A Patient’s Guide to Cavity Treatment Options

Tooth decay sounds quite extreme, yet the word cavity is used so frequently that many don’t think twice about what it implies. In reality, these phrases are synonymous: without proper care, tooth decay creates cavities that spread to neighboring oral structures, causing substantial tooth loss and irreversible damage. 

Treatments for tooth decay are based on the severity of damage to the affected teeth. If cavity damage is minimal, the dentist will likely perform a filling, whereas irreversible damage impacting the jaw bone will likely result in tooth extraction. Moderate cavities–characterized by the decay of external tooth structure that has yet to spread to the bone–require unique treatments, such as crowns and bridges. By explaining treatments for mild, moderate, and severe cavities, this article helps patients understand their options and feel confident in their dental care decisions. 

1. Fillings (mild cavity treatment)

Dental fillings help repair tooth cavities by “filling in” specific areas of decay. There are two major types of dental fillings:

      A. Direct fillings

Direct fillings only require one office visit during which the dentist directly places the fillings to treat cavities. These fillings are commonly made of resins, tooth-colored glass ionomers, or silver-colored amalgam. 

       B. Indirect fillings

Indirect fillings generally require two office visits and are used when a tooth has too much damage for a direct filling but not enough to warrant the use of a dental crown. At the first visit, a special putty will be used to take an impression of the tooth requiring the filling. The indirect filling will then be made in a lab so that it will perfectly fit within the patient’s damaged tooth. During the patient’s second visit, their dentist will place the filling and bond it to the natural tooth. Gold and porcelain are the two most commonly used materials. 

2. Crowns (moderate cavity treatment)

Dental crowns are custom-made synthetic caps that cover damaged or decayed teeth to restore their structure and protect them from further harm. There are several different types of dental crowns made from a variety of materials. 

1. Metal crowns

Metal crowns are highly durable and require minimal enamel removal. Due to their silver appearance, metal crowns most often cover teeth that aren’t generally visible, such as molars, located in the back of the mouth. 

2. Porcelain-fused-to-metal (PFM) crowns

PFM crowns have a core metal substructure covered by a layer of porcelain, creating a more natural tooth-like appearance compared to metal crowns.​​ However, PFM crowns may chip over time, revealing the metal beneath the porcelain. Such chipping can also wear on the enamel of opposing teeth. 

3. All-ceramic/all-porcelain crowns

All-ceramic crowns closely mimic natural tooth enamel and are a good choice for those with metal allergies. In particular, zirconia crowns are highly durable and gentler on opposing teeth.

4. All-resin crowns

All-resin crowns are a more affordable option, but they are also much more fragile and only last three to five years. They are often used as temporary crowns while the patient’s final version is being made in the dental lab. 

 3. Implants (severe cavity treatment)  

Implants are a surgical option for tooth replacement. They are made of small, threaded posts with an artificial tooth attached. Implant placement may take more than one procedure and several months of healing before the implant functions as a natural tooth. The two major types of implants are endosteal and subperiosteal. 

1. Endosteal implant

Endosteal implants are the most common type of implant. In this procedure, the implant is placed in the jawbone and can hold one or multiple teeth. These implants are generally made of titanium.

2. Subperiosteal implant

Subperiosteal implants are placed on top of the bone and are used when patients do not have enough healthy jawbone for an endosteal implant. These implants are less common as they generally have a lower long-term success rate.  

     4. Dentures (severe cavity treatment) 

Dentures are removable prosthetic devices that replace the function of missing teeth. Similar to crowns, dentures may be made of acrylic, resin, nylon, metal, or porcelain. To meet your unique needs, there are several types of dentures available:

1. Full dentures

Full (or complete) dentures replace an entire arch of teeth. They are placed in the patient’s mouth once all teeth are removed and gum tissue has healed. Dentures directly rest on the gums, using the patient’s palate or lower jawbone ridge for support. If patients seek additional stability, denture adhesive may also be used. Most patients remove their dentures at night to clean them and allow their gums to rest.

2. Partial dentures

Partial dentures attach to remaining natural teeth to effectively fill in gaps where several teeth have been removed. This prevents the surrounding natural teeth from shifting out of place. 

3. Implant-retained dentures

Implant-retained dentures attach to dental implants–small posts that are placed in the jawbone. Although these dentures are removable, they are more stable than traditional dentures and typically do not require denture adhesive. 

4. Implant-supported dentures

Implant-supported dentures are fixed prosthetics that provide a more permanent solution after tooth extraction compared to other denture types. These dentures cannot be removed at home and require careful daily brushing and flossing.

       5. Bridges (severe cavity treatment)

Dental bridges are used to replace either one missing tooth or a row of missing teeth. They are made up of crowns that cover the patient’s natural teeth on either side of the gap and artificial teeth to bridge the gap. There are four major types of dental bridges:

1. Traditional dental bridge

Traditional dental bridges have crowns on the healthy teeth at both ends of the gap which are used to hold the artificial teeth in place. Traditional bridges are used when patients have healthy teeth on either side of the gap. 

2. Cantilever dental bridge

Cantilever dental bridges only have a crown on one end, and thus, are used for patients that only have healthy teeth on one side of the gap. Because of this, cantilever bridges are usually less stable than traditional bridges. 

3. Maryland dental bridge

Maryland dental bridges use metal wings that are bonded to the back of the patient’s natural neighboring teeth to hold the bridge in place. These bridges are weaker than traditional bridges, so they are most commonly used on front teeth as they cannot withstand the chewing force of back teeth.

4. Implant-supported bridge

Implant-supported bridges rest on top of dental implants instead of natural teeth. These implants are used when a patient is missing three or more teeth in a row. 

      6. Important Factors to Consider

When choosing between fillings, crowns, and dentures the most important factor to consider is the extent of tooth loss and decay. Minor tooth damage is typically treated with fillings or crowns, whereas extensive damage resulting in extraction requires dentures, bridges, or implants. While implants are the only surgical option, they are also the most long-lasting and natural solution for those with severe dental decay. Dentures and bridges can both be used to replace extracted teeth, but bridges are generally used when there are only a few missing teeth, whereas dentures can replace the function of an entire row of teeth.

Patients must also consider cost when choosing which treatment is right for them, alongside their dental provider. Fillings are the most affordable option, with a price generally between $50-$250. Crowns, bridges, and dentures are all comparable in price. While a single crown can cost between one and three-thousand dollars, which is similar to the cost of a full set of dentures, dentures require greater long-term upkeep and the accrual of post-procedure costs. Implants generally cost around $1,500 per tooth, but this can vary depending on the practice, implant material, and bone density of the patient.

       7. Pros and Cons

Treatment Option	Pros	Cons
Fillings	-Affordable  -Quick, convenient procedure -Lasts up to fifteen years -Require less drilling than crowns	-Limited to mild cavities -May fail over time and require additional procedures
Crowns	-Long lasting -Durable and convenient -Protects the natural tooth from further decay -Minimally invasive, targeted solution -Lasts up to fifteen years	-More expensive than fillings -Can trap bacteria if they aren’t fitted properly -Cannot address extensive tooth loss
Implants	-Long-term solution, permanent solution -Most similar to a natural tooth -Endosteal implants preserve the jawbone	-Most invasive, surgical procedure -Long recovery time -Requires healthy bone structure -Most expensive procedure
Dentures	-Removable -Effectively addresses large-scale tooth decay -Supports facial muscles and enables normal chewing/speaking	-May shift out of place -Often require additional clinic visits and adjustments -Typically only last seven to ten years
Bridges	-No surgery required -Fills in gaps while preserving remaining natural teeth	-Long-term maintenance costs similar to dentures -Typically only last seven to ten years -Affects neighboring healthy teeth

  8. Key Takeaways 

The first step in assessing which cavity treatment is right for you is consulting with your dentist who can professionally evaluate your oral health needs. In general, fillings are best for minimal decay, crowns are better suited for preserving individual teeth with moderate decay, and dentures/implants/bridges are used to restore the typical mouth functions (i.e., chewing, talking, etc.) of extracted teeth. When choosing between one of the many options available for each procedure, patients should consider their budget, bone density, and ability to provide long-term maintenance.