"Play it as it lays" may be a good rule for a card game, but not for dental care. You shouldn't have to settle for anything less than the perfect condition of your teeth.

For decayed, damaged, or worn teeth, several solutions are available, ranging from fillings to inlays, onlays, or crowns. (In general, a filling restores the smallest amount of tooth necessary, while a crown covers the entire tooth.) If the tooth is too damaged for a filling, but not so damaged that it requires a crown, an inlay or onlay may be the best solution.

Inlays and onlays

Similar to a filling, an inlay fits in the groove between the cusps of your tooth, as this picture shows. (The cusp is the pointed part on the top of the tooth.) An onlay covers more of the tooth's biting surface, including the groove and at least one cusp. It also helps to hold your tooth together, which may keep the tooth from splitting or fracturing easily.

Depending on the tooth, we select different materials to create the inlay or onlay, including gold, metal alloys, porcelain, or composite resin. For example, back molars need chewing strength, so durable, gold or metal alloy materials may be a better choice. But for teeth that show when you smile, a tooth-colored porcelain material may be a better choice.

Inlays and onlays are custom-crafted to fit your unique tooth. That's why we schedule two or more appointments for this process.

During your first appointment

The first appointment accomplishes several steps, including:

• Removing decay and shaping the area to be fitted with an inlay or onlay
• Taking impressions of your teeth and your bite, so that the lab can build a model of your mouth and create the inlay or onlay precisely
• Placing a temporary inlay or onlay

Between appointments

It may take a week or more for the dental lab to create your final inlay or onlay. During this period, be sure to take good care of your temporary restoration. For example:

• Immediately after the procedure, wait at least half an hour before eating, to ensure that the temporary inlay or onlay is secure. Then, avoid chewing until your mouth no longer feels numb.
• Avoid ice, hard or sticky foods, and chewing gum. If possible, chew only on the opposite side of your mouth.
• Continue to brush and floss your teeth, but use a desensitizing toothpaste if your teeth feel sensitive to hot, cold, or pressure.
• To reduce any discomfort, rinse your mouth 3 times a day, using a salt water mixture of 1 tsp. salt per glass of warm water.
• Follow instructions about taking antibiotics or other medications.

Don't worry if your gums feel sore or if a small portion of the temporary restoration comes off. But do call our office if your teeth continue to feel overly sensitive, if most or all of your temporary restoration comes off, if your bite feels uneven, or if you have any other questions or concerns.

During your second appointment

During your second appointment, we remove the temporary inlay or onlay. Next, we place and check the fit of your final inlay or onlay. We also check that your teeth come together properly when you bite. Last, we cement or bond your new inlay or onlay into place.

You will be given instructions similar to the ones above to care for your final inlay or onlay. After the first few days, it should feel like a natural part of your tooth, and you may eat and chew normally again.

For more information

Removing decay promptly is critical for your dental health. We will be happy to recommend the best solution for your particular situation in order to restore and maintain your teeth. Also, you might find the following websites useful:

• American Dental Association at http://www.ada.org/public/topics/fillings.asp, then click on the link to download the Restoring Your Smile: Dental Filling Options PDF.
• Canadian Dental Association at http://www.cda-adc.ca/en/oral_health/procedures/fillings/overview.asp