The Filling

Direct Restorations

Tags: dentist, london dentist, nhs, whitening, inman aligner, cosmetic dentist, checkup, dental, anish, anish dentist, london hygienist, dental hygiene, root canal.

by Mr Anish Patel


If you have been diagnosed as needing a filling there are a few choices to consider. The cavity ( hole) needs to be explored and all dental decay removed so a filling can be put in its place to prevent further decay and breakdown of the tooth. During your initial visit we would have noticed active decay, a failing filling, worn, or chipped teeth. All this would have been noticed visaully, through probing the area of concern, or via xrays. Depending on your aesthetic needs there are few options.

Which filling used depends on the site of decay and your aesthetic needs. E.g Having a metal filling on a front tooth may not be the best option, whereas having it on an upper back tooth is considered by many as an ideal solution when done properly.

Instead of metal or white filling you can opt to have an inlay. An inlay is a filling made at the laboratory from a mould of your teeth. The inlay is made from ceramic and is cemented in place at a second visit. The major advantage of having these are that they are resistant to shrinkage, which means minimal leakage of bateria between the tooth and the filling preventing post-op decay and sensitivity. They are hard-wearing and will last as long as your natural teeth with proper oral hygiene.

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What Caused This?

There are four main criteria that contribute to dental decay (caries) of which two areas you could modify to prevent decay. They are decay-causing bacteria (plaque) on the tooth surface and sugars (ferementable carbohydrates). These bacteria with a ready source of food will produce acids, breaking down (demineralises) teeth over time. Normally our salvia, fluoride in toothpastes etc will help fight back and harden (remineralise) teeth, however if this fine balance is disturbed (by too much sugar and poor oral hygiene) then decay and breakdown is the only result.

To prevent decay you need to improve your oral hygiene (brushing technique, mouthwashs, floss), consume less sugars, and see the dentist regulary. Sounds simple, however many patietns are lost when they are told they need a filling and are puzzled when asked to pinpoint the exact cause. We work with you to see where we could adjust habits to better your oral health.

The Procedure

Amalgam and Composite fillings
1.  We always start by making sure you are numb. we do this by first placing numbing gel on the gums to stop you feeling the scratch of the injection. Once the injection has been placed we will always wait 10+minutes for it to work.

2.  Once suitably numb, we start by using the dental drill to create a small hole in your tooth. We use this small hole to determine the extend of the hole and how much more we need to remove to access the decay fully.

3.  We then switch to the slower drill (without water spray) and hand instruments to gently remove all the decay.

4.  The resulting void is cleaned and dried, before the cavity is to be filled. We add some layers to protect the nerves of the tooth which reduce sensitivity after the filling. The choice of material we use is a combined decision between us prior to the appointment.

5.  Metal or composite white fillings are both placed in stages. The only difference is the white filling needs to be hardened with a high intensity blue light which activates the resin within the composite. They are both build up to the surface and carved to look exactly like the patterns of your natural tooth and fit well with opposing tooth.

6.  We will follow this always by checking that you are biting down correctly with indicator paper. If needing we will reduces the surface and polish accordingly.

What To Expect After A Surgery

After a filling, your lips and gums may remain numb for a few hours until the anesthetic wears off. Later you may have throbbing pain, which you can treat with pain medicines, such as ibuprofen, paracetamol, or a stronger prescription painkiller just before the anaesthetic wears off. The pain usually lasts only a day or two. If it does not, you should return to the surgery for further treatment.

Risks Of Having And Not Having Treatment

A specific risk of not having treatment is further break-down and decay of the teeth. What could have been treated as a simple filling may progress to a nerve infection requiring root canal treatment to save the tooth.


"I have some tooth decay, but not having any pain? Do I need a filling?"
This for me unless extensive would be a watch-and-wait situation. If small, the decay could be old and stable, i.e you previously had decay but your oral health has increased enough to fight back and prevent progression. I would normally take xrays at 6 monthly intevals and check for progression. If there has been or you experienced some pain we would proceed with a filling.

If extensive and near the nerves of the tooth, I would say you should have the area explored with the idea that you may need to have root canal treatment.This is only a guide and cannot say for sure, a through examination of your oral health and xrays would need to be done

Is the mercury in metal fillings dangerous, everyone is telling me to have white?
Although there is mercury in dental amalgam, once it is combined with the other materials in the amalgam filling its chemical nature is changed rendering it harmless. During the placement we pressurise the amalgam so the mercury is forced to the top, where it is removed. Research into the safety of dental amalgam has been carried out for over a century and to date, no trustworthy controlled studies have found a connection between amalgam fillings and any medical problem.

Whilst composite (tooth coloured) fillings are becoming more popular, amalgam fillings represent the most durable and long-lasting form of filling available. (Apart from gold fillings which are more expensive).

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