Do We Really Need Dental Fillings?

Many people consider dental fillings to be the solution to every dental problem. Unfortunately, this is not true. The scientific term for a tooth filling is dental restoration. As the name suggests, a tooth is restored whenever it gets infected with caries and becomes sensitive to hot or cold.
Dentists nowadays use various materials for dental restorations, such as silver amalgams, composites, and glass ionomers. However, the use of amalgam restorations is declining throughout the world due to concerns raised about their safety and biocompatibility. Tooth colored composites are currently the filling materials of choice, due to their superior aesthetics and adequate strength.

When Do Patients Require a Dental Filling?
It is commonly observed that if the teeth are looked after properly, through regular brushing and flossing, the chances of occurrence of a tooth decay is minimized. In fact, teeth become carious only when their tooth cleaning is ignored. This results in adherence of harmful bacteria on the teeth, leading to a reduction in the pH of the oral cavity, carried out by the breakdown products of bacteria and food debris.
Whenever the normal pH of the oral cavity is disturbed, the natural balance between tooth remineralization and demineralization is also effected. In case of an acidic oral pH, the process of tooth demineralization is significantly enhanced, leaving the dental enamel weakened and vulnerable to fracture. Once the enamel gets demineralized, the relatively weaker and richly innervated dentin gets exposed, leading to tooth sensitivity, dental infection and eventually, tooth fracture. In these cases, it becomes necessary to remove the caries effected part of the tooth, and replace it with a suitable restorative materials.
What is the Principle behind Tooth Restoration?
The function of a restorative material is to serve as a replacement for the dental enamel and dentine lost as a result of caries. Hence, a dental restorative material must be sufficiently strong, to withstand the forces generated within the oral cavity. Another requirement of a filling material is to occlude exposed dentinal tubules, so as to prevent tooth sensitivity, in addition to preferably possessing fluoride releasing properties that helps in reducing the incidence of dental caries.
In Which Cases is Dental Filling Not Possible?
As discussed earlier, tooth filling should not be considered the solution for every dental problem. For example, if the dental pulp becomes exposed and gets infected, a root canal treatment might be indicated before opting to restore it. It must be stressed here that many patients insist on getting their grossly infected teeth filled without undergoing any treatment for the infection, despite the dentist’s opinion on the contrary. This practice should be avoided and dentist’s recommendations should be followed.
Similarly, if a crack in a tooth extends up to the root, then there will not be any benefit of treating the tooth merely with a filling material. In these cases, other advanced dental procedures might be required before getting them filled.
Will Dental Fillings Last Forever?
Unlike the teeth, filling materials are manmade products, and possess a limited lifetime. Composite fillings are expected to serve well for about 5-10 years under ideal circumstances. On the other hand, the amalgam restorations are longer lasting, and serve their purpose for up to 30 years, even more.
Do Filling Materials Have Side Effects?
Apart from the concern raised regarding the potential toxicity caused by dental amalgam, the rest of the dental materials are pretty safe, and carry minimal risk of any local or systemic toxicity. However, in rare cases, some patients may be allergic to the monomer of the composites restorative materials.