Background Information:

What are the other Names for the Procedure?

• Cavity Filling Repair
• Dental Cavity Filling Replacement
• Tooth Cavity Filling Repair

What is Dental Cavity Filling Repair Procedure?

• When a tooth structure is damaged, chiefly due to dental cavities, a dental cavity filling is used to restore its function. This can help avoid further tooth decay and entry of food particles into the damaged space, which can be then infected by bacteria
• However, the dental filling is generally not a permanent or long-term process, in some cases. The filling may get eroded, removed, or broken due to various reasons. In such cases, a Dental Filling Cavity Repair (or Replacement) procedure is undertaken

What part of the Body does the Procedure involve?

A Dental Cavity Filling Repair procedure involves the teeth.

Why is the Dental Cavity Filling Repair procedure Performed?

A Dental Cavity Filling Repair procedure is performed for the following reasons:

• The bonding of the previous filling with the tooth was poor and the inlay breaks or comes off; especially, if the filling was done when the tooth was wet. The correct procedure is to do it when the tooth surface is free of moisture and saliva
• Broken cavity fillings need to be repaired or replaced, which can occur due to poor filling
• The tooth with the filling has broken, or the tooth has further decayed
• Taking very hot or cold foods may cause severe stress on the filled material (expansion or contraction) and it may get damaged gradually over time
• The filling is under severe bite stress due to improper placement (during initial filling)
• The tooth is too small to support the filling (to ensure that the filling gets a proper grip), such as when done in a child
• The filling develops tiny leaks (micro-leakage), cracks, or there is a small gap between the tooth and the filling (this may result in sensitivity). Or, the filling (amalgam, composite resin) has caused tiny fissures in the tooth
• The filling is looking unsightly
• Existing cavity filling is worn out
• People who grind their teeth will wear out their fillings earlier than others (in such cases, a mouth guard may offer some protection)

What are some Alternative Choices for the Procedure?

Typically, there are no alternative choices available to Dental Cavity Filling Repairs.

What are the Recent Advances in the Procedure?

The advances in the field of Dental Cavity Filling Repair procedures are more to do with use of reliable and long-lasting filling materials.

What is the Cost of performing the Dental Cavity Filling Repair Procedure?

The cost of Dental Cavity Filling Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Dental Cavity Filling Repair procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.colgate.com/en-us/oral-health/procedures/fillings/what-is-a-filling (accessed on 01/04/2018)

http://www.ada.org/~/media/ADA/Publications/Files/patient_52.pdf?la=en (accessed on 01/04/2018)

http://jamiethedentist.com/dental-fillings/risks-and-problems (accessed on 01/04/2018)

Prior to Dental Cavity Filling Repair Procedure:

How is the Dental Cavity Filling Repair procedure Performed?

Dental Cavity Filling Repair may be undertaken by dentists in the following manner:

• A visual examination of the tooth in concern is made (if necessary using a special mirror)
• If necessary, local anesthesia is administered to numb the region
• The dentist removes the existing filling using special instruments. The cavity is then scraped and cleaned
• The cleaned cavity is then prepared to receive the filling (a synthetic material). An acid gel may be used as cementing substance on the surface of the cleaned-out cavity
• The filling is applied in layers and may be set and hardened using heat or bright light

Any of the following filling materials may be used depending on the dental professional’s evaluation of the condition:

• Porcelain
• Plastic or resin-based composites
• Amalgams (of elements such as silver, copper, or mercury)
• Gold
• Glass ionomer: It consists of a mixture of fine glass powder, fluoride base and acid. It can be matched to the shade of tooth

Of these, composite resins and porcelain may be matched to the color of teeth; but, the former may not last longer than 3-10 years. Also, a porcelain inlay can resist staining better than other materials.

Where is the Procedure Performed?

Dental Cavity Filling Repairs are usually performed in an out-patient surgery center facility, a dentist or an oral surgeon’s clinic or office.

Who Performs the Procedure?

A dentist typically performs the Dental Cavity Filling Repair procedure.

How long will the Procedure take?

A Dental Cavity Filling Repair procedure may take anywhere from 30 to 90 minutes, depending on the extent of repair necessary.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Dental Cavity Filling Repair procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication, food items, or the filling material used in the procedure
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Dental Cavity Filling Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Dental Cavity Filling Repair Procedure?

Before a Dental Cavity Filling Repair procedure, the patient may have to undergo certain tests such as:

• Visual examination of teeth
• Routine blood and urine analysis, as required
• X-ray of the mouth

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Dental Cavity Filling Repair procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Dental Cavity Filling Repair Procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia may be administered for the procedure.

How much Blood will you lose, during the Procedure?

Typically, no blood loss is involved during a Dental Cavity Filling Repair procedure.

What are the possible Risks and Complications during the Dental Cavity Filling Repair procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Dental Cavity Filling Repair include:

• Anesthetic complications
• Allergic reaction to the material used in filling
• Damage of tooth during the procedure

What Post-Operative Care is needed at the Healthcare Facility after the Dental Cavity Filling Repair procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Dental Cavity Filling Repair Procedure:

What are the possible Risks and Complications after the Dental Cavity Filling Repair procedure?

The possible risks and complications that may arise after a Dental Cavity Filling Repair procedure are:

• Bleeding from the gums
• The filling does not match the profile of the teeth
• The filling comes off

What is the Prognosis after the Surgery?

The prognosis after a Dental Cavity Filling Repair procedure is usually good. However, it also depends on the underlying cause, which resulted in the repair. In some cases, the procedure may have to be repeated until optimal results are achieved.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• The filling falls-off or cracks
• Pain or swelling around the gums and teeth
• Bleeding or fluid drainage from region
• Tooth sensitivity is observed
• Signs of an infection
• Headache
• Fever, feeling sick
• Dizziness

What Post-Operative Care is needed at Home after the Dental Cavity Filling Repair procedure?

At home, the following post-operative care is recommended after Dental Cavity Filling Repairs:

• Avoid food items, such as soft drinks, wine, coffee, etc., for a period of time; use straw if you need to drink these
• Avoid smoking or chewing tobacco
• Avoid very hot or cold food items for a few days following the procedure
• Brush and floss regularly after taking food, or twice daily

How long does it normally take to fully recover, from the Procedure?

There is no recovery time involved and individuals are able to resume full function of their teeth after a short duration following the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis.

Who will you receive a Bill from, after the Dental Cavity Filling Repair procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A dentist

The patient is advised to inquire and confirm the type of billing, before the Dental Cavity Filling Repair procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA