Tooth-colored fillings

What it is

Decay starts when germs in plaque (the sticky film on your teeth) turn sugar into acid. The acid softens the enamel (the hard outer layer of the tooth) until a hole forms. Left alone, the cavity keeps growing toward the pulp (the soft center of the tooth, where the nerve is).

A tooth-colored filling is made of composite, a mix of plastic resin and fine glass particles. It goes in soft, is shaped to match your tooth, and is hardened with a blue light. Because it bonds to the tooth, your dentist can often remove less healthy tooth than an older silver filling needs.

Who it helps

You might have a cavity if a tooth is sensitive to sweets, cold, or heat, hurts when you bite, or has a dark spot or rough edge you can feel with your tongue. Many cavities cause no symptoms at all and show up only on an exam or X-ray.

Fillings also repair small chips and cracks, and they replace old fillings that have cracked or started to leak.

What happens

1. Numbing. We dry the gum, rub on a numbing gel, and then give a small shot of local anesthetic (numbing medicine). You’ll feel a small pinch, then your lip, cheek, or tongue will feel thick and heavy. Very small fillings sometimes don’t need numbing.
2. Removing the decay. Your dentist uses a small drill to remove the soft, decayed part of the tooth. You’ll feel vibration and water spray and hear a whine. Tell your dentist if anything feels sharp, since more numbing can help.
3. Preparing the tooth. The tooth is kept dry, sometimes with a thin rubber sheet called a dental dam. A mild gel and a bonding liquid help the filling grip the tooth.
4. Filling and shaping. The filling goes in a layer at a time, and each layer is hardened with the blue light. Then your dentist shapes it to look and work like the rest of the tooth.
5. Checking your bite. You’ll bite on a thin strip of colored paper that marks any high spots, and your dentist smooths them and polishes the filling. Your bite is hard to judge while you’re numb, so it can be adjusted later if needed.

Recovery and aftercare

Tooth-colored fillings are hard before you leave, so you can eat once the numbness wears off, usually within a few hours. Until then, avoid hot drinks and chewing, so you don’t burn or bite your cheek or tongue.

Mild sensitivity is common for a little while and usually fades. Call the office if your bite still feels high after a day or two, or if the tooth aches more over time.

Brushing, cleaning between your teeth, and regular checkups help your fillings last, because new decay can start at a filling’s edge.

Cost and insurance

The cost of a filling depends on its size, how many surfaces of the tooth it covers, and which tooth it’s on.

Most dental plans cover fillings as basic care and pay part of the cost. Some plans pay for a tooth-colored filling on a back tooth only up to what a silver filling would cost, and you pay the difference. Your plan’s benefit details will say. For help with the rest, see insurance and financing.

Alternatives

• Watching and waiting. A very early spot that hasn’t broken through the enamel can sometimes be treated with fluoride and watched. Once there’s a hole, though, a cavity usually keeps growing. Waiting can mean a bigger filling later, or a root canal if decay reaches the nerve.
• A silver (amalgam) filling. Silver fillings are strong and long-lasting, but they show, and more of the tooth has to be removed to hold them in place. Ask your dentist whether they’re an option for you.
• An inlay, onlay, or crown. For a large cavity, an inlay or onlay (a filling made outside the mouth) or a crown may protect the tooth better. These take more than one visit and cost more.