Dental Fillings

Common reasons

• A hole caused by decay. Decay may not cause any symptoms at first¹. It is often found at a check-up, or on an X-ray, before it hurts.
• A broken, chipped or worn tooth. A small break can often be rebuilt with a filling. A cracked or damaged tooth, or a loose or broken filling³, can also cause toothache.
• An old filling that has failed. A filling that has broken, come loose or has new decay at its edge may be repaired or replaced. See "How long do fillings last?" below.

When a filling may not be needed yet

In its early stages, decay can be reversed⁴. If it goes on, the tooth surface breaks down and a cavity forms. For early decay, a dentist can prescribe or apply fluoride treatments like mouthwash or varnish¹. A review of 44 trials compared treatments that aim to stop decay without drilling. They include sealants, a thin coating over the grooves of back teeth, used with fluoride varnish, and high-fluoride toothpaste. It ranked these treatments for different kinds of decay, but its pooled results do not say how often decay stopped⁵ with each one. Whether early decay can be watched or needs a filling is decided at an examination.

When a filling may not be enough

• Deep decay close to the nerve. In very deep decay, the risk of exposing the nerve (the pulp, the soft tissue inside the tooth) is high. A 2026 European guideline on deep decay says this risk should be anticipated⁶. Ask your dentist to discuss it with you before treatment. Whether the nerve needs treatment is sometimes clear only while the decay is being removed. If the nerve is exposed, the guideline suggests removing only part of the nerve (pulpotomy)⁶ for some teeth; the certainty of the evidence is low. The guideline also expects that not all dentists will be able to perform pulpotomies⁶ in adult teeth. Ask whether it is an option for your tooth. If the nerve cannot recover, root canal treatment or having the tooth out is discussed.
• A large part of the tooth lost. When the walls or cusps of a back tooth are weakened, cracked or broken, a filling may not be enough. An inlay, an onlay or a crown may be considered, depending on how much sound tooth is left and whether the cusps are weakened. Only an onlay or a crown covers the cusps, the raised points on the biting surface. See "When a filling is not enough" below.

Decay is diagnosed at an examination. The dentist looks at the teeth and the old fillings, and takes X-rays where needed. Tell your dentist about any medical conditions, the medicines you take and any allergies. Say too if you are pregnant or breastfeeding.

Even a dentist's eye does not always get early decay right. A Cochrane review looked at how well a visual examination finds early decay in enamel, the tooth's outer layer. In its worked example, 28 in every 100 tooth surfaces have early decay. Of every 1,000 surfaces examined, about 40 decayed surfaces would be missed and about 163 sound surfaces would be wrongly called decayed⁷. The certainty of the evidence is low, and 48 of the 67 studies were laboratory studies.

A photograph alone cannot show whether a tooth needs a filling: that needs an examination, with X-rays where needed. If you are told you need several fillings and you are unsure, ask to see the X-rays, or ask another dentist for an opinion.

Deep cavities

How deep a cavity goes is sometimes clear only once the dentist is working on it. For deep decay in a tooth with no symptoms, or only brief sensitivity, the European guideline suggests removing the decay selectively or in two stages⁶. In these approaches, some softened decay next to the nerve is left in place. This is a weak recommendation, and the certainty of the evidence is very low.

If the decay is removed in two stages, the second stage is at a later appointment. Ask before treatment when that would be.

The material depends on where the tooth is, how big the cavity is, your bite, your health and your preferences. Ask your dentist to explain the options for each tooth.

• White (tooth-coloured) composite. Composite is placed in layers, shaped to the tooth and hardened with a special light. It is bonded to the tooth, and its shade can be matched to the tooth. How composite is shaped and colour-matched on front teeth is explained on our page on composite bonding.
• Silver-coloured amalgam. Amalgam contains mercury⁸. It is not tooth-coloured and does not bond to the tooth. It is retained in the tooth by mechanical means⁸, such as the shape of the cavity.
• Gold and porcelain. These fillings are usually made in a dental laboratory to fit your tooth, and usually need 2 appointments². Gold is sometimes used for molars, the large back teeth. Laboratory-made fillings are usually called inlays or onlays; see our page on inlays and onlays.
• Other materials. If another material is proposed, such as glass ionomer, ask why it suits that tooth and how long it is expected to last.

Composite or amalgam?

A 2021 Cochrane review included eight trials. Its main analysis combined two of them, in children with fillings in back teeth. It found that composite fillings may have almost double the failure rate⁹ of amalgam. Composite had a much higher risk of new decay at the edge, but was not more likely to fracture. The certainty of this evidence is low, and composites have improved since those trials. These findings are from published studies, not from our own records. The review found no consistent or clinically important harms⁹ from either material, but that evidence was of very low certainty.

In 2015 a scientific committee of the European Commission (SCENIHR) concluded that current evidence does not rule out either amalgam or alternative materials⁸. It advised basing the choice of material on the patient. The factors it named were baby or adult teeth, pregnancy, allergy to mercury or other components of filling materials, and reduced kidney function⁸. The 2021 Cochrane review adds that the global phase-down of dental amalgam under the Minamata Convention on Mercury⁹ is an important consideration. It says the choice depends on a shared decision between dentist and patient, and on local rules and protocols⁹. Ask which material is planned for each tooth, and why.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, tell your dentist before any filling is planned. In its 2015 opinion, SCENIHR advised that caution should be exercised when considering the placement of any dental restorative material in pregnant women⁸. Of resin-based filling materials such as composite, it wrote that, as with amalgam, their use in pregnant women is discouraged⁸.

The American College of Obstetricians and Gynecologists (ACOG) is a professional body of obstetricians and gynaecologists in the US. It considers dental treatment safe¹⁰ in pregnancy, including examinations, dental X-rays and local anaesthetic. It says that treatment which cannot wait, such as a filling, may be managed at any time during pregnancy¹⁰. It adds that delaying treatment may result in more complex problems¹⁰. Ask your dentist which treatment is urgent and which can wait until after the birth, and which material is planned.

No cavity size has been identified at which a filling stops being enough. The choice depends on how much of the walls and cusps remains. Cusps are the raised points on the biting surface of a back tooth.

• A large filling made in the mouth. Depending on the tooth, a large cavity can still be filled directly with composite. Two reviews, published in 2023 and 2024, compared such fillings with laboratory-made composite inlays and onlays in large back-tooth cavities. They reached different conclusions¹¹. One found no clear difference; the other reported fewer failures with direct fillings¹². Both rated the certainty of their evidence as very low, and neither covers ceramic.
• Inlay or onlay. An inlay fills the space between the cusps; an onlay also covers one or more cusps. Both are usually made in a laboratory and then bonded to the tooth.
• Crown. A crown covers the whole visible part of the tooth. It may be recommended for a tooth that is badly damaged or broken, weakened by a large filling, root canal treated, worn down or cracked¹³. A laboratory study on plastic model back teeth measured how much tooth each preparation removes. Full crown preparations removed about two thirds to three quarters¹⁴ of the visible part of the tooth. For inlays and small bonded preparations, the figure was about 5 to 27 per cent. These are laboratory values and give only a sense of scale. How much is removed from a real tooth depends on the existing damage and old fillings. See our page on dental crowns.
• After root canal treatment. A back tooth that has had root canal treatment can be restored with a filling, an onlay or a crown. A Cochrane review updated in 2015 found only one small study comparing a crown with a filling. It did not find any study¹⁵ comparing an inlay or onlay with a crown. So the evidence does not favour one option for every tooth; the decision rests on how much sound tooth is left.

The steps below are for a filling made directly in the mouth. Your dentist will advise whether a local anaesthetic is needed, depending on the extent of the work. If you would like one, or feel anxious about treatment, tell your dentist.

A filling usually means removing some tooth, and removed enamel and dentine (the layer under the enamel) do not grow back. So before any tooth is drilled, make sure you understand why the filling is needed. You can ask for changes to the plan. You can say no, or ask to stop, at any stage. Turkey's patient rights regulation gives you the right to refuse treatment or ask for it to be stopped¹⁶; the possible consequences are explained to you. Ask what is likely to happen to the tooth if you decide against the filling. Once treatment has started, ask what would happen to the tooth if it stopped at that point.

Benefits

• Fillings repair holes caused by decay¹⁷ and restore the shape of the tooth, so you can chew on it again.
• A filling made in the mouth needs no laboratory stage.
• A white filling can be matched to the colour of the tooth.

Limitations

• It cannot be undone. Tooth removed for a filling does not grow back. From then on, that part of the tooth depends on a restoration.
• No filling lasts forever. Fillings can become chipped or worn or change colour over time².
• A filling does not protect the tooth from decay. New decay can start at the edge where the filling meets the tooth.
• Whitening does not lighten fillings. It will not work on fillings¹⁸, crowns or veneers. Next to whitened teeth, a filling can look darker, and it may need to be polished or replaced¹⁹. A 2011 review suggests avoiding whitening on ceramic (porcelain) restorations¹⁹, especially on front teeth, because their surface may become rougher. If you are thinking about teeth whitening, raise it before the plan is made.

Risks and complications

• Sensitivity. After a filling, the tooth may be sensitive to hot and cold for a while. See "Aftercare and sensitivity" below.
• A high bite. If the filling is slightly high, biting can hurt. Your dentist can adjust it.
• The nerve of the tooth. In a deep cavity, the nerve may be exposed while the decay is removed. For some teeth, part of the nerve can be removed (pulpotomy); if the nerve cannot recover, root canal treatment or extraction is discussed. After a deep filling, ask your dentist which signs to watch for.
• Failure over time. New decay at the edge and fracture are the main reasons fillings fail (see "How long do fillings last?").

If you had a local anaesthetic, it can take a few hours to wear off. Do not eat until the numbness has gone, and take care not to bite your cheek, lip or tongue. If your bite feels high in the first few days, tell your dentist; it can be adjusted.

Sensitivity after a filling

After a filling, the tooth may be sensitive to hot and cold for a while. Tell your dentist if it does not settle or keeps getting worse. Pain that starts on its own, lingers after something hot or cold, or wakes you at night is more than simple sensitivity: see a dentist. See a dentist too for toothache that lasts more than 2 days³, or that painkillers do not ease.

Daily care

• England's national prevention guidance advises all adults to brush at least twice a day with fluoride toothpaste of 1,350 to 1,500 ppm (parts per million)²⁰. One of these times is last thing at night. Spit out the toothpaste rather than rinsing.
• The same guidance advises keeping sugary food and drinks to a minimum, and avoiding them at bedtime²⁰.
• Clean between your teeth every day with floss or interdental brushes.
• Do not bite hard objects such as ice, pens or your nails.
• If you clench or grind your teeth, tell your dentist.
• Keep to your regular check-ups.

Studies show how groups of fillings fare over time. They cannot tell you how many years your own filling will last, and no filling lasts forever². The figures below come from published studies, not from our own records.

A 2014 analysis pooled data on 2,816 composite fillings in back teeth, from 12 studies that followed them for at least 5 years. During follow-up, 569 of these fillings failed, mainly because of new decay or fracture²¹. Failure was more common²¹ in people at high risk of decay and in fillings that covered more surfaces of the tooth. This figure is not a failure rate over a set number of years, and it does not predict the outcome for any one filling.

Repair or replacement

An old filling that is still sound does not need replacing just because it is old. A filling with a defect can sometimes be repaired instead of being replaced in full. A review of studies comparing the repair of defective fillings with their replacement found no clear difference²² in the risk of failure. Only 3 studies were included; the risk of bias was high and the certainty of the evidence very low. Ask your dentist whether a repair is possible, and if not, why not.

If a filling keeps failing, or the tooth around it is weakened or cracked, an onlay or a crown may be discussed instead. See "When a filling is not enough" above. If several old fillings, crowns or other restorations need replacing, see our page on replacing previous dental work.

Contact your dentist if any of the following happens:

• Sensitivity that does not settle, or keeps getting worse
• Pain that starts on its own, lingers after something hot or cold, or wakes you at night
• Toothache that lasts more than 2 days³, or that does not go away when you take painkillers
• Pain when you bite, or a bite that feels high
• Toothache with a high temperature, red gums or a bad taste in your mouth³, or a swollen cheek or jaw
• A filling that cracks, breaks, feels rough or falls out, including a temporary filling
• Food catching at the edge of a filling, or a dark line or new hole at its edge

If you think you have a dental abscess, see a dentist without delay. An abscess does not go away on its own and needs urgent treatment by a dentist²³.

Emergencies. The signs below need urgent medical help²³. Do not wait for a dental appointment. Go to a hospital emergency department or call 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling around your eye or in your neck³
• A painful eye, or sudden problems with your sight
• A lot of swelling inside your mouth
• Difficulty opening your mouth

At our clinic, fillings are placed by our dentists. In Turkey, a dentist does not have to be a specialist to place fillings. Turkish law authorises every dentist²⁴ to diagnose and treat the teeth, the gums and the tissues of the mouth and jaw. It ties the specialist title to a specialist certificate²⁴, issued and registered by the Ministry of Health²⁵. Restorative dentistry is one of the nine dental specialties set by law²⁴.

You have the right to be told, on request, who is treating you, and their role and title¹⁶. Ask who will examine your teeth and place your fillings.

Turkey's patient rights regulation says what you are told before treatment. It includes who will carry out the treatment, where and how, the other options with their benefits and risks, and the possible complications¹⁶. Ask for your plan in writing as well. It should answer these questions:

1. Which teeth need a filling, and which might need root canal treatment, an onlay or a crown?
2. Which material is planned for each tooth, and why?
3. How many appointments are needed?
4. If a tooth turns out to need more than a filling, what changes in the plan and the cost?

In private dental clinics, you are asked to sign a consent form for every treatment²⁶. The form is signed in two copies, and one copy is given to you¹⁶. Ask for your copy.

Private dental clinics also record the diagnosis, the treatment and any X-rays in detail, with tooth numbers²⁶. You can look at your records and get a copy¹⁶. For your fillings, ask for a record that shows:

• which tooth was filled, and which surfaces
• the material and, for a white filling, the shade
• whether the decay was deep, and whether the nerve was treated
• anything that still needs to be done, and by when

Ask for copies of any X-rays as well. A dentist who treats you later can then see what was done.

This page carries no prices. A treatment plan is prepared for you after an examination. The main factors that shape it are:

• How many teeth need a filling, and how large each cavity is
• The material for each tooth
• Whether a tooth needs more than a filling: root canal treatment, an inlay or onlay, or a crown
• Whether the examination and any X-rays are included
• Repair or replacement that may be needed over time

Ask for your plan in writing, including what it covers and how a filling that fails later would be handled.