Dental fillings for cavities and damaged teeth

When is it necessary to get dental fillings?

You can reduce the risk of needing a filling by 40% by thoroughly brushing your teeth, going for regular dental check-ups and keeping your consumption of sugary drinks and snacks to a minimum. Even if you're careful, however, it's still possible to end up with cavities.

Cavity-causing bacteria eat into the inside of the tooth and can even attack the roots and bones. A dentist will first remove the damaged part of the tooth with a small drill – or for smaller spots, with a laser or chemicals. These holes will then be filled. Fillings are also needed for cases such as broken teeth or excessive enamel loss.

What types of dental fillings are there?

Dentists and patients now have a wide variety of different dental fillings to choose from. These differ in terms of durability, materials and appearance. Generally, a distinction is made between soft fillings and inlays. Soft fillings are directly applied to the defective tooth and harden while in position. Inlays are custom made in a dental lab. The recommended type of dental filling depends primarily on the extent of the damage and where the cavities are located.

1 Amalgam fillings

Amalgam fillings consist of different metals like silver, copper, tin and mercury.

Pros: they are firm and bacteria-resistant and easy to shape. They are also relatively durable and inexpensive.

Cons: they contain mercury, which makes them not entirely harmless from a health perspective. They cannot be used for children, breastfeeding/pregnant women, patients with amalgam allergies and patients with severe kidney failure. Enamel has to be sacrificed when placing this filling. The filling can cause exposed tooth borders and fractures. Some people avoid this type of filling for aesthetic reasons (silver coloured). It can also trigger allergic reactions.

Used for: molars, side teeth

2 Composite (resin) fillings 

Composite fillings consist of around 20% resin and 80% glass and quartz particles. There are different ways of applying this filling depending on the severity of the cavities:

• Simple composite filling: soft composite material is positioned onto the defective tooth and hardened with a light

• Layered composite filling: several layers of composite are applied in one sitting, each one hardened with a light

• Multicolour technique: several different coloured composite layers are applied in one sitting in order to achieve a natural-looking result.

Pros: as the filling is tooth-coloured, it is very discreet.

Cons: cavity-causing bacteria can enter the small crack between the filling and the tooth. This type of filling is also relatively expensive.

Used for: front teeth and surface treatments of side teeth and molars. The material is also used to affix crowns and root implants.

3 Glass ionomer (cement) fillings 

Cement fillings consist of a soft mineral cement paste that hardens into a light-coloured matt material.

Pros: this is a good aesthetic alternative to amalgam fillings and is easy and cheap to apply.

Cons: enamel has to be sacrificed when placing this filling. Durability is limited.

Used for: affixing dental implants, temporary fillings, baby teeth.

4 Ceramic fillings 

Ceramic is a high-quality material with a relatively high level of strength and good durability. It is formed into an inlay – either in a dental lab or directly at the dental practice – and applied to the defective region of the tooth.

Pros: the filling can be matched to the colour of the tooth. Allergic reactions to ceramic are relatively rare.

Cons: they are rather difficult to produce, which makes ceramic fillings relatively expensive. If the filling is produced in a dental lab, several visits to the dentist will be required.

Used for: side teeth (front teeth not possible).

5 Gold inlays 

Gold inlays are made from alloys that contain a high percentage of gold as well as metals such as silver, copper, platinum and palladium. Gold inlays are produced for a custom fit in advance and are applied to the tooth with cement adhesive.

Pros: gold inlays offer good strength and durability. They don't cause abrasion. Allergic reactions are rare.

Cons: good oral hygiene is a prerequisite. Application is difficult and expensive. The metallic colour stands out in visible parts of the mouth.

Used for: side teeth, preferably on the upper jaw due to decreased visibility

6 Gold foil compaction fillings

Gold foil compaction fillings consist of several gold foil layers that are successively hammered into place at the site of the defect.

Pros: they are long-lasting and hygienic. Allergic reactions relatively rare.

Cons: they are rather difficult to produce, so are therefore comparatively expensive. The gold colour makes them more noticeable.

Used for: side teeth (front teeth not possible), in more severe cases of difficulty with chewing.

7 Dental crowns

Crowns are also used if larger parts of the tooth are affected by cavities. The affected tooth is sanded down into a cylindrical shape before the crown is applied. In this way, the crown is more like a cap than a filling. Crowns can be made from gold, ceramic or other materials.

Pros: a crown can be produced to match the colour of the teeth. The tooth can be retained even if the problem is more severe.

Cons: sanding down the tooth can cause nerve damage. New cavities may form if the crown is improperly fitted. The tooth must be re-sanded to install a new crown.

Used for: severe tooth decay/damage where a filling is not sufficient.

Risks associated with dental fillings

The risks associated with dental fillings are generally low. However, there can be undesirable side effects such as:

• Swollen gums (should subside quickly)

• Pain from nerve irritation (should subside quickly)

• Inflamed roots

• Allergic reactions to amalgam or composite fillings

• Exposed tooth borders and fractured teeth (amalgam fillings)

• Infection and abscess

• Bleeding

• Injury to muscles, bones and nerves

• Damage to nearby teeth

• Loss of the tooth being treated