The Global Burden of Disease Study, 2019, found that untreated tooth decay in permanent (adult) teeth is the most common health condition worldwide. Oral Health Surveys carried out by University College Cork on Irish adults found on average a need for between 2 and 3 fillings on decayed teeth for different adult age groups in the population.
What is Tooth Decay and how does it happen ?
Tooth Decay is a dynamic process that starts, stops, sometimes reversing damage already caused and becoming active again, repeating this cycle continuously depending on factors such as diet and oral hygiene practices. Two things are essential to start dental decay, dental plaque biofilm which is a sticky collection of bacteria adhering to tooth surfaces and sugars, mostly free sugars found in confectionery, sweets, chocolate and soft drinks.
Some bacteria in dental plaque biofilm react with sugar causing saliva to become acidic, this results in a demineralisation episode ( loss of calcium and phosphate) from the tooth surface into saliva. This lasts for approximately 30 minutes and reverses again especially if there is fluoride present in saliva. Dental decay progresses when there are frequent repeated demineralization episodes and the tooth is unable to repair itself. Early demineralisation of a tooth can be observed as one or several white spots on a tooth. These can be reversed into healthy enamel by making small changes to the diet, reducing frequency of sugars intake and using a fluoride toothpaste correctly.
A dental cavity (hole in the tooth) occurs when a tooth is unable to arrest or reverse the dental decay process because it is overwhelmed by repeated acid attacks caused by frequent sugar intakes. The decay process extends through the white shiny dental enamel, the hardest substance in the body and into dentin, a softer material under the enamel. The enamel is undermined and collapses into the dentin. At this point a hole forms in the tooth that needs to be repaired by a filling.
What is a Filling / Restoration?
A filling is required to repair a small hole or cavity in a tooth caused by tooth decay. Your dentist will remove all the decayed tissue from the tooth and fill the space with the chosen type of filling. If there is extensive tooth decay, when for example the decay has been spreading for a number of years, or a tooth has been filled a number of times, a filling may not be sufficient, instead, a crown, root canal or extraction of the tooth may be required depending on the extent of the damage to the tooth.
How to know you might need a filling / restoration?
- Sensitivity to Hot or Cold Temperatures
- Periodic Tooth Pain of a few minutes duration
- You may be able to see a cavity or hole in the tooth
- Part of the tooth is chipped or cracked
- Lose a part of a previous filling in that tooth
If you have any of these signs or symptoms you should make an appointment with your dentist as soon as possible.
What are the different types of fillings / restorations ?
In Ireland, there are several types of restorations (fillings) used for restoring teeth. The oldest type is an amalgam filling (otherwise known as “silver filling”), this type of filling has been used very successfully for over a century in dentistry. It is a very strong filling material and lasts many years. Traditionally, this type of filling is placed in teeth towards the back of the mouth, such as molars.
More recently another type of filling made from composite resin material (otherwise known as a “white or tooth coloured filling”) has become more popular. These type of fillings are more expensive than amalgam fillings and are normally placed in teeth that are visible when we talk or smile as they are less noticeable in comparison to amalgam fillings. Stainless steel crowns and composite crowns and fillings are used to restore baby teeth.
What happens when you need a filling during a dental visit?
When your dentist detects that tooth decay has spread into dentin in your tooth and determines that a filling is the best course of action – initially your dentist will talk through the process and the different types of fillings available and get your consent to do the filling agreed by you.Then, a topical gel (numbing cream) or local anesthetic administered by an injection will be used to numb the tooth nerves and surrounding area. Whilst this is taking effect you will either stay in the dental chair or be asked to return to the waiting room.
Once the tooth and surrounding area are numb the dentist will then use a few different tools to loosen the decay and clean the tooth. The filling material will then be added to the tooth and the filling will be smoothed out to ensure no sharp edges.
How to prevent the need for fillings?
- Limiting ‘free sugars’ which would commonly be found in foods such as, chocolate, sweet, confectionary and fizzy drinks for example. The World Health Organization recommends that we lower our free sugars intake to 10% of our total energy intake or ideally under 5% of our daily energy intake.
- Use toothpaste that contains fluoride with at least 1450 parts per million.
- Spit out but do not rinse out after brushing.
- This action is crucial to keeping the fluoride level in saliva high enough to prevent and repair dental decay.
- Brush your teeth, for 2 minutes at least twice a day with a fluoride toothpaste. To help ; Eliminate dental plaque biofilm. Protect and repair your teeth from dental decay. Reduce your need for fillings.