How to Know when Tooth Fillings Are Unnecessary

Few people relish the prospect of having a cavity filled, yet most accept that it is a better alternative than delaying until a root canal, tooth extraction, or other significant dental procedure is necessary.^{[1]XExpert SourcePradeep Adatrow, DDS, MS
Board Certified Dentist & Oral SurgeonExpert Interview. 30 September 2020.} We want to trust the dentist’s advice, but we can also be skeptical if a tooth filling is really necessary, especially if there is no current pain, discomfort, or cosmetic trouble. Opinions both inside and outside the dental community vary widely about whether a more aggressive or patient approach is best when dealing with tooth fillings. Don’t avoid the dentist out of confusion or distrust; instead, inform yourself on the options, ask questions, and don’t be afraid to seek a second opinion.

Part 1

Part 1 of 2:

Recognizing Symptoms and Treatments

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Do not ignore pain or tooth problems. You may come across articles and posts describing an epidemic of unnecessary dental procedures and decide that no dentist can be trusted.^{[2]XResearch source} However, regular dental care is essential to good oral and overall health, and signs of tooth pain or discomfort should never be ignored. Visit multiple dentists if you must, but make sure you visit a dentist when treatment is required.^{[3]XResearch source}
- Only a trained dentist can properly diagnose and treat dental problems. In regards to tooth fillings, they are almost always a first-line treatment if you are experiencing: nerve (pulpal) pain; severe discomfort (like from a jagged tooth edge); functional problems (such as trouble chewing); or severe aesthetic issues.
- How to Get Rid of Tooth Pain offers some good tips on temporary and at-home remedies, but note that none of these can replace a proper dental evaluation.
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Have regular dental evaluations.^{[4]XExpert SourcePradeep Adatrow, DDS, MS
Board Certified Dentist & Oral SurgeonExpert Interview. 30 September 2020.} It is true that a small minority of experts believe the traditional notion of visiting the dentist every six months is overkill, and that a three to five-year window is sufficient.^{[5]XResearch source} Six months remains the common standard, however, and regular examinations will at very least provide you with up-to-date information regarding the status of your teeth. Your dentist might take x-rays to check for decay and other evolution of dental conditions such as root canals and dental implants. This information can help inform your decision-making in regards to any signs of tooth decay.^{[6]XResearch source}
- Waiting until you have tooth pain before going to the dentist will almost always result in a tooth filling or other necessary procedure. Going before there is pain is more likely to give you treatment options in dealing with potential or emerging cavities.
- There is also some debate regarding the value of professional tooth cleaning, but this is almost always a standard component of a dental examination. Talk to your dentist if you have questions or concerns about the value of regular scaling and polishing procedures.
- Prevention is always less expensive and healthier than treatment; make regular dental appointments!
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Ask about preventative measures. The best way to avoid the question of whether you need a filling is to keep your teeth healthy and clean, through regular brushing, flossing, and making food choices that limit your intake of acids and sugars. If the dentist spots a sign of a potential or emerging cavity, though, you still may have preventative treatment options available that can allow you to avoid the “drill and fill.”^{[7]XResearch source}^{[8]XResearch source}
- When your dentist recommends a filling, never be afraid to ask if there are other, less drastic options that can be tried first.
- While some dentists are quick to recommend filling cavities that are not yet fully-formed, others are more open to recommending risk-management approaches. These usually involve regular observation, proper cleaning, and treatments that focus on neutralizing acid, killing mouth bacteria, and strengthening tooth enamel.
- Resin sealants can also sometimes be used to stop cavities on the biting surfaces of teeth from developing further.^{[9]XResearch source}
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Know the basics of cavities and fillings. In basic terms, a cavity occurs when decay (from bacteria, acid, etc.) causes a hole to be bored through both the protective enamel and the dentin beneath, reaching the tooth’s interior components. “Incipient carious lesions,” also sometimes called “microcavities,” exist when the dentin has not yet been penetrated. Dental lesions are the first stage of tooth decay, when the damage is only beginning to affect the enamel.^{[10]XResearch source}
- A tooth filling involves drilling out the dental caries (cavity) and often surrounding tooth material, in order to create a pocket that can be filled. Local anesthesia is often administered. The filling itself is meant to seal off the inner tooth material and replace the damaged and removed dentin and enamel. Fillings can be made of gold, metal alloys, ceramic, or various composite materials, and should last for several years at least.^{[11]XResearch source}

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Working with Your Dentist(s)

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Ask about your dentist’s approach to cavities.^{[12]XExpert SourcePradeep Adatrow, DDS, MS
Board Certified Dentist & Oral SurgeonExpert Interview. 30 September 2020.} As in other medical fields, more sophisticated diagnostic equipment has made it possible for dentists to identify potential cavities far sooner and more easily than in years past. As a result, some dentists have become much more aggressive in taking preventative steps to halt incipient (or even just potential) cavities before they can develop into something more severe.^{[13]XResearch source}^{[14]XResearch source}
- Alongside this aggressive “drill and fill” approach, other dentists have taken things in the opposite direction, using increased information regarding the development of cavities to formulate a “watchful waiting” approach. It basically comes down to deciding whether it is best to nip a potential cavity in the bud or wait to see if it becomes an actual problem first. Some dentists now use lasers to treat cavities, as it is minimally invasive.
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Be aware of (without assuming) unnecessary dentistry. The growth of the “drill and fill” approach to possible cavities has led some to question the motives of dentists. Dentists are, after all, typically paid by insurers for the work they actually do, with the determination of the necessity of that work left up to them. It can be claimed that dentists have a financial incentive to do unnecessary tooth filling, and there have been demonstrated instances of such activity.^{[15]XResearch source}
- Many if not most “drill and fill” dentists genuinely believe in the health value of being proactive with fillings, however. If your dentist advocates an aggressive approach, you have every right to ask for a clear explanation as to why he or she believes this is the best way to go. In the end, you have to decide whether to trust his or her opinion.
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Determine if you can wait and see. If your dentist recommends a filling but you are not experiencing pain or discomfort, you may want to consider asking whether it might make sense to wait and see if the cavity develops further. Tooth decay does not follow a universal pattern, and some potential cavities never develop into actual problems.^{[16]XResearch source}
- Modern evidence indicates that cavities typically develop more slowly than often assumed, taking on average around four to eight years to fully form. Therefore, if you are visiting your dentist every six months, you should theoretically have ample time to catch a developing cavity before it becomes a serious problem that might lead to a root canal or tooth extraction.
- You should also ask for an intra-oral camera check to make sure that the lesion has penetrated your enamel and can turn into a problem.
- It is your mouth and your choice, of course. Don’t let a dentist scare you into taking action, but also accept that he or she has the expertise and experience in the field. Inform yourself, ask questions, and be ready to weigh the risks versus benefits of waiting.
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Get a second opinion. Getting a tooth filled is typically not an overly expensive, painful, or intrusive procedure, but that doesn’t mean you should submit to it without a second thought. As with any medical procedure, you should always be ready to seek out an alternative professional opinion if you have any doubts or concerns.^{[17]XResearch source}^{[18]XResearch source}
- If your dentist seems angry or offended that you want a second opinion, it is probably for the best that you seek out a new dentist anyway.

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Are fillings necessary?
Pradeep Adatrow, DDS, MS
Board Certified Dentist & Oral Surgeon
Dr. Pradeep Adatrow is the only board certified Dentist, Periodontist, and Prosthodontist in the southern United States. With over 15 years of experience, Dr. Adatrow specializes in dental implants, TMJ treatments, periodontal plastic surgery, surgical and non-surgical periodontics, bone regeneration, laser treatments, and soft tissue and gum graft procedures. He received a BS in Epidemiology and Biostatistics from the University of Alabama and earned his Doctor of Dental Surgery (DDS) degree from the University of Tennessee College of Dentistry. Dr. Adatrow then completed a three-year postgraduate program in periodontics and implantology at Indiana University and went on to complete another three-year postdoctoral program in advanced prosthodontics from the University of Tennessee. He also serves as a full-time professor and the Director of Surgical Prosthodontics at the University of Tennessee. Dr. Adatrow received the Dean's Junior Faculty Award and the John Diggs Faculty Award, and he was inducted into the Deans Odontological Society. He is board certified by the American Board of Periodontology and is a Fellow of the prestigious International College of Dentistry – a feat that only 10,000 others worldwide can claim.
Pradeep Adatrow, DDS, MS
Board Certified Dentist & Oral Surgeon
Expert Answer
If you have tooth decay, yes. A filling is a conservative option for saving a tooth and preventing further decay. If you're concerned about the procedure, you can always ask your dentist for more information before moving forward.
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