Amalgam fillings: should you have them replaced?

Having an amalgam filling does not mean that it needs to be removed. If it is sound and there is no decay underneath, replacing it simply because it contains mercury can expose you to unnecessary treatment.

A dentist should assess the filling and the surrounding tooth. The decision is different when there is decay, a fracture, symptoms or a suspected reaction to a material.

What is dental amalgam?

Amalgam is a metallic filling material made by combining mercury with other metals, including silver, tin and copper. It has been used for many years, particularly in back teeth. It is durable, but its dark appearance may be noticeable and preparing a tooth for it can require removal of more tooth tissue than some alternatives.

No filling lasts indefinitely. The size of a restoration, the remaining tooth, your bite and daily care all affect how well it performs. A dark filling is not, by itself, evidence of poisoning or decay.

What does the evidence say about health?

The US Food and Drug Administration states that studies do not show conclusive evidence of harmful health effects from amalgam in the general population. Its guidance does recommend considering alternatives for new fillings in certain higher-risk groups, including pregnancy, breastfeeding, young children, and people with relevant allergies, neurological conditions or kidney problems.

That precaution is not a recommendation to remove every existing filling in those groups. Discuss your medical history with the dentist and, where appropriate, your doctor. See the FDA’s patient guidance.

Claims that the FDA has proved amalgam causes Parkinson’s disease, Alzheimer’s disease, autoimmune disease or cancer misrepresent that guidance. The claim about Wi-Fi in the earlier version of this article is not a sound basis for deciding to remove a filling.

When might replacement be appropriate?

A dentist may recommend treatment if the filling or tooth is damaged, decay is present, or another clinical problem is found. A repair may sometimes be possible; replacement is not automatically the only option.

Removing a sound amalgam filling takes away additional tooth tissue and can temporarily increase exposure to mercury vapour. This is why preventive removal solely to avoid future illness is not normally advised. Do not attempt to remove or drill a filling yourself.

If treatment is needed, ask about the suitable materials, how much tooth can be preserved, the expected maintenance and the cost. Tooth-coloured composite is one option, but the choice depends on the tooth rather than colour alone.

What about restrictions on new amalgam fillings?

Rules on placing new amalgam fillings and policies to reduce mercury use are separate from advice about keeping a sound existing filling. They vary by jurisdiction and should not be inferred from an old list of overseas bans. Ask your dentist which current rules and materials apply to your treatment.

Contact us if a filling has broken, you have symptoms or you would like it checked. For current listed treatment costs, see our general dentistry fees.