Dental Fillings
A filling repairs a tooth where decay has taken part of it away. We place tooth-colored composite as a matter of course — shade-matched, mercury-free, and conservative with the healthy tooth around it — at our Vienna office, a few minutes from Tysons Corner.
What a filling is actually doing
Tooth decay is a bacterial process. Bacteria in plaque produce acid, the acid dissolves mineral out of enamel, and once the surface breaks down the softening spreads into the dentine underneath. A filling deals with that in two steps: the softened, infected tooth is removed, and the space it leaves is sealed so the process cannot continue underneath.
The goal throughout is to keep as much healthy tooth as possible. Enamel is the hardest substance in the body, harder even than bone, and it does not regenerate. Every millimeter of it that survives is a millimeter that never needs replacing with something manufactured, which is why a small cavity caught early is a genuinely different proposition from the same cavity found two years later.
Caught early enough, a cavity is a short appointment. Left long enough, the same tooth may need an onlay, a crown, or root canal therapy. Nothing about that sequence is unusual, but the first step is much easier than the third.
Composite or amalgam
We place tooth-colored composite as a matter of course. Amalgam still has a place, and it is worth knowing what each material is for rather than assuming one is simply modern and the other is not.
Composite resin, the tooth-colored option
Shaded to match the tooth so the repair is not visible, bonded directly to the tooth structure, and conservative, meaning less healthy tooth has to be removed to hold it. It is mercury-free and durable in normal use. This is what we use for the great majority of fillings.
Amalgam, the silver option
The traditional material, still economical and hard-wearing where a cavity in a back tooth is very large. It is not bonded to the tooth, so it needs a shape that mechanically locks it in, which means removing a little more tooth than composite would.
Which is right depends less on preference than on where the cavity is and how much tooth is left around it. Dr. Lokitis will tell you what she is recommending and why before anything is drilled.
Finding it before it finds you
Most cavities do not hurt at the stage when they are easiest to fix. They are found on digital X-rays and at the tooth-by-tooth examination that is part of every checkup and cleaning, which is the unglamorous reason regular visits are worth keeping.
Our intraoral scanner builds a three-dimensional model of your teeth in a few minutes and puts it on the screen beside you. It means that when we say a tooth needs attention, you can look at the tooth rather than take our word for it. Seeing the problem tends to make the decision about it a good deal easier.
How the appointment goes
A single filling is usually a short visit. This is the shape of it.
1. Numbing the area
Local anesthetic, given so that the tooth and the gum around it are comfortable before anything starts. Tell us if you are not fully numb. There is nothing to be gained from enduring it.
2. Removing the decay
The softened tooth is cleared away and the sound tooth around it is left alone. This is the part people associate with the noise; it is usually the shortest part of the appointment.
3. Placing the composite
The tooth is prepared for bonding and the composite is placed in layers, each one shaped and set with a blue curing light. Layering is what lets the material follow the anatomy of the tooth instead of filling it like a bucket.
4. Shaping and polishing
The filling is contoured to the shape of the original tooth, smoothed and polished. A well-polished surface holds less plaque, so this step is not only cosmetic.
5. Checking the bite
You bite together and we adjust anything sitting high. A filling a fraction too tall will feel wrong and can make a tooth ache, and it takes moments to correct.
If dental work makes you anxious
A good many people put off a small filling for years, and the reason is almost never the filling. It is the anticipation. Say so when you book, and again when you sit down; it changes how the appointment is run rather than being noted and ignored.
The practice keeps a Comfort Menu: soft blanket, neck pillows, stress ball, fidget toys, aromatherapy, weighted blanket, lumbar support pillow, and noise-cancelling headphones with music options. Nitrous oxide is available for an additional fee. None of that is unusual equipment, but being asked what you would like rather than having to request it makes a difference.
More practically: a filling is one of the shortest appointments in dentistry, and a cavity that is dealt with now is far less likely to become the root canal you were dreading. If it has been years, that is more common than you would think and there is no lecture waiting. See our new patient page for what a first visit involves.
Composite bonding, the same material used cosmetically
The composite used to fill a cavity is also used to reshape a tooth. Esthetic bonding corrects chips, cracks, small gaps and discoloration by adding shaded resin to the tooth surface and sculpting it, which the practice describes as quick and non-invasive: usually one visit, usually no anesthetic, and very little or no enamel removed.
It is a cost-effective alternative to veneers or crowns for the right case, and it is customizable, which in practice means the result depends on the eye of the person doing it. Her own materials put the working life of bonding at generally 7-10 years, with proper daily dental hygiene and regular checkups.
Where the change you want is larger, or the tooth is worn as well as chipped, porcelain veneers or a crown may be the more durable answer. See dental bonding for the cosmetic side of this in full.
When a filling is not enough
There is a point at which a filling stops being the right tool. Once too much of the chewing surface is gone, a large filling is holding thin walls of tooth together rather than being held by them, and those walls tend to fracture. That is the moment for an inlay or onlay, which is made in a laboratory and cemented in as one solid piece, or for a crown.
If decay has reached the nerve, no filling will settle it, and the tooth needs root canal therapy followed by a crown. Occasionally a tooth is too far gone to keep, in which case extraction and a plan to replace it is the honest answer. The whole ladder is laid out on our restorative dentistry page.
Dr. Julia Lokitis holds a DDS from the University of Maryland, Baltimore with special honors in prosthodontics and has spent over 15 years in general practice. Our office is on Old Courthouse Road in Vienna, a few minutes from Tysons Corner and convenient to McLean, Dunn Loring, Merrifield, and Falls Church.
Frequently Asked Questions
Are tooth-colored fillings as strong as silver ones? expand_more
For the great majority of cavities, yes. Modern composite is durable and it bonds to the tooth, which means less healthy tooth has to be removed to hold it in place. Amalgam still has an edge in very large cavities in back teeth that take heavy load. The honest answer depends on how much sound tooth is left around the cavity, which is what the exam is for.
Do I need to replace my old silver fillings? expand_more
Not simply because they are silver. An amalgam filling that is sealed, sound and not cracked can be left alone. The reasons to replace one are decay getting in around or underneath it, a crack in the filling or the tooth, or the filling breaking down. Wanting a tooth-colored filling instead is a perfectly reasonable preference, but it is a choice rather than a clinical need.
How long will a filling last? expand_more
It varies with the size of the filling, where it sits, how heavily you bite, and how well the tooth is kept clean. Her own materials put composite bonding at generally 7-10 years, with proper daily dental hygiene and regular checkups, and fillings sit in a similar range. Small fillings in low-stress positions often go longer, and grinding tends to shorten it.
Does having a filling hurt? expand_more
The tooth is numbed with local anesthetic first, and most people describe pressure and noise rather than pain. Tell us if you are not fully numb before we start. The practice keeps a Comfort Menu, including a weighted blanket and noise-cancelling headphones with music, and nitrous oxide is available for an additional fee if that would help.
Why is my tooth sensitive after a filling? expand_more
Some sensitivity to cold for a few days, sometimes a few weeks, is common and settles on its own, particularly after a deeper filling. What is worth a call is pain when you bite down, which usually means the filling is sitting a fraction high and needs a quick adjustment, or pain that arrives on its own and lingers, which needs looking at rather than waiting out.
Can I eat straight after a filling? expand_more
Composite is set hard by the curing light, so the filling itself is ready immediately. The thing to wait for is the anesthetic. Until normal sensation is back you cannot feel your cheek, lip or tongue properly, and biting them is the most common way people leave a filling appointment sore.
Will the filling be noticeable? expand_more
Composite is shade-matched to the tooth it is going into, so a filling in a back tooth is not something anyone will see. On a front tooth, matching shade and translucency is more demanding and the result depends on the material and the shaping. If a front tooth needs more than a repair, veneers or a crown may hold up better in the long run.
A small cavity is a short appointment.
If a tooth is catching floss, feeling rough, or reacting to cold, it is worth a look now rather than later. Contact our Vienna office, minutes from Tysons Corner, or call and we will find you a time.