Why do I need a filling? You\u2019ve just been for your six monthly routine dental examination. You went in thinking it would be a quick in-and-out as there\u2019s been no problems that you were aware of. You\u2019ve had no toothache, no sensitivity and you can eat pretty much any kind of food without any problems. However, at the end of the dental check-up, your dentist sat you up to tell you that he\u2019s going to need to see you again to do a filling on your lower left back tooth. How can this be? Your tongue immediately shoots down to this tooth and has a good feel around. He must be mistaken! This tooth feels completely normal to you. There\u2019s no hole in this tooth.\u00a0 So why do I need a filling? Firstly let\u2019s dispel a few myths about fillings, cavities and tooth decay. Here are some common things we hear from patients at our dental clinic in Fleet: \u201cCavities hurt. I will know if I need a filling.\u201d \u201cI will feel a hole in my tooth if I need a filling.\u201d \u201cHaving a filling done hurts.\u201d \u201cFillings look ugly\u201d All of the above statements are incorrect. Time and time again we hear people say \u201c I don\u2019t go to the dentist unless I have a problem. I\u2019ll know if I need a filling\u00a0 as I\u2019ll be in pain.\u201d Tooth decay itself does not hurt or is even sensitive, unless it progresses deep into the nerve. To understand this a little more, let\u2019s take a look at a short video that explains the progression of decay and the anatomy of a tooth: When tooth decay begins in a back tooth, it often starts in the small grooves in the biting surface or in between the teeth where they meet. This is because, these are common areas where food and dental plaque are packed and aren\u2019t always successfully cleaned out. The bacteria in the plaque digests carbohydrates in the food and produces acid. This acid attacks the enamel, softening it and causing it to break down. The dental decay usually breaks through the enamel through a very small hole at the base of one of these pits or grooves in the tooth, into the softer dentine underneath. Once in the dentine, the decay spreads out in all directions, undermining the enamel. Then the decay is able to progress in the dentine with a largely intact shell of normal enamel over the top, acting like an enamel roof. This enamel roof does not collapse until the dental decay progresses far into the dentine. This is the reason why you do not feel a hole until the late stages of decay. So if you feel a hole in your tooth, it is likely that the tooth has been decayed for some time, and it is also a higher chance that the nerve in the tooth may become involved. As the dentine feels hot and cold, it needs to be exposed for the tooth to feel pain or sensitivity. Therefore, you do not feel sensitivity or pain from a decayed tooth until the later stages, when the enamel collapses, exposing the dentine. Pain can also be felt if this dentine decay spreads deep enough in the tooth for the nerve to become involved. The decay can progress for years under the enamel without you feeling any hole or sensitivity. This is why regular dental examinations are extremely important. I am certain, that given the choice, you would prefer to have a small filling, than to wait until the decay had progressed deep within the tooth and a risk of needing root canal treatment has become a possibility. So how can your dentist tell that you need a filling and you can\u2019t? At a dental examination, your dentist will look at each tooth individually. There are numerous appearances of a tooth that would suggest decay forming. Most commonly, the enamel surrounding the grooves in the tooth will appear very grey. However, enamel can also appear frosty, opaque or even be an orange like colour, when there is decay lurking below in the dentine. Below is an example of a decayed tooth picked up at a routine dental examination at our dental clinic in fleet: Note how grey the enamel looks around the grooves of the teeth, especially when compared to the adjacent teeth. Even when patients see this greyness of enamel, it can be difficult for them to visualise the extent of the decay occurring in the dentine underneath. I find it really useful for patients to see photographs of the dentine, once the enamel has been removed during the dental filling process.\u00a0 Below are two images of two teeth. The first was taken at the initial appointment to show the patient the greyness in the enamel. The second taken at the filling appointment, once the enamel was removed from over the top of the decayed dentine. Note the brown or black appearance of the dentine. The dentine should be yellow in colour. The decayed dentine was then removed, before restoring the cavities with white filling material. As you can see in this image, the extent of the decay in the dentine is much worse than the greyness of the enamel could suggest. If this decay had not been treated at this point, it may have progressed into the nerve of the tooth which would have led to the tooth requiring root canal treatment. This patient had absolutely no symptoms from these teeth when they were noted at their dental examination. Having a dental filling does not need to be a bad experience. Having a filling does not hurt as dentists use a local anaesthetic. This local anaesthetic numbs the tooth, so that you feel no discomfort whilst the filling is being placed.\u00a0 Dental fillings also do not need to be ugly in today\u2019s world of cosmetic dentistry. Grey metal fillings are mostly being phased out now in favour of modern, adhesive, white, composite fillings. With a white filling in your tooth, it is likely you will not even be able to see it. Below is an example of a cavity before and after restoration with a white filling: If, after reading this blog, you are concerned that you may need a filling, please contact your dentist and request a dental examination. If you do not have your own dentist, we welcome new patients at our dental clinic in Fleet. Also, if you just have a question that you would like to ask, we are more than happy to help. Please email any questions to firstname.lastname@example.org or call on 01252 614818 to arrange an appointment.