Making Restorations Last: Long-Term Maintenance

Decay beside a restoration is found at its margin, where it meets the tooth, most often at the edge nearest the gum.

This decay is called secondary caries. A Belgian university clinic checked 4,036 restorations in 450 patients: 146 (3.6%) had it, with 63.0% of lesions at the gum-side margin, 28.1% at the biting-surface margin and under 10% elsewhere (Nedeljkovic and colleagues, 2020). A 2020 review (Askar and colleagues) puts the gum-side share at up to 90%, with most data from back teeth, and finds surprisingly little data on secondary caries.

A 2020 European consensus (Schwendicke and colleagues) says secondary caries may be ordinary decay beside a restoration, or may come from significant margin defects that let acid or harmful plaque in.

Cleaning along the gum line and between the teeth targets where decay beside a restoration is most often found. UK guidance advises:

• Brush every tooth surface and the gum line with fluoride toothpaste at least twice a day, including last thing at night.
• Clean between your teeth each day, to below the gum line.
• Clean beneath a bridge's false tooth with special floss or cleaning aids.
• Keep sugary and acidic food and drink to mealtimes.
• With a crown, do not bite hard objects such as ice.

Sources: Delivering Better Oral Health (the UK prevention toolkit), Sussex Community NHS Foundation Trust and the Oral Health Foundation. Technique and sizing are in our guides to cleaning between your teeth and how to brush your teeth properly.

The evidence is indirect. The 2020 European consensus says managing your decay risk also manages the risk of secondary caries to a certain extent, a weak recommendation. A 2019 Cochrane review found no trials that assessed decay between the teeth, so Delivering Better Oral Health says there is no evidence on whether interdental aids reduce decay compared with brushing alone.

Speak to a dentist if you lose a filling or crown, or a restored tooth aches.

NHS 111 Wales says if you have the crown, keep it safe and take it to the dentist. For pain, NHS toothache guidance says:

• See a dentist if toothache lasts over 2 days, painkillers do not clear it, or it comes with a high temperature, pain on biting, red gums, a bad taste or a swollen cheek or jaw. Do not go to a GP, who cannot give dental treatment.
• With no dentist or no emergency appointment available, call 111 or visit 111 online.
• Go to A&E if you have toothache and swelling around your eye or neck, or swelling in your mouth or neck makes it difficult to breathe, swallow or speak. Do not drive there: ask someone to drive you or call 999, and bring any medicines you take.

Restoration maintenance sits beside recovery after treatment among the options in this section. Restorations are part of repairing and rebuilding damaged teeth, which saves natural teeth where possible, as distinct from implants. Our dental hygiene section covers professional hygiene appointments.