When to place a filling and when you can wait.

Discover when dental fillings are necessary and when you might be able to wait with the right care.

We see many patients at our office; new patients and returning patients. It is very common after a thorough new patient examination or during a recall exam (an exam that is done after a cleaning /scaling appointment) that a recommendation is made that a filling is necessary. Frequently after such a recommendation, the question is asked “do I really have to do a filling, or can I wait? “

This is a valid question, so let us break this down.

Understanding Tooth Anatomy and Decay

Before determining when a filling is necessary, it’s essential to understand the structure of your tooth and how decay progresses.

Layers of the Tooth

• Enamel: The hard, outer layer visible in your mouth.
• Dentin: The softer, yellow layer beneath the enamel.
• Pulp: The innermost layer containing the tooth’s nerve and blood supply.
• Cementum: The root surface beneath the gums, softer and more porous than enamel.

These layers work together to protect your teeth, but when these layers are compromised, decay can spread, leading to the need for restorative treatments like fillings.

Most importantly, we need to understand what happens that warrants needing a filling placed. This requires the ability to make an informed decision.  

Signs You May Need a Filling

Your dentist identifies the need for a filling based on specific signs and symptoms:

• Sticky pits or grooves on biting surfaces: These areas are detected when a dental instrument catches in the tooth’s surface.
• Soft or worn areas along the gumline: Often sensitive to hot and cold, these areas indicate root decay or abrasion.
• Shadows on x-rays: Dark spots on radiographs can show decay between teeth or within the tooth.
• Visible grey shadows or fractures: Grey discoloration, broken fillings, or chips signal the need for intervention.
• Fractures or gaps between teeth: These can trap food and irritate gums, leading to inflammation and potentially permanent bone loss.
• Compromised crowns or caps: Softness or gaps around existing crowns can indicate a need for replacement.
• Decalcifications or white patches on enamel: These early signs of decay require attention to prevent further progression.

What is a Cavity?

A cavity is tooth decay caused by the breakdown of tooth structure, which occurs when:

1. Bacteria in the mouth combine with
2. Sugar from foods and drinks, producing acid that attacks tooth enamel.

Bacteria and sugar combine to form acid, which aggressively attacks enamel, dentin, and root surfaces. Proper oral hygiene and dietary choices play critical roles in slowing or preventing this process. Regular brushing with fluoride toothpaste, flossing, and minimizing sugar intake are essential strategies for keeping cavities at bay.

When to Proceed with a Filling?

Based on the what your dentist finds, they may recommend the following:

1. For a sticky pit on the biting surface: at this stage the cavity most likely is small but will continue to worsen because the tooth has numerous pits and grooves that you cannot clean properly. It is ideal to do a filling at this time. Since the cavity is very minor, we place what is called a PRR (a preventive resin restoration). You can have it done without a needle and retain as much enamel as possible. Smart, conservative and preventive. This area will only worsen over time, deepen and require a deeper filling in the future.
2. A soft and worn area along the gum line: abrasion and root decay will also continue to worsen and become more sensitive over time on this softer part of the tooth. Fluoride toothpaste, fluoride applications and rinses will aid in decreasing sensitivities and slow the decay process down. Individuals with medical conditions that result in dry mouth and oral habits such as grinding and clenching and incorrect brushing may also contribute and will need further discussions. However, on this softer part of the root a restoration is most likely needed.
3. Shadows on the x-ray in between the teeth: this is where you may be able to make a difference. When a cavity starts in between the teeth and is small this means it has only penetrated the ENAMEL, we call this incipient. Which means it has not moved to the dentin YET! With daily flossing, low sugar intake and fluoride toothpaste combined with exceptional hygiene it may remineralize and not progress and therefore not need a filling.  
4. A grey shadow the dentist can see in your mouth: this is a judgment call by the dentist.  They will use past x-rays, as well as comparing to the current x-rays combined with their clinical evaluation to decide whether to place a filling or not.
5. Broken or leaking filling: once the seal has been broken on a previous filling the restoration has been compromised and  needs to be replaced. Depending on the size it may even need a crown or cap.
6. A simple chip on a front tooth: this may be an esthetic issue, not decay. In this situation have a conversation with your dentist to determine if the restoration is just cosmetic or if the tooth is at risk for further breakage if not treated.
7. A fracture on a back tooth: sometimes back tooth chips or breaks as well, and we recommend a filling. This is required to reseal the tooth but most importantly to close the gap. If food gets caught in between two teeth (especially in the back) it will lead to inflammation in the gums (gingivitis). If this happens the bone in between the teeth could recede permanently (periodontitis) and may also lead to a cavity. It is important to repair these problems with a filling. If very large a cap/ crown may be necessary for a permanent repair.  
8. A softness or opening around a crown/cap: when this area has been compromised it is nearly impossible to seal from the outside with a filling. Most likely it will result in a new cap being needed.
9. Decalcification or early white areas on enamel: these areas respond very well to fluoride toothpastes, fluoride rinses, professional fluoride applications and exceptional home hygiene. It is possible to get these areas to remineralize and avoid fillings.

As you can see there are very different scenarios, but it is most important for you to be with a dental health care provider you trust. You need to be able to have open and honest communication to acquire the information you need to aid in your decision. Patient care is individualized and based on your diet, hygiene, past history of restorations and crowns, and how often you have x-rays and proper dental examinations.  

There is a lot to digest, what this all means for all patients is to  to be with a team you trust and can communicate with. You need to be confident your dentist and hygienist have your best interest at heart and will spend the time explaining what you need and why.

Be with a team you trust!!!