Placing a Filling

Young children may have some difficulty with dental treatment. But the experience can be a positive one if the dentist has training and experience with this age group. Here's how a filling is placed.

Your child will receive an anesthetic gel or ointment applied directly to a small area of the gum or inner cheek. Once the area is numb, the dentist will inject a local anesthetic. This will numb the teeth and surrounding area during treatment.

After giving the local anesthesia and any sedation, the dentist will put a rubber dam on your child's teeth. This is a piece of latex or similar material that isolates the tooth your dentist is treating. A hole is punched in the dam so the tooth comes up through the hole. The dam protects the rest of the mouth.

Most dams are latex, but some are made of other materials for children with latex allergies. Some rubber dams are scented or flavored.

The dam has several advantages:

It protects the cheeks, tongue and lips and keeps them out of the way of the procedure.

It keeps saliva away from the procedure. Most of the materials that dentists work with are more effective if kept dry. In some cases, saliva can weaken a filling.

It prevents the child from accidentally swallowing or choking on anything during the procedure.

It makes many children feel safer to have a rubber dam between them and the dentist.

Almost all fillings are prepared using a dental drill. Dentists call this a handpiece. A newer method of removing decay is known as air abrasion. This can be used in certain circumstances, usually when preparing a tooth for a plastic filling.

Air abrasion is very quick. It often can be used without local anesthesia. However, very few dentists have air abrasion units. Even when air abrasion is used, the dentist will often still need to use a drill.

The dentist uses the drill or air abrasion to remove the decayed part of the tooth and shape the tooth to receive the filling. If a plastic filling will be used, the hole the dentist makes is etched with a weak acid for 15 seconds. This prepares the tooth so the plastic filling will bond to it.

A plastic filling must be placed in thin layers. Then each layer must be hardened with a special light before the next is added. This is one reason that plastic fillings take longer than amalgam ones.

Once the filling has hardened, your dentist will smooth and polish it. He or she will remove the rubber dam and ask your child to bite down gently on a piece of special marking paper. This will show whether the filling has affected the bite (the way the teeth come together). If the bite is not correct, the filling will be reshaped until it fits.

Fillings can be placed in children with braces. If your dentist can't reach the decay, your orthodontist will need to remove a band or bracket to reach the tooth.

Some children with braces should see a dentist three or four times a year. Twice a year may not be enough because it's more difficult for them to keep their teeth clean. Your orthodontist will let you know the appropriate time between cleanings.

Your child should feel little discomfort after a filling is placed. Any discomfort usually is caused by irritation of the tooth's pulp or the soft tissue around the tooth. This typically goes away after the first 24 hours. If your child complains of pain for several days, contact your dentist's office. Over-the-counter pain medicines can help relieve discomfort.

After receiving a filling, a child sometimes may accidentally suck, chew or bite on a numbed lip because it feels swollen. This can cause significant injury. The dentist should warn your child not to do this. You also should watch your child until the anesthesia wears off. If your child injures a lip or cheek, just keep the area clean. It will heal on its own.

Feed your child only soft foods until the numbness goes away. This can help to prevent accidental bites on the lip or cheek. After feeling is restored, your child can eat normally.

Pay attention if your child complains that his or her teeth don't come together right, or that biting "feels funny." The filling may need to be reshaped. Contact the office to see if the dentist should check the filling. Sometimes, the filling will settle by itself within a few days.

Some local anesthetic shots can nick small blood vessels. This may cause bleeding under the skin. You may notice a slight swelling or a black-and-blue area on your child's face. This happens in only 3 to 5 of every 100 cases. It does not require treatment. It is like any other simple bruise. You can put ice on the side of your child's face to bring down the swelling. It should go away completely in a few days.

A filling can break or crack. This is more likely to happen if the bite is not correct and too much pressure is placed on the filling.

Fillings also can leak. This occurs if the filling doesn't fit tightly enough against the tooth. As a result, saliva and bacteria can seep under the filling. Leakage can cause sensitivity and further decay. It is more common in plastic fillings. Fillings also may fail if new decay starts.

It's important for your child to visit a dentist at least twice a year. During the examination, your child's dentist will check to make sure fillings are still in place and are not leaking.