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Tooth decay or cavities are most commonly treated with direct restorations which are commonly referred to as fillings.

Tooth decay is the result of oral bacteria in plaque converting sugar from our diets to acid. Plaque is constantly forming and is very sticky to the teeth. It keeps the acid produced by the bacteria in close contact to the teeth allowing the acid to dissolve or demineralize the enamel and making that area of the tooth soft. Untreated decay continues to progress through the enamel layer into the dentin which is already less mineralized (softer) to begin with. Once it hits this layer, the progression rate increases and the cavity can get much larger in a shorter period of time. If the decay progresses deep into the tooth and reaches the pulp (nerves and blood vessels), a filling is no longer adequate treatment. Root canal therapy must be initiated at this time (see the root canal page for more information on this). Therefore, it is ideal to catch decay when it is smaller.

Tips for preventing decay and the need for fillings:

  • Brush twice a day with a fluoride toothpaste
  • Floss to clean in between the teeth as this is where many cavities start
  • Eat a good diet that is low in sugar and other carbohydrates
  • Limit snacking
  • Visit the dentist regularly and have your teeth cleaned and checked for cavities with an exam and X-rays.

The procedure for a dental filling is as follows. First, the tooth is anesthetized (frozen) with a local anesthetic to prevent discomfort during the tooth preparation. The tooth is then isolated with either the use of a rubber dam (a sheet that goes over the tooth to expose the teeth for treatment and ensures the tooth stays clean and dry by keeping the tongue and other tissues out the way) or a dry shield (special suction unit that continually removes water and saliva while retracting the tongue and cheeks). The decayed area of the tooth is then removed with the dental hand-piece (drill) to prepare the tooth for the filling. The tooth is then filled with the material of choice in either a direct or indirect fashion. Direct is most common as the treatment is done in one visit because the material is placed directly into the prepared cavity. Indirect involves creating a model of the prepared tooth on which the filling or restoration is created and then it is placed in the tooth (sometimes requiring 2 visits).


  • Amalgam (silver)
    Amalgam is a metal alloy that is very strong, predictable and easy to place. It lasts a very long time but does not have high aesthetics so is reserved for posterior teeth.
  • Composite (white)
    Composite materials are very aesthetic as there are multiple shades for matching adjacent teeth. They require that the tooth be isolated well for placement and proper bonding. These are the most common fillings placed even though they may not last as long as the metal materials.


  • Gold inlay/on-lay
    After the tooth is prepared, a mould is taken with an impression material or a scan is taken with our digital scanner, which is then sent to a dental lab. They fabricate a restoration out of a gold alloy that is cemented in the tooth at a second visit. These restorations are very strong and long-lasting.
  • Porcelain inlay/on-lay
    Often these restorations are completed similar to the cast gold restorations. However, we have a CEREC machine in the office, which allows us to make this filling in office in one visit. Instead of taking a mould, we use a digital scanner, which takes a picture of the tooth and sends it to the milling machine where it is made. After some staining and glazing, the filling is cemented in the tooth. These are great restorations as they last a very long time and do not take a lot more time than white fillings.

Written by Hometown Dental Okotoks

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