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Dental treatments - fillings and crownsPublished by BUPA's health information team, healthinfo@bupa.com, August 2007. This factsheet is for people who would like information about having dental treatments that can be used to restore teeth. Teeth that are decayed, worn, broken or affected by gum disease may need to be restored by your dentist. The most common type of tooth damage is decay, caused by a combination of poor brushing and a sugary diet.
What are dental treatments to restore teeth?The treatment options described in this factsheet include fillings, crowns, inlays, onlays and root fillings. The extent of the damage to your teeth will determine which treatment is most suitable for you. Your dentist will discuss with you which type of restoration is the best option. FillingsFillings are used to fill holes (cavities) that have formed, usually as a result of decay or tooth wear. There are many types of filling, each suitable for different cavities. Most people have a local anaesthetic injection to completely numb the area while the filling is being done. The numbness can take several hours to wear off. The decayed and weakened parts of the tooth are removed using small drills and the hole is washed. If the hole has spread to the side wall of the tooth, a band will be placed around the tooth with a small wedge holding it in place. This ensures that the filling hardens into the correct shape. To protect the tiny nerves and blood vessels inside the tooth, very thin layers of underlinings, such as resin, are painted inside the hole before the filling material is packed in. The filling will begin to harden during the first few minutes or, for some materials, a blue light is used to make it set within a few seconds. Sometimes temporary fillings are used where there may not be enough time to do the full treatment, at emergency appointments for example. Temporary fillings can last for quite a long time, but they are not very strong so you must always arrange to have a durable filling placed within a few weeks. Amalgam fillingsAmalgam fillings are made of a combination of metals including silver, tin, copper and mercury. The advantage of using amalgam is that it's extremely durable and able to withstand the grinding and chewing of the molar teeth over long periods of time. Tooth coloured fillingsTooth coloured fillings can be chosen to match the colour of the teeth, making them a natural-looking alternative to amalgam fillings. Tooth coloured fillings are often used in teeth that show during smiling or talking. They aren't as durable as amalgam, and so they aren't always suitable for the grinding and chewing surfaces of the back teeth. There are a few different types of tooth coloured filling materials. The most common are called composite and glass ionomer. They are soft and can be moulded to look like the shape of a tooth before they are hardened, usually using a blue light. Tooth coloured filling materials stick to teeth, so they can be used to build up the edges of chipped or worn teeth. Composite shrinks very slightly under the blue light. This can pull on the tooth and may cause sensitivity. It can also produce a tiny gap between the filling and the tooth that may lead to further decay. Tooth coloured fillings must be kept completely dry until they have set, so the dentist will take special precautions to keep saliva away from the area. This may include placing a sheet of rubber over the tooth (called a rubber dam). CrownsIf a tooth has been broken, or weakened by a lot of decay or a large filling, a crown (or cap) can be fitted to strengthen it. An X-ray may be taken to check the tooth. Crowns are shaped like natural teeth. For teeth near the front of the mouth, crowns are usually made of porcelain-like materials. Crowns on back teeth may be made of porcelain or gold, or a combination of both. A local anaesthetic injection may be given to numb the tooth. Your dentist shapes the tooth so that there is room for the new crown. A mould is taken in a putty-like material so that the laboratory can make a crown that fits the tooth precisely. The laboratory work may take one or two weeks, so a temporary crown is fitted until the second appointment. At the second appointment, your dentist will take off the temporary crown and cement the gold or porcelain one in place. Inlays and onlaysInlays and onlays are similar to fillings. However, like crowns, they are made in a laboratory and then cemented to the tooth with special adhesive. This process generally requires two visits to the dentist. During the first visit, the dentist removes the old filling or decay and makes a mould of the tooth in a putty-like material. A temporary filling is placed to protect the tooth while the laboratory uses the mould to make the inlay or onlay. On the second visit, the temporary filling is removed and the inlay or onlay cemented in place. Inlays and onlays are very strong and, in some circumstances, may be more durable than ordinary fillings. They are suitable for the grinding surfaces of the molar teeth and can be made out of gold, porcelain or composite material. Root fillingsTeeth have a core of blood vessels and nerves at their centre, in a space called the root canal. Very deep decay or injury to a tooth can destroy this living tissue. A "dead" tooth is prone to infection. The root canal needs to be cleaned out thoroughly before a filling or crown can be placed. An injection of local anaesthetic can be used to numb the area. Then your dentist will remove any decay using a drill. A rubber dam will be placed over the tooth to keep it dry. Disinfectant and thin instruments are used to remove bacteria and dead cells from the root canals. There can be as up to four root canals in each tooth, and they all need to be cleaned out in this way. Afterwards, the tooth is sealed by placing a rubbery filling into the root canal. A filling or crown can then be placed on top. Root fillings are complicated to perform, and may take two or more appointments to complete. A number of X-rays need to be taken during root canal treatment. When completed, a root filling should feel no different to an ordinary filling. Deciding on treatmentAmalgam fillingsSome people have concerns about the safety of amalgam fillings. This is because, in large doses mercury is toxic, but fillings only use very small amounts. Very small amounts of mercury collect in our bodies from a number of sources including the environment, our food and our amalgam fillings. It's estimated that amalgam fillings account for a sixth of the average daily amount - about nine millionths of a gram. Extensive research has been done to investigate the effect of amalgam fillings on general health. No harmful effects have been shown, and the World Health Organization supports the continued use of amalgam fillings. However, dentists take special precautions when removing amalgam fillings, because drilling into the amalgam creates higher levels of mercury vapour. Your dentist uses extra water and suction to minimise the amount of vapour. Although there is no evidence linking amalgam to birth problems, placing and removing amalgam fillings in pregnant women is generally avoided. If you are or think you may be pregnant you should always tell your dentist so he or she can plan your treatment accordingly. A very small number of people are allergic to metals in amalgam and may need to have another type of restoration. Tooth coloured fillingsTooth-coloured filling materials don't contain mercury. However, there have been concerns that they release a chemical called bisphenol A. This chemical is also used in the manufacture of some food packaging and water pipes. Bisphenol A appears to mimic the action of human oestrogen hormones, and has been linked to breast cancer, prostate cancer and male infertility. The British Dental Association has looked into this, and found that most filling materials don't release bisphenol A. This chemical is being used less in newer filling products. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Brian Franks BDS (U. Lond) LDS RCS (Eng) MFGDP (UK) FPFA ACIArb, clinical director (dentistry) BUPA Wellness and other BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2007. Expected review date August 2009.
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