Replacing Metal Fillings
My dentist recommended replacing my metal fillings with a composite material. Is this necessary? That depends on the reason for your dentist's recommendation.
As of 2019, if your metal fillings are defective or show a cavity, it's important to replace them. Untreated cavities may eventually lead to a tooth infection (abscess). In some cases, replacing metal fillings may benefit the long-term health of the tooth.
Generally, replacing metal fillings for aesthetic reasons should only be done after careful consideration and if your dentist feels it will not compromise the long-term health of the tooth.
Most metal fillings are dental amalgam — a stable alloy made with about 50% mercury, silver, tin, copper and other metals. Although concerns have been raised over the years about the safety of mercury in dental amalgam, the American Dental Association supports the use of dental amalgam as a safe, reliable and effective treatment for dental cavities.
Replacing Metal Fillings Risks
Metal fillings also know as dental amalgam or silver filling contains elemental mercury. It releases low levels of mercury vapor that can be inhaled. High levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys.
FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages 6 and above. The amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects. Even in adults and children ages 6 and above who have fifteen or more amalgam surfaces, mercury exposure due to dental amalgam fillings has been found to be far below the lowest levels associated with harm. Clinical studies in adults and children ages 6 and above have also found no link between dental amalgam fillings and health problems.
There is limited clinical information about the potential effects of metal fillings know as dental amalgam fillings on pregnant women and their developing fetuses, and on children under the age of 6, including breastfed infants. However, the estimated amount of mercury in breast milk attributable to dental amalgam is low and falls well below general levels for oral intake that the Environmental Protection Agency (EPA) considers safe. FDA concludes that the existing data support a finding that infants are not at risk for adverse health effects from the breast milk of women exposed to mercury vapor from dental amalgam. The estimated daily dose of mercury vapor in children under age 6 with dental amalgams is also expected to be at or below levels that the EPA and the Centers for Disease Control and Prevention (CDC) consider safe. Pregnant or nursing mothers and parents with young children should talk with their dentists if they have concerns about dental amalgam.
Some individuals have an allergy or sensitivity to mercury or the other components of dental amalgam (such as silver, copper, or tin). Dental amalgam might cause these individuals to develop oral lesions or other contact reactions. If you are allergic to any of the metals in dental amalgam, you should not get amalgam fillings. You can discuss other treatment options with your dentist.
If you're unsure whether you need to replace your metal dental fillings, ask your dentist to explain the options and help you understand what's best in your case.
Does mercury in the silver fillings in your mouth pose any long-term health risks?
This section is dedicated to the latest information about these and other oral health topics, pulled from authoritative sources such as the American Dental Association.
Latest news on amalgam replacement from the American Dental Association.
Replacing Metal Fillings with Composite
Advances in modern dental composite materials and techniques increasingly offer new ways to create more pleasing, natural-looking smiles. Researchers are continuing their often decades-long work developing esthetic materials, such as porcelain and composite compounds that mimic the appearance of natural teeth. As a result, dentists and patients today have several choices when it comes to selecting materials used to replace metal filling repair, broken teeth or teeth with cavities.
The advent of these new materials has not eliminated the usefulness of more traditional dental restoratives, which include gold, metal alloys and dental amalgam know as metal fillings. The strength and durability of traditional dental composite materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.
Replacing Metal Fillings with Porcelain
Replacing metal filling also know as Amalgam, with porcelain depends on the metal filling condition and your dentist's recommendation. They may be replace for cast gold restorations, porcelain, and composite resins. Gold and porcelain restorations take longer to make and can require two appointments. Porcelain fillings, or white fillings, are esthetically appealing, but require a longer time to place.
Frequently asked questions on metal fillings
Are dental metal filling know as "amalgams" and "silver filling" safe? Is it possible to have an allergic reaction to metal filling like amalgam? Is it true that metal filling "amalgams" have been banned in other countries? Is there a filling material that matches tooth color? If my tooth doesn't hurt and my filling is still in place, why would the filling need to be replaced? Read this interesting and informative discussion from the American Dental Association.
FDA consumer update: dental amalgams
The Food and Drug Administration and other organizations of the U.S. Public Health Service (USPHS) continue to investigate the safety of amalgams used in dental restorations (fillings). However, no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergic reactions.
ATSDR - public health statements: mercury
The Centers for Disease Control and Prevention offers some scientific background on mercury (contained within silver-colored fillings), and whether it believes the substance presents any health hazards.
Analysis reveals significant drop in children's tooth decay
Children have significantly less tooth decay in their primary (baby) and permanent teeth today than they did in the early 1970s, according to the Journal of the American Dental Association (JADA). The analysis reveals that among children between the ages of six and 18 years, the percentage of decayed permanent teeth decreased by 57.2 percent over a 20-year period. In addition, children between the ages of two and 10 years experienced a drop of nearly 40 percent in diseased or decayed primary teeth.
Common alternatives to replace metal fillings and silver amalgam:
- Composite fillings - Composite fillings are a mixture of acrylic resin and finely ground glasslike particles that produce a tooth-colored restoration. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be "bonded" or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth. In teeth where chewing loads are high, composite fillings are less resistant to wear than silver amalgams. It also takes longer to place a composite filling.
- Ionomers - Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that help patients who are at high risk for decay. Glass ionomers are primarily used as small fillings in areas that need not withstand heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for non-load bearing fillings (between the teeth) and they have low to moderate resistance to fracture. Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.
- Porcelain (ceramic) dental materials - All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel. All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. Their strength depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.