One question that dentists hear many times over is whether patients should be concerned about having silver fillings and if they should be removed. Millions of people have silver or amalgam dental fillings because this material has been used for more than 150 years to restore teeth. Not surprisingly, when a material has been in use for that long, concerns about its safety do arise every so often.

Usually, people are worried about the mercury content in dental amalgam as approximately 50% of the material consists of liquid mercury which is mixed with other metals including tin, copper, and silver to form a paste or putty that can be packed into a prepared cavity in a tooth. These other metals are in powder form, and mercury reacts with the powders to form a solid compound that is very stable and hard-wearing.

Concerns about the toxicity of mercury are understandable, but studies have shown that amalgam fillings are safe, cost-effective and long-lasting. It’s also worth talking about the type of mercury used in dental fillings as it’s what’s called elemental mercury, but once the mercury has reacted with other metals and has set to form amalgam, no elemental mercury remains present in the filling.

Elemental mercury is completely different from methylmercury which is a far more dangerous compound that can be stored in the body tissues. Methylmercury is most commonly found in large fish which is why pregnant women and young children are frequently advised to limit their consumption of certain types of fish.

Why Some Dentists Still Choose to Use Amalgam Fillings

Lots of dentists still choose to use amalgam fillings because they are the least expensive form of filling material, and when used to repair back teeth amalgam fillings can be a great option for anyone on a budget. Additionally, amalgam is easy to work with and quickly hardens so it’s particularly suitable for dental fillings that extend below the gum line and which are difficult to keep dry during filling application. With other materials, for example, composite resin, it’s essential to keep the cavity dry during application and generally the appointment required to place composite resin is a little longer than an amalgam because it’s more technique-sensitive.

Why Some Dentists Have Chosen to Become Amalgam-Free Dental Offices

Even though silver fillings are still popular, an increasing number of family dentists are choosing to use other restorative materials that are far more modern, more cosmetically pleasing and just as hard-wearing. Some dental offices are even amalgam-free. Most dental offices will go to great lengths to keep patients safe during the removal of amalgam fillings because this is when amalgam fillings are at their most dangerous.

Previously it was thought that dental amalgam would leak mercury while the filling was in place in the mouth, but now we know that the most exposure to mercury occurs when the filling is being placed or removed. It’s been shown that during the placement and removal of silver amalgam fillings, trace amounts of mercury vapor are released. The amount of mercury vapor that is released is minuscule, but dental offices take extensive precautions to keep patients and their staff safe during this treatment.

These dental offices will often have sophisticated extraction systems designed to remove mercury vapor from the air before it can be inhaled. Afterward, the amalgam filling material is safely disposed of, so it cannot harm the environment.

In Europe, the European Parliament has voted to phase out the use of dental fillings that contain mercury by 2030, and this is largely due to concerns about mercury contamination in the environment rather than worries about people’s health.

But Is It Necessary to Have Silver Fillings Removed?

Silver fillings have been deemed safe for use, so it’s not essential to have them removed but they will eventually begin to fail and will start to leak and crumble. Your dentist will continually monitor the condition of all your fillings, including any silver fillings and can recommend the most suitable time to replace them. However, if you are concerned about having silver fillings and would prefer your mouth to be metal-free, it’s worth discussing this with your dentist to see what they suggest. Nowadays there are good alternatives filling materials that are completely metal-free, and which can look fantastic.

What Are the Alternatives to Silver Colored Fillings?

The alternatives include tooth-colored composite resin which is suitable for small to medium-sized fillings, or solid porcelain fillings for cavities that are larger, and which require something a little harder wearing.

Composite resin is a great material for repairing teeth because it’s what’s called a biomimetic material, meaning it closely replicates the natural tooth structure so it can work harmoniously with your teeth. If you choose to have a composite resin filling, your dentist will prepare your tooth and will need to remove slightly less material than for a silver colored filling.

Next, the cavity is prepared and must be thoroughly dried before the filling material is applied in small increments. It’s hardened using ultraviolet light before being shaped and polished. Your dentist will have chosen the exact shade of composite resin so the filling blends in with your natural tooth so that it will be virtually invisible. Composite resin is a great option for repairing both front and back teeth and will last for several years.

Porcelain fillings are larger and do cost a little more, but they will last longer. A porcelain filling is called an inlay or onlay and is fabricated outside the mouth to fit precisely in the cavity. Some dental offices have advanced technology to create a porcelain filling while you wait while others may temporarily fill the cavity and will take an impression of your teeth, so your filling can be made in a dental lab. With this method, you will need to return on another day to have your filling fitted and bonded in place.

Both these types of fillings are cosmetically pleasing, and it can be a great way to refresh your smile. Removing silver fillings and replacing them with tooth-colored fillings will help to eliminate dark areas at the back of your mouth, especially as silver fillings can gradually discolor.