an issue.
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 and will last for many years. They’re usually made of gold or porcelain – porcelain can be made to match the colour of your existing teeth.
Unlike normal fillings, your dentist may take an impression of your tooth for inlays and onlays. The inlay or onlay may then be made by a dental technician. Your dentist may fit a temporary filling, which will protect your tooth while the inlay or onlay is being made. You’ll then go back for another appointment and 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.
FAQ: Will teeth whitening whiten my tooth-coloured filling? Will teeth whitening whiten my tooth-coloured filling?
No, tooth whitening treatments will only affect your natural teeth and not your fillings. The bleach used in whitening treatments only whitens natural teeth. It won’t whiten any fillings, crowns or veneers you have. But you may be able to have a lighter shade of composite (tooth-coloured) filling placed over your existing filling. Or your dentist may suggest putting a new composite filling in to match your whitened teeth, so they don’t look a different colour.
Before you start your whitening treatment, ask your dentist about the effect it will have on the appearance of your fillings.
FAQ: Veneer fittings – will my tooth look odd between appointments? Veneer fittings – will my tooth look odd between appointments?
Your dentist will try to make sure that your tooth looks as good as possible during the time between your appointments.
Your dentist will shave off a thin layer of enamel from the surface of your tooth when they prepare it for a veneer. It won’t look 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. If you’re worried about this and have an important event coming up for example, plan with your dentist when the best time is to have the veneer fitted.
Your dentist may recommend you have a temporary veneer until your second appointment. They’ll try to make it as lifelike as possible. Temporary veneers aren’t as strong as permanent ones, so treat them gently when you clean your teeth and eat, to stop them coming loose.
Depending on what material your filling is made from, it can last for many years (as many as 40 years if you have an amalgam filling). But it might fall out as a result of wear and tear, excessive biting pressure or if you have tooth decay in the surrounding area, for example. If your filling falls out, make an appointment with your dentist to have it replaced as soon as possible.
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’s 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, which will look more natural. But this may depend on where in your mouth the filling is.
It’s important to visit your dentist regularly, so they can pick up any problems with your fillings early on.
No, before you have a filling, your dentist will usually give you an injection of local anaesthetic to block pain from the area.
While your dentist is doing your filling, you’ll be able to feel the instruments in your mouth and some pressure. But you shouldn’t feel any pain.
If you’re worried about having a local anaesthetic injection, tell your dentist. They may put some anaesthetic gel on your gum before they inject you. This will numb your gum so you won’t feel so much pain from the needle.
After the procedure, it may take a few hours before the feeling comes back into your mouth. Be careful not to bump or knock your mouth or bite your tongue, particularly when you speak, drink or eat. It’s best not to eat or drink anything too hot, or to smoke while your mouth is still numb. You may burn your lip or mouth since you can’t feel the area.
- Restorative dentistry. Oxford handbook of clinical dentistry (online). Oxford Medicine Online. oxfordmedicine.com, published August 2010
- NHS dental charges from April 2016. Department of Health. www.gov.uk, published 11 March 2016
- Some dental and periodontal diseases. PatientPlus. patient.info/patientplus, last checked 3 July 2014
- Dental decay. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Anesthesia and sedation. American Dental Association. www.mouthhealthy.org, accessed 2 October 2017
- Analgesia, anaesthesia, and sedation. Oxford handbook of clinical dentistry (online). Oxford Medicine Online. oxfordmedicine.com, published August 2010
- Different filling materials. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Scientific committee on emerging and newly identified health risks: SCENIHR opinion on the safety of dental amalgam and alternative dental restoration materials for patients and users. European Commission. ec.europa.eu, published 29 April 2015
- Caries. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2016
- Use of dental amalgam in the UK: What do I need to know? British Dental Association. www.bda.org, accessed 2 October 2017
- Personal communication, Dr Steve Preddy, Bupa Dentist, 10 October 2017
- White fillings. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Root canal treatment. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Crowns. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Veneers. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Tooth whitening. Oral Health Foundation. www.dentalhealth.org, accessed 2 October 2017
- Bonding & veneers. Canadian Dental Association. www.cda-adc.ca, accessed 2 October 2017
- Personal communication, Dr Bhav Kotecha, Clinical Lead and Dental Surgeon at Bupa UK, November 2011
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, October 2017
Expert reviewer Steve Preddy, Bupa Dentist
Next review due October 2020
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