A dental filling is a treatment in which a tooth damaged by decay is cleaned and rebuilt with a material such as composite resin or ceramic. When decay is caught early, the tooth can usually be saved with a simple filling; if it is left too long, root canal treatment or extraction may become necessary. At our clinic in Denizli, Turkey, the treatment plan is made after the depth of the decay and the condition of the tooth have been assessed at an examination.
- Preventive care, a filling or pulp capping, depending on the stage of decay
- Tooth-coloured composite fillings in different types for front and back teeth
- CAD/CAM ceramic fillings for teeth with extensive loss of structure
- An approach that aims to keep the tooth’s nerve alive wherever possible
Treatment process
Examination and diagnosis
The location and depth of the decay are identified clinically and, where needed, with an X-ray, and its relationship to the nerve is assessed.
Removing the decay
Decayed tissue is removed and the cavity is prepared while preserving as much healthy tooth as possible.
Choosing the material
A composite or ceramic filling is planned according to the size of the defect and the position of the tooth; pulp capping is considered when decay is very close to the nerve.
Placing the filling
Composite is placed through etching, bonding and light-curing in layers; a ceramic filling is milled with CAD/CAM and bonded to the tooth.
Check and prevention
The bite is checked, home-care advice is given and a regular check-up interval is agreed.
How does tooth decay develop?
Dental plaque, a film of bacteria on the teeth, produces acids from leftover sugary and starchy food. These acids dissolve the mineral structure of the tooth, weakening the enamel and eventually forming the holes dentists call cavities.
Tooth decay has four main contributing factors:
- Bacterial plaque (dental plaque)
- Carbohydrate-rich food (sugar, flour and similar)
- Host factors (tooth structure, saliva composition and similar)
- Time (how long decay-causing factors remain in the mouth)
Decay always starts on the surface of the tooth and progresses into the dentine. Because dentine is softer than enamel, decay spreads faster there and moves towards the pulp (nerve). The speed of progression varies from person to person and from tooth to tooth.
When should you see a dentist?
The most important warning sign is sensitivity to cold, heat, sweet or sour stimuli. Its intensity varies between individuals. If the pain stops once the stimulus is removed, the tooth can usually still be saved with a filling.
Untreated decay tends to cause pain that becomes constant, a sign that it has reached deeper layers and that root canal treatment or extraction may be needed. Seeking care promptly in the following situations can keep treatment simpler:
- Teeth that are sensitive to heat and cold, or painful
- Chalky white spots (early decay)
- Brown discolouration or visible holes
Stages of decay and treatment options
- Early stage: The initial lesion can be removed with micro-invasive techniques and further decay prevented with fissure sealants, flowable composite and fluoride application.
- Moderate stage: The tooth shows mild sensitivity to hot, cold and sweet foods. It is restored with a composite or ceramic filling.
- Advanced stage: Marked sensitivity to hot and cold, and spontaneous, throbbing pain that often worsens at night and may not respond to painkillers. These symptoms indicate that decay has reached the pulp, and root canal treatment is usually required.
Pulp capping: keeping the tooth alive
With very deep decay, it is sometimes possible to save the tooth without root canal treatment. Pulp capping involves placing a protective barrier between the nerve and the filling. In suitable cases, keeping the tooth vital in this way is a healthier option than making it non-vital with root canal treatment.
Because the nerve remains alive beneath the filling, some sensitivity to cold in the first days and weeks is normal. If sensitivity persists after around 4–6 months, or if severe pain develops, root canal treatment is started.
Amalgam, composite and ceramic fillings
Amalgam fillings
Amalgam is a durable material that has been used for many decades, but its dark colour is not aesthetic. Because it contains mercury, its use is being phased down under international regulations. Very large amalgam fillings can, after many years, contribute to cracks in the tooth. For these reasons, composite or ceramic fillings are generally preferred today.
Composite fillings
Composite fillings are tooth-coloured. There are more aesthetic types for front teeth and more heavily filled, stronger types for back teeth. The bonding system that attaches the composite to the tooth also has a direct effect on the result.
Placing composite is a technique-sensitive process: etching and rinsing times, the type of bonding agent, layering, and adequate curing-light power and duration all matter. When each step is carried out correctly, composite fillings can be long-lasting.
Ceramic (porcelain) fillings
Ceramic fillings are milled from a solid ceramic block using a CAD/CAM system. They are more resistant to fracture, wear and staining than composite, so they are mainly used for teeth with extensive loss of structure. They are an option for patients whose tooth is badly damaged but who prefer to avoid a crown. They cost more than other types of filling.
How to prevent tooth decay
- Brush after breakfast and before bed, covering the inner, outer and biting surfaces of every tooth, as well as the tongue.
- A toothbrush cannot reach between the teeth, so clean these surfaces with floss every day.
- Limit sugary foods and drinks such as cola that contain both sugar and acid; they cause erosion as well as decay.
- Keep sweet foods to main meals and avoid snacking, especially before bed: saliva flow drops during sleep and the mouth’s natural defence weakens.
- If you cannot brush, rinse your mouth with water; sugar-free chewing gum, which stimulates saliva, can also help.
- Regular dental check-ups are the most reliable way to prevent decay and catch it early.
Conditions and medicines that reduce saliva flow, as well as low fluoride intake, increase the risk of decay. See our Preventive Dentistry and Oral Hygiene page for more detail.
Frequently asked questions
How do I know if I need a filling?
Temporary sensitivity to cold, heat or sweets, brown discolouration or a visible hole can all be signs of decay. Early decay often causes no symptoms, which is why regular check-ups matter. The final decision is made after an examination and, if needed, an X-ray.
Should I choose a composite or a ceramic filling?
Composite is usually sufficient for small and medium cavities. For teeth with large defects, a CAD/CAM ceramic filling, which resists fracture and staining better, may be considered. The choice depends on the condition of the tooth and is made at the examination.
Is sensitivity after a filling normal?
Some sensitivity to cold in the first days and weeks is common, especially after deep fillings close to the nerve. If it does not settle within a few months, or if severe spontaneous pain develops, contact your dentist, as root canal treatment may be needed.
Should I replace my old amalgam fillings?
Sound, trouble-free amalgam fillings do not usually need replacing for that reason alone. If a filling is fractured, leaking, has decay underneath or you would like a more aesthetic result, replacement can be discussed at your examination.
Can tooth decay heal on its own?
Once a cavity has formed, it will not heal by itself and will gradually deepen. Only very early decay, seen as white spots, can be arrested with fluoride and good oral hygiene.
Isn't the mercury in amalgam fillings toxic? I've heard it causes Alzheimer's.
According to World Health Organization data as of 2020, no complications or side effects linked to amalgam had been identified. Amalgam is a durable filling material that can last many years in the mouth; it is used less today mainly for aesthetic reasons. Correctly placed composite fillings can be similarly durable, so composite or ceramic fillings are generally preferred today. A known drawback of amalgam is that very large fillings may cause the tooth to crack after many years.
The sensitivity in my new filling won't go away. Why might this be?
When decay is treated late, it reaches close to the nerve (pulp), and the filling ends up sitting close to it as well. The deeper the decay, the deeper the filling, and in such cases a protective procedure called pulp capping is carried out. Its aim is to keep the tooth alive without the need for root canal treatment. Sensitivity to cold, heat or biting can be normal for up to 4–6 months after pulp capping; if it gets worse, contact your dentist.
My fillings keep falling out. Is it my fault?
There can be several reasons. The most common are errors while placing the composite filling, an initial misdiagnosis (for example, a composite filling where a crown or ceramic inlay was needed) and habits such as cracking hard-shelled nuts with your teeth. Identifying the cause at an examination makes it possible to choose the right type of restoration.
Can I find out the cost of a filling over the phone?
The cost of a filling depends on its size and the condition of the tooth. Even during treatment it may become clear that the tooth needs root canal treatment, a ceramic inlay or a crown. For this reason we cannot give accurate information over the phone; the soundest approach is to plan after the initial examination (oral diagnosis).
The information on this website is for general information only and does not replace an examination, diagnosis or treatment plan by a dentist. Treatment and outcomes vary from person to person.